NC0055786_Annual Report_20180223

LEXINGTON
NORTH CAROL] NA
WATER RESOURCES
QUALITY FIRST
02/19/2018
Mr. Monti Hassan
NC DENR
DWQ/PERCS Unit
Pretreatment Unit
1617 Mail Service Center
Raleigh, N.C. 27699-1617
LIAR �� 201
VN�ter ptesSect ®ro
permitting
Re: City of Lexington's Pretreatment Program Annual Report 2017
Dear Sir,
Attached are two copies of the City of Lexington's Pretreatment Program Annual
Report for the period of January 1, 2017 to December 31, 2017.
Sincerely,
Gisele H. Comer
Lab Supervisor/ Pretreatment Program Coordinator
cc: WSRO
500 0endhle Road - Lexirtgt p, NC 27292 - 336. 57 7589
WWW LEXINGTONNC GOV

City of Lexington
Pretreatment Program Annual Report
January 1, 2017 to December 31, 2017

ANNUAL PRETREATMENT PROGRAM REPORT
POTW NAME: City Of Lexington
REPORT DATE: _Feb. 23, 2018
PERIOD COVERED BY THIS REPORT: FROM: 01/01/2017 TO: 12/31/2017
PERIOD COVERED BY PREVIOUS REPORT: FROM: 01/01/2016 TO: 12/31/2016
NAME OF WASTEWATER TREATMENT PLANT (S) NPDES PERMIT NUMBER
Lexington Regional WWTP_ _NC0055786
PERSON TO CONTACT CONCERNING INFORMATION CONTAINED IN THIS REPORT:
NAME: Gisele H. Comer
TITLE: Lab Supervisor /Pretreatment Program Coor.
MAILING ADDRESS:
_28 West Center Street
_Lexington, N. C. ZIP CODE: _27292
TELEPHONE: ( 336 ) _357-7889
I HAVE PERSONALLY EXAMINED AND AM FAMILIAR WITH THE INFORMATION SUBMITTED IN THIS
DOCUMENT AND ATTACHMENTS. BASED UPON MY INQUIRY OF THOSE INDIVIDUALS IMMEDIATELY
RESPONSIBLE FOR OBTAINING THE INFORMATION REPORTED HEREIN, I BELIEVE THAT THE SUBMITTED
INFORMATION IS TRUE, ACCURATE AND COMPLETE. I AM AWARE THAT THERE ARE SIGNIFICANT
PENALITES FOR SUBMITTING FALSE INFORMATION.
i
GNATURE OF OFFICIAL
DATE 2/23/2018
_Title: Lab Super/Pretreatment Program Coor.

Narrative Summary

NARRATIVE SUMMARY
January 1, 2017 - December 31, 2017
I. Letter of Delegation of Pretreatment Signatory Authority: Enclosed
II. Toxicity Bioassay Analyses
During the past year, Lexington Regional WWTP has passed February, May,
August and November bioassay.
III. Cardinal Container Service — I.U. #0010
A. The IDSF for Cardinal's percent reflect monthly average and half BDL
B. Inspections enclose
IV. Asco Power Technologies — I.U. #0038
A. The IDSF for Asco's percent reflect half on BDL
B. Inspections enclosed
C. Letters for certification for TTO are enclosed
V. Matcor Metal Fabrication — I.U. #0012
A. The IDSF for Matcor's percent reflect half on BDL
B. Inspection enclosed
C. Letters for certification for TTO enclosed
VI. Tier Rack — I.U. #0045
A. The IDSF for Tier Rack is not enclosed, no discharge has occurred and
Tier Rack is pump and hauling to HAZMAT, papers enclosed. Tier Rack
is in the process of adding a new system.
B. Inspection enclosed.
C. Letters for certification for TTO enclosed
VII. Leggett & Platt Plant # 1— I. U. #0027
A. The IDSF for Leggett's percent reflect half on BDL
B. Inspection enclosed
C. Letters for certification for TTO enclosed

VIII. Leggett & Platt Plant # 2 — I. U. #0028
A. The IDSF for Leggett's percent reflect half on BDL
B. Inspection enclosed
C. Letters for certification for TTO enclosed

n
Chapter 9, PAR Guidance
Pretreatment Performance Summary (PPS)
1. Pretreatment Town Name: City of Lexington
2 "Primary" NPDES Number NC00 55786
or Non Discharge Permit # if applicable =>
3. PAR begin Date, please enter 01/01/yy or 07/01/yy 3. => 1/1/2017
4 PAR end Date, please enter 06/30/yy or 12/31/yy 4. => 12/31/17
5 Total number of SATs, includes CIUs 5 => 6
6. Number of CIUs 6. => 5
7 Enter the Higher Number, either (7a) or (7b) here => 0
7a. Number of SIUs not sampled by POTW 7a => 0
7b Number of SIUs not inspected by POTW 7b => 0
8. Number of SIUs with no lUP, or with an expired IUP 8. => 0
9. Total Number of SIUs in SNC due to either IU Reporting violations or
IUP Limit violations. To avoid double counting some SIUs
Enter ( 9a + 9b ) - 9c here => 0
10
11
12.
13.
14
15.
16
17
Enter the Number of SIUs in SNC for:
9a. IU Reporting violations
9b IUP Limit violations
9c Both IU Reporting & Limit violations
Number of SIUs in SNC due to IU Reporting violations
that were not sampled or inspected by POTW
Number of SIUs in SNC due to violation of
Compliance Schedule due dates
Number NOVs, NNCs, AOs, or similar assesed to SIUs
Number Civil or Criminal Penalties assessed to SIUs
Number of SIUs included in public notice
Number of SIUs from which penalties collected
Total Amount of Civil Penalties Collected 16. => $
Total Number of SIUs on a compliance schedule
Notes: AO Administrative Order
CIU Categorical Industrial User
CO Consent Order
IUP Industrial User Pretreatment Permit
NNC Notice of Non -Compliance
9a. =>
0
9b. =>
0
9c =>
0
This Column
for office
use only
EPA
WENDB
PSSD
PSED
SIUS
CIUS
NOIN
NOCM
PSNC
MSNC
SNPS
10. => 0 SNIN
11 => 0 SSNC
12 =>
0
FENF
13 =>
0
JUDI
14 =>
0
SVPU
15. =>
0
IUPN
0
17. => 0 socs
NOV
Notice of Violation
PAR
Pretreatment Annual Report
POTW
Public Operated Treatment Works
SIU
Significant Industrial User
SNC
Significant Non -Compliance, formerly RNC
Chapter name PAR Guidance File name PAR_PPUdfnftDtrenmmvdafhaiAetgi&dptb89A Section B, Page 5 Blank PPS Form, Copy and use in your PAR

Pretreatment Program info Ib Wbase
for Program Name Lexington
WWTP Name City of Lexington
grogram Approval Date 06/10/1983
Pretreatment Status
Full
Region
WSRO
County
Davidson
NPDES Number
NCO055786
printed on: 12/18/2017
Stream Information -10 IWC % at 7Q10 60.03
_ 7Q10 Flow cf /S mgd 6.7 / 433
1 Q1 0 Flow cfs / mgd 557 / 360
Stream Classification WS -V & B
Basin Number YAD07
Receiving Stream Name ABBOTTS CREEK
NPDES Effective Date 02/01/2016
Last PAR Rec 03/01/2017
PAR Due Date 03/01/2018
mercury
NPDES Expire Date 04/30/2019
Current Fiscal
1631
required
TRUE
Year PCI Done
es
POTW is Primary WWTP
Last Audit on 09/21/2017
Audit Year Next 21/22
Design Flow mgd 6.5000 % Design mgd is SIU permitted 2.03
Permitted SIU flow (mgd) [Pt _SIU) 132
WWTPSIU's
Program SIUs
__`= R =
JHI A
--`'` z
WWTPCIU's
5 Program CIUsI� I
u LTMP
IWS SUO
E )
date Inactive _ Date Next --Due
07/01/2019
10/01/2019
Date Received by DWR
01/09/2015 10/07/2016
01/09/2015 01/08/2013
06/01/2010
Date Approved
06/10/2015 11/04/2016
02/06/2015 01/09/2013
07/02/2010
Adopt Date Required
Date Adopted
Info in this Box from Pt Contacts Date Date Date
PT Pro Attended Attended Attended
Formal Name g Prime Phonel ext Fax HWA Wksp IUP Wksp PAR Wksp
Gisele Comer jPr1rn [phone] [phone] 5/12/2009 11/22/2011 2/4/2004
[e-mail] Lab Supervisor/Pretreatment 28 W. Center Street 7292
Ms Eglantina Minerali [phone] 11/19/2017 1 5/17/2016 1/18/2017
EMinerali@LexingtonNC gov Chemist 128 W Center Street IP7292
ent Related NOVs from
NOV Failure to pro,
IQ DWR Central Office Contact livionti Hassan
information upon request which DWR Regional Contact Pim Gonsiewski
" "McOLA SAC-

Pretreatment Annual Report (PAR)
Significant Non -Compliance Report (S CR)
WWTP = Wastewater Treatment Plant, use separate form for each WWTP.
SIU = Significant Industrial User
SNC = Significant Non -Compliance
PAR covers this calendar year => 1/1/17 - 12/31/17
Control Authority=Program=Town Name => City of Lexington
WWTP Name => Lexington Regional WWTP
NPDES # => NCO055786
A SNCR Form must be submitted with every PAR, please write "None " if you had No SIUs in SNC during calendar year
IUP
#
Pipe
#
Industry Name
Parameter
or "Reporting"
SNC ? ( Yes / No)
for each 6 -month period.
Jan. - June
July -Dee.
NONE
Attach a copy of the Division's "SIUs in SNC Historical Report" for your POTW's SIUs behind this page.
Is the database correct ? Notify the Division of any errors ! Database indicates SNC history for previous years.
EVERY SNC MUST be explained in the Narrative, How was, is, or will it be resolved?
REPEAT SNCs are serious matters that MUST be explained in the Narrative.
Form name PAR,SNCR,2001
Date Revised 1/4/2001

neq
�.= TIE CITY of
NORTH� * LEXINGTON
CAROLINA
"GROWING NTH THE PIEDMONT"
''OFFICE OF THE
February 14, 2012'
NC Division of Water Quality —
1617 Mail SeivicCenterpERCS Unit
Raleigh, -NC 27699-1617
Subject: Delegation of pretreatment Signatory Authority
City Of Lexington, NC (NPDES NC0055786)
Davidson County
NC State Lab #t43
�Dear PERCS:
As the Mayor of the City of Lexington, I hereby delegate responsibility for overall
operation of the 'City of Lexington's pretreatment Program to Gisele Comer, -
Laboratory Supervisor/pretreat hent program Coordinator. '
This designation will provide Mrs. Osele H Comer with the authority to sign all r
documents under the pretreatment Pro e4
Pretreatment Annual �"� incIuding the authority to sign the
Report (FAR) and submit It to the NC Division, of Water Quality
Pretreatment, Emergency Response and Collection Systems (pERCS) unit .
any questions, please contact me at 336-243-2489 or If you have
Gisele H. Comer At 336-357-7889•
M
Sincerely,
Newell Clark
Mayor
CC: Roger Spach, Water Resources Superintendent
Rick Coarser, Public Services Director
CENTER RTRFRT 9 r Rwve-,TrAT VnWrlr n A TI.,..... ___

Ii
Allocation Table

Workbook Name: Lexington_HWA 2014 Approved.xlsx, Worksheet Name: AT Printed 207J2017,12:36 PM
Page 1 of 5
Allocabon Table
Headworks last approved 05/10/15
Alio cab on Table updated 06/10/15
Permits last modified 05/31/14
Spreadsheet Instructions
1) Applicable Values should be entered in the Heavy Bordered cells_ Rest ofworksheet is protected, password is
..2.,
2) Formulas are discussed in the Comprehensive Guidance, Chapter 6, Section C
3) HWAand ATworksheets in this workbook are linked. Pollutant Names, MAHLs, Basis, and Uncontrollable load
in this AT worksheet are automatically entered from the HWA spreadsheet This includes pollutant names in
columns AT through BK
HWA.AT
Revised November 2005
Industry
Type
Renewal
Modification Date
Pemut Limits
Pemut Limits
Permit Limits
IUP
INDUSTRY NAMES Permit
Pipe
of
Effective
Effective Permit
Conc Load
Conc. Load
Count
(pzmJig a,pba>Wi,) number
number
Industry
Date
Date Expires
MGD
gal/day
mg/l lbs/day
ntgA lbs/day
1
Cardinal Container 0010
0001 1
Cont.
05/31/14
05/31/19
0.05001
50,000
2517.99 105000
2
Matcor Metal 0012
0001 1
433
05/31/14
05/31/19
001701
17,000
3
FierRack 0045
0001
433
05/31/14
1 05/31/19
001701
17,000
4
ASCO Power 0038
0001
433
05/31/14
05/31/19
0.0080
8,000
5
Leggett & Platt #1 0027
0001
433
05!31/14
05/31/19
0.0200
20.000
6
ggett a Platt #2 0028
0001
433
05/31/14
05/31/19
0.0200
20,000
7
8
9
10
Column Totals >
0.1320
132,000
1050
C
Basis=>
NPDES
Design
Design
MARL from HWA (lbs/day)>
NPDES Permitted Flow--
6.5000
14691
9161
Uncontrollable Loading (lbs/day)>
27100
8430
5447
Total Allowable for Industry (MAIL) (lbs/day) >
3.7900
6261
3715
Total Permitted to Industry Obs/day) >
0.1320
1050
0
MAIL left (Ibs/day) =->
36580
5211
3715
Percent Allow Ind_ (MAIL) still available (%) >
96 5 %
83.2 %
100.0
Percent MAHL still available (%) >
5 Percent MAHL Obs/day) >
0 3250
735
458
HWA.AT
Revised November 2005

POTW:
NPMGM
lUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name: LexingtonPunted: 2/27/2017, 12:36 PM
_HWA 2014 Approved.xlsx, Worksheet Name: AT page 2 of 5
Allocation Table
Headworks last approved: 06/10/15
Allocation Table updated:06/10/15
Permits last modified 05/31/14
LRWWTP
01
000001
00709
1 23094
1 17006
1 0.4445
Sludge
AS/Nit/rF
Sludge
NCO055786
Basis -->
Design
Ceiling
Ammonia
Arsenic
Cadmium
Chromium
Copper
Cyanide
05811
Industry
90035
Permit Limits
Permit Lunits
Permit Limits
Pemnt Limits
Permit
Limits
Permit Limits
INDUSTRY NAMES
Permit
Pipe
Cone Load
Cone. Load
Cone
Load
Coac.
Load
Cone.
Load
Cone.
Load
V�i,uaiyezbW4)
number
number
mg/I lbs/day
mg/1 lbs/day
mg/1
lbs/day
mg/1
lbs/day
mg/1
lbs/day
mg/l
lbs/day
ardinal Container
0010
0001
52 7Percent
MARL still available (%) =>
005521
0.0230
273381
1.1400
0.6835
02850
Percent MARL (]bs/day) =>
35 51
Matcor Metal
0012
0001
0.5241
0.0498
007001
0.0099
17100
02424
2.0700
02935
0.6500
0.0922
ier Rack
0045
0001
007001
0.0099
17100
02424
20700
02935
0.6500
0.0922
SCO Power
0038
0001
0 0700
0 0047
17100
0.1141
2.0700
0.1381
06500
00434
eggett& Platt 41
0027
0001
0070
0.0117
17100
02852
2.0700
0.3453
0.6500
01084
Leggett & Platt 42
0028
0001
0.0700
00117
17100
02852
2.0700
0.3453
065001
01084
Column Totals =>
01
000001
00709
1 23094
1 17006
1 0.4445
Sludge
AS/Nit/rF
Sludge
Basis -->
Design
Ceiling
NPDES
inhibition
Ceding
Stream Std
NIAHL from HWA (lbs/day) =>
710.15
05811
0 2077
90035
104812
09954
Uncontrollable Loading (lbs/day) =>
400.04
0.1130
00226
0.1356
2 1743
00565
Total Allowable for Industry (MAIL) (lbs/day) =>
310.11
0.4681
01851
8.8679
83070
0.9389
Total Permitted to Industry (lbs/day) _>
000
0.0000
00709
2.3094
17006
04445
MAIL left (lbs/day) y
31011
0.4681
01143
6.5585
66063
04944
Percent Allow. Ind (MAIL) still available (%) =>
100.0 %
t00 0 %
61 7 %
79.5 %
52 7Percent
MARL still available (%) =>
43 7 %
80.6 %
55.0 %
"7140
63.0 %
49 7 %5
Percent MARL (]bs/day) =>
35 51
0.0291
0 0104
0.5241
0.0498
HWA.AT
Revised:November 2005

Workbook Name: Lexington_HWA 2014 Approved.xlsx, Worksheet Name: AT Printed: 2/2712017,12:36 PIN
Page 3 of 5
Allocation Table
Headworks last approved: 06/10/15
Allocation Table updated - 06/10/15
Permits last modified: 05/31/14
WDE39-
HWA AT
Revised:November 2005
Industry
Permit Lm -its
Permit Limits
Permit Limits
Permit Limits
Permit Limits
Permit Limits
IUP
INDUSTRY NAMES Permit
Pipe
Cone
Load
Cone Load
Cone Load
Conc.
Load
Cone Load
Cone.
Load
Count cri-1a�1pbbuasi number
number
mg/l
lbs/day
mg/1 lbs/day
mgA lbs/day
mg/l
lbs/day
mg/1 lbs/day
mgA
lbs/day
I
Cardinal Container 0010
0001
1 1990
0 5000
0.00098 0.00041
09113
03800
2
Matcor Metal 0012
0001
0.43001
00610
1.5000
02127
0.2400
00340
3
ier Rack 0045
0001
043001
00610
15000
02127
0.2400
00340
4
SCO Power 0038
0001
043001
00287
15000
01001
02400
00160
5
eggett & Platt #1 0027
0001
0.43001
00717
15000
02502
02400
00400
6
Leggett & Platt #2 0028
0001
0.4300
00717
15000
02502
02400
00400
7
8
9
10
Column Totals =>
07941
0.000410
0.0000
14058
0 00001
01641
Sludge
Sludge
AS/Nit/rF
Digester
Basis-->
NPDES
Ceding
Ceding
mhibihon
NPDES
Inhibition
MAHL from HWA (lbs/day) _>
19922
0.109215
1.4496
57129
03656
49815
Uncontrollable Loading (lbs/day) _>
03096
0.009267
01740
0 0972
0.0565
00927
Total Allowable for Industry (MAIL) (lbs/day) _>
16826
0.099949
1.2756
56157
0.3091
48889
Total Permitted to Industry (lbs/day) =>
07941
0.000410
0.0000
1.4058
0.0000
01641
MAIL left (lbs/day) _>
08885
0.099539
1.2756
42099
0.3091
47247
Percent Allow Ind (MAIL) still available (%) _>
99 6 %
100.0%
75.0 %
100 0 %
966%
Percent MARL still available (%) =>
M52.181
911%8.0%
73.7 %
84 5 %
948%
5 Percent MARL (lbs/dav) _>
0.005461
0.0725
0.2856
0.0183
02491
HWA AT
Revised:November 2005

IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name: Lexington_HWA 2014 Approved.xlsx, Worksheet Name: AT Printed 2/2712017, 12 36 PM
J 0.00
0.0000 0000
Sludge
Page 4 of 5
Allocation Table
Ceiling
NPDES
NPDES
Headworks last approved 06/10/15
133.12
1.2473
8.0167
Allocabon Table updated.06/10/15
0 4452
136016
-1447
Permits last mod�ied 05/31/14
25121
0.00 000
00000 0.0000
LRWWTP
-14.47
08020
81.5 %
NCO055786
100.0
O/C0.06
51.3%
-109%
Zinc
Total Nitrogen
Total Phos.
Phenols d
Industry Permit Lurnts
Permit Limits
Permit Limits I
Perrmt Limits Permit Limits Permit
INDUSTRY NAMES Permit Pipe Cone Load
Conc Load
Conc Load
Conc_ Load Conc Load Conc_
(p1�huw
atphabd.) number number MPA Ibs/dav
me/1 lbs/dav
mall lhdtiav
man 1he/Aav roan the/rrav —A
Column Totals =>
Basis=>
MAHL from HWA (lbs/day) =>
Uncontrollable Loading (lbs/day) y
Total Allowable for Industry (MAIL) (lbs/day) =>
Total Permitted to Industry (lbs/day) _>
MAIL left (lbs/day) =>
Percent Allow Ind_ (MAIL) stili available (%) =>
Percent MARL still available (%) =>
5 Percent MAHL (lbs/dav) =>
HWA.AT
Revised November 2005
0
0
0
0
2 5121
J 0.00
0.0000 0000
Sludge
Ceiling
NPDES
NPDES
216183
133.12
1.2473
8.0167
147.59
0 4452
136016
-1447
0.8020
25121
0.00 000
00000 0.0000
110895
-14.47
08020
81.5 %
100.0/
100.0
O/C0.06
51.3%
-109%
643%
10804
6.6558

Workbook Name: Lexington_HWA 2014 Approved.xlsx, Worksheet Name: AT Pnnted:2/27/2017, 1236 PM
Page 5 of 5
Allocation Table
Headworks last approved- 06/10/15
Allocation Table updated 06/10/15
Permits last mod)fied. 05/31/14
Porw-, I LRWWTP
NPDESS=> NC0055786
IUP
Coun
1
2
3
4
5
6
7
8
9
10
INDUSTRY NAMES
We- I-alphzb-cly)
Cardinal Container
Matcor Metal
M
Industry
Permit
number
0010
0012
Pipe
number
0001
0001
Limits
Load
lbs/day
Permit Limits
Conc Load
mg/1 lbs/day
9
Permit Limits
Cone Load
mg/I lbs/day
h
Permit Limits
Cone. Load
mg/1 lbs/day
I
Permit Limits
Cone Load
mgf1 lbs/day
Rack
0045
0001
ASCO Power
0038
0001
Leggett & Platt 41
0027
0001
ggett &Platt #2
0028
0001
Column Totals =>
0.0000
000001
00000
0 0000
0.0000
Basis=>
MAHL from H WA (lbs/day) _>
Uncontrollable Loading (lbs/day) _>
Total Allowable for Industry (MAIL) (lbs/day) =>
Total Permitted to Industry (lbs/day) =>
MAIL left (lbs/day)
Percent Allow. Ind. (MAIL) still available
Percent MARL still available (%)
5 Percent MAHL (lbs/day) y
i
HWA-AT
Revised:Noverber 2005
1 000001
1 0.00001

Industrial Data Summary Forms

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each Industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations,(chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Control Authority,
Town Name =>
WWTP Name =>
NPDES # _>
1st 6 months, dates =>
2nd 6 months, dates =>
City of Lexington
Lexington Regional WWTP
NC0055786
1/1/2017 to 06/30/2017
7/1/2017 to 12/31/2017
Industry
Name Asco Power Tech.
IUP # 0038
Pipe # 'O1
Arsenic Cadmium
Chromium
COD
1st 6 months 2nd 6 months 1st 6 months
2nd 6 months
1st 6 mont s 2n
6 mont s 1st 6 months 2nd 6 mons s
10
10
10
10
0.001
0.001
0 01
001
10
10
0.102
0.081
0.001
0 001
0 O1
0.01
0%0%
0%
0%
0%
0%
0%
0% _j
Copper
Cyanide
Lead
Mercury
1st 6 months
2n 6 months
1st 6 months
2nd 6 months
1st 6 months
2nd 6 months 1st 6 months 2nd 6 months
10
10
2
2
10
10
0.102
0.081
'0.0025
'0.0025
10.01
1001
0.069
0 061
00025
0.0025
0.01
0.01
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
BDL => Below Detection Limit mg/1 => milligrams per Mer
* POTW must enter at least one of these IUP — Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6 -month & if BDL, 1/213DL, or zero values used TRC — Technical Review Cntena WWTP => wastewater treatment plant
*Reflect monthly and daily limits half of BDL
Chapter PAR Guidance File name PfYFoiii¢S�ia��eiGarode¢t ia�t�iB�s'�cl&Ri1B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page / of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or. Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Industry Name
IUP #
Pipe #
ASCO POWER TECHNOLOGIES
0038
Nickel
Selenium
'Silver
inc
st mon
months n
months st mn
m
st mn
monthss
10
10
10
15
10
0.073
0.005
0.005
0.145
0.299
0.040
'0.058
00025
'0.0025
0.09
0 168
0%
10%
0%
10%
6%
0%
0%
0%
0%
0%
0%
0%
1 st 6 months 2nd 6 months 1 st 6 months 12nd 6 months 1 st 6 months 2nd 6 months 1 st 6 months 2nd 6 months
PCTW must enter at least one of these IUP — Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC — Significant Non -Compliance mgd — million gallons per day
Avg period could be month, Qtr, or 6 -month & if BDL , 1/2BDL, or zero values used TRC => Technical Review Criteria W WTP => wastewater treatment plant
Chapter PAR Guidance Fite name PA(R SdhmkReV@mcde pages Copy y pipe g z
p � ¢ aQt si�c189itB, a es 12, 13, 14 Blank IDSF Form, Co and use in our PAR Number each set for each IUP i e -Pae of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (Ib/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations,(chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (Ib/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Control Authority,
Town Name =>
City of Lexington
WWTP Name =>
Lexington Regional WWTP
NPDES # _>
NCO055786
1 st 6 months, dates =>
01/01/17 to 06/30/17
2nd 6 months, dates =>
07/01/17 to 12/31/17
Industry
Name Leggett Platt # 1
IUP # 0027
Pipe # 01
111
fRi[i iTiTiTifilif�f►�G i2TTifii�f[3'i[. iiiTrTifii�V.iTG'iiTiTifli�fl�[i
� iTTTiiii��f►•iTG i'iiT�3if;i�fR3��'iiTiSifiil�V.iTG i'i'iT.;if1i1;�
1st 6 months 2n 6 months 1st 6 mont s
2nd 6 months
1st 6 months
2n 6 mont s 1st 6 mont s 2n 6 months
10
8
10
8
0.001
0.001
0 032
0.111
10
8
Arsenic Cadmium
Chromium
COD
1st 6 months 2n 6 months 1st 6 mont s
2nd 6 months
1st 6 months
2n 6 mont s 1st 6 mont s 2n 6 months
10
8
10
8
0.001
0.001
0 032
0.111
10
8
0.164
0.550
0.001
0.001
0.012
0 031
0%
0%
0%
0%
0%
0%
0%
0%
Copper
Cyanide
Lead
Mercury
1 st 6 months
2nd 6 months
1 st 6 months
2nd 6 months
1 st 6 months
2nd 6 months 1 st 6 months 2nd 6 months
10
8
2
2
10
8
0.164
0.550
0.0025
0.0025
0.01
0.055
0.044
0.149
0.0025
0.0025
001
0.017
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
BDL — Below Detection Limit mgl1=> milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC — Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6 -month & if BDL, 1/2BDL, or zero values used TRC — Technical Review Criteria WWTP => wastewater treatment plant
*Reflects monthly and daily limits and half BDL
Chapter PAR Guidance File name P.MoiliPSEWsRev@uckOfiba¢tgtW*cl&lir1B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe -Page / of Z'

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (1DSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximumm /1
( g )_>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loadmg (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Industry Name Leggett Platt #I
IUP # 0027
Pipe #
01
ice
Selenium
'Silver
inc
st mont s
n mont s st 6 months
2nd 6 mont sst mon s
2nd (a months
I st 6 months
'2nd 6 months
10
8
10
8
10
8
0.104
0.068
0.0025
0.0025
1.151
1.434
0.024
0.030
0.0025
0.0025
0.272
0.390
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
1st 6 mont s 2n 6 mont s Ist6months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 mont s 2nd 6 months
BDL _> Below Detection Limit mg/l — milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit Ib/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd — million gallons per day
Avg period could be month, Qtr, or 6 -month & if BDL, 1/2BDL, or zero values used TRC => Technical Review Criteria WWTP => wastewater treatment plant
*Reflects monthly and daily limits and half BDL
Chapter PAR Guidance File name PAf 4if@SffiukBeNQrabEOft titgpW*cIPMB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe -Page hof zz

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each Industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations,(chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Control Authority,
Town Name =>
City of Lexington
WWTP Name =>
Lexington Regional WWTP
NPDES # _>
NC0055786
1st 6 months, dates =>
01/01/17 to 06/30/17
2nd 6 months, dates =>
07/01/17 to 12/31/17
Industry
Name Leggett Platt # 2
IUP # 0028
Pipe # 01
'Arsenic Cadmium
'fes. i'iiTiTifiil7ir�[. u. i i�f�i . iTT.Tiiiix7f►•iT[. iTTiiif��f�'iG iTiT.iii;i��f►�TiG
iTiTiif;i� . . P•PTGTT.iifii��
Ist6months, 2nd 6 months 1st 6 months
2nd 6 months
1 st 6 months
2n 6 mont s 1st 6 mont s 2nd 6 mont s
10
9
10
9
0.001
0 001
0.01
0.078
10
9
'Arsenic Cadmium
Chromium
COD
Ist6months, 2nd 6 months 1st 6 months
2nd 6 months
1 st 6 months
2n 6 mont s 1st 6 mont s 2nd 6 mont s
10
9
10
9
0.001
0 001
0.01
0.078
10
9
0.050
0 271
0.001
0 001
0.01
0.019
0%
0%
0%
0%
0%
0%
1 0%
0%
Copper
Cyanide
Lead
Mercury
1 st 6 months
2nd 6 months
1 st 6 months
2nd. 6 months
1 st 6 months
2nd 6 months 1 st 6 months 2nd 6 months
10
9
2
2
10
9
0.050
0 271
0.0025
0.0025
0.01
0.01
0.036
0 072
0.0025
00025
0.01
0.01
0%
0%
0%
0%
0%
0%
0%
0%
1 0%
0%
0%
0%
BDL => Below Detection Limit mg/1=> milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit 16/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6 -month & if BDL, 1/2BDL, or zero values used TRC => Technical Review Cntena W WTP => wastewater treatment plant
*Reflects monthly and daily limits and half BDL
Chapter. PAR Guidance File name PPrMLf4SMWs sRex@ruhe4M*t%ik*ctW4B, pages 12, 13,14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe -Page ( of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Industry Name Leggett Platt #2
IUP # 0028
Pipe # 01
Nickel
e enium
Silver
ZInc
st 6 months
nd 6 months
Tn7 r mon s stmont s
n mon sI
st 6 months
2nd 6 months
10
9
10
9
10
9
0.010
0.105
0.0025
0.0025
0.168
0.472
0 010
0.032
0.0025
0.0025
0.108
0 157
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
1 st 6 months 2nd 6 months 1 st 6 months 2nd 6 months 1 st 6 months 2nd 6 months 1 st 6 months '2nd 6 months
- ucww " LVi uuu i.uuu mgn miingrams per liter
* POTW must enter at least one of these IUP — Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6 -month & if BDL, 1/2BDL, or zero values used TRC — Technical Review Criteria W WTP => wastewater treatment plant
*Reflects monthly and daily limits and half BDL
Chapter PAR Guidance File name P. GI 3n'@ ffiekRetGmcdeOfta¢t%**ctWAB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each NP pipe -Page of -2—

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations,(chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Control Authority,
Town Name =>
WWTP Name =>
NPDES # _>
1 st 6 months, dates =>
2nd 6 months, dates =>
City of Lexington
Lexington Regional WWTP
NC0055786
01/01/17 to 06/30/17
07/01/17 to 12/31/17
Industry
Name Matcor Metal Fab
IUP # 0012
Pipe # 01
Flow, mg'Ammonia
I
st 6 months 2nd 6 month s I st 6 months i 2ndmonths I st 6 months
2nd 6 mont sst mont s 2nd 6 months
I
2nd 6 months
1st 6 months
2nd 6 mont s 1st 6 mont s 2nd 6 months
10
9
10
9
0.001
0.001
0.010
0.010
10
9
Arsenic Cadmium
I
Chromium
COD
1st 6 mont 2nd 6 mon s 1st months
2nd 6 months
1st 6 months
2nd 6 mont s 1st 6 mont s 2nd 6 months
10
9
10
9
0.001
0.001
0.010
0.010
10
9
0.036
'0.151
0.001
0.001
0.010
0.010
0%
0%
0%
0%
0%
0%
0%
0%
'Copper
Cyanide
'Lead
Mercury
1st 6 months
2n 6 months
1st 6 months
2n 6 months
Ist6months
2nd 6 months 1st 6 mont s 2nd 6 months
10
9
2
2
10
9
0.036
'0.151
0.0025
0.0025
001
0.01
0.028
0.105
0.0025
0.0025
001
0.01
0%
0%
1 0%
0%
0%
0%
0%
0%
0%
0%
1 0%
0%
BDL — Below Detection Limit mg/l => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC — Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr, or 6 -month & if BDL, 1/2BDL, or zero values used TRC — Technical Review Criteria WWTP => wastewater treatment plant
*Reflects monthly and daily limits and half BDL
Chapter PAR Guidance File name PMocPFAWsRev&iohOZiaQtgtW*ciRNB, pages 12, 13, 14 Blank IDSF Foran, Copy and use in your PAR Number each set for each IUP pipe -Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (]b/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Industry Name
IUP #
Pipe #
Matcor Metal Fab
0012
01
1 st 6 months 2nd 6 months 1 st 6 months 2nd 6 months 1 st 6 months 26Imonths 1 st 6 months 2nd. 6 months
1 st 6 months 2nd 6 months 1 st 6 months 2n 6 months 1 st 6 months 2nd 6 months 1 st 6 months 2nd 6 months
BDL => Below Detection Limit m9/1 => mdharamc ner hter
* POTW must enter at least one of these IUP — Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd — million gallons per day
Avg period could be month, Qtr, or 6 -month & if BDL, 1/2BDL, or zero values used TRC => Technical Review Criteria W WTP => wastewater treatment plant
*Refects monthly and daily limits and half BDL
Chapter PAR Guidance File name P. BLil@g imkitef ch -,00 r*tgfts%ciRMB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe -Page of
e emum
inc
TNicke
n s
n mon s st mont s
n mont sonts
n mon s
st mon s
n mont s
9
7SHver
0
9
10
9
9
0.022
05
0.00546
00133
0.317
0.025
10.011
0.0025
0.0025
0 096
0.160
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
1 st 6 months 2nd 6 months 1 st 6 months 2nd 6 months 1 st 6 months 26Imonths 1 st 6 months 2nd. 6 months
1 st 6 months 2nd 6 months 1 st 6 months 2n 6 months 1 st 6 months 2nd 6 months 1 st 6 months 2nd 6 months
BDL => Below Detection Limit m9/1 => mdharamc ner hter
* POTW must enter at least one of these IUP — Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd — million gallons per day
Avg period could be month, Qtr, or 6 -month & if BDL, 1/2BDL, or zero values used TRC => Technical Review Criteria W WTP => wastewater treatment plant
*Refects monthly and daily limits and half BDL
Chapter PAR Guidance File name P. BLil@g imkitef ch -,00 r*tgfts%ciRMB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe -Page of

INSPECTIONS

SILT INSPPECTION FORINT
Name Of Industry: 44 c c_,-, , QA YUP #
Address Of Industry; 7 WP Expiration Date:
tv C.
Industry Representatives: Tick
.�n n � a . P r, n — �1
POTW Representati es: Title
nu�g4—
Date Of Inspection: Time Of tion:—"
Purpose of Inspection: Annual Other(Describe) am/Pm
to which IU discharges W W 12 NPDES 0
Is SIU currently in SNC? _ }y^sIf yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application the following:
Product YES COMAEM
Raw materials used YES *=:E
Manufaetu ing processes YES /
Categorical, if applicable YES / N
Rroduetion rate YES /
Number of employees YES /
Number of shifts YES / O
Comments
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where
there are drains to the POTW.
Plant T� w Section A - PRODUCTION AND STORAGE AREAS
1. Aro there floor drains in the production area? YES NO Where do they go?
2. Are production areas diked, contained. or ' constructed in such a way as to prevent harm to the
eci
WWTP. esp211Y from spilus gr slugs? FrS I NO Comments:
3. Are there floor drains in the storage area? YES O Where do they go?
4. Are storage tanks and area diced, contained,constructed in such a way as to prevent harm
to the WWTP, especially from spills or slugs? �N0 Comments:
S. Are process and storage tanks and pipes labeled?
6. How are off -spec raw materials, and products di
'/ NO
of?.,
7. When is the production area cleaned?
8. Is the wastewater from cleaning the productioJarea discharged to the POTO? YES figo
9. What non-procan wolawatm aro discharged to POTW?
.c ..
Comments:
Title: SW InpWim Form
File none: COMMSP App 7.D
Revidw data: Augurt 1. 1994 Pape

SIU INSPECTION FORM
PART II • Plant Tour Section B -PRETREATMENT SYSTEM
Ask the operator to describe preuleatment system.
1. Does operator seem knowledgable about the system? Y �/ NO Comments:
----------------
2. Are all units operational? VLAW1 NO
3. es How often dooperator/mainte wce person check system?
4, Is there an operator for each shift? YES / NQ
S. How and when is sludge dlsposed of?
6. Is there a schedule for preventative maintenance?, ~
/NO
Comments:
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW
OW
(Collect a sample if desired.)
1. Does an outside lab complete sampling? 66/ NO If yes. name of .lab„ _
2. If industry Completes sa+npitng the iadus
Comments:
0 rY rap' -=wove to describe sampling procedures,
J. Is flow measurement
operational?
.NU Comments!
4. Is there a calibration log for the flow meter? QMV / NO Commdnts:
Comments: '�`�' `'a '., =vw�. a� l 16
PART III - EXIT INTERVIEW
Review monitoring records and o1bgr SW records required by UP,
1- Are tiles well organize <9P NO Comments:
2. Are sample collection / chain -of. custody forms filled out proparp rvwclj NO
3.
_ Comments: _
Do results in ales agree with reports sent to POTW?
T. ••.'%? I"= nutnonty to strut down production should $ spill or
VU Comments:
S. Haw docs 5TU inform employees of whom to c at PQTW in case of
If slug/spill plan is already required by l'O . view
6. Is SIU implementing switspin plan? / NO Contmertts.:
Comments:
INSPECTION RESULT
5lug1Spill Control Pian Needed? NO
Comments. Required Or RecommeM Actions:
Tine: sru roweion Fong
Fila not: COMP.INSP App 7-D
Iteviden data: Aupst 1, 1994
Page 2

/ SIU INSPECTION FORM
Name Of Industry: 5K = ' =V— 1 IUP # -Oo,� -7-
Address Of Industry: IUP Expiration Date:
nA.
Industry Representatives: Title
Leona rd G-4 .S
POTW Representa 'ves:\ Title
�P,tict�+..
Date Of inspection: Time Of Inspection. _
Purpose of Inspection. Annual_ Other (Describe)
POTW to which IU discharges Lk yj u! T -P NPDES #
Is SIU currently in SNC? /V a If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following.
VS
COMMENTS
ProductRaw materials used
Manufacturing processes Categorical, if applicable/ NO
Production rate YE 0
Number of employees 0 <3.�
Number of shifts �NO
Comments.
1
am/pm
C ' OD — (q,. 3,0 rl — 7 14-
W45
+
W45 — 3'.W4-11 til —T(4-
PART
TI+
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area`s (9/ NO Where do they go?
2. Are production areas diked 'c9mikined, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? / NO Comments:
3. Are there floor drains in the storage area? NO Where do they go?
4: Are storage tanks and areas diked, contact or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs V NO Comments.
5. Are process and storage tanks and pipes labeled?/ NO
6. How are off -spec raw materials, and products disposed of?
C.lL'
7. When is the production area cleaned?
8 Is the wastewater from cleaWng the production area discharged to the POTW? YES /
9. What non -process wastewaters are discharged to POTW?
Comments:
Title, 31U 1upscaion Form
File name- COMP INSP App 7-D
Revision data. August 1, 1904
Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? ®/ NO Comments:
2. Are all units operational?�%YF� I NO
3. How often does operator/maintenance person Awk system?-� —
4 Is there an operator for each shift?
5. How and when is sludge disposed //o�fd I
6. Is there a schedule for
Comments: kA/ epk'!y
/NO
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES /41VIf yes, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments -
3. Is flow measurement equipment operational S NO Comments:
4. Is there a calibration log for the flow meter? S NO Comments.
Comments: (,xr� cJ,,:,6A,". JQMIQ� 9
PART DI - EXIT INTERVIEW
Review monitoring records and oIhmSIU records required by IUP.
1. Are files well organized? S O Comments:
2. Are sample collection / am -of -custody forms filled out properly? YES / NO Comments:
3 Do results in files agree with reports sent to POTW? YES / NO Comments:
Who has authority to shut down production should a
5. How does SIU inform employees of whom to call at POTW in case of spill/slug'! '
If slug/spill plan is already required by PO 'hkgeview procedures.
6 Is SIU implementing slug/spill plan?C / NO Comments:
Comments.
INSPECTION .RESULTS
Slug/Spill Control Plan Needed? YES /0
Comments, Required Or Recommended A ons:
Signature Of Inspectors) — r --Q-
Title: SN Inpseotim Fornl
Rename. C0W.lKSP App 7-D
Revision data: August 1, 1994
0=
Date:
Page 2
m0

This is to certify that on January 9, 2017,1 calibrated your Wastewater NCM Transit Time Flow Meter with 2"
PVC piping according to factory recommendations at Linwood Plant I. The meter is reading the correct flow
rate and is programmed correctly. Flow Meter totalizer reads in Gallons and Gallons per Minute. Flow
calculation check by flow comparison with a Badger Transit Time Flow Meter SN 118529.
Flow readings from NCM Flow Meter compared to Transit Time flow meter:
NCM meter
Transit Time meter
Error
8.1 GPM
Jnn
wlivw.clearlrvatelmc.nei
8.1 GPM
January 16, 2017
Less than 1 % error
Mr Everett Leonard
7.8 GPM
Leggett & Platt, Inc.
3040 Junior Order Home Road
Lexington, NC 27292
Dear Mr. Leonard:
This is to certify that on January 9, 2017,1 calibrated your Wastewater NCM Transit Time Flow Meter with 2"
PVC piping according to factory recommendations at Linwood Plant I. The meter is reading the correct flow
rate and is programmed correctly. Flow Meter totalizer reads in Gallons and Gallons per Minute. Flow
calculation check by flow comparison with a Badger Transit Time Flow Meter SN 118529.
Flow readings from NCM Flow Meter compared to Transit Time flow meter:
NCM meter
Transit Time meter
Error
8.1 GPM
8.0 GPM
Less than 2 % error
8.1 GPM
8.1 GPM
Less than 1 % error
8.1 GPM
7.8 GPM
Less than 4 % error
Calibration check — OIC. A calibration sticker was placed on the meter
This is to certify that on January 9, 2017, 1 calibrated your Wastewater GPI TM Series Turbine Flow Meter
with 2" PVC piping according to factory recommendations at Proctor Plant 2. The meter is reading the correct
flow rate and is programmed correctly. Flow Meter totalizer reads in Gallons and Gallons per Minute. Flow
calculation check by flow comparison with a Badger Transit Time Flow Meter SN 118529.
Flow readings from GPI Flow Meter compared to Transit Time flow meter:
NCM meter
Transit Time meter
Error
18.0 GPM
18.7 GPM
Less than 4 % error
17.0 GPM
17.2 GPM
I
I Less than 2 % error
14.5 GPM
15.0 GPNq
I
Less than 4 io error
I IO:),��" ;i`tc'.C't (:QUII til I IIclCOry, N(�Ilh C%11��IIIG� 7fiCiU? I' (t3)i;j 8!i5-�s 18J 1= (E32,�) 3'.i5-� IB,',
1 ;J �:ofpoInIo Llvr{ 1r1r'"'11 11'11 f1f)lIII (:dnc,lircI P (80J) 91 -0852 1 (70-1) 8') i 6� 66

SIU INSPECTION FORM
Name Of Industry: ",Q.2- - pl—�' �--2— WP # 00
Address Of Industry. IUP Expiration Date:
Industry Representatives: Title E
E ver erg- I n � -d
Title
r
POTW Represent fives:92
Time Of Inspection:
Date Of Inspection: r%AW t -
Purpose of Inspeedon: Annual ,..
POTW to which IU discharges
Is SILT currently in SNC?
— am/pm
(Describe)
-_ NPDES# 00SS*-$6
If yes, for what?
PART I - DMIAiL INTERVIEW
Has anytiring changed since the last inspection or IUP application in the following.
COMMENTS
Product
Raw materials used
Manufacturing processes
YES /(Q
YES'
'YES /
Categorical, if applicable YES /
Production rate YES
Number of employeesED
S /
Number of shifts YES COO
Comments.
Q 4.->0-3_90A-iT
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW. 11
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? �NO Where do they go? 4're
2. Are production areas diked, conte , otherwise constructed In such
away as to preveru Harm w tiuo
especially from spills or slugs? YE NO Comments:
3. Are there floor drains in the storage area? YES Q 0 Where do they 907
WWTP,
4. Are storage tanks and areas diked, contained, o o erwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? YES O Comments:
5. Are process and storage tanks and pipes labeled? (YES/
6 How are off -spec raw materials, and products dispose-Tof?
NO
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production area discharged to the POTW? YES !
9. What non -process wastewaters are discharged to POTW? 74
Comments:
Title, SN Inpsection 170M
Be name- COIvII'.INSP App 7-D Page 1
1%Mion dOta. August 1, 1994

Sni INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system9 S NO Comments:
2. Are all units operational?
3. How often does operatorlmamteru
4. Is there an operator for each shift?
5. How and when is sludge disposed
/NO
check system?
6. is there a schedule for preventative maintenance?
Comments. �V��
/NO
PART II - Plant Tour Section C - SAA FLING POINT(S) AND FLOW 1NiEASU1ltENIENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES isientative
If yes, name of lab.
2. If industry completes sampling, ask the industry r to describe sampling procedures. Comments:
3. Is flow measurement equipment operational / NO Comments:
4. Is there a calibration log for the flow meter? QV/N0 Comments:
Comments. L _ c=""" " 1 e3`C"` ' 17 --
PART III - EXIT INTERVIEW
Review monitoring records anSIU records required by IUP.
1. Are files well organized? / NO Comments:
2. Are sample collection / cham-of-custody forms filled out properly? YES / NO Comments: 404-
3.
/ -
3. Do results in files agree with reports sent to
NO Comments.
4 Who has authority to shut down production should a spill or slug discharge occur?
5. How does SIU inform employees of whom to call at POTW in case of spill/slug?
(12-m—
If slug/spill plan is already required by POSreview procedures.
6. Is SIU implementing slug/spill plan?(�/ NO Comments:
Comments:
INSPECTION RESULTS
Sh4SVIU Cpntrol Plan Needed? YES /
Comments, Required Or Recommended Actions:
Signature Of Inspectors)
Title: SIU Inpsection Fom1
File nate: CUW.INSP App 7-D
Revision clads: August 1,1994
Date:
n Sol -A.
Page 2

IE
SIU INSPECTION FORM
Name Of Industry! AI 740/2 m gnlz Aw. IUP # 40/02
Address Of Industry: IUP Expiration Date:
Industry Representatives: Title
POTW Represe�n.tatives: --�- Title
Date Of Inspection: 9 / 7 Time Of Inspection: 37:00170;
Purpose of Inspection: Annual p
m'P P �_ Other (Describe)
POTW to which IU discharges Z.&g&g O NPDES # �[llj, I
Is SIU currently in SNC? .r/o If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following.
COMMENTS
Product
YES ,(Sj))
Raw materials used
YES /
Manufacturing processes
YES /
Categorical, if applicable
YES /
Production rate
YES /
Number of employees
/®
Number of shifts YES /�ES
Comments:
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? YE (NO Where do they go?
/.. Are proaucuon areas diked, coed, or otherwise constructed in such a way as to prevent harm to the W WTP,
especially from spills or slugs? CY061 / NO Comments:
3. Are there floor drains in the storage area? YES 1W Where do they go?
�+. Are storage tanks and areas diked, con or otherwise constructed in such away as to prevent harm to the
WWTP, especially from spills or slugs?� �ES NO Comments -
/__N
5. Are process and storage tanks and pipes labeled?
6. How are off -spec raw materials, and products dis
7.
8.
9.
When is the production area cleaned?
Is the wastewater from cleaning the production area ' ch
What non -process wastewaters are discharged to POTW?
Comments:
'l'ttle: SIU Inpsection Form
File name. COMP.INSP App 7-13
Revision data: August I, 1994
RM
;ed to the POTW? YES / NO
�.- k\ -c W kd
Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system9 (20/ NO Comments:
2. Are all units operational? ffE / NO
3. How often does operator/mai nancen check system?
4. Is there an operator for each shift? G NO
5. How and when is sludge disposed of?
6. Is there a schedule for preventative maintenance?—@P/ NO
Comments: W flfi—�
PART II - Plant Tour Section C - SAMPLING POINTS) AND FLOW MEASUREMENT
(Collect a sample if desired.) r�
1. Does an outside lab complete sampling? YES / 1If yes, name of lab
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measurement equipment operational?
4. Is there a calibration log for the flow meter?
Comments.
/NO Comments:
/NO Comments -
PART III - EXIT INTERVIEW
Review monitoring records anddGe"Ix SIU records required by IUP
1. Are files well organized NO Comments:
2. Are sample collection/ chain -of -custody forms filled out properly? / NO Comments:
3. Do results in files agree with reports sent to POTW? ':Y -W / NO Comments:
4. '$ho has authority to shut downZproductiopliqulda spill,or slug discharge occur? Ovty,4 C0,0M4
5. How does SIU inform employees°of whom to call at POTW in case of spill/slug9
If slug/spill plan is already required by PPOIV, review procedures
6. Is SIU implementing slug/spill plan // Y / NO Comments:
Comments:
INSPECTION RESULTS ,
Slug/Spill Control Plan Needed? E / NO
Comments, Required Or Recommen a Actions:
Signature Of Inspectors)
Title: SIU Inpsectlon Form
File name. COMP.INSP App 7-D
Revision data- August 1, 1994
Date:
Page 2

SIU INSPECTION ]FORM
Name Of Industry: IUP # ©01 �O
Address Of Industry: IUP op Date.
I—
Industry Representatives:
POTW Repr�irtat}ves:
Date Of Inspection: 1-W-1 13_1 1 f--
Purpose of Inspection: Annual _yj_ Other
POTW to which IU discharges L 9— W k
Time Of Inspection:
Is SIU currently in SNC? CL If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or
Product
Raw materials used
Manufacturing processes
YES / O
YES/
YES/
Categorical, if applicableP—
Comments:
Production rate
Number of employeesNumber of shifts YES
/ 1� L-- •_
am/pm
NPDES 4 _N G p O S 5 9+-2f A
IUP application in the following
COMMENTS
a ss
PART H - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? 40 / NO Where do they go? _
2 Are production areas diked, co ed, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? / NO Comments -
3. Are there floor drains in the storage area? YES /6S)Where do they go?
4. Are storage tanks and areas diked, cont ' or otherwise constructed in such away as to prevent harm to the
WWTP, especially from spills or slugs? S / NO Comments.
5. Are process and storage tanks and pipes labeled? ftV / NO
6. How are off -spec raw materials and p oducts dis osed oft
7. When is the production area cleaned?
S. Is the wastewater from cleaning the production area disc ed t6 the POTW? VES /O
9 What non -process wastewaters are discharged to POTW`?
Comments.
Title: SN h4mation Form
File name: COW.INSP App 7-1)
Revision data: August 1, 1994 Page I

SIU INSPECTION FORM
PART n - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? (2P/ NO Comments:
2.
• 3.
4.
5.
Are all units operational? / NO
How often does operator/maintenance person ae* system?
Is there an operator for each shift? YES I3QJ
How and when is sludge disposed oft _ _
6. Is there a schedule for preventative maintenance? (/TE) / NO
Comments:
PART H - Plant Tour Section C - SANPLING POINT(S) AND FLOW MEASUBEMENlI'
(Collect a sample if desired.)
• 1. Does an outside lab complete sampling? YE� If yea, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3 Is flow measurement equipment operational?
Comments:
4. Is there a calibration log for the flow meter? SO
NO Comments:
Comments:
Wl(a--lig
PART M - EXIT INTERVIEW
Review monitoring records and SIU records required by IiJP.
1. Are files well organized? NO Comments.
2. Are sample collection / chain -of -custody firms filled out properly? YES / NO Comments:
3. Do results in files agree with reports sent to POTW? /NO Comments:
4. Who has authority to shutdown production should a spill or slug discharge occur?
5. How does SN inform employees of whom to call at POTW in case of spillisiug?
If slug/spill plan is already required by POTW, review procedures.
6„ Ip SN implemegting,*lup/spill plan? _YES 1W Comment'.
Comments:
INSPECTION RESULTS
Shig/Spill Control Plan Needed?S / O
Comments, Required Or Recommen ctions:
Signature Of Inspector(s)
Title: SN inpsection Farm
Pile name: C0W.INSP App 7-D
R,evisim data: August 1, 1994
Date:
/(,? /,� -/,---
Page 2
0

SIFT INSPECTION FORM
Name Of Industry: L eN E,, c- IUP #
Address Of Industry: IUP Expiration Date:
IndustryRepresemat. v Title
n0 G 7-,a aro 11 P ti 61 n
POTW Representatives: Title nn
12A,,-L-1+
Date Of Inspection: & I L1 31= Time Of Inspection: am/pm
Purpose of Inspection: Annual V Other (Describe)
POTW to which IU discharges L '[Z W V ]D NPDES N C- -4-,e ,e
Is SIU currently in SNC? �,�_ If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMA ENTS
YES asYES
YES twCategorical, if applicable YES '
Production rate YES
Number of employees XROao
dumber of shifts YES /
Product
Raw materials used
Manufacturing processes
Comments:
6 • -L-,'3-0
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STOPPAGE AREAS
1. Are there floor drains in the production area? YES ^0 Where do they go? L�
2. Are production areas diked, cg`s- , or otherwise constructed in such a way as to prevent hum to the WWTP,
especially from spills or slugs? NO Comments.
3. Are there floor drains in the storage areal Qf.ESINO Where do they go?
4: Are storage tanks and areas diked,
otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? cont Comments:
5. Are process and storage tanks and pipes labeled? �E VINO
6. How are off -spec raw materials, and products dispos of?
ed to POTW'7
9. What non -process wastewaters are tc .
C._ p
7. When is the production area cleaned? ate-.
S. Is the wastewater from cleaning the production area ' charged to the POTW? YES ANLO
d's,arg
Comments,
Title: SIU Inpsection Form
File name: COMP INSP App 7-D
Revision data: August 1, 1994 Pap I

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? @/ NO Came
IV-V% i ME
2.
3.
4
5.
Are all units operational? / NO
How often does operator/maintenance Person check system?
Is there an operator for each shift? / NO
How and when is sludge disposed of? i
6. Is there a schedule for preventative maintenance?
/NO
Comments:
PART H - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired )
1. Does an outside lab complete sampling? YES / If yes, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3 Is flow measurement equipment operational? YES/AO) Comments. —
I
4. Is there a calibration log for the flow meter? YES / UO Comments.
Comments:
PART III - EXIT INTERVIEW
Review monitoring records and o r SIU records required by IUP.
1 Are files well organized? (NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly? YES / NO Comments: }�
3. Do results in files agree with reports sent to POTW? YES / NO Comments:
4. Who has authority to shut down production should a spill or slug discharge occur? - th,4040
5. How does SIU inform employees of whom to call at POTW in case of spill/slug? VxD S
If slug/spill plan is already required by POTJA; iew procedures.
6. Is SIU implementing slug/spill plan? (YES NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spiil Control Plan Needed?S 0
Comments, Required Or Recommended Actions:
Signature Of Inspector(s) L+
Date: 2.1 14 11 -�-
Title. SN Inpseohon Form ���
File name- COWIIVSP App 7D
Revision data. August 1, 1994 Page 2

ASCO POWER TECHNOLOGIES
IUP #0038

ASCOower
Tachnologies
June 1, 2017
Ms Gisele Comer
Pretreatment Coordinator
Water Resources Department
500 Glendale Road
Lexington, NC 27292
RE TTO Statement
Dear Ms Comer,
Per the requirements of our TTO program I am submitting the following statement
ASCO Power Technologies
P 0 Box 689
325 Welcome Center Blvd
Welcome, NC 27374
T [phone]
F [phone]
"Based on my Inquiry of the person or persons directly responsible for managing compliance with the
standards for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of
concentrated organics into the waste -streams has occurred since filing the last discharge monitoring report.
I further certify that this facility is implementing the toxic organic management plans submitted to the Control
Authority "
Regards,
ASCO Power Technologies
J�77
Daniel Clark
Environmental Health and Safety Manager
FedEx Tracking
7302 6604 2637

ASCOTechnologles
December 8, 2017
Ms Glsele Comer
Pretreatment Coordinator
Water Resources Department
500 Glendale Road
Lexington, NC 27292
RE- TTO Statement
Dear Ms. Comer,
Per the requirements of our TTO program I am submitting the following statement
ASCO Power Technologies
P O Box 689
325 Welcome Center Blvd
Welcome, NC 27374
T [phone]
F [phone]
"Based on my Inquiry of the person or persons directly responsible for managing compliance with the
standards for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of
concentrated organics into the waste -streams has occurred since filing the last discharge monitoring report
I further certify that this facility is Implementing the toxic organic management plans submitted to the Control
Authority "
Regards,
ASCO Power Technologies
Daniel Clark
Environmental Health and Safety Manager
FedEx Tracking 730266091900

CARDINAL CONTAINER SERVICE
IUP #0010

LEGGETT & PLATT #1
IUP #0027

FAS H [10 KNI
BED GROUP
P. Box 140
Unwooa, NC 272M
3304MG-8000
TOTAL TOXIC ORGANICS CERTIFICATION STATEMENT
Based on my inquiry of the person or persons directly responsible for managing compliance with
pretreatment standard for TTOs, I certify that to the best of my knowledge and belief, this
facility, Leggett & Platt, # 1 (Linwood) does not store, use, or discharge to the sanitary sewer
system any toxic organic chemicals.
CERTIFYING OFFICIAL:
Q, X017
Signature Date
Printed Name and Title
��'.^R `�'•". s� x _ ,.. � = sir.-'—���.��r - - �`'�."+"r�.�.�..�^ .'=ai � '� 2rii_�-.�.L..a����� ..::s_,.. �:�L.�.`'u�-.�;�

1�7-
k
i
® 3YCOE3PO�A7ED
TOTAL TOXIC ORGANICS CERTIFICATION STATEMENT
Based on my inquiry of the person or persons directly responsible for managing compliance with
pretreatment standard for TTOs, I certify that to the best of my knowledge and belief, this
facility, Leggett & Platt, # 1 (Linwood) does not store, use, or discharge to the sanitary sewer
system any toxic organic chemicals.
CERTIFYING OFFICIAL: Y //
,f
r
/yl "
Signature
&e'e--q 5sI mangyc'-
Printed Name and Title
7
Date
P 0 BOX 140 • LINWOOD, NORTH CAROLINA 27299.336/956-5000

LEGGETT & PLATT #2
IUP #0028

BED GROUP
A
O. Box 940
Unwood, NC 27299
338-956-6=
TOTAL TOXIC ORGANICS CERTIFICATION STATEMENT
'Based on, my inquiry' of the person or persons directly responsible for managing compliance with
pretreatment standard for TTOs, I certify that to the best of my knowledge and belief, this
.facility, Leggett & Platt, # 2 (Proctor) does not store, use, or discharge to the sanitary sewer
system any toxic organic chemicals.
CERTIFYING OFFICIAL:
"12
Signature Date
Printed Name and Title

foinCORPORU ED
•
TOTAL TOXIC ORGANICS CERTIFICATION STATEMENT
Based on my inquiry of the person or persons directly responsible for managing compliance with
pretreatment standard for TTOs, I certify that to the best of my knowledge and belief, this
facility, Leggett & Platt, # 2 (Proctor) does not store, use, or discharge to the sanitary sewer
system any toxic organic chemicals.
CERTIFYING OFFICIAL:
Signature Date
EVQ-C- - � epaalr i
Printed Name and Title
P 0 BOX 140 • LINWOOD, NORTH CAROLINA 27299.336/956-5000

MATCOR METAL FABRICATIONS
IUP #0012

6oh-� N N IL
--r. I a t WV_LI% 0 1 M
January 2, 2017
City of Lexington
Ms. Gisele Hedrick -Comer
Pretreatment Program Coordinator
28 W. Center Street
Lexington, NC 27292
835 Salem Road
Post Office Box 729
Welcome, NC 27374
Phone: [phone]
"I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or
persons who manage the system or those persons directly responsible for gathering the
information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fine and imprisonment for knowing violations."
"Based upon my inquiry of the person or persons directly responsible for managing compliance
with the permit limitation for Total Toxic Organics (TTO), I certify that, to the best of my
knowledge, no dumping of concentrated toxic organics into the wastewater has occurred since
filing of the last monitoring report. I further certify that this facility is implementing the Toxic
Organic Management plan submitted to the Control Authority".
Signed:�/C� 2.
Print Name: Joe Edwards
Title: EHS Coordinator
Date Signed: January 02, 2017

AINM%AJK
METAL FABRICATION
September 11, 2017
City of Lexington
Ms. Gisele Hedrick -Comer
Pretreatment Program Coordinator
28 W. Center Street
Lexington, NC 27292
835 Salem Road
Post Office Box 729
Welcome, NC 27374
Phone: [phone]
"I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or
persons who manage the system or those persons directly responsible for gathering the
information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fine and imprisonment for knowing violations."
"Based upon my inquiry of the person or persons directly responsible for managing compliance
with the permit limitation for Total Toxic Organics (TTO), I certify that, to the best of my
knowledge, no dumping of concentrated toxic organics into the wastewater has occurred since
filing of the last monitoring report. I further certify that this facility is implementing the Toxic
Organic Management plan submitted to the Control Authority".
Signed:
Print Name: Joe Edwards
Title: EHS Coordinator
Date Signed: September 11, 2017

TIER RACK
twi-18111AW

NAME OF FACILITY TIER -RACK
Business Address: 200 Prospect Drive, Lexington, NC 27292
Discharge Address (if different from above):
TOTAL TOXIC ORGANICS CERTIFICATION STATEMENT
Based on my inquiry of the person or person directly responsible for managing compliance with
pretreatment standard for TTOs, I certify that to the best of my knowledge and belief, this
facility does not store, use, or discharge to the sanitary sewer system any toxic organic
chemicals.
CERTIFYING OFFICAL-
Signature
Printed Name & Title
EXECUTIVE OFFICER.
,y.:_>.
Signature
Printed Name & Title
Date
Date

NAME OF FACILITY: TIER -RACK
Business Address- 200 Prospect Drive, Lexington, NC 27292
Discharge Address (if different from above).
TOTAL TOXIC ORGANICS CERTIFICATION STATEMENT
I
Based on my inquiry of the person or person directly responsible for managing compliance with
pretreatment standard for TTOs, I certify that to the best of my knowledge and belief, this
facility does not store, use, or discharge to the sanitary sewer systern any toxic organic
chemicals.
CERTIFYING OFFICAL•
Signature
Printed Name & Title
EXECUTIVE OFFICER:
Date
e W
Signature Date
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Printed Name & Title