NC0055786_Pretreatment Annual Report_20190214

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,rk-Lmj-�
LEXINGTON
NORTH CAROLINA
WATER RESOURCES
Q U A L I T Y FIRST
2/14/19
Mr. Monti Hassan
NC DENR
DWQ/PERCS Unit
Pretreatment Unit
1617 Mail Service Center
Raleigh, N.C. 27699-1617
REcE-1VED/DENR/DWR
FEB 18 2019
XWater Resources
rmitting Section
Re: City of Lexington's Pretreatment Program Annual Report 2018
Dear Sir,
Attached is a copy of the City of Lexington's Pretreatment Program Annual Report
for the period of January 1, 2018 to December 31, 2018.
Sincerely,
Eglantina Minerali
Lab Supervisor/ Pretreatment Program Coordinator
cc: WSRO
500 Glendale Road - Lexington, NC 27292 - 336.357.7889
WWW.LI.XING"fONNC.GOV

City of Lexington
Pretreatment Program Annual Report
January 1, 2018 to December 31, 2018

Annual Pretreatment Program Report
POTW Name: City of Lexington
Report Date: February 14, 2019
Report Covered By This Report: From 01/01/2018 to 12/31/2018
Period Covered By Previous Report: From 01/O1/2017 to 12/31/2017
Name of Wastewater Treatment Plant(s): Lexington Regional WWTP
NPDES Permit Number: NC0055786
Person to Contact Concerning Information Contained In This Report: Eglantina Minerali
Title: Lab Supervisor/Pretreatment Program Coordinator
Mailing Address: 28 West Center Street, Lexington, NC 27292
Telephone: [phone]
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 penalties for submitting false information.
Date:02/14/2019
Signature of Official
Title: Lab Supervisor/Pretreatment Program Coordinator

r �
fl �
LEXINGTON
NORTH CAROL 1 N A
WATER RESOURCES
QUALITY FIRST
January 28, 2019
NC Division of Water Resources - PERCS Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Pretreatment Program Signatory Authority
City of Lexington (NPDES Permit NC0055786)
Davidson County
Dear PERCS:
As the Mayor of City of Lexington, I hereby delegate responsibility for overall operation of the
City of Lexington's Pretreatment Program to Eglantina Minerali, Laboratory Supervisor /
Pretreatment Coordinator.
This designation will provide Ms. Minerali with the authority to sign all required documents
under the Pretreatment Program, including the authority to sign the Pretreatment Annual Report
(PAR) and submit it to NC DWR PERCS.
If you have any questions, please contact me at [phone] or Eglantina Minerali at
[phone].
Sincerely,
Newell Clark,
Mayor
cc: Tom Johnson, Water Resources Utility Director, Public Services Admin
500 0lendale lWad - Lexington, NC 27292 - 336.357.7889

Narrative Summary

Narrative Summary
January 1, 2018 — December 31, 2018
I. Letter of Delegation of Pretreatment Signatory Authority: Enclosed
II. Toxicity Bioassay Analyses
During the year of 2018, Lexington Regional WWTP has passed February (Ceriodaphnia Dubia),
May (Ceriodaphnia Dubia) , September(Ceriodaphnia Dubia, Pimephales promelas) , and
November (Ceriodaphnia Dubia, Pimephales promelas) bioassay.
III. Cardinal Container Service— IUP #0010
A. The IDSF for Cardinal's percent reflect monthly averages and half on BDL
B. BOD samples for the month of November needed to be diluted more so greater than (>)
results were produced. The actual numbers were used for calculating the averages.
C. Inspections enclosed
IV. Asco Power Technologies — IUP #0038
A. The IDSF for Asco's percent reflect half on BDL
B. Inspections enclosed
C. Letters for certification for TTO enclosed
V. Matcor Metal Fabrication — IUP #0012
A. The IDSF for Matcor's percent reflect half on BDL
B. Inspections enclosed
C. Letters for certification for TTO enclosed
VI. Tier Rack— IUP #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. Inspections enclosed
C. Letters for certification for TTO enclosed

VII. Leggett & Platt Plant #1— IUP #0027
A. The IDSF for Leggett's percent reflect half on BDL
B. Inspections enclosed
C. Letters for certification for TTO enclosed
VIII. Leggett & Platt Plant #2 — IUP #0028
A. The IDSF for Leggett's percent reflect half on BDL
B. Inspections enclosed
C. Letters for certification for TTO enclosed

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/yyyy
3. _>
1/1/2018
4.
PAR End Date, please enter 12/31/yyyy
4. =>
12/31/2018
5.
Total number of SIUs, includes CIUs
5. =>
6
6.
Number of CIUs
6. =>
5
7.
Number of SIUs with no IUP, or with an expired IUP
7. =>
0
8.
Number of SIUs not inspected by POTW
8. =>
0
9.
Number of SIUs not sampled by POTW
9. =>
0
10.
Number of SIUs in SNC due to IUP Limit violations
10. =>
0
11.
Number of SIUs in SNC due to Reporting violations
11. =>
0
12.
Number of SIUs in SNC due to violation of a Compliance Schedule, CO, AO or similar
12. =>
0
13.
Number of CIUs in SNC
13. =>
0
14.
Number of SIUs included in Public Notice
14. =>
0
15
Total number of SIUs on a compliance schedule, CO, AO or similar
15. =>
0
16.
Number of NOVs, NNCs or similar assesed to SIUs
16. =>
0
17.
Number of Civil Penalties assessed to SIUs
17. =>
0
18.
Number of Criminal Penalties assessed to SIUs
18. =>
0
19.
Total Amount of Civil Penalties Collected 19. =>
$
0
20.
Number of IUs from which penalties collected
20. =>
0
Votes:
AO Administrative Order IUP Industrial User Pretreatment Permit POTW
CIU Categorical Industrial User NNC Notice of Non -Compliance SIU
Publicly Owned Treatment Works
Significant Industrial User
CO Consent Order NOV Notice of Violation SNC
Significant
Non -Compliance
IU Industrial User PAR Pretreatment Annual Report
revised 1/2018: PAR PPS 2018

Pretreatment Annual Report (PAR)
Significant Non -Compliance Report (SNCR)
PAR covers this calendar year => 2018
Control Authority=Program=Town Name =>
WWTP = Wastewater Treatment Plant, use separate form for each WWTP.
SIU = Significant Industrial User
SNC = Significant Non -Compliance
WWTP Name =>
NPDES # _>
City of Lexington
Lexington Regional WWTP
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 - Dec.
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

Pretreatment Program Info Database
for Program Name Lexington
WWTP Name City of Lexington
Program Approval Date 06/10/1983
Pretreatment Status Full
Region WSRO
County Davidson
printed on: 12/12/2018
Stream Information I lWC % at 7Q10 60.03
7Q10 Flow cfs / mgd 6.7 / 4.33
lQ10 Flow cfs / mgd 5.57 / 3.60
Stream Classification WS-V & B
Basin Number YAD07
Receiving Stream Name ABBOTTS CREEK
NPDES Number NCO055786
Last PAR Rec 03/13/2018
PAR Due Date 03/01/2018
mercury
NPDES Effective Date 02/01/2016
1631
NPDES Expire Date
P 04/30/2019
Current Fiscal
Year PCIDone
required
es
POTW is Primary WWTP TRUE
Last Audit on 09/21/2017
Audit Year Next21/22
Design Flow mgd 6.5000 % Design mgd is SIU permitted 2.03 Permitted SIU flow (mgd) (Pt_SIU)
.132
WWTP SIU's
5
Program SIUs
�RN
HWA LTMP
IWS SUO
WWTP CIU's
Program CIUs�
ERP
date Inactive Date Next Due
01/06/2020�
04/01/2020
F
Date Received by DWR
_01/0912015 10/07/2016
01/0 1 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 q.Prime Phonel ext Fax HWA Wksp IUP WksD PAR WksD
Ms. Eglantina Minerali
Prim
336) 357-7889
1/23/2017 5/17/2016 1/22/2018
[e-mail] Chemist 128 W. Center Stree P7292
Pretreatment Related NOVs from DWQ DWR Central Office Contact Imonti Hassan
6/11/2010 NOV: Failure to provide information upon request which I DWR Regional Contact Fim Gonsiewski
iq,o P � s-J-oC t cry— 5 N c,

Allocation Table

POTW
NPDES#
IUP
Count
2
3
4
5
6
7
8
9
10
Workbook Name: HWA _2014_Approved, Worksheet Name: AT Printed: 2/5/2019, -Iz:05 PM
Page 1 of 5
Allocation Table
Headworks last approved: 06/10/15
Allocation Table updated: 06/10/15
Permits last modified: 05/31/14
LRWWTP
NCO055786
Spreadsheet Instructions:
1) Applicable Values should be entered in the Heavy Bordered cells. Rest of worksheet is protected, password is
"2".
2) Formulas are discussed in the Comprehensive Guidance, Chapter 6, Section C.
3) HWA and AT worksheets 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.
Pipe
number
Type Renewal
of Effective
Industry Date
Modification Date
Effective Permit
Date Expires
Industry
INDUSTRY NAMES Permit
(plena list alphabcticly) number
FLOW
Permit Limits
BOD
Permit Limits
TSS
Permit Limits
MGDgal/day
Cone. Load
mg/1 lbs/da
Cone. Load
m I Ibs/da
Cardinal Container
0010
0001
Cont.
05/31/14
05/31/19
0.0500
50,000
2517.99
1050.00
Matcor Metal
0012
0001
433
05/31/14
F 05/31/19
0.0170
17,000
Tier Rack
0045
0001
433
05/31/14
05/31/19
0.0170
17,000
ASCO Power
0038
0001
433
05/31/14
05/31/19
0.0080
8,000
Leggett & Platt #1
0027
0001
433
05/31/14
05/31/19
0.0200
20,000
Leggett& Platt #2
0028
0001
433
05/31/14
05/31/19
0.0200
20,000
Column Totals =>
0. 13201
132,000
1050
0
Basis=>
MAHL from HWA (Ibs/day) => NPDES Permitted Flow=>
Uncontrollable Loading (Ibs/day) =>
Total Allowable for Industry (MAIL) (lbs/day) =>
Total Permitted to Industry (Ibs/day) =>
MAIL left (Ibs/day) =>
Percent Allow. Ind. (MAIL) still available (%) =>
Percent MAHL still available (%) =>
5 Percent MARL fibs/davl =>
NPDES
Design
Design
6.5000
14691
9161
2.7100
8430
5447
3.7900
6261
3715
0.1320
1050
0
3.6580
5211
3715
96.5 ON
83.2 %
100.0 %
56.3 %
35.5 %
40.5 %
0.3250
735
458
HWA.AT
Revised: November 2005

POTW=:
NPDESi--:
IUP
Count
2
3
4
5
6
7
8
9
10
Workbook Name: HWA_2014_Approved, Worksheet Name: AT
Allnnntinn Tnhla
Printed: 2/5/2019, 12:05 PM
Page 2 of 5
Headworks last approved:
Allocation Table updated:
Permits last modified:
06/10/15
Pipe
number
06/10/15
05/31/14
LRWWTP
NCO055786
Industry
INDUSTRY NAMES Permit
(Please fist a)pnabaicy) number
Ammonia
Permit Limits
Arsenic
Permit Limits
Cadmium
Permit Limits
Chromium
Permit Limits
Copper
Permit Limits
Cyanide
Permit Limits
Cone. Load
m lbs/da
Conc. Load
mg/1 lbs/day
Conc. Load
m I Ibs/da
Conc. Load
mg/1 lbs/da
Cone. Load
m lbs/day
Conc. Load
mgA lbs/da
Cardinal Container
0010
0001
0.0552
0.0230
2.7338
1.1400
0.6835
0.2850
Matcor Metal
0012
0001
0.0700
0.0099
1.7100
0.2424
2.0700
0.2935
0.6500
0.0922
Tier Rack
0045
0001
0.0700
0.0099
1.7100
0.2424
2.0700
0.2935
0.6500
0.0922
ASCO Power
0038
0001
0.0700
0.0047
1.7100
0.1141
2.0700
0.1381
0.6500
0.0434
Le ett & Platt #1
0027
0001
0.0700
0.0117
1.7100
0.2852
2.0700
0.3453
0.6500
0.1084
Le ett& Platt #2
0028
0001
0.0700
0.0117
1.7100
0.2852
2.0700
0.3453
0.6500
0.1084
Column Totals =>
0
0.0000
0.0709
2.30941
1 1.7006
1 0.4445
Sludge
AS/Nit/TF
Sludge
Basis=>
Design
Ceiling
NPDES
inhibition
Ceiling
Stream Std
MAHL from HWA (Ibs/day) =>
710.15
0.5811
0.2077
9.0035
10.4812
0.9954
Uncontrollable Loading (lbs/day) =>
400.04
0.1130
0.0226
0.1356
2.1743
0.0565
Total Allowable for Industry (MAIL) (lbs/day) =>
310.11
0.4681
0.1851
8.8679
8.3070
0.9389
Total Permitted to Industry (lbs/day) =>
0.00
0.0000
0.0709
2.3094
1.7006
0.4445
MAIL left (lbs/day) =>
310.11
0.4681
0.1143
6.5585
6.6063
0.4944
Percent Allow. Ind. (MAIL) still available (%) _>
0.0 %
100.0 %
61.7 %
74.0 %
79.5 %
52.7 %
Percent MAHL still available (%) _>
3.7 %
P35.51
80.6 %
55.0 %
72.8 %
63.0 %
49.7 %
5 Percent MAHL (Ibs/day) =>
0.0291
1 0.0104
0.4502
0.5241
0.0498
HWA.AT
Revised: November 2005

POTW=:
NPDES#
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name: HWA_2014_Approved, Worksheet Name: AT Printed: 2/5/2019, 12:05 PM
Page 3 of 5
Allocation Table
Headworks last approved:
Allocation Table updated:
Permits last modified:
06/10/15
Pipe
number
06/10/15
05/31/14
LRWWTP
NCO055786
Industry
INDUSTRY NAMES Permit
cpl- ust alphabeucly> number
Lead
Permit Limits
Mercury
Permit Limits
Molybdenum
Pennit Limits
Nickel
Permit Limits
Selenium
Permit Limits
Silver
Permit Limits
Conc. Load
m lbs/da
Cone. Load
mg/1 Ibs/da
Conc. Load
m Ibs/da
Conc. Load
m I lbs/da
Cone. Load
mg/1 lbs/da
Conc. Load
m lbs/da
Cardinal Container
0010
0001
1.1990
0.5000
0.00098
0.00041
0.9113
0.3800
Matcor Metal
0012
0001
0.4300
0.0610
1.5000
0.2127
0.2400
0.0340
Tier Rack
0045
0001
0.4300
0.0610
1.5000
0.2127
0.2400
0.0340
ASCO Power
0038
0001
0.4300
0.0287
1.5000
0.1001
0.2400
0.0160
Leggett& Platt #1
0027
0001
0.4300
0.0717
1.5000
0.2502
1 0.2400
0.0400
Leggett& Platt #2
0028
0001
0.4300
0.0717
1 1.5000
0.25021
1 0.2400
0.0400
Column Totals =>
0.7941
1 0.000410
0.0000
1.4058
0.0000
10.1641
Sludge
Sludge
AS/Nit/TF
Digester
Basis=>
NPDES
Ceiling
Ceiling
inhibition
NPDES
Inhibition
MAHL from HWA (Ibs/day) =>
1.9922
0.109215
1.4496
5.7129
0.3656
4.9815
Uncontrollable Loading (lbs/day) _>
0.3096
0.009267
0.1740
0.0972
0.0565
0.0927
Total Allowable for Industry (MAIL) (Ibs/day) _>
1.6826
0.099949
1.2756
5.6157
0.3091
4.8889
Total Permitted to Industry (Ibs/day) _>
0.7941
0.000410
0.0000
1.4058
0.0000
0.1641
MAIL left (Ibs/day) =>
0.8885
0.099539
1.2756
4.2099
0.3091
4.7247
Percent Allow. Ind. (MAIL) still available (%) =>
52.8 %
99.6 %
100.0 %
75.0 %
100.0 %
96.6
Percent MAHL still available (%) =>
44.6 %
91.1 %
5 Percent MAHL ilbs/davl =>
0.0996
0.005461
0.0725
0.2856
0.0183
0.2491
HWA.AT
Revised: November 2005

POTW
NPDESt
IUP
Count
2
3
4
5
6
7
8
9
10
Workbook Name: HWA_2014_Approved, Worksheet Name: AT Printed: 2/5/2019, 12:05 PM
Page 4 of 5
Allocatinn Table
Headworks last approved:
Allocation Table updated:
Permits last modified:
06/10/15
Pipe
number
06/10/15
05/31/14
LRWWTP
NCO055786
Industry
INDUSTRY NAMES Permit
(please list alphabeticly) number
Zinc
Permit Limits
Total Nitrogen
Permit Limits
Total Phos.
Permit Limits
Phenols
Permit Limits
0
Pennit Limits
I
Permit
Conc. Load
m /l lbs/dav
Conc. Load
mRA lbs/da
Conc. Load
m lbs/da
Conc. Load
m lbs/da
Conc. Load
m lbs/da
Conc.
mg/1
Cardinal Container
0010
0001
3.5971
1.5000
Matcor Metal
0012
0001
1.4800
0.2098
Tier Rack
0045
0001
1.4800
0.2098
ASCO Power
0038
0001
1.4800
0.0987
Leggett& Platt #1
0027
0001
1.4800
0.2469
e ett & Platt #2
0028
0001
1.4800
0.2469
Column Totals
1 2.5121
1
0.00
0.00001
0.0000
Basis=>
MAHL from HWA (Ibs/day)=>
Uncontrollable Loading (Ibs/day) =>
Total Allowable for Industry (MAIL) (Ibs/day) =>
Total Permitted to Industry (Ibs/day) =>
MAIL left (Ibs/day) =>
Percent Allow. Ind. (MAIL) still available (%) =>
Percent MAHL still available (%) =>
5 Percent MAHL Obs/dav) =>
Sludge
Ceiling
NPDES
133.12
147.59
-14.47
0.00 0.00
-14.47
100.0 %
-10.9 %
6.6558
NPDES
1.2473
0.4452
0.8020
0.0000
0.8020
100.0 %
64.3 %
0.0624
22.6014
0.00
#VALUE!
#VALUE!
21.6183
8.0167
13.6016
2.5121
11.0895
81.5 %
51.3 %
1.0809
HWA.AT
Revised: November 2005

POTW=:
NPDES#--.
IUP
Count
2
3
4
5
6
7
8
9
10
Workbook Name: HWA_2014_Approved, Worksheet Name: AT Printed: 2/5/2019, 12:05 PM
Page 5 of 5
Allnnntinn Tahla
Headworks last approved:
Allocation Table updated:
Permits last modified:
06/10/15
06/10/15
05/31/14
LRW WTP
NCO055786
Industry
INDUSTRY NAMES Permit
(a(.. (m.lpft ktic(,) number
Limits
f
Permit Limits
g
Permit Limits
h
Permit Limits
I
Permit Limits
Pipe Load
number lbs/da
Cone. Load
m lbs/da
Conc. Load
mg/1 Ibs/da
Conc. Load
m lbs/da
Conc. Load
mg/1 lbs/da
Cardinal Container
0010
0001
Matcor Metal
0012
0001
Tier Rack
0045
0001
ASCO Power
0038
0001
Leggett& Platt # 1
0027
0001
Leggett& Platt #2
0028
0001
Column Totals =>
0.00001
0.0000
1 0.000
1 0.0000
0.0000
Basis=>
MAHL from HWA (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 MAHL still available (%) _>
5 Percent MAHL (lbs/davl =>
0.0000
0.00
0.0000
0.0000
0.0000
0.0000
#######
#######
#######
#######
#######
#######
1#######
#######
#######
H WA.AT
Revised: November 2005

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 # _>
1 st 6 months, dates =>
2nd 6 months, dates =>
City of Lexington
Lexington Regional WWTP
NC0055786
1/l/2018 to 06/30/2018
7/ 1 /2018 to 12/31 /2018
Industry
Name Asco Power Tech.
IUP # 0038
Pipe # '01
ow, inga
HUD
INN
Aullmonia
st 6 months
2nd 6 months
2 n d 6 m o n t rs
T Trmon s
2nd 0 mont s
s mon s
271 o mont s
Arsenic
Uadinium
Uhromium
UOD
st mont s2nd 6 months
2nd 6 months
I st 6 months
n mont s st mont s
n mont s
8
8
8
8
0.001
0.0005
0.055
0.053
0.001
0.0005
0.019
0.015
0%
0%
0%
0%
0%
0%
0%
0%
Copper
Uyanide
Lead Mercury
st 6 months
2nd 6 months
2nd 6 months
st mont s
2nd 6 months T7mont s
'2nd 6 months
8
8
2
2
8
8
0.287
0.205
0.0025
0.0025
0.005
'0.002
0.152
0.107
0.0025
0.0025
0.005
0.002
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
BDL => Below Detection Limit mg/I => 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
*Reflect monthly and daily limits half of BDL
Chapter: PAR Guidance File name: PAi dfoSAmkkeCCiaibeOCtdia¢ttgLWsiGclWAB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

wer Tech. Pretreatment Annual Report (PAR)
)38 Industrial Data Summary Form (IDSF)
01 Use separate forms for each industry/pipe
Enter BDL values as < (value)
2nd 6 months
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 %) =>
'2nd 6 months
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 %) =>
2nd 6 months
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 ASCO POWER TECHNOLOGIES
IUP # 0038
Pipe # I
INICKel
Selenium
I ver
kine
s mon s
n mon s
s mon s
2nd 0 months s mon s
2nct o months
st 6 Months
8
8
8
8
8
0.164
0.148
0.0025
0.0025
1.274
0.072
0.083
0.0025
'0.0025
0.413
0%
10%
0%
10%
0%
0%
0%
0%
0%
0%
st months
n months
st 6 months 12nd
6 months Ist6months
2nd6months
Ist6months
st 6 months n mont s st 6 months I 2ndmonths I st 6 months 2nd 6 months I st 6 months
BDL => Below Detection Limit mg/1 => 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
t Avg period could be month, Qtr, or 6-month & if BDL, 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment plan
Chapter: PAR Guidance File name: P �odi�Fdha6aide�i�detlta�tgisl�ct&IMB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page i— of Z

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 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 %) _>
Control Authority,
Town Name =>
WWTP Name =>
NPDES # _>
1 st 6 months, dates =>
2nd 6 months, dates =>
Lexington
LRWWTP
NCO055786
1/1 /2018 to 6/30/2018
7 1 to 12/31 /2018
Industry
Name Matcor Metal
IUP # 12
Pipe # 1
ow, mg
mmonla
st 6 months
2nd 6 months TsTrmMrs
2nd 0 months
s mon s
2nd 6 months s mon s
2nd 0 months
Arsenic
a inium
romium
UOD
mont s st mont s
n months
=ontsn
mn
months s
n months
8
7
8
7
0.001
0.001
0.011
0.046
0.001
0.0006
0.007
0.021
0
0
0
0
0
0
0
0
Copper
yani
Lead Mercury
st 6 months
2nd 6 months
I st 6 months
__2nd 6 months'
I st 6 months
2nd 6 months st mont s
2nd 6 months
8
7
2
2
8
7
0.257
0.974
0.00025
0.00025
0.005
0.003
0.178
0.475
0.00025
0.00025
0.005
0.0026
0
0
0
0
0
0
0
0
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 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 I/2BDL or zero values used. TRC => Technical Review Criteria W WTP —> wastewater treatment plant
Chapter: PAR Guidance File name: PABodiofAmkke�Ctaii OBhaotedrWtctMMB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page J— of .L

Pretreatment Annual Report (PAR) Industry Name
Industrial Data Summary Form (IDSF) luP #
Use separate forms for each industry/pipe Pipe #
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 =>
* or Minimum =>
% 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 %) _>
INICKell
Selenium
Sliver
71ne
lst6months n
mon s s mon s
n mon s
s mon s
n mon s
s mon s
n mon s
8
7
8
7
8
7
0.044
0.063
0.008
0.074
0.290
1.017
0.021
0.0357
0.0045
0.0257
0.158
0.500
0
0
0
0
0
0
0
0
0
0
0
0
P
st mont s
n
mont s st mont s
2nd 6 months T77 Monts
2nd 6 months
rs77 mont s
2nd 6 months
N/A
st mont s n mont s st Monts 2nd 6 months st mont s 2nd 6 months I TsTTmont s 2nd 6 months
BDL => Below Detection Limit mg/1 => 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 W WTP => wastewater treatment plant
Chapter: PAR Guidance File name: pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page z of -z—

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
O1/01/18 to 06/30/18
07/01/18 to 12/31/18
Industry
Name Leggett Platt # 1
IUP # 0027
Pipe # 01
Ammonia
s months
n months
s mon s
n mon s
s mon s
n months
s mon s
2nd 0 months
Arsenic
Uadmium
Uhromium
UIUOV
st 6 months
2nd 6 months
I st 6 months
2nd 6 months
I st 6 months
n mont s
st mont s
n mont s
8
8
8
8
0.001
0.001
0.018
0.105
0.001
0.00056
0.0074
0.0193
0%
0%
0%
0%
0%
0%
0%
0%
opper
Uyanide
Lead
IVIercury
st 6 months
'2nd 6 months
Ist6months
2nd6months
I st 6 months
2nd 6 months
st mont s
2nd 6 months
8
8
2
2
8
8
0.209
1
0.0025
0.0025
0.005
0.032
0.1
0.144
0.0025
0.0025
0.0050
0.0059
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
BDL => Below Detection Limit mg/I => 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: PFQaidipEdhekReGdbiedCtdlaotq�LBt sLeIRI 1B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page i of z

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 (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (Ib/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 91
IUP # 0027
Pipe # 01
IN ><c e e enium
Sliver inc
s months n mon s s mon s
n mon s
s mon s n mon s
n months
8 8
8 8
70.2417
8
0.042 0.109
0.0025 0.0025
11.083
0.025 0.028
0.0025 0.0025 0.181
0.278
0% 0%
0% 0% 0%
0%
0% 0%
0% 0% 0%
0%
st 6 months
2nd 6 months
I st 6 months
2nd 6 months
I st 6 months
2nd 6 months
I st 6 months
2nd 6 months
st 6 months
2nd 6 months
I st 6 months
2nd 6 months
I st 6 months
2nd 6 months
I st 6 months
2nd 6 months
BDL => Below Detection Limit mg/I => 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: PKBori�f�¢�Ret�iode¢aQt�#sct�lhlB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page z 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/]8/ to 06/30/18
07/01/18 to 12/31/18
Industry
Name Leggett & Platt # 2
IUP # 0028
Pipe # 01
ow, mg mmonia
Arse n><c
a mium
Uhromium
UOD
st mont s2nd
6 months
I st 6 months
n mont s
I st t, months
n inont s Tst Monts 2nd 6 months
7
8
7
8
0.001
0.0005
0.005
0.025
0.001
0.0005
0.005
0.0077
0%
0%
0%
0%
0%
0%
0%
0%
opper
Uyanide
Lead
Mercury
st mont s
n mont s
st mont s
n mont s
st mont s
n mont s st mont s
2nd 6 months
7
8
2
2
8
8
0.100
0.220
0.0025
0.0025
0.005
0.025
0.056
1 0.079
0.0025
0.0025
0.005
0.0055
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
1 0%
0%
BDL => Below Detection Limit mg/1=> 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: PAOB dVMmkRedieiWOgaha¢tqp�Wtct&f3r3B, 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 (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 Ob/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
><c e
Selenium
Sliver me
s months s n mon s
s months n months
s mon s n months s mon s
n months
7 8
7 8 7
8
0.02 00.034
0.0025 0.007 0.213
0.435
0.008 0.0136
0.0025 0.0033 0.130
0.173
0% 0%
0% 0% 0%
0%
0% 0%
0% 0% 0%
0%
st 6 months
2nd 6 months
st mont s
2nd 6 months st mont s
2nd 6 months
I st 6 months
2nd 6 mont s
st 6 months
2nd 6 months
st mont s
2nd 6 months st mont s
2nd 6 months
st mont s
2nd 6 months
BDL => Below Detection Limit mg/I => 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: *c18A4B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page Z of Z—

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
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 %)
_> o
% violations,(chronic SNC is >= 66%)
_>
% TRC violations, (SNC is >= 33 %)
_> 2
Total # of samples =>
* Maximum =>
* or Minimum =>
% violations, (chronic SNC is >= 66%) _> ,,
% TRC violations, (SNC is >= 33 %) _> o
% 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 %)
_> o
% violations,(chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _> mi
Industry Name Cardinal Container Servises
IUP # 10
Pipe # 1
IN ICKel
Selenium
ve
11 c
st 6 months
s mon s
n s mon
s s mon
n coons
s mon s
n mon
8
70061
8
8
8
8
0.0007
0.0003
0.0023
0.154
0.2114
0.0004
0.0028
0.0002
0.0006
0.0692
0.1332
0
0
N/A
N/A
0
0
0
0
N/A
N/A
0
0
0
0
N/A
N/A
0
0
0
0
N/A
N/A
0
0
P
I
st 6 months
2nd 6 months
st mont s
2nd 6 months
st mont s
2nd 6 months
T77wrmmmomnmtrs
2nd 6 months
N/A
1 jr
I
st 6 months
2nd 6 months
I st 6 months
2nd 6 months I
st mont s
2nd 6 months
rsmM mont s
2nd 6 mont s
2
2
2
2
1.7935
0.6815
467.3069
4.3114
1.4005
0.6397
233.9525
3.2358
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
BDL => Below Detection Limit mg/I => 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
Chapter: PAR Guidance File name: PP(Bodi�E� �e�Creiuolell aatt si�ctl2 B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page � of 2.—

Column Averages => 0.0LEN
Maximum
Generic Data Summary Spreadsheet Cardinal 1
data summary
Page 1 of 14 pages
2/11/2019, 9:25 AM
Revision: August 1999
Generic Data Summary Spreadsheet Cardinal 1
Used in Calculated
<
m L
Calculation Ibs/day
863
863 115.16
810
810 74.31
661
661 77.18
1082
1082
117.31
744
744
49.64
761
761
57.12
411
411
17.14
506
506
12.66
854
854
9599
605.5
605.5
34.14
729.75
65.06
117.31

Generic Data Summary Spreadsheet Cardinal 1
ARSENIC
Column Averages => 0.00988
Maximum 0.016
Generic Data Summary Spreadsheet Cardinal 1
data summary
Page 2 of 14 pages
2/11/2019, 9 25 AM
Revision. August 1999
Used in
Calculated
<
m /L
Calculation
Ibs/day
<
0.002
0.001
0.0001
<
0.002
0.001
0.0001
<
0.002
0.001
0.0001
<
0.002
0.001
0.0001
<
0.002
0.001
0.0001
<
0.002
0.001
0.0001
<
0.002
0.001
0.0000
<
0.002
0.001
0.0000
0.0001
0.0001
o.00 l0 0.0001
0.0001
CHROMIUM
< m /l.
Used in Calculated
Calculation Ibs/day
< 0.01
0.005
0.0007
0.0107
0.0107
0.0010
< 0.01
0.005
0.0006
0.0107
0.0107
0.0012
< 0.01
0.005
0.0003
< 0.01
0.005
0.0001
< 0.01
0.005
0.0002
< 0.01
0.005
0.0001
0.0008
0.0003
0.006.1 0.0006
0.00 12

Column Averages => 0.00988
Maximum 0.016
Generic Data Summary Spreadsheet Cardinal 1
data summary
Page 3 of 14 pages
2/11/2019, 9:25 AM
Revision: August 1999
Generic Data Summary Spreadsheet Cardinal 1
Used in
Calculated
m /l
Calculation
lbs/day
0.0117
0.0117
0.0016
0.0334
0.0334
0.0031
0.0191
0.0191
0.0022
0.0601
0.0601
0.0065
0.01109
0.01109
0.0007
0.03685
0.03685
0.0028
0.01381
0.01381
0.0006
0.01619
0.01619
0.0004
0.0033
0.0011
0.0253
0,0022
0.0065
d in
Calculated
7Calculation
Ibs/day05
0.000705
O 0005
<
0.01
0.005
0.0006
<
0.01
0.005
0.0005
<
0.01
0.005
0.0003
<
0.01
0.005
0.0004
<
0.01
0.005
0.0002
0.01447
0.01447
0.0004
0.0006
0.0003
0.0062
0.0004
0.0007

Column Averages => 0.00988
Maximum 0.016
Generic Data Summary Spreadsheet Cardinal 1
data summary
Page 4 of 14 pages
2/11/2019, 9:25 AM
Revision: August 1999
Generic Data Summary Spreadsheet Cardinal 1
0.00013 0.00001
0.00004
MOLYBDENUM
Used in Calculated
Used in Calculated
<
m /L
Calculation lbs/day
<
m
Calculation ]bs/day
<
0.01
0.005 0.0007
<
0.01
0.005 0.0005
<1
0.01 1
0.005 0.0006
<
0.01
0.005 0.0005
<
0.01
0.005 0.0003
<
0.01
0.005 0.0004
<
0.01
0.005 0.0002
<
0.01
0.005 0.0001
0.0006
0.0003
0.0050 0.0004
0.0007

Column Averages => 0.00988
Maximum 0.016
Generic Data Summary Spreadsheet Cardinal 1
data summary
Page 5 of 14 pages
2/11/2019, 9:25 AM
Revision: August 1999
Generic Data Summary Spreadsheet Cardinal 1
0.0025 0.0002
0.0003
0.8354 0.0692
0.1540

Generic Data Summary Spreadsheet Cardinal 1
Sample Location:
Cardinal Container Services
•
MGD
<
•
m /L
Used in Calculated
Calculation lbs/day
Sample Date
3/5-6/2018
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells.
Rest of
worksheet is
protected,
password is
2
2) For below
detection data,
enter "<" in "<"
column, and enter enter detection
level in Influent
or Effluent
mg/I columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 112
value entered.
0.016
3/6-7/2018
0.011
3/7-8/2018
0.014
3/8-9/2018
0.013
4/9-10/2018
0.008
4/ 10-1 1 /2018
0.009
4/11-12/2018
0.005
4/12-13/2018
0.003
1 st month Avg
0.0135
2nd month Avg
Column Averages =>
Maximum
0.00988
0.016
Generic Data Summary Spreadsheet Cardinal 1
data summary
Page 6 of 14 pages
2/11/2019, 9 25 AM
Revision: August 1999

Column Averages => 0.00988
Maximum 0.016
Generic Data Summary Spreadsheet Cardinal 1
data summary
Page 7 of 14 pages
2/11/2019, 9:25 AM
Revision: August 1999
Generic Data Summary Spreadsheet Cardinal 1
Sodium
®�
®
®
TN
Used in Calculated
ay

Sample Location:
Cardinal Container Services
7MG
Sample Date
10/1-2/2018
SpreadsheetInstructions:
1) Data
entered only in
Heavy
Bordered cells.
Rest of
worksheet is
protected,
password is
2
2) For below
detection data,
enter "<' in '<'
column, and
enter detection
level in Influent
or Effluent
mg/I columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 112
value entered.
10/2-3/2018
.
10/3-4/2018
0.015
10/4-5/2018
0.023
12/3-4/2018
0.008
12/4-5/2018
0.014
12/5-6/2018
0.020
12/6-7/2018
0.015
1 st Month Avg
0.01975
2nd Month Avg
Column Averages =>
0.01700
Maximum
0.023
Generic Data Summary Spreadsheet
data summary
Page 1 of 7 pages
2/11/2019, 9:25 AM
Revision: August 1999
Generic Data Summary Spreadsheet
Used in
Calculated
<
m /L
Calculation
lbs/day
>
1454
1454
218.27
>
1566
1566
300.39
>
1508
1508
188.65
>
1292
1292
247.83
3110
3110 1
207.50
2761
2761
322.37
759
759
126.60
949
949
118.72
238.79
193.80
216.29
322.37

Sample Location:111LOTAW
Cardinal Container Services
MGD
Sample Date
10/1-2/2018
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells.
Rest of
worksheet is
protected,
password is
2
2) For below
detection data,
"<" in '<.
column, and
enter detection
level in Influent
or Effluent
mg/I columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 112
value entered.
0.018
10/2-3/2018
0.023
10/3-4/2018
0.015
10/4-5/2018
0.023
12/3-4/2018
0.008
12/4-5/2018
0.014
12/5-6/2018
0.020
12/6-7/2018
0.015
1 st Month Avgenter
0.01975
2nd Month AV
Column Ave ra es =>
0.01700
Maximum
0.023
Generic Data Summary Spreadsheet
data summary
Page 2 of 7 pages
2/11/2019, 9:25 AM
Revision: August 1999
Generic Data Summary Spreadsheet
CADMIUM
Used in
Calculated
<
m /L
'alculation
Ibs/day
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
0.0001
0.0001
0.0001
0.0001
CHROMIUM
Used in
Calculated
<
m L
Calculation
Ibs/dav
0.005
0.005
0.0008
0.01
0.01
0.0019
0.007
0.007
0.0009
0.009
0.009
0.0017
0.021
0.021
0.0014
0.011
0.011
0.0013
<
0.005
0.0025
0.0004
<
0.005
0.0025
0.0003
0.0013
0.0009
0.001 1
0.0019

Sample Location:
Cardinal Container Services
7MGD
Sam le Date
10/1-2/2018
SpreadsheInstructions10/2-3/2018 1) Data.
entered only in
Heavy
Bordered cells.
Rest of
worksheet is
protected,
password is
„2.,
2) For below
detection data,
enter "<" in "<"
column, and
enter detection
level in Influent
or Effluent
mg/I columns,
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 1/2
value entered.
10/3-4/2018
0.015
10/4-5/2018
0.023
12/3-4/2018
0.008
12/4-5/2018
0.014
12/5-6/2018
0.020
12/6-7/2018
0.015
1 st Month Avg
0.01975
2nd Month Avg-
0.01425
Column Averages =>
0.01700
Maximum
0.023
Generic Data Summary Spreadsheet
data summary
Page 3 of 7 pages
2/11/2019, 9:25 AM
Revision: August 1999
Generic Data Summary Spreadsheet
Used in Calculated
<
m /L
Calculation Ibs/day
0.019
0.019 0.0029
0.028
0.028
0.0054
0.022
0.022
0.0028
0.032
0.032
0.0061
0.026
0.026
0.0017
0.016
0.016
0.0019
0.013
0.013
0.0022
0.011
0.011
0.0014
0.0043
0.0018
0.0030
0.0061
Used in
Calculated
<
m /L
Calculation
Ibs/day
<
0.002
0.001
0.0002
<
0.002
0.001
0.0002
<
0.002
0.001
0.0001
0.003
0.003
0.0006
0.095
0.095 1
0.0063
0.047
0.047
0.0055
0.014
0.014
0.0023
0.014
0.014
0.0018
0.0003
0.0040
0.0021
0.0063

Sample Location:
•
Cardinal Container Services
MGD
Sample Date
10/1-2/2018
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells.
Rest of
worksheet is
protected,
password is
2.,
2) For below
detection data,
enter '< in <"
column, and
enter detection
level in Influent
or Effluent
mg/I columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 1/2
value entered.
10/2-3/2018
0.023
10/3-4/2018
0.015
10/4-5/2018
0.023
12/3-4/2018
0.008
12/4-5/2018
0.014
12/5-6/2018
0.020
12/6-7/2018
0.015
1 st Month Avg
0.01975
2nd Month Avg
1�
Column Averages =>
0.01700
Maximum
0.023
Generic Data Summary Spreadsheet
data summary
Page 4 of 7 pages
2/11/2019, 9:25 AM
Revision: August 1999
Generic Data Summary Spreadsheet
Used in
Calculated
Calculation
lb/day
<
0.0002
0.0001
0.00002
F<-r
0.0002 1
0.0001
0.00002
<
0.0002
0.0001
0.00001
<
0.0002
0.0001
0.00002
<
0.0002
0.0001
0.00001
<
0.0002
0.0001
0.00001
<
0.0002
0.0001
0.00002
<
0.0002
0.0001
0.00001
0.00002
0.00001
0.00001
0.00002
MOLYBDENUM
lm�Used in Calculated
01
Used in
Calculated
< m /L
Calculation
lbs/day
< 0.01
0.005
0.0008
< 0.01
0.005
0.0010
0.012
0.012
0.0015
< 0.01
0.005
0.0010
0.08
0.08
0.0053
0.052
0.052
0.0061
0.019
0.019
0.0032
0.028
0.028
0.0035
0.0010
0.0045
0.0028
0.0061

Sample Location:
• Ty
Cardinal Container Services
MGD
Sample Date
10/1-2/2018
Spreadsheet
Instructions:
1) Data
0.018
10/2-3/2018
0.023
10/3-4/2018
entered only in
Heavy
Bordered cells.
Rest of
worksheet is
protected,
password is
„2.,
2) For below
detection data,
enter ^<" in ^<"
column, and
enter detection
level in Influent
or Effluent
mg/I columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 1/2
value entered.
0.015
10/4-5/2018
0.023
12/3-4/2018
0.008
12/4-5/2018
0.014
12/5-6/2018
0.020
12/6-7/2018
1st Month Avg
0.015
0.01975
2nd Month Avg
Column Avera es =>
0.01700
Maximum
0.023
Generic Data Summary Spreadsheet
data summary
Page 5 of 7 pages
2/11/2019, 9:25 AM
Revision: August 1999
IRW
Generic Data Summary Spreadsheet
e�
■---
SELENIUM
-__
---
,
..:
SILVER
1 111�
1 111
1 111�
1 11 1 •
1 11
���
�
�
�1
1 •1:
ZINC
l
®
1:
..,
ay
11•
1®
1 1
e
Q
Q
Q
1 11
1 11
1 11
®
®
�
--
-�

Generic Data Summary Spreadsheet
Sample Location:
Cardinal Container Services
•
MGD
<
•
m /L
Used in Calculated
Calculation Ibs/day
Sample Date
10/1-2/2018
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells.
Rest of
worksheet is
protected,
password is
2.,
2) For below
detection data,
enter '<" in "• "
column, and
detection
level in Influent
or Effluent
mg/I columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 1/2
value entered.
0.018
10/2-3/2018
0.023
10/3-4/2018
0.015
10/4-5/2018
0.023
12/3-4/2018
0.008
12/4-5/2018
0.014
12/5-6/2018
0.020
0.015
12/6-7/2018
1 st Month Avg
0.01975
2nd Month Avgenter
�.01425
Column Avera es =>
0.01700
Maximum
0.023
Generic Data Summary Spreadsheet
data summary
Page 6 of 7 pages
2/11/2019, 9:25 AM
Revision: August 1999
Chlorides
Total
Phosphorus

Sample Location
0 KOTAW
Cardinal Container Services
MGD
Sample Date
10/ 1-2/2018
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells.
Rest of
worksheet is
protected,
password is
2.,
2) For below
detection data,
enter '< in ' <
column and
enter detection
level in Influent
or Effluent
mg/I columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 1/2
value entered.
0.018
10/2-3/2018
0.023
10/3-4/2018
0.015
10/4-5/2018
0.023
12/3-4/2018
0.008
12/4-5/2018
0.014
12/5-6/2018
0.020
12/6-7/2018
0.015
1 st Month Avg
0.01975
2nd Month Avg
Column Averages =>
0.01700
Maximum
0.023
Generic Data Summary Spreadsheet
data summary
Page 7 of 7 pages
2/11/2019, 9:25 AM
Revision: August 1999
Generic Data Summary Spreadsheet
Conductivity
®�Used in Calculated
Used in
Calculated
m /L
Calculation
lbs/day
14.39
14.39
2.1602
64.62
64.62
4.3114
2.1602
4.3114
3.2358
4.3114

ASCO POWER TECHNOLOGIES
I U P #0038

ASCOTeochnologies
June 26, 2018
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.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
429366289859

ASCOTechnologies�
December 4, 2018
Mrs. Eglantina Minerali
Pretreatment Coordinator
Water Resources Department
500 Glendale Road
Lexington, NC 27292
RE: TTO Statement
Dear Mrs. Minerali,
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.
further certify that this facility is implementing the toxic organic management plans submitted to the Control
Authority."
Regards,
ASCO Power Technologies
7�
Daniel Clark
Environmental Health and Safety Manager
FedEx Tracking 4293 66331591

LEGGETT & PLATT #1
I U P #0027

® ;.FC3RP^3r1� 5E
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:
Signature Date
Lerc-l-L �C'urd 5 r-44' �(r� sir Wa vla c'
Printed Name and Title
P.O. BOX 140 • LINWOOD, NORTH CAROLINA 27299.336/956-5000

F
ell I
;YCOAFOSA7ZD
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:
Signature Date
Printed Name and Title
P.O. BOX 140 • LINWOOD, NORTH CAROLINA 27299.336/956-5000

LEGGETT & PLATT #2
I U P #0028

i
i
:\C®RPORiTED
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:
ignature
,t t`
U�Y'C-TT F—LC141C',,r� ✓D��G�`N1 � rU�rV fY�GnY�A�.✓'
Printed Name and Title
6c '-)F
Date
P.O. BOX 140 • LINWOOD, NORTH CAROLINA 27299.336/956-5000

1
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
Printed Name and Title
1AUS&
Da e
P.O. BOX 140 • LINWOOD, NORTH CAROLINA 27299.336/956-5000

MATCOR METAL FABRICATIONS
I U P #0012

ph -
January 2, 2018
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 Na e: Joe Edwards
Title: EHS Coordinator
Date Signed: January 02, 2018

835 Salem Road
Post Office Box 729
Welcome, NC 27374
Phone: [phone]
September 17, 2018
City of Lexington
Ms. Eglantina Minerali
28 W. Center Street
Lexington, NC 27292
"I certify tinder 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 systern 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 17, 2018

Al K=
METAL FABRICATION
December 4, 2018
City of Lexington
Ms. Eglantina Minerali
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: December 4, 2018

IIIa Oki :T_TOFll
I U P #0045

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:
Signature
f/
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
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:
Signature %
-1� rs„
Printed Name & Title
Date

HAZ-MAT '02241
MA
"� Wnifost No.
AfALZ*sT
PO No
MMMENM
NON -HAZARDOUS SPECIAL WAS" E
GrNETIATOR LOCA11ON
Tier Rack Company
'reet Tier -Rack Company
425 Sovereign Ct.
Lexin too 27292 Ballwin 63011
336-248-4992
Jack
Non -Hazardous waste woter-&,sludge
j- 4 vT
Er
E L E-
UON
r_ CAW AFr
HAZ-MAT T f I A N""� 0 rj R T F
7Tljll.­R0N%Vl—' Z
IV. i I F 1\1 ORM "f'ji V f�j' I
ORIG:NAL _lN­. .iL. 41f, ',S- TS j. .`)LD

HAZ-MAT Manifest No.
ENVIRONMENTAL SERVICES
AwwmAr P.O. BOX 37392 - CHARLOTTE, N.C. 28237 P.O. No.---.
[phone]
FAX [phone] Job Na
NON -HAZARDOUS SPECIAL WASTE
1 Section 1. G EN ERATO u
GENERATOR LOCATION WORK CONTRACTED BY
Bill To (It different from infornna€on at left)
NAME
ORIGINATING ADDRESS
MAILING ADDRESS
rITY
STATE — __ _ ZIP
NAME . ----- ---
ADDRESS--
CITY
STATE — ZIP
PHONE NO. — —_ --- 1;, 1 - PHONE NO
CONTACT NAME CONTACT NAME
DES, OF WASTE
No 'Type Units Quantity
I Section 11. INVOICE INFORMAI-ION GALLONS DRUMS
QUANTITY
LINE TOTAL
1 PETROLEUM CONTACT WATER
2. OFF -SPEC LIGHT OIL, DIESEL OR GAS
3, NOWHAZARDOUS LIQUIDS
4. SEDIMENT OR SOLIDS
5. 55-GALLON DRUM REMOVED - SOLID OR EMPTY
6. 55-GALLON DRUM REMOVED - LIQUID
1.
10. ARRIVALTIME DEPARTURE TIME -
GENERATOR'S CERTIFICATION I hereby certify that the above named material is not a hazardous waste as defined by 40 GFR Part 261 or any applicable state law, has beer, properly
described, classified and packaged, and is in proper condition for transportation according to applicable regulations. Geru,,ratorlCustomer shall reimburse HAZ-MAT its reasonable expenses
and charges for handling, analyzing, loading, preparing, transporting, staring or caring for nonconforming or off spec waste including costs of decontamination and cleaning of equipment
Generator must notify HAZ-MAT of any changes to the waste stream prior to shipment
Generatorl'Authonzed Agent Name Signature
_VC[loti 111. TRANSPORTER
HAZ- MAT TRANSPORTER II
e Name
ENVIRONMENTAL SERVICES
P.O. BOX 37392 - CHARLOTTE, N.C. 28237 f. Address
a Driver NamelTitle
b Phone No --- c. Truck No
Hazardous Waste Transporter Permits
EPA NCDO48461370
d .-
g. Driver Name; Title
h. Phone No
I. Transporter 11 Permit Nos
t Truck No
0,wei S-qawre Dale smwtv, r r zn, 62tt
Section IN'. FACILITY INFORNLATION AND CERTIFICATE OF DISPOSAL
Site Name _H ji z -_N a Phone No. 704-332-5600
._ &LEnvimrirrlental a-rvi(e§
Physical Address:Dalton Av_gnu b Mailing Address P.O Box 37392
Charlotte, N.0 28206 Charlotte, N.C, 2823
Discrepancy Indication Space
--
is is jDosr* JIM al non4vadous malarial removedirarriabove loom has bean recaNsdand iii1be dspased of ri a=dm w& applicabie om A* and Javal moations in the Jobliling manner (1) PeIrieurn, MMM
are bWxW rM a beneficial reusable hid for use in lays indluskiel burrIsrs. (2) Waft a6m are ID be Issled wit polymers. 04 a*sW and a toaAWL rior, floArs, rmign a Jsovod aF flotmon symm for pleves"ent 9vaiation,
then Into ft CMUD sandaticin sewer system undo{ perrnit ILIP#5012. (3) Sludges from Nurtmerill systems are hauled to E R A approved facditles for prow disposal Manifest and certificate of disposal are on file
(4) Our lrviatrnent system operates on a first in, first out bin si plpdud should be piccessed w*0 seven days
SIGNATURE OF FACUTYAGENT DATE NEAR- I MONTH DAY I
FINAL TS D - YELLOW - DISPOSER - PINK - 1ST T.S.D. - G

HAZ- MAT
ENVIRONMENTAL SERVICES
P.O. BOX 37392 - CHARLOTTE, N.C. 28237
[phone]
FAX [phone]
NON -HAZARDOUS SPECIAL WASTE
Manifest No. __-__ _ _ _._
P.O. No.
Job No....._------_r,__a.__.
Section I. � GE �11Ii 14J [l tl enrr rc i,irvataf. t. a�. t ,,rrc=rr
GENERATOR LOCATION WORK CONTRACTED BY
NAME
Bill To (if different from information at left)
__.____.— ..�:w
ORIGINATING ADDRESS NAME
MAILING ADDRESS _ ADORES$
CITY STATE_______,.____.Zip
PHONE NO,
CITY
PHONE NO.
STATE _ ZIP
CONTACTNAME _ ; w ), CONTACT NAME
DES, OF WASTE: 71 m
No Type Units Quantity
Sec-60n It. IN 'OIC'E INFORMATION GALLONS t)RUMS
1 PETROLEUM CONTACT WATER
_ —
QUANTITY
L�rAL
2 OFF -SPEC LIGHT OIL, DIESEL OR GAS
3. NON -HAZARDOUS LIQUIDS —
4. SEDIMENT OR SOLIDS
5. 55-GALLON DRUM REMOVED - SOLID OR EMPTY-
6.55-GALLONDRUM REMOVED -LIQUID
7.
10. ARRIVAL TIME: DEPARTURE TIME: '..
GENERATOR'S CERTIFICATIONS I hereby certify that the above named material is not a hazardous waste as defined by 40 CFR Part 261 or any applicable state law. has been property
described, classified and packaged, and is in proper condition for transportation according to applicable regulations. Generator/Customer shall reimburse HAZ•MAT its reasonable expenses
and charges for handling, analyzing, loading, preparing, transporting, storing or caring for nonconforming or off spec waste. including costs of decontamination and cleaning of equipment.
Generator must notify HAZ-MAT of any changes to the waste stream prior to shipment,
Generator Authorized Agent Name Signature sn*e,u oat
.-.—. T4a«u rr ii tra.r wkway .
HAZ^-MAT TRANSPORTER I!
ENVIRONMENTAL SERVICES e. Name
P.O. BOX 37392 -CHARLOTTE, N.C. 28237 f. Address
a. Driver Name+Title_ -- —
b. Phone No..- -_.—
Hazardous Waste Transporter Permits
EPA NCD048461370
g Driver Name; Title
c Truck No
h Phone No
1. Transporter 11 Permit Nos.
Section IV. FACILITY INFORMATION AND ('ERTIFIC.gTE OF I7I5I'C7SAL
i. Truck No.
Site NameHaz-Mat Envirur muntai Sr ryi a, Phone No 704-332-5600
Physical Address. 210 Dalton Aonwe b. Mailing Address, P.O. Box 37 a
Qhartot,_ te, N.C. 28E0o Charlotte. N.0 28237
crepancy Indication Space-_.-_
regulars in Ole tulutAtfg
to d ty that r k rn remnvad from atlas kxaC x; has been ran d and vWl beds{»ad ctt n aomrtiartt� rtYt appiaable iocri slats and tedaral (1) P�nlam productr
are t �txtetl nm a t artebt ramie Nei G7/ use in idge axh sfnel bunters. (2) Via* was are to be tram me pahmtets, pH tt*sjem and a florxulart pteri Aorws Nttough a dssd�ed air AoleYort sy9ern for
prt�etrent saparallon,
then into ilia GMUO sanitation sewer system under permit fUP#5092. (3) Sludges from treatment systems are named to E.PA- approved facilities for proper disposal. Manifest and certificate of disposal are on file.
(4) Our trealirmt system operates on a first In, first out basis and product should be processed within seven days,
o.� t vice yr rlMOU l T At lLN i ! DATE
( —
_-- i MONTH DAY YEAR

INSPECTIONS

SIU INSPECTION FORM
Name Of Industry: Uv C� IUP # DO 3 f
Address Of Industry: IUP Expiration Date:
ustry Re esentatives: Title
n Sr l r / i fie,
POTW Representatives: Title
n e,,rotl ,
Date Of Inspection: Time Of Inspection: ln! yo /pm
Purpose of Inspection: Annual er (Describe) �,p
s t' NPDES # /� G
POTW to which IU dischargeO� $S -�f'a
Is SIU currently in SNC? 14_ If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES /
Raw materials used YES
Manufacturing processes YES
Categorical, if applicable Y NO
Production rate NO
41
Number of employees NO
Number of shifts YES / PIO
Comments:
I_ -
I
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?
2. Are production areas diked, nNO
ed, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? Comments:
3. Are there floor drains in the storage area? / NO Where do they go?
4. Are storage tanks and areas diked, contanEo
otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? Comments:
5. Are process and storage tanks and pipes labeled? NO 6. How are off -spec raw materials, and products disposed of? (10-01
7. When is the production area cleaned? '
8. Is the wastewater from cleaning the productioi area discharged to the POT ? YES /
9. What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 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? IQ/ NO Comments:
2.
3.
4.
s.
Are all units operational? ES / NO
How often does operator/mat ance person Oftk system?
Is there an operator for each shift? YES
How and when is sludge disposed of?
6. Is there a schedule for preventative maintenance?
Comments:
aS
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? G�;)/ NO 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? YE / NO Comments:
4. Is there a calibration log for the flow meter?
Comments:
NO Comments:
PART III - EXIT INTERVIEW
Review monitoring records anjdpthqr 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? YE / NO Comments:
4. Who has auth rity to shut down C� prod ction should a spt1 or slug isc ge occur?TT��� tt�l�fr�t g�i`�_Ca r� �Ca✓
5 i-inw iin Cii T F t 1 �
at ru i w in case of spill/slug?
If slug/spill plan is already required by POT?W, review procedures.
6. Is SIU implementing slug/spill plan? E / NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? OFActions:
NO
Comments, Required Or Recomme
Signature
Title: SIU InpsWtion Form
File name: COMRINSP App 7-D
Revision data: August 1, 1994
Date:
0
I'age 2

SIU INSPECTION FORM
Name Of Industry: Lft42�F L- 'r LQ.A L _1 l
Address Of Industry:
In
(p -c ; hl
IuP # oc.) a -4-
lUP Expiration Date:
Industry Representatives: �t-+000ZK4 Title
POTW Representatives: — n,� Y1Q 14 Title r a
C�oti.o��n,.a
ate Of Inspection: 8 Time Of Inspection: !O'-t0 m
Purpose of Inspection: Annual Othero (Describe)
POTW to which lU discharges _L�.1IJ 1ni 1 1 NPDES # G
Is SIU currently in SNC? X-0 If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES /
Raw materials used YES AW'
Manufacturing processes YES /(50-
Categorical, if applicable YES / NO
Production rate YE�,/ NO
Number of employees C I / NO —�
Number of shifts (�2�ES d NO
Comments: Ll J
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? 091
NO Where do they go?
2. Are production areas diked, �Vn orotherwise constructed in such away as to prevent harm to the WWTP,
especially from spills or slugs?NO Comments: _
3. Are there floor drains in the storage area? YE� NO Where do they go?
4. Are storage tanks and areas diked, cont ' d, or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? / NO Comments:
5. Are process and storage tanks and pipes labeled? U18 / NO %/�
6. How are off -spec raw materials, and products disposed of? _ o�J L .X.L�_. C O ht.. S'f .G(_ CC.
7. When is the production area cleaned? cllc .
8. Is the wastewater from cleaning the production area Nscharged to the POTW? YES / Q',
9. What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU Inpsection Form
Pile name: COMP.INSP App 7-D
Revision data: August 1, 1994 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? YE / NO Comments:
2.
3.
4.
Are all units operational? QtS NO
How often does operator/maintenance check system?
Is there an operator for each shift? ES / O
5. How and when is sludge disposed or _
6. Is there a schedule for preventative maintenance? ES O
Comments:
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
I. Does an outside lab complete sampling? YES / 10If yes, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
Al 1 4
Is flow measurement equipment operational?
NO Comments:
4. Is there a calibration log for the flow meter? rYWNO Comments:
Comments:
PART III - EXIT INTERVIEW
Review monitoring records and SIU records required by IUP.
1. Are files well organized? ES O 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 d wn duction shoulda spill or slug discharge occur? n C164
4
5. How does SIU inform employees of whom to call at POTW in case of spill/slug? k
If slug/spill plan is already required by POT,,eview procedures.
6. Is SIU implementing slug/spill p1�NES NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? , YE / NO
Comments, Required Or Recomme ed Actions
Signature Of Inspector(s)
Title: SIU Inpsection Form
File name: COMP.INSP App 7-13
Revision data: August I, 1994
Page 2

SIU INSPECTION FORM
Name Of Industry: 1944� Q $ 2-
Address Of Industry:
! ro
Industry Representatives: Q Title ,�----Ij
—Y
- S
POTW Repre entatives: Title
• QL, 1(� S.Q_
Date Of Inspection: Time Of Inspection: 11, ns rt pm
Purpose of Inspection: Annual �z Other (Describe)
POTW to which IU discharges L i-yJ WV NPDES # Ae C 0,*SC
Is SIU currently in SNC? —N e) If yes, for what?
IUP # 00 2—if
IUP Expiration Date:
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES
Raw materials used YES
Manufacturing processes YES /
Categorical, if applicable YES
Production rate YES
Number of employees eo")
S 0Number of shifts YES
Comments:
C _. L(, -�p `f' 1T
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? YES NO Where do they go?
�
2. Are production areas diked, co i d, or otherwise constructed in such a way as to prevent harm to the W WTP,
especially from spills or slugs? YES / NO Comments:
3. Are there floor drains in the storage area?
NO Where do they go?
4. Are storage tanks and areas diked, contai or otherwise constructed in such a way as to prevent harm to the
W WTP, especially from spills or slugs? Y NO Comments:
S. Are process and storage tanks and pipes labeled?
6. How are off -spec raw materials, and products dis
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production are isch
9. What non -process wastewaters are di h d t POTW0
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
to the POTW? YES
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? C 0/ NO Comments:
4�
2. Are all units operational? ENO
3. How often does operator/maintenance check system?
4. Is there an operator for each shift? NO
5. How and when is sludge disposed of?
6. Is there a schedule for preventative maintenance?
Comments:
& S WI
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 K CO 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? ('YE, / NO Comments:
4. Is there a calibration log for the flow meter? E / NO Comments:
Comments:
'9_1L- l / q( l
PART III - EXIT INTERVIEW
Review monitoring records and other SIU records required by IUP.
1. Are files well organized? / NO Comments:
2. Are sample collection / ch i -of-custody forms filled out properly? YES / NO Comments:
3. Do results in files agree with reports sent to POTW? YES / NO
4. Who has authority to shut down production should a spill or slug discharge occur?
Qf j N S- \
How does SIU inform employees of whom to call at POTW in case of s M/0, 9
- p g.
If slug/spill plan is already required by P review procedures. o
6. Is SIU implementing slug/spill plani� / NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? ES�NO
Comments, Required Or Recommen ed Actions:
Signature Of Inspector(s)
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D <
Revision data: August 1, 1994 page 2

SIU INSPECTION FORM
Name Of Industry: eA.QL IUP # 001 2--
Address Of Industry: IUP Ex iratio Date:
35 ad 5 3��[�
y_1 a �cOnn.2� f l c 4L 3
Industry Representatives: Joe, W g Title C 14 S iK�
POTW Re resentatives: Title _Pr.,z
Date Of Inspection: Time Of Inspection: t o ! 00 (9/pm
Purpose of Inspection: Annual Other Describe)
POTW to which IU discharges L 1tiI W NPDES # N G flQ SS 71 J5
Is SIU currently in SNC? I1— If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product
YES /
Raw materials used
YES
Manufacturing processes
YES /
Categorical, if applicable
YES
Production rate
YES
Number of employees / NO
Number of shifts YES tKO
Comments: 3 S7 3 ;
/ = p
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? YES /(NO) Where do they go?
2. Are production areas diked, conl�t�ay'S��d, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? (YES � NO Comments:
3. Are there floor drains in the storage area? YES(" O Where do they go?
4. Are storage tanks and areas diked, cont' ,or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? YES)/ NO Comments:
5. Are process and storage tanks and pipes labeled?
6. How are off -spec raw materials, and products dis
7. When is the production area cleaned? Z)0.
8. Is the wastewater from cleaning the production area digelkarged to the POTW? YES NO
9. What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU Inpsection Form
Filename: COMP.INSP App 7-D
Revision data: August I, 1994 Page 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? YE NO Comments:
2. Are all units operational? - E / NO
3. How often does operator/main enance pqMn check system?
4. is there an operator for each shift? rE�NO
5. How and when is sludge disposed of? ` r,�
6. Is there a schedule for preventative maintenance? S NO
Comments:
L'ur e—Q--kll
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 (0 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? / NO Comments:
4. Is there a calibration log for the flow meter? ES / NO Comments:
Comments:
PART III - EXIT INTERVIEW
Review monitoring records and er SIU records required by IUP.
1. Are files well organized YE / NO Comments:
2. Are sample collection / cham-of-custody forms filled out Pronei
3. Do results in files agree with reports sent to POTW? YES /
YES / NO Comments:
Comments:
4. Who has authority to shut down production should a spill or slug discharge occur? c� r
How does SIU inform employees of
to call at POTW in case of spill/slug?
If slug/spill plan is already required by POI�iew procedures.
6. Is SIU implementing slug/spill pla , YES / O Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? PeActions:
0Comments, Required Or Recommen
Signature Of Inspector(s)
Title: SIU Inpsection Form
rile name: COMRINSP App 7-D
Revision data- August 1, 1994
Date:
Page 2

SIU INSPECTION FORM
Name Of Industry: Cc>,� hex—
IUP # oO l LO
Address Of Industry:
IUP Expiration Da e:
NL
Industry Representatives:
Titl
�o.c�PA,�_C o�-�- /Y�o n --
Title
�u
POTW Representatives:
n,Q_
10 ; 00 (!P/pm
Date Of Inspection: 02 e2•D1
Time Of Inspection:
Purpose of Inspection: Annual
POTW to which IU discharges
t/ Other (Describe)
W ta/ -1 P
G ©O 55
NPDES #
Is SIU currently in SNC?
If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or ]UP application in the following:
COMMENTS
Product
YES
Raw materials used
YES /
Manufacturing processes
YES /
Categorical, if applicable
YES / NO
Production rate
(TJO/ 1yS�
Number of employees
Number of shifts
ES
YES /
Comments: 9
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? ES / NO Where do they go? V
2. Are production areas diked, co d, or otherwise constructed in such a way as to prevent harm to the W WTP,
especially from spills or slugs? ES NO Comments:
3. Are there floor drains in the storage area? ES / NO Where do they go?'`�
4. Are storage tanks and areas diked, contai , or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? / NO Comments:
5. Are process and storage tanks and pipes labeled? Y / NO
6. How are off -spec raw materials, and products disposed of?
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production area"discharged to the POTW? YES/6O
9. What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU Inpsection Form
Filename: COMP.INSP App 7-D
Revision data: August I, 1994 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? YES NO Comments:
2. Are all units operational? YE NO
3. How often does operator/maintenance person ghee c system? ✓
4. Is there an operator for each shift? YES
5. How and when is sludge disposed of?
6. is there a schedule for preventative maintenance? E / NO
Comments: % p�
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 KO If yes, name of lab.
2. If industry completes sampling, ask the industry representativq tdescribe sampling procedures. Comments:
3. Is flow measurement equipment operational? E NO Comments:
4. Is there a calibration log for the flow meter? ES / NO Comments:
Comments: C ' - a � mot" 'L'�r� 11 11 )--O ( 9
PART III - EXIT INTERVIEW
Review monitoring records ander SIU records required by IUP.
1. Are files well organized? YE / 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:
Af 1 A-
4. Who has authority sl)tt down production should a spill or slug discharge occur?
5. How does SIU
employees of
to ''all at POTW ifs case of spill/slug?
If slug/spill plan is already required by POD",eview procedures.
6. is SIU implementing slug/spill plan? ES / NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? YE NO
Comments, Required Or Recommen ed Actions:
h41
Signature Of Inspector(s) I—
/2 av
Title: SIU Inpsection Form / z Zd //!;�F
File name: COMP.INSP App 7-D
Revision data: August I, 1994
Date:
Page 2

SIU INSPECTION FORM
Name Of Industry: I e_(- � IUP # O'D' 15
Address Of Industry: ]UP Ex irati n Date:
e- EA,r . � t q
G
Industry Representatives: Title
Cj
POTW Representative � Title�� vi �-
Date Of Inspection: Time Of Inspection: In ' DO Cfn?pm
Purpose of Inspection: Annual t_ Other (Describe)
POTW to which IU discharges R WWig' NPDES # C 190 _S
Is SIU currently in SNC? IVif yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES / O
Raw materials used YES /
Manufacturing processes YES
Categorical, if applicable YE / NO
Production rate NO
Number of employees / NO
Number of shifts YES(ON
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? (9/ NO Where do they go?
2. Are production areas diked, co ' d, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? E / NO Comments:
3. Are there floor drains in the storage area? ES / NO Where do they go?
4. Are storage tanks and areas diked, contai or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? (fE / NO Comments:
5. Are process and storage tanks and pipes labeled? - YF / NO
6. How are off -spec raw materials, and products disposed of? _
7. When is the production area cleaned? U3 h-e_9 I
8. Is the wastewater from cleaning the production area discharged to the POTW? YES /
9. What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU lnpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 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? YES NO Comments:
11
2. Are all units operational? �ES3. How often does operator/mat
4. Is there an operator for each shift?
5. How and when is sludge disposed
Rue
I check system?
NO
6. Is there a schedule for preventative maintenance? YES /
Comments:
44QJ4
cin -, - M aA- v&-Cu,
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 / 3o If yes, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
A
3. Is flow measurement equipment operation? YES / NO Comments:
4. Is there a calibration log for the flow meter? YES / NO /NComments:�
T• ,
Comments:
PART III - EXIT INTERVIEW
Review monitoring records and r SIU records required by IUP.
1. Are files well organized?Co / NO Comments:
2. Are sample collection / chain -of -custody forms filled out proly? YES / NO Comments:
pe
3. Do results in files agree with reports sent to POTW? YES / NO Comments
4. Who has authority to shu down roduction should a spill or slug discharge occur? Q
�7n&7- , 1"— „ta^" 5n . -7„�, , I - -- I - --
5. How
employees of whofrlto call at POTW in case
If slug/spill plan is already required by POTW review procedures.
6. Is SIU implementing slug/spill plan?� NO Comments:
Comments:
INSPECTION RESULTS �
Slug/Spill Control Plan Needed? 0 NO
Comments, Required Or Recommended Actions:
Signature Of Inspector(s)
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
ug?
Date:
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