CITY OF CAYCE
NON-DOMESTIC WASTE SURVEY
QUESTIONNAIRE
City of Cayce
1800 Twelfth Street
P. O. Box 2004
Cayce-West Columbia, South Carolina 29171
(803) 796-9020
NON-DOMESTIC WASTEWATER CONTRIBUTION PERMIT
APPLICATION
CITY OF CAYCE, SOUTH CAROINA
The undersigned being the ________________________________________
(Owner, Leasee, Tenant, Etc.)
of property located at ________________________________________
________________________________________
does hereby request a Wastewater Discharge Permit. The Permittee is
engaged in __________________________________________ business at the
said location.
The exact Name of the Permittee (Industry) that should appear on the
Wastewater Discharge Permit is:____________________________________
The mailing address is: ________________________________________
________________________________________
The following documents area required prior to issuing a Wastewater
Discharge Permit:
1.
A plan to the property showing accurately all sewers and
drains.
2.
Plan and specifications covering the work proposed to be
performed under this permit.
3.
A complete schedule of all process waters and industrial
wastes produced or expected to be produced at said
property, including a description of the character of
each waste, the daily volume and maximum rates of
discharge, representative analyses, and compliance with
any applicable Pretreatment Standard or Requirements. “I
understand that it is my responsibility to operate and
maintain the pretreatment facility, and to meet the Wastewater
Discharge Limits that will be issued in the Wastewater
Discharge Permit by the City of Cayce. I also understand that
I must obtain a Permit to Construct from SCDHEC prior to the
construction of pretreatment facilities and a Permit to
Operate from SCDHEC and the City of Cayce prior to the start-
up of pretreatment facilities, if applicable.”
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 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, including the
possibility of fine and imprisonment for knowing violations.”
_________________________________________________________
Signature Printed Name Title Date
1
APPENDIX B
NON-DOMESTIC WASTE SURVEY QUESTIONNAIRE
SECTION A - GENERAL INFORMATION
A.1. Company name, mailing address, and telephone number:
____________________________________________________________
____________________________________________________________
____________________________________________________________
Zip Code___________________
Telephone No. ( )
A.2 Address of production or manufacturing facility. (If same
as above, check _______.)
____________________________________________________________
____________________________________________________________
Zip Code___________________Telephone No. ( )
Note to Signing Official: In accordance with Title 40 of the Code
of Federal Regulations Part 403 section 403.14, information and
data provided in this questionnaire which identifies the nature
and frequency of discharge shall be available to the public
without restriction. Requests for confidential treatment of
other information shall be governed by procedures specified in 40
CAR Part 2. Should a discharge permit be required for your
facility, the information in this questionnaire will be used to
issue the permit.
This is to be signed by an authorized official of your firm after
adequate completion of this form and review of the information by
the signing official.
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, including the
possibility of fine and/or imprisonment.
_________________ ___________________________________
(Date) Signature of Official
(Seal if applicable)
2
A.3 Name, title, and telephone number of person authorized to
represent this firm in official dealings with the Sewer
Authority and/or City:
____________________________________________________________
____________________________________________________________
A.4 Alternate person to contact concerning Information provided
herein:
Name__________________Title________________Tel. No._________
A.5 Identify the type of business conducted (auto repair, machine shop,
electroplating, warehousing, painting, printing, meat packaging,
food processing, etc.
A.6 Provide a brief narrative description of the manufacturing,
production, or service activities your firm conducts.
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
A.7 Standard Industrial Classification Number(s) (SIC Code)for your
facilities:
_____ _____ _____ _____ _____ _____ _____ _____ _____
A.8 This facility generates the following types of wastes (check all
that apply):
AVERAGE GALLONS PER DAY
1. [ ] Domestic wastes ____________ [ ] estimated [ ] measured
(restrooms, employee showers, etc.)
2. [ ] Cooling water, ____________ [ ] estimated [ ] measured
non-contact
3. [ ] Boiler/Tower ____________ [ ] estimated [ ] measured
blow down
4. [ ] Cooling water, ____________ [ ] estimated [ ] measured
contact
5. [ ] Process ____________ [ ] estimated [ ] measured
6. [ ] Equipment/ ____________ [ ] estimated [ ] measured
Facility wash down
7. [ ] Air Pollution ____________ [ ] estimated [ ] measured
Control Unit
3
8. [ ] Storm water runoff
to sewer ____________ [ ] estimated [ ] measured
9. [ ] Other (describe) ____________ [ ] estimated [ ] measured
Total A.8.1 - A.8.9 _________
A.9 Waste are discharged to (check all that apply):
AVERAGE GALLONS PER DAY
[ ] Sanitary sewer ____________ [ ] estimated [ ] measured
[ ] Storm sewer ____________ [ ] estimated [ ] measured
[ ] Surface water ____________ [ ] estimated [ ] measured
[ ] Ground water ____________ [ ] estimated [ ] measured
[ ] Waste haulers ____________ [ ] estimated [ ] measured
[ ] Evaporation ____________ [ ] estimated [ ] measured
[ ] Other (describe) ____________ [ ] estimated [ ] measured
Provide name and address of waste hauler(s), if used.
_____________________________________________________
A.10 Is a Spill Prevention Control and Countermeasure Plan
prepared for the facility? [ ] Yes [ ] No
A.11 List any environmental control permits issued to the
facility and any discharge limits associated with those
permits.
____________________________________________________________
____________________________________________________________
N ote: If your facility did not check one or more of the items
listed A.8.4 through A.8.9 above, then you do not need
to complete any further sections in this survey/
application. If any items A.8.4 through A.8.9 were
checked, complete the remainder of this
survey application.
4
SECTION B - FACILITY OPERATION CHARACTERISTICS
B.1 Number of employee shifts worked per 24-hour day is _______.
Average number of employees per shift is __________.
B.2 Starting times of each shift: 1st___am 2nd____am 3rd____am
pm pm pm
Note: The following information in this section must be
completed for each product line.
B.3 Principal product produced:_________________________________
B.4 Raw materials and process additives used: (Use separate sheet
if needed).
#Day or Gal/Day ____________________________________________
____________________________________________________________
B.5 Production process is:
[ ] Batch [ ] Continuous [ ] both %batch ___________
%Continuous______
B.6 Hours of operation: ______a.m. to _____p.m. [ ] Continuous
B.7 Is production subject to seasonal variation? [ ] Yes [ ] No
If yes, briefly describe seasonal production cycle.
____________________________________________________________
____________________________________________________________
B.8 Are any process changes or expansions planned during the next
three years? [ ] Yes [ ] No
If yes, attach a separate sheet to this form describing the
nature of planned changes or expansions.
B.9 Average monthly water usage:
____________________________________________________________
5
SECTION C - WASTEWATER INFORMATION
C.1 Please indicate with an “X” all of the following activities which
are a part of operations at your facility:
1. [ ] Adhesives Formulation
2. [ ] Aluminum Forming
3. [ ] Asbestos Manufacturing
4. [ ] Battery Manufacturing
5. [ ] Beverage Bottling
6. [ ] Cement Manufacturing
7. [ ] Carbon Black Manufacturing
8. [ ] Coal Mining
9. [ ] Coil Coating
10. [ ] Copper Forming
11. [ ] Dairy Products Processing
12. [ ] Electric & Electronic Components Manufacturing
13. [ ] Electroplating
14. [ ] Explosives Manufacturing
15. [ ] Ferroalloy Manufacturing
16. [ ] Fertilizer Production
17. [ ] Food/Edible Products Processing
18. [ ] Glass Manufacturing
19. [ ] Grain Mills
20. [ ] Gum & Wood Chemicals Manufacturing
21. [ ] Hospital
22. [ ] Inorganic Chemicals Manufacturing
23. [ ] Iron & Steel
24. [ ] Laundry
25. [ ] Leather Tanning & Finishing
26. [ ] Mechanical Products Manufacturing
27. [ ] Metal Finishing
28. [ ] Metal Molding
29. [ ] Mineral Mining
30. [ ] Nonferrous Metals Forming
31. [ ] Oil & Gas Extraction
32. [ ] Ore Mining
33. [ ] Organic Chemicals, Plastics, or Synthetic Fibers
34. [ ] Paint & Ink Manufacturing
35. [ ] Paving & Roofing Materials
36. [ ] Pesticides Manufacturing
37. [ ] Petroleum Refining
38. [ ] Pharmaceuticals Manufacturing
39. [ ] Phosphate Manufacturing
40. [ ] Photographic Supplies Manufacturing
41. [ ] Plastics Processing
42. [ ] Porcelain Enameling Processing
43. [ ] Printing & Publishing
44. [ ] Pulp & Paper Processing
45. [ ] Rubber Processing
46. [ ] Slaughter/Meat Packing/Rendering/Feedlots
6
47. [ ] Soaps & Detergents Manufacturing
48. [ ] Steam Electric Power Generating
49. [ ] Textile Mills
50. [ ] Timber Products Processing
51. [ ] Other
C.2. Pretreatment devices or processes used for treating wastewater or
sludge (check as many as appropriate).
[ ] Air Flotation
[ ] Centrifuge
[ ] Chlorination
[ ] Cyclone
[ ] Filtration
[ ] Flow Equalization
[ ] Grease or oil separation, type ________________________
[ ] Grease trap
[ ] Grit Removal
[ ] Ion Exchange
[ ] Neutralization, pH correction
[ ] Ozonation
[ ] Reverse Osmosis
[ ] Screen
[ ] Sedimentation
[ ] Septic tank
[ ] Solvent separation
[ ] Spill protection
[ ] Sump
[ ] Biological treatment, type_____________________________
[ ] Rainwater diversion or storage
[ ] Other chemical treatment, type_________________________
[ ] Other physical treatment, type_________________________
[ ] Other, type____________________________________________
[ ] No pretreatment provided
C.3 If any wastewater analyses have been performed on the wastewater
discharge(s) from your facilities, attach a copy of the most recent
data to this questionnaire. Be sure to include the date of analysis,
name of laboratory performing the analysis, and location(s) from
which sample(s) were taken (attach sketches, plans, etc., as
necessary).
C.4 Priority Pollutant Information: Please indicate by placing
an "X" in the appropriate box by each listed chemical whether
it is "Suspected to be Absent," "Known to be Absent," "Suspected
to be Present," or "Known to be Present" in your manufacturing or
service activity or generated as a by-product.
7
CHEMICAL KNOWN SUSPECTED KNOWN SUSPECTED
COMPOUND PRESENT PRESENT ABSENT ABSENT
Synonym in ( )
________________________________________________________________
I. METALS AND
INORGANIC
1. Antimony [ ] [ ] [ ] [ ]
2. Arsenic [ ] [ ] [ ] [ ]
3. Asbestos [ ] [ ] [ ] [ ]
4. Beryllium [ ] [ ] [ ] [ ]
5. Cadmium [ ] [ ] [ ] [ ]
6. Chromium [ ] [ ] [ ] [ ]
7. Copper [ ] [ ] [ ] [ ]
8. Cyanide [ ] [ ] [ ] [ ]
9. Lead [ ] [ ] [ ] [ ]
10. Mercury [ ] [ ] [ ] [ ]
11. Nickel [ ] [ ] [ ] [ ]
12. Selenium [ ] [ ] [ ] [ ]
13. Silver [ ] [ ] [ ] [ ]
14. Thallium [ ] [ ] [ ] [ ]
15. Zinc
II. PHENOLS AND
CRESOL
16. Phenol(s) [ ] [ ] [ ] [ ]
17. Phenol, 2-chloro [ ] [ ] [ ] [ ]
18. Phenol, 2,4 [ ] [ ] [ ] [ ]
dichloro
19. Phenol,2,4,6 [ ] [ ] [ ] [ ]
trichloro
20. Phenol, [ ] [ ] [ ] [ ]
pentachloro
21. Phenol,2-nitro [ ] [ ] [ ] [ ]
(para-nitro)
22. Phenol, 4-nitro [ ] [ ] [ ] [ ]
(ortho-nitro)
23. Phenol, 2,4- [ ] [ ] [ ] [ ]
Dinitro
24. Phenol, 2,4 [ ] [ ] [ ] [ ]
Dimethyl
25. m-Cresol, [ ] [ ] [ ] [ ]
p-chloro
(4-chloro-3-methylphenol)
26. o-Cresol, [ ] [ ] [ ] [ ]
4-6-dinitro
(4,6-dinitro-2-methylphenol)
8
CHEMICAL KNOWN SUSPECTED KNOWN SUSPECTED
COMPOUND PRESENT PRESENT ABSENT ABSENT
Synonym in ( )
________________________________________________________________
III. MONOCYCLIG AROMATICS (EXCLUDING PHENOLS, CRESOLS AND PHTHALATES)
27. Benzene [ ] [ ] [ ] [ ]
28. Benzene, chloro [ ] [ ] [ ] [ ]
29. Benzene, 1,2 dichloro [ ] [ ] [ ] [ ]
(ortho-dichloro)
30. Benzene, 1,3 dichloro [ ] [ ] [ ] [ ]
(meta-dichloro)
31. Benzene, 1,4 dichloro [ ] [ ] [ ] [ ]
(para-dichloro)
32. Benzene, 1,2,4 trichloro [ ] [ ] [ ] [ ]
33. Benzene, hexachloro [ ] [ ] [ ] [ ]
(perchloro)
34. Benzene, ethyl [ ] [ ] [ ] [ ]
35. Benzene, nitro [ ] [ ] [ ] [ ]
36. Toluene [ ] [ ] [ ] [ ]
(methylbenzene)
37. Toluene, 2,4 dinitro [ ] [ ] [ ] [ ]
38. Toluene, 2,6 dinitro [ ] [ ] [ ] [ ]
IV. PCBs AND RELATED COMPOUNDS
39. PCB-1016 [ ] [ ] [ ] [ ]
40. PCB-1221 [ ] [ ] [ ] [ ]
41. PCB-1232 [ ] [ ] [ ] [ ]
42. PCB-1242 [ ] [ ] [ ] [ ]
43. PCB-1248 [ ] [ ] [ ] [ ]
44. PCB-1254 [ ] [ ] [ ] [ ]
45. PCB-1260 [ ] [ ] [ ] [ ]
46. 2-Chloronaphthalene [ ] [ ] [ ] [ ]
V. ETHERS
47. Ether, bis
2-chloroethyl [ ] [ ] [ ] [ ]
48. Ether, bis
(2-chloroisopropyl) [ ] [ ] [ ] [ ]
49. Ether, 2-
chloroethyl vinyl [ ] [ ] [ ] [ ]
50. Ether, 4-bromophenyl
phenyl [ ] [ ] [ ] [ ]
51. Ether, 4-chlorophenyl
phenyl [ ] [ ] [ ] [ ]
52. Bis (2-chloroethoxy)
methane [ ] [ ] [ ] [ ]
9
CHEMICAL KNOWN SUSPECTED KNOWN SUSPECTED
COMPOUND PRESENT PRESENT ABSENT ABSENT
Synonym in ( )
________________________________________________________________
VI. NITROSAMINES AND OTHER NITROGEN CONTAINING COMPOUNDS
53. Nitrosamine, dimethyl [ ] [ ] [ ] [ ]
54. Nitrosamine, diphenyl [ ] [ ] [ ] [ ]
55. Nitrosamine, di-n-propyl [ ] [ ] [ ] [ ]
56. Benzidine [ ] [ ] [ ] [ ]
57. Benzidine, 3,3'-dichloro [ ] [ ] [ ] [ ]
58. Hydrazine, 1,2-diphenyl [ ] [ ] [ ] [ ]
(hydrazobenzene)
59. Acrylonitrile [ ] [ ] [ ] [ ]
VII. HALOGENATED
ALIPHATICS
60. Methane, bromo- [ ] [ ] [ ] [ ]
61. Methane, chloro- [ ] [ ] [ ] [ ]
(methyl chloride)
62. Methane, dichloro [ ] [ ] [ ] [ ]
63. Methane, chlorodibromo [ ] [ ] [ ] [ ]
64. Methane, dichlorobromo [ ] [ ] [ ] [ ]
65. Methane, tribromo [ ] [ ] [ ] [ ]
66. Methane, trichloro [ ] [ ] [ ] [ ]
(chloroform)
67. Methane, tetrachloro [ ] [ ] [ ] [ ]
(carbon tetrachloride,
carbon tet.)
68. Ethane, chloro [ ] [ ] [ ] [ ]
(ethylchloride)
69. Ethane, 1,1-dichloro [ ] [ ] [ ] [ ]
(ethylidene chloride)
70. Ethane, 1,2-dichloro [ ] [ ] [ ] [ ]
71. Ethane, 1,1,1-trichloro [ ] [ ] [ ] [ ]
72. Ethane, 1,1,2-trichloro [ ] [ ] [ ] [ ]
(vinyl trichloride)
73. Ethane,
1,1,2,2-tetrachloro [ ] [ ] [ ] [ ]
(acetylene tetrachloride)
74. Ethane, hexachloro [ ] [ ] [ ] [ ]
(perchloro, perc)
75. Ethene, chloro [ ] [ ] [ ] [ ]
(vinyl chloride)
10
CHEMICAL KNOWN SUSPECTED KNOWN SUSPECTED
COMPOUND PRESENT PRESENT ABSENT ABSENT
Synonym in ( )
________________________________________________________________
76. Ethene, 1,1-dichloro [ ] [ ] [ ] [ ]
77. Ethene, trans-dichloro [ ] [ ] [ ] [ ]
78. Ethene, trichloro [ ] [ ] [ ] [ ]
79. Ethene, tetrachloro [ ] [ ] [ ] [ ]
80. Propane, 1,2-dichloro [ ] [ ] [ ] [ ]
(propylene dichloride)
81. Propene, 1,3-dichloro [ ] [ ] [ ] [ ]
(1,3 dichloropropylene)
82. Butadiene, hexachloro [ ] [ ] [ ] [ ]
83. Cyclopentadiene,
hexachloro [ ] [ ] [ ] [ ]
(Ethene = Ethylene)
VIII.PHTHALATE ESTERS
84. Phthalate, di-o-methyl [ ] [ ] [ ] [ ]
85. Phthalate, di-n-ethyl [ ] [ ] [ ] [ ]
86. Phthalate, di-n-butyl [ ] [ ] [ ] [ ]
87. Phthalate, di-n-octyl [ ] [ ] [ ] [ ]
88. Phthalate, bis
2-ethylhexyl [ ] [ ] [ ] [ ]
89. Phthalate, butyl benzyl [ ] [ ] [ ] [ ]
XI. POLYCYCLIC AROMATIC
HYDROCARBONS
90. Acenaphthene [ ] [ ] [ ] [ ]
91. Acenaphthylene [ ] [ ] [ ] [ ]
92. Benzo (a) anthracene [ ] [ ] [ ] [ ]
93. Benzo (b) fluoranthene [ ] [ ] [ ] [ ]
94. Benzo (k) fluoranthene [ ] [ ] [ ] [ ]
95. Benzo (ghi) perylene [ ] [ ] [ ] [ ]
96. Benzo (a) pyrene [ ] [ ] [ ] [ ]
97. Chrysene [ ] [ ] [ ] [ ]
98. Dibenzo (a,h,)
anthracene [ ] [ ] [ ] [ ]
(1,2,5,6 dibenzanthracene)
99. Fluoranthene [ ] [ ] [ ] [ ]
100. Fluorene [ ] [ ] [ ] [ ]
101. Indeno (1,2,3-cd)
pyrene [ ] [ ] [ ] [ ]
102. Naphthalene [ ] [ ] [ ] [ ]
103. Phenanthrene [ ] [ ] [ ] [ ]
104. Pyrene [ ] [ ] [ ] [ ]
105. Anthracene [ ] [ ] [ ] [ ]
11
CHEMICAL KNOWN SUSPECTED KNOWN SUSPECTED
COMPOUND PRESENT PRESENT ABSENT ABSENT
Synonym in ( )
________________________________________________________________
X. PESTICIDES
106. Acrolein [ ] [ ] [ ] [ ]
107. Aldrin [ ] [ ] [ ] [ ]
108. BHC Alpha [ ] [ ] [ ] [ ]
109. BHC Beta [ ] [ ] [ ] [ ]
110. BHC Gamma (or Lindane) [ ] [ ] [ ] [ ]
111. BHC Delta [ ] [ ] [ ] [ ]
112. Chlordane [ ] [ ] [ ] [ ]
113. DDD [ ] [ ] [ ] [ ]
114. DDE [ ] [ ] [ ] [ ]
115. DDT [ ] [ ] [ ] [ ]
116. Dieldrin [ ] [ ] [ ] [ ]
117. Endosulfan Alpha [ ] [ ] [ ] [ ]
118. Endosulfan Beta [ ] [ ] [ ] [ ]
119. Endosulfan Sulfate [ ] [ ] [ ] [ ]
120. Endrin [ ] [ ] [ ] [ ]
121. Endrin aldehyde [ ] [ ] [ ] [ ]
122. Heptachlor [ ] [ ] [ ] [ ]
123. Heptachlor expoxide [ ] [ ] [ ] [ ]
124. Isophorone [ ] [ ] [ ] [ ]
125. TCDD (or Dioxin) [ ] [ ] [ ] [ ]
126. Toxaphene [ ] [ ] [ ] [ ]
C.5. If you are unable to identify the chemical constituents of
products you use that are discharged in your wastewater,
attach copies of the materials safety data sheets for such
products.
12
SECTION D - OTHER WASTES
D.1 Are any liquid wastes or sludge from this firm disposed of by
means other than discharge to the sewer system?
[ ] Yes [ ] No
If "No", skip remainder of Section D.
IF "Yes", complete items 2 and 3.
D.2 These wastes may best be described as:
Estimated Gallons or Pounds/Year
[ ] Acids and Alkalies ________________________________
[ ] Heavy Metal Sludge ________________________________
[ ] Inks/Dyes ________________________________
[ ] Oil and/or Grease ________________________________
[ ] Organic Compounds ________________________________
[ ] Paints ________________________________
[ ] Pesticides ________________________________
[ ] Plating Wastes ________________________________
[ ] Pretreatment Sludge ________________________________
[ ] Solvents/Thinners ________________________________
[ ] Other Hazardous Wastes
(Specify) ________________________________
____________________________ ________________________________
____________________________ ________________________________
[ ] Other wastes (specify) ________________________________
____________________________ ________________________________
____________________________ ________________________________
D.3 For the above checked wastes, does your company practice:
[ ] On-site storage
[ ] Off-site storage
[ ] On-site disposal
[ ] Off-site disposal
Briefly describe the method(s) of storage or disposal checked above.
13
SECTION E - WASTE STREAM CHARACTERISTICS
E.1 Number of discharges from regulated processes (those with
an existing or proposed categorical limit) to sanitary
sewer system and their locations.
E.2 Provide a schematic drawing showing the regulated process
waste streams, unregulated waste streams, domestic
wastewater flows, cooling water, boiler blow down, etc.
E.3 Wastewater Characteristics
a. Daily Flow: Average Daily Flow (GPD) _______________
Average Maximum Daily Flow (GPD)_____________
b. Identify the discharge from each regulated process and check
type of discharge.
Process Continuous Intermittent Batch Flow (GPD)
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
c. Waste characteristic at point of discharge:
BOD_______________________mg/L pH________________________
COD_______________________mg/L NH3-N_____________________
TSS_______________________mg/L TKN_______________________
14
Priority Pollutants shown in Section C.4.
Pollutants Concentration (mg/L)
____________________________ ______________________________
___________________________ ______________________________
____________________________ ______________________________
____________________________ ______________________________
____________________________ ______________________________
____________________________ ______________________________
Flow at time sample Collected ___________________________MGD
Priority Pollutants at each regulated process:
Process # Pollutants Concentration (mg/L)
_________ ___________ ____________________
_________ ___________ ____________________
_________ ___________ ____________________
_________ ___________ ____________________
_________ ___________ ____________________
_________ ___________ ____________________
E.4. Does the wastewater discharged:
a) Create a fire or explosion hazard?
b) Have a pH lower than 5.0?
c) Contain a substance that can obstruct the flow in the
collection system?
15
TABLE I
PRIORITY POLLUTANTS
COMPOUND NAME
1. *acenaphthene
2. *acrolein
3. *acrylonitrile
4. *benzene
5. *benzidine
6. *carbon tetrachloride (tetrachloromethane)
*chlorinated benzenes (other than dichlorobenzenes)
7. chlorobenzene
8. 1, 2, 4-trichlorobenzene
9. hexachlorobenzene
*chlorinated ethane (including 1, 2-dichloroethane,
1, 1, 1-trichloroethane and hexachloroethane)
10. 1, 2-dichloroethane
11. 1, 1, 1-trichloroethane
12. hexachloroethane
13. 1, 1-dichloroethane
14. 1, 1, 2-trichloroethane
15. 1, 1, 2, 2-tetrachloroethane
16. chloroethane
*chloroalkyl ethers (chloromethyl, chloroethyl and mixed ethers)
17. bis (2-chloroethyl) ether
16
18. 2-chloroethyl vinyl ether (mixed)
*chlorinated naphthalene
19. 2-chloronaphthalene
*chlorinated phenols (other than those listed elsewhere:
includes trichlorophenols and chlorinated cresols)
20. 2, 4, 6-trichlorophenol
21. parachlorometa cresol
22. *chloroform (trichloromethane)
23. *2-chlorophenol
*dichlorobenzene
24. 1, 2-dichlorobenzene
25. 1, 3-dichlorobenzene
26. 1, 4-dichlorobenzene
*dichlorobenzidine
27. 3, 3-dichlorobenzidine
*dichloroethylenes (1,1-dichloroethylene and 1, 2-dichloroethylene)
28. 1, 1-dichloroethylene
29. 1, 2-trans-dichloroethylene
30. *2, 4-dichlorophenol
*dichloropropane and dichloropropene
31. 1, 2-dichloropropane
32. 1, 2-dichloropropylene (1, 3-dichloropropene)
33. *2, 4-dimethylphenol
*dinitrotoluene
34. 2, 4-dinitrotoluene
35. 2, 6-dinitrotoluene
36. *1, 2-diphenylhydrazine
17
37. *ethylbenzene
38. *fluoranthene
*haloethers (other than those listed elsewhere)
39. 4-chlorophenyl phenyl ether
40. 4-bromophenyl phenyl ether
43. bis (2-chloroisopropyl) ethers
44. bis (2-chloroethoxy) methane
*halomethanes (other than those listed elsewhere)
45. methylene chloride (dichloromethane)
46. methyl chloride (chloromethane)
47. methyl bromide (bromomethane)
48. bromoform (tribromomethane)
49. dichlorobromomethane
50. chlorodibromomethane
51. *hexachlorobutadiene
52. *hexachlorocyclopentadiene
53. *isophorone
54. *naphtalene
55. *nitrobenzene
*nitrophenols (including 2, 4-dinitrophenol and dinitrocresol)
56. 2-nitrophenol
57. 4-nitrophenol
58. *2, 4-dinitrophenol
59. 4, 6-dinitro-o-cresol
*nitrosamines
18
60. N-nitrosodimethylamine
61. N-nitrosodiphenylamine
62. N-nitrosodi-n-propylamine
63. *pentachlorophenol
64. *phenol
*phthalate esters
65. bis (2-ethylhexyl) phthalate
66. butyl benzyl phthalate
67. di-n-butyl phthalate
68. di-n-octyl phthalate
69. diethyl phthalate
70. dimethyl phthalate
*polynuclear aromatic hydrocarbons
71. benzo(a) anthracene (1, 2-benzanthracene)
72. benzo(a) pyrene (3, 4-benzopyrene)
73. benzo(b) fluoranthene (3, 4-benzofluoranthene)
74. benzo(k) fluoranthane (11, 12-benzofluoranthene)
75. chrysene
76. acenaphthylene
77. anthracene
78. benzo(ghi)perylene (1, 12-benzoperylene)
79. fluorene
80. phenanthrene
81. dibenzo(ah)anthracene (1, 2, 5, 6-dibenzanthracene)
82. indeno (1, 2, 3-cd)pyrene (2, 3-o-phenylenepyrene)
83. pyrene
19
84. *tetrachloroethylene
85. *toluene
86. *trichloroethylene
87. *vinyl chloride (chloroethylene) pesticides and metabolites
88. *aldrin
89. *dieldrin
90. *chlordane (technical mixture & metabolites)
*DDT and metabolites
91. 4, 4'-DDT
92. 4, 4'-DDE (p, p'-DDX)
93. 4, 4'-DDD (p, p'-TDE)
*endosulfan and metabolites
94. alpha-endosulfan
95. beta-endosulfan
96. endosulfan sulfate
*endrin and metabolites
97. endrin
98. endrin aldehyde
*heptachlor and metabolites
99. heptachlor
100. heptachlor epoxide
*hexachlorocyclohexane (all isomers)
101. alpha-BHC
102. beta-BHC
104. gamma-BHC (lindane)
20
105. delta-BHC
*polychlorinated biphenyls (PCB's)
106. PCB-1242 (arochlor 1242)
107. PCB-1254 (arochlor 1254)
108. PCB-1221 (arochlor 1221)
109. PCB-1232 (arochlor 1232)
110. PCB-1248 (arochlor 1248)
111. PCB-1260 (arochlor 1260)
112. PCB-1016 (arochlor 1016)
113. toxaphene
114. antimony
115. arsenic
116. asbestos
117. beryllium
118. cadmium
119. chromium
120. copper
121. cyanide, total
122. lead
123. mercury
124. nickel
125. selenium
126. silver
127. thallium
128. zinc
129. 2,3,7,8-tetrachloro-dibenzo-p-dioxin (TCDD)
21
TABLE II
INDUSTRIAL CATEGORIES
INDUSTRY INDUSTRY
1. Adhesive 18. Pulp & paper
2. Leather Tanning and Finishing 19. Textile Mills
3. Soaps & Detergents 20. Timber
4. Aluminum Forming 21. Coal Mining
5. Battery Manufacturing 22. Ore Mining
6. Coil Coating 23. Petroleum Refining
7. Copper Forming 24. Steam Electric
8. Electroplating 25. Organic Chemicals
9. Foundries 26. Pesticides
10. Iron & Steel 27. Pharmaceutical
11. Nonferrous Metals 28. Pesticides Materials
12. Photographic Supplies 29. Rubber
13. Plastic Processing 30. Auto & Other Laundries
14. Porcelain Enamel 31. Mechanical Products
15. Gun & Wood Chemicals 32. Electric & Electronic
Components
16. Paint & Ink 33. Explosives Manufacturing
17. Printing & Publishing 34. Inorganic Chemicals
22
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