NCG210115_COMPLETE FILE - HISTORICAL_20180703

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
LX HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ Ao I z 011 oQ
YYYYMMDD

A.
Division of Energy, Mineral, and Land Resources
Land Quality Section 1 Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources flnrlivirl„al I anal!„ Racnnn�ihla fnr Darmi+l
FOR AGENCY USE ONLY
Date Received
Year tYtOflttl
Day
,6Q' .1v
fA
-W/o
Use this form if there has been: `��MW'ITERp A 17
NO CHANGE In facility ownership or facility name, but the Individual Ne
t who ,is-iegally-resporis'f-ble,fflr the permit has changed.
If the name of the facility has changed; or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean`.'
The person is either: JUL 0 3 2018
• the responsible corporate officer (for a corporation); CENi-t,f,L r'_,, FS
• the principle executive officer or ranking elected official (for a municipalrty,-1 fate, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
N I C 1.S
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(61) Certificate of Coverage
N I C I G 2 11 10 11 11 15
Elkin Facility
Weyerhaeuser NR Company
524 Pride Way
Address
Elkin NC 28621
City State Zip
To find the current legally responsible person associated with your pen -nit, go to this website:
http://deq. nc.gov/about/divisions/energy-mineral-land-resources/enerQy-mi neral-land-perinits/stor-mwater-program
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Dennis R Atkinson
First M I Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Ross Gardner
First MI Last
Page I of 2
S WU-OWNERAFFIL-23March2017

r�
NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
Mill Manager
Title
524 Pride Way
Mailing Address
Elkin NC 28621
City State zip
336 ) 626-6494 mss.gardrre tyweyer} aeuserr4om
Telephone E-mail Address
336 ) e35" 7 I e3
Fax Number
5) Reason for this change:
❑✓ Employee or management change
A result of: Inappropriate or incorrect designation before
❑ Other
if otherlVease explain: Mill Manager retired
The certification below must be completed and signed by the permit holder.
PERM ITT EE CERTIFICATION:
I Ross Gardner , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processec
4 C zt
116
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website
at: http://de_g.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
Page 2 of 2
swu-0wNERAFFn_23Mar2017

46
Division of Energy, Nlineral, and Land Resources
Land Quality Section / Storm -water Program
National Pollutant Discharge Elimination System (NPDES)
Energy. Mineral& PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
VVYMOr+MENr1LOUAWIV . (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR A6 ENC Y 1JSF ONLY
I)aIL' kt'i L'l1'L'L1
Yca r
MIS
E70
JUL 02 2g18
DENR-LAND QUAL/TY
)Rmwar,,._ �_
NO CHANGE in facility ownership or facility name, but the individual
who is legally re'sponsible.for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What sloes "legally responsible individual" inean?
The person is either:
• the responsible corporate officer (for a cotj)oration);
• the principle eXecutive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a pamiership or sole proprictorsliip),
• or, the duly authorized representative of oiie of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
lnciividut]i Pcnt�it
N C I S
2) Facility Information:
Facility name:
Company/Owner Organization
Facility address:
(or) Certificate of Coverage
N I C G J2 1 0 1 1 5
Elkin Facility
Weyerhaeuser NR Company
524 Pride Way
Address
Elkin NC 28621
city state zip
To find the current legally responsible person associated with your permit, go to this website:
htW//dM.nc.gov/about/divisions/energy-mineral.-land-resources/enerev-mineral-land-perrnits/storrnwater- mm
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Dennis R Atkinson
First 3tit 1 Last
4) NEW OWNER AFFILIATION (legally responsible For the permit):
Person legally responsible for this permit: Ross Gardner
First N I Last
Page 1 of ?
SWLJ-OWN'ERAFFIt_ 23March2017

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
Mill Manager
Tisle
524 Pride Way
Mailing Address
Elkin NC 28621
City State zip
(336) 62F-64g4 tross.gatdrterqu weyerhaeusep,eom
"telephone E-mail Address
t 336 ) 6357183
Fax Number
5) Reason for this change:
Employee or management change
A result of: Inappropriate or incorrect designation before
❑ Other
ljothcrldease exlVain: Mill Manager retired
The certification below must be completed and signed by the permit holder.
PERI%IITTEE CERTIFICA'HON:
Ross Gardner , attest that this application for this change in Owner Affiliation
(person legally responsible for the penuit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this Form are not completed, this change may not he
prcZe
4
C z�
Signature Date
PLEASE SEND THE COMPLETED FORM 1'0:
DI NILR - Stormwater Program
Dept. of l-Invironniental Quality
1612 Mail Service Center
Raleigh. North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the websitc
at: httpJ/deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
Page 2 ol'2
SWU-OWNERA1_V1L-?3Nbr2017

F, -�7\,
I
pril 12, 2018
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Signature Authority
WEYERHAEUSER NR COMPANY
NPDES Permit Number NCG210115
To Whom It May Concern:
RECEIVED
JUN 2 0 2018
CEN-rRAL FILES
t']1NR SECTIO[ t
RRCEIVEC
MAY 14 2018
DENR.LAND QUALITY
STORMWATER PERMI771NG
By notice of this letter, I hereby delegate signatory authority to each of the following individuals for all
permit applications, discharge monitoring reports, and other information relating to the operations at
the subject facility as required by all applicable federal, state, and local environmental agencies
specifically with the requirements for signatory authority as specified in 15A NCAC 213.0506.
Individual #1
Individual #2 (if applicable)
V
Ross Gardner
Mill Manager
524 Pride Way
Elkin, Nc 28621
i
,Title: ° �wP` 3y
Ma li`i* �Ad e '
Physical Add
I m iEma=ress; :
weyerhaeuser.com
ro*[e-mail]
�Qffice l?hon • J
336 - 526 - 6404
- -
Mol;ilE IPhane
- -
- -
If you have any questions regarding this letter, please feel free to contact me at
[e-mail] weyerhaeuser.com or 202-539-3988.
Sincerel
(Dl
Authorized Signing Official's Name: Ardian Blocker
Authorized Signing Official's Title: Senior Vice President of Wood Products
220 Occidental Avenue
Seattle, Wa 98104
Email Address: Adrian. Blockera Weyerhaeuser.Com
202-539-3988
Mobile Phone
cc: Winston-Salem Regional Office, Water Quality Pemitting Section

ti
4"
R; ISM
'=t1BMTORIES IV,
Weyerhaeuser Corporation
Dennis Atkinson
524 Pride Way
Elkin, NC 28621
NC Certification No. 402
SC Certification No. 99012
Full -Service Analytical $ NC Drinking Water Cert No. 37735
Environmental Solutions VA Certification No.460211
DoD EL.AP: L-A-B Accredited Certificate No. L2307
ISOIIEC 17025 L-A-B Accredited Certificate No_ L2307
Project? Stormwater
Lab Submittal Date: 10/06/2015
Prism Work Order: 5100077
Case Narrative
10/09/2015
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
6. �
Cara C. Rusmisell
Project Manager
Data Qualifiers Key Reference:
Reviewed By Cara C. Rusmisell
Project Manager
HT Sample received and analyzed outside of the hold time.
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference
* Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entirety, without the wntten consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0643
Phone: [phone] - Toll Free Number: 1-8001629-6364 - Fax: [phone] Page 1 of 4

6- f
r.� Sample Receipt Summary
A`r� Full -Se -ice Analytical &
L1JIi R1SM y
Envlrpnrnental Solutions 10109l2015
Prism Work Order: 5100077
Client Sample ID Lab Sample ID Matrix Date Sampled Date Received
Stormwater 5100077-01 Water 09l21115 10/06/15
Samples were received at 8.5 degrees C. See case narrative for further information.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - charlotte, NC 28224-0543
Phone: [phone] - Toll Free Number: 1-8001529.6364 - Fax: [phone] Page 2 of 4

AER
\ Laboratory Report
IFull -Service Anal tical 8RISm
Environmental Solutions 10/09/2015
v�weoarow
Weyerhaeuser Corporation Project: Stormwater Client Sample ID: Stormwater
Attn: Dennis Atkinson Prism Sample ID: 5100077-01
524 Pride Way Prism Work Order: 5100077
Elkin, NC 26621 Sample Matrix: Water Time Collected: 09/21/15 15:30
Time Submitted: 10/06/15 09:15
Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch
Limit Factor Date/Time ID
General Chemistry Parameters
Total Suspended Solids 19 HT mg1L 8.3 0.80 1 'SM 2540 A 10/6115 16:40 EGC P5J0109
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: 704J529-6364 - Toll Free Number: 1-8001529-6364 - Fax: [phone] Page 3 Of 4

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TO BE FILLED IN BY CLIENT/SAMPLING PERSONNEL
CertMlDation: NI=LAC_ LISACE FL NO
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Water Chlorinated: Y _ADO
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RENDERED BY PROM t.A96riATORIE8, INC. 7D CLIENT)
Sample Iced l3 coon: YES NO
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North Carolina Department of Environmental Quality
Pat McCrory
Governor
October 8, 2015
Dennis Atkinson
Weyerhaeuser Nr Company
524 Pride Way
Elkin, NC 28621
Subject: Compliance Evaluation Inspection
NPDES General Stormwater Permit NCG210000
Certificate of Coverage NCG210115
Weyerhaeuser Nr Company - Elkin
Surry County
Dear Mr. Atkinson:
Donald R. van der Vaart
Secretary
Glen White of the Winston-Salem Regional Office of the NC Division of Energy, Mineral, and Land Resources
(DEMLR) met with you onsite and conducted a compliance evaluation inspection at the 524 Pride Way facility
on October 08, 2015. It was a pleasure to meet you and your assistance and cooperation throughout the
inspection were greatly appreciated. An inspection checklist is attached for your records and the inspection
findings are summarized below.
1. Permit
This facility holds General Stormwater Permit No. NCG210115 to discharge Stormwater from activities
associated with Lumberand Wood Products under the National Pollutant Discharge Elimination System
(NPDES). The permit became effective October 1, 2014 and expires September 30, 2019. Your permit
renewal package must be received in the Central Office in Raleigh no later than 180 days prior to the
expiration date of the permit.
2. Records Reports
Part !l, Section A of the permit requires the -development of a Stormwater Pollution Prevention Plan (SPPP).
The plan must include all 9 sections of Part Il, Section A requirements of the permit. This site is not required
to complete analytical monitoring but qualitative monitoring is required to be completed and documented
twice yearly as defined in Part II, Section C of the permit The plan must be updated annually and qualitative
monitoring must be conducted semi-annually to maintain compliance with the permit. This facility has
maintained its Stormwater Pollution Prevention Plan and permit and all records are available all the way back
to 2008.
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carokna 27699-1612 • 919-707-9200 / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http://QortaI.ncdenr.org/web/lr/
An Equal Opportunity \ Affirmative Action Employer— 50% Recycled \ 10% Post Consumer Paper

3. Facility Site Review
The facility was operating with reduced operation due to a period of scheduled maintenance, renovation and
upgrade. This site is served by a retention pond that captures industrial wastewater. Water from the pond
empties into a created wetland area with riser and trash rack before emptying'into the creek through a
culvert pipe. Samples for testing are captured below the wetland area. It's somewhat hard to reach. A path
should be cleared and stabilized to allow safe and ease of access to complete monitoring.
4._Effluent/Receiving Waters
This site is adjacent to the Yadkin River and discharges directly from the creek into the Yadkin River..
5. Self -Monitoring Program
Analytical Monitoring: This site is required to perform analytical monitoring. A review of monitoring records
verified that monitoring has been conducted per the permit requirements.
6. Qualitative Monitoring: All qualitative monitoring records were current and available for review at the
time of inspection. Records go back several years with monitoring completed twice annually. Records do
not need to be submitted to DEMLR, however, the records must be kept on file at the facility for a period of
five years.
Your assistance with the inspection and the work you've done to keep your facility and permit compliant are
greatly appreciated. If you have any questions concerning this letter or the attached inspection report,
please contact Glen White at [phone].
Sincerely,
Matthew E. Gantt, P.E.
Regional Engineer
Land Qua litySection
Attachments:
1. BIMS Inspection Checklist
CC: Division of Land Quality — WSRG

Permit: NCG210115
SOC:
County: Surry
Region: Winston-Salem
Compliance Inspection Report
Effective: 08/01/13 Expiration: 07/31/18 Owner: Weyerhaeuser Nr Company
Effective: Expiration: Facility: Elkin facility
Contact Person: Billie A Caudill Title:
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 10/08/2015 Entry Time: 09:OOAM
Primary Inspector: Glen White
Secondary Inspector(s):
Certification:
Phone: [phone]
Phone:
Exit Time: 10:00AM
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Timber Products Stormwater Discharge COC
Facility Status: ® Compliant [] Not Compliant
Question Areas:
M Storm Water
(See attachment summary)
Page: 1

-.-4
permit: NCG210115 Owner- Facility: Weyerhaeuser Nr Company
Inspection Date: 10/0812015 inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
This site, the SPPP with all of it's components and monitoring records are well maintained and current.
The facility is currently on reduced operation due to a period of scheduled maintenance, renovation and upgrade.
The retention pond, wetland area and outfall were observed during inspection.
The facility also has a stormwater improvement plan that will be going into effect this year.
Page: 2

Permit: NCG210115 Owner - Facility: Weyerhaeuser Nr Company
Inspection Date: 10/08/2015 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Stormwater Pollution Prevention Plan
Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan?
N ❑ ❑ ❑
# Does the Plan include a General Location (USGS) map?
N ❑ ❑ ❑
# Does the Plan include a "Narrative Description of Practices"?
® ❑ ❑ ❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
0 ❑ ❑ ❑
# Does the Pian include a list of significant spills occurring during the past 3 years?
■ ❑ ❑ ❑
# Has the facility evaluated feasible alternatives to current practices?
®❑ ❑ ❑
# Does the facility provide all necessary secondary containment?
IN El ❑ ❑
# Does the Plan include a BMP summary?
N ❑ ❑ ❑
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
®❑ ❑ ❑
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
® ❑ ❑ ❑
# Does the facility provide and document Employee Training?
® ❑ ❑ ❑
# Does the Plan include a list of Responsible Party(s)?
®❑ ❑ ❑
# Is the Plan reviewed and updated annually?
® ❑ ❑ ❑
# Does the Plan include a Stormwater Facility Inspection Program?
® ❑ ❑ ❑
Has the Stormwater Pollution Prevention Plan been implemented?
N ❑ ❑ ❑
Comment: SPPP complete, well maintained and current through 2015. Updated annually with records all
the way back to 2008.
Qualitative Monitoring
Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually?
N ❑ ❑ ❑
Comment: Monitoring records current and show „that monitoring has been performed bi-annually as
required.
Analytical Monftorirt_g Yea No NA NE
Has the facility conducted its Analytical monitoring? ®❑ ❑ ❑
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas? ❑ ❑ 0 ❑
Comment: Testing and result records current and within reauired parameters. Testing performed on
required schedule.
Permit and Outfalls Yjs_No NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site? ❑ ❑ ❑
# Were all outfalls observed during the inspection? ® ❑ ❑ ❑
# If the facility has representative outfall status, is it properly documented by the Division? N ❑ ❑ ❑
# Has the facility evaluated all illicit (non stormwater) discharges? ®❑ ❑ ❑
Page: 3

permit: NOG210115 Owner - Facility: Weyerhaeuser Nr Company
Inspection date: 1010812015 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Comment: This site is served by a retention pond that captures industrial wastewater. Water from the pond
empties. into a created wetland area with riser and trashrack before empying into the creek
through a culvert pipe. The area where samples is collected is somewhat hard to reach. A
handrail allows access down a deep slope to the oufall. A stepped access may offer a more
safe alternative. A cleared path should be cleared to allow ease of access for conducting
monitoring and collection of sample.
Page: 4

April 21, 2014
Sherri Knight
Aquiiier Protection Regional Supervisor
North Carolina Department of Environment and Natural Resources
585 Waughton Street
Winston Salem, NC 27107
Re: Weyerhaeuser Company, Elkin Manufacturing Facility
NPDES Stormwater General Permit No. NCG210000
Certificate of Coverage No. NCG210115
Dear Sherri:
N.C,Bept. ofENR
APR Z 3 tog
A'�+^sign-5alem
Per requirements of the above referenced general permit, this letter is to notify you of the
fourth occasion of valid sampling results for stormwater discharges from OutfaIl 001 that
have exceeded the benchmark value for Chemical Oxygen Demand (COD). The fourth
occasion of sampling results exceeding the benchmark value for COD occurred on March
25, 2014. We have taken the following immediate actions to address this issue:
• Plan to dredge in the next few weeks, the stormwater wet pond located on west
side of the facility to remove accumulated solids.
• Initiated practice of better capturing solids and wash water associated with the
Wet Electrostatic Precipitator (WESP).
We believe that these actions should be effective in preventing the discharge of
stormwater with elevated COD concentrations on a near term basis. Concurrently, we are
also working with URS Corporation to investigate and evaluate other potential solutions
that will address this issue on a long term and sustainable basis.
Please know that Weyerhaeuser is making every effort to address this issue in a timely
and responsible manner. If you have any questions or need additional information, please
contact Dennis Atkinson at [phone].
Sincerely,
r
Dennis Atkinson
Environmental Manager
Weyerhaeuser NR Company

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quaiity
Pat McCrory Thomas Reeder John Skvarla
Governor Acting Director Secretary
July 24, 2013
Ms. Rina Allen, Unit Manager
Weyerhaeuser Company
184 Gentry Road
Elkin, NC 28621
Subject: General Stormwater Permit Inspection
Weyerhaeuser Company
Certificate of Coverage # NCG210115
Surry County
Dear -Mrs. Allen:
On July 10, 2013, Gary Hudson of this office met with Billie Caudill to perform a General
Stormwater Permit Inspection at the Weyerhaeuser OSB facility located near Elkin. This
inspection evaluated the areas as designated on the attached inspection form. Observations
from each area are addressed below:
1. Permit
Weyerhaeuser Company holds Certificate of Coverage # NCG210115 for the discharge of
stormwater from the facility. The General Permit becomes effective August 1, 2013 and expires
July 31, 2018.
2. Records/Reports
All monitoring and laboratory records are maintained as specified by the permit.
3. Facility Site Review
The site appeared very clean and well managed. No concerns were noted.
4. Effluent/Receiving Waters
Stormwater runoff from the facility reaches the Yadkin River, Class "C waters in the
Yadkin/Pee-Dee River Basin.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet www.ncwaterquality.arg
An Equal Opportunity 1 Affirmative Action Employer
Nne
orthCarolina
)V tul'lll,ff

Mrs. Rina Allen, Unit Manager
Page 2
July 24, 2013
5. Monitoring Program
Part III, Section B of the permit requires that semi-annual qualitative (visual) monitoring be
performed and documented once in the spring (April - June) and once in the fall (September —
November). A review of the facility files found that the qualitative monitoring has been
conducted as required.
Part III, Section C of the permit requires that analytical monitoring be performed. A review of
the facility files found that the analytical monitoring has been conducted as required_
The analytical monitoring for on -site vehicle maintenance listed in Section B of the permit is not
required since the Weyerhaeuser plant uses less than 55 gallons of new motor oil per month
when averaged over the calendar year.
Ms. Caudill has done an exceptional job of developing and implementing • the .stormwater
program. The Division thanks Ms. Caudill and the Weyerhaeuser Company for their efforts in
managing its stormwater program and for their part in safeguarding the natural resources of
North Carolina for future generations. Should you have any questions concerning this letter,
please contact Gary Hudson or me at [phone].
Sincerely,
W. Corey Basinger
Regional Supervisor
Surface Water Protection Section
cc: NPS Assistance and Compliance Oversight Unit
Central Files — SWP
WSRO

6
4
Compliance Inspection Report
Permit: NCG210115 Effective: 08/01/08 Expiration: 07/31113 Owner: Weyerhaeuser Nr Company
SOC: Effective: Expiration: Facility: Elkin facility
County: Surry 184 Gentry Rd
Region: Winston-Salem
Elkin NC 28521
Contact Person: Billie A Caudill Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 07110/2013
Primary Inspector: Gary Hudson
Secondary Inspector(s):
Certification: Phone:
Entry Time: 09:00 AM Exit Time: 10:OO AM
Phone:
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Timber Products Stormwater Discharge COC
Facility Status: ■ Compliant C1 Not Compliant
Question Areas:
® Storm Water
(See attachment summary)
Page: 1

Permit: NCC3210115 Owner - Facility: Weyerhaeuser Nr Company
Inspection Bate: 07110120i3 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary.
Page: 2

Permit: NCG210115 Owner - Facility: Weyerhaeuser Nr Company
Inspection Date: 0711012013 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Stormwater Pollution Prevention Plan Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan?
®❑
❑ ❑
# Does the Plan include a General Location (USGS) map?
■ ❑
❑ ❑
# Does the Plan include a "Narrative Description of Practices"?
■ ❑
❑ ❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
■ ❑
❑ ❑
# Does the Plan include a list or significant spills occurring during the past 3 years?
■ ❑
❑ ❑
# Has the facility evaluated feasible alternatives to current practices?
■ ❑
❑ ❑
# Does the facility provide all necessary secondary containment?
■ ❑
❑ ❑
# Does the Plan include a BMP summary?
■ ❑
❑ ❑
# Goes the Plan include a Spill Prevention and Response Plan (SPRP)?
■ ❑
Cl ❑
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
■ ❑
❑ ❑
# Does the facility provide and document Employee Training?
■ ❑
Cl ❑
# Does the Plan include a list of Responsible Party(s)?
■ ❑
❑ ❑
# Is the Plan reviewed and updated annually?
■ ❑
❑ ❑
# Does the Plan include a Stormwater Facility Inspection Program?
■ ❑
❑ ❑
Has the Stormwater Pollution Prevention Plan been implemented?
■ ❑
❑ . ❑
Comment: .
Qualitative Monitoring
Yes No
NA NE
Has the facility conducted its Qualitative Monitoring semi-annually?
■ ❑
❑ ❑
Comment:
Analytical Monitoring
Yes No
NA NE
Has the facility conducted its Analytical monitoring?
■ ❑
❑ ❑
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
❑ ❑
■ ❑
Comment: .
Permit and Outfalls Yes No NA NE
# is a copy of the Permit and the Certificate of Coverage available at the site? ■ ❑ ❑ ❑
# Were all outfalls observed during the inspection? ■ ❑ ❑ ❑
# If the facility has representative outfall status, is it properly documented by the Division? ■ ❑ ❑ ❑
# Has the facility evaluated all illicit (non Stormwater) discharges? ■ ❑ ❑ ❑
Comment: .
Page: 3

A Weyerhaeuser
►3Z]St IS TA �POPES I'u1{ilE f FORESTRY
INli,a" 4E
524 Pride Way, Elkin, NC 28621
March 28, 2013
Division of Water Quality
Aquatic Toxicology Unit
1621 Mail Service Center
Raleigh, NC 27699-1621
Attn: Todd Christenson
Subject: Weyerhaeuser NR Company
Biocide/Chernical Treatment
NPDES No. NCG500272
Surry County
RECEIVED -
N.C.Dept. of ENR
APR 0 12013
Winston-Saiem
Weyerhaeuser, Elkin NC would like: to change cooling tower treatment products under the above
reference permit. Enclosed you will find completed Biocide/Chemical Treatment Workshect-1=orm 101
and a copy of the MSDS for Ancocide 4050.
We will switch products after approval. Please contact me i f you have questions.
Sincerely,
Billie Caudill
Environmental Specialist
bi Ilie.caudil lOt-weyerhaeuser.com
[phone]
C: Mike Mickey, Surface Water Protection Supervisor, DWQ Winston Salem Regional Office

I
BIOCIDE/CHEMICAL TREATMENT
WORKSHEET-FORM 101
The following calculations are to be performed on any biocidal products ultimately discharged to the surface waters of
North Carolina. This worksheet must be completed separately for each biocidal product in use. This worksheet is to be
returned with all appropriate data entered into the designated areas with calculations performed as indicated.
I. Facility Name Weyerhaeuser NR Company
NPDES # NCG500272 Outfall # 1
County Surr
Receiving Stream Yadkin River 7Q10 350 (cfs)
(All above information supplied by the Division of Water Quality)
What is the Average Daily Discharge (A.D.D.) volume of the water handling systems to the receiving water body?
A.D.D. = 0.006477 (in M.G.D.)
Please calculate the Instream Waste Concentration (IWC in percent) of this discharge using the data entered
above.
lWC = (A,D.D.)X100 _ (0.006477)X900 = 0.0029 %
(7Q10)(0.646)+(A.D.D) (3.50)(0.646) + (0.006477)
This value (IWC) represents the waste concentration to the receiving stream during low flow conditions.
II. What is the name of the whole product chemical treatment proposed for use in the discharge identified in Part I?
ANCOCIDE 4059
Please list the active ingredients and percent composition:
? Dibromo-3-nitrilo rroopionamide %
ne 95 %
Total _ �4Q_%
What feed or dosage rate (D.R.) is used in this application? The units must be converted to maximum grams
of whole product used in a 24hr period.
D.R.= 435 grams/24hr period
Please note, fluid ounces (a volume) must be converted to grams (a mass). The formula for this conversion is:
Grams of product = fluid oz. of product X 11 aal. water X 8.34 lbs. X specific gravity of product X 453.59a.
128 fl. oz. 1 gal. water 1 lb.

f
Facility Name: Weyerhaeuser NR Company NPDES #: NGG500272
Estimate total volume of the water handling system between entry of biocidal product and NPDES discharge point.
On an attached sheet please provide justification for this estimate (system volume, average cycles per blowdown,
holding lagoon size, etc.)
Volume = 0035` million gallons
What is the pH of the handling system prior to biocide addition? If unknown, enter NIA. 8.9
What is the decay rate (D.K.) of the product? If unknown, assume no decay (D.K,=O) and proceed to asterisk.
The degradation must be stated at pH level within 1 /2 pH standard unit within handling system. Enter the half life
(Half Life is the time required for the initial product to degrade to half of its original concentration)_ Please provide
copies of the sources of this data.
H.L. = 0,375 Days (9 hours)
The decay rate is equal to H1L X 0.69 = _1. 4 = Decay Rate (DA.)
Calculate degradation factor (D.F_). This is the first order loss coefficient.
D.F. - - Af Q.D.) + (D.K.) - (0.006477) + (1.8a) _ _3-� (Volume) (0,0035)
Calculate Steady State Discharge Concentration:
Disehg Conc. _ (DR.) _ (435gm) _ mgil
(D.F.)(Volume)(3785) 4 (3.6906)(0.0035)(3785) Z�
Calculate concentration of biocide instream during low flow conditions.
(Receiving Stream Concentration)
(Dischq. Conc.) x (IWC%) _ (8.8973)x(0.0029) _
100 - - 0.0003 mg/l
100
Receiving Stream Concentration
III. Calculate regulated limitation.
List all LC50 and EC50 data available for the whole product according to the following columns. (Note that units
should be in mg11). Please provide copies of the sources of this data.
Organism Test -901= LC501EC50 (mn1l)
—5hiegiR nri h $¢ hn-. - i r 50 _ 1.3 (1.0— 1.61 moll
Rainbow Trgsli _16 hours_ LC54 1,0 (0.6 -1.5) mg/1
Fathead in 9¢ hqurS- LC50 _1,36 (1,24— 1.48mU1_
�aphnids ,_ 48 hours - LC54 _1.2Q{a..�46— 1.941ma11
Larne Mouth Bass Finaertinas 0 h0u[5--.LQ4_ _1. 1 — 1 /1
D. W. Q. h or -in 101 (612000)
2

I
Facility Name: Weyerhaeuser NR Company NPDES #: NGG500272
Choose the lowest LC501EC50 listed above:
Enter the LC501EC50: 1.0 mgll
If the half life (H,L.) is less than 4 days, perform the following calculation.
Regulated Limitation = 0.05 x LC50 = 0.05 mgtl
If the half life (H.L.) is greater than or equal to 4 days or unknown, perform the following calculation.
Regulated Limitation = 0.01 x LC50 = nla mg/1
Choose the appropriate regulated limitation from the calculations immediately above and place in this blank:
0.05 mg/lister
From Part II enter the receiving stream concentration:
0.003 mg/liter
IV. Analysis.
If the receiving stream concentration is greater than the calculated regulated limitation, then this biocide is
unacceptable for use.
Person in Responsible Charge
Debbie Tadlock, Mill Manager
Name (Print)
Signature Date
Person Completing This Worksheet (if different from above)
Kiran B. Jain
Name (Print)
X 2 $"�Z3-2�2D13
Signature Date
Please submit to: Division of Water Quality
Aquatic Toxicology Unit
1521 Mail Service Center
Raleigh, NC 27699-1521
Attn: Todd Christenson
D.W.Q. Form 101 (612000)
3

rr
Facility Name: _ Weyerhaeuser NR Company NPDES #: NCG500272
Supplemental Metals Analysis
If copper, zinc, or chromium are present in the proposed biocidal compound, complete this worksheet. A separate form
must be used for each metal and/or metal compound present in the biocide. List the metal, its chemical formula, molecular
weight (MW), formula weight (FW), and the concentration of the metal compound in the biocide (MCC). Complete a
separate form for every metal present in the biocide.
Mal
EXAMPLE
Copper
CuSO4. H2O 63.546 g/mole 249.680 g/mole 0.2
Dosage rate of Biocide (DR) (from page 1):
DR = grams/day
Average Daily Discharge (ADD) (from page 1):
ADD = million gallonslday
Discharge Concentration (DC) of Biocide:
DC - DR - { gramslday) _ ADD million gallons/day) - grams/million gallons
Convert DC to microgramslliter (ppb):
t3Wgg_
DC (pgll) = DC (grams/million gal) x 3.785 x 106 liters/million gal. p911
Calculate the fraction of metal in the metal -containing compound (MF):
MW rams/mole
MF = FW = { grams/mole) _
Calculate the fraction of metal in the biocidal compound (BF):
_
BF = MF x MCC M %
x 100 = (100)
Calculate the concentration of metal in the discharge (M):
M = DC x BF = pgll x = pgll
Calculate the instream metal concentration (IMC) at low -flow conditions:
IMC = M x IW_ c_ % = ug/l x % _ P94
100 100
Regulated limitation of metal (from below): p911
NC General Statutes 15A NCAC 213.0211 define:
Copper- 7 ugllwater quality action level" Zinc- 50 pgll waterquality action level`
Chromium- 50 pgll water quality standard
("Values which exceed action levels must be addressed directly by aquatic toxicity testing; )
D.W.Q. 1, orai 101 (6120(10)
4

Material Safety Data Sheet: ANCOCIDE 4050
Supercedes Date 0210712007 Issuing Date 02/10/2012
� h: r :s'i 'if4 tv�A `tsk'k:ac �i a1 `ii 14 tit! PROD UCT,'ANIYCOMPANY�IDENTIFIGATION
Product Name ANCOCIDE 4050
Recommended use Bbadal product
Information on Manufacturer
CHEM-AQUA, INC
BOX 152170
IRVING, TEXAS 75015
Product Code 1T2Z
Chemical nature Aqueous dispersion
Emergency Telephone Number
CHEMTREC® 800-424-9300
sf + P:ct-s' i 71
Color Coloriess - Brown
Potential Health Effects
Principle Route of Exposure
Primary Routes of Entry
Acute Effects
Eyes
Skin
Inhalation
Ingestion
Chronic Toxicity
Target Organ Effects
Aggravated Medical Conditions
Potential Environmental Effects
Emergency Overview
DANGER
Combustible liquid and vapor
Corrosive
Causes skin and eye burns
May cause allergic skin reaction
May cause delayed lung injury and burns
Harmful or fatal if swallowed
Physical State Liquid
Skin contact, Eye contact, Inhalation.
Skin Absorption, Inhalation.
Odor Mild
Corrosive to the eyes and may cause severe damage including blindness.
Causes skin burns, May cause allergic skin reaction.
Harmful by inhalation. Causes burns. May cause central nervous system depression. Symptoms and signs'mciude
headache, dizziness, fatigue, muscular weakness, drowsiness and in extreme cases, loss of consciousness.
Rnhalalion may cause central nervous system effects.
if ingested, severe burns of the mouth and throat, as well as a danger of perforation of the esophagus and the
stomach. Aspiration hazard if swallowed - can enter lungs and cause damage. Maybe fatal if swallowed and
enters airways.
Inhaled corrosive substances can lead to a toxic edema of the lungs, Kidney injury may occur. May cause
sensilizabon by skin contact.
Central nervous system, Kidney, Bone Marrow.
Respiratory disorders, Skin disorders, Kidney disorders, Neurological disorders_
See Section 12 for additional Ecological information.
;Wr`iy5 M"Ur�„`�"r"`1'?3"�GOMPOSITIONthINF,ORMATION"ONjINGREDIEIVTS
Component
CAS -No
Pol elh lere glycol
25322-68-3
2,2-Dibromo-3-nitrilo ro ionamide
10222-01-2
Sodium bromide
7647-15-6
,* "0�31�?� C�VOW' 4'FIRSTAlCf, IEASURESI''rrr.r r _ :
General Advice Do not gel in eyes. on skin or on clothing. Do not breathe vapors or spray mist.
Eye Contact If in eyes, rinse with water for 15 minutes. Remove contact lenses. Call a physician or poison control center
immediately.
Skin Contact Remove contaminated clothing and shoes. Wash off immediately with plenty of water for at least 15 minutes. Call a
physician or poison control center immediately.
inhalation Move to fresh air. tf not breathing, give artificial respimliam Call a physician or poison control center immediately,
Ingestion Call a physician or Poison Control Center immediately_ Give small amounls of water to drink. Do not induce vomiting
without medical advice. Never give anything by mouth to an unconscious person.
Notes to physician The product causes burns of eyes, skin and mucous membranes. Control of circulatory system, shock therapy it
needed.
?rZm'4irCks:sltt:$3��'`ra3+i5FlRE`FIGHTING'tJEASORES, ''tkt��?1+k��v�`i` 1fSv
Flash Point 199'F793'C Method Closed cup
Autoignition Temperature No information available.
Flammability Limits in Air % No information available. Upper No data available Lower No data available
Suitable Extinguishing Media
Foam. Carbon dioxlde (CO2). Dry chemical. Water spray. Use extinguishing measures that are appropriate to focal circumstances and the surrounding environment.
Specific hazards arising from the chemical
Solvent vapors are heavier than air and may spread along floors. Vapors may ignite and explode. Material can create slippery conditions. Conlaci with metals
Page 1 14

1T2Z-ANCOCIDE 4050
Issuing Date 10-Feb-2012
liberates hydrogen gas.
Protective Equipment and Precautions for Firefighters
As in any fire, wear self-contained breathing apparatus pressure -demand. MSHAINIOSH (approved or equivalent) and full protective gear.
NFPA Health 3 Flammability 2 Instability 0
HMIS Health 3 Flammability 2 Instability 0
''' � I ���iEJ��6R'ACCIi)EiJTAL}RELEASE+MEASURE5f;���4"� '.,a_�n a. ,..YFa�pi,
Personal Precautions
Use personal protective equipment. Remove all sources of ignition. Ensure adequate ventilation. Prevent further
leakage or spillage if safe to do so. Material can create slippery conditions.
Environmental Precautions
Do not flush into surface water or sanitary sewer system.
Methods for Containment
Contain spillage, soak up with non-combustible absorbent material, (eg, sand, earth, diatomaceous earth,
vermiculite) and transfer to a container for disposal according to localf national regulations (see section 13).
Methods for Cleaning Up
Use clean non -sparking tools to collect absorbed material.
Neutralizing Agent
Neutralize with lime milk or soda and ftushwith plenty of water.
i`Kr��'> "t�,'"t'.;i�tk � 5my- =1
Handling Do not get in eyes, on skin or on clothing. Do not breathe vapors or spray mist.
Storage Store in original container. Keep containers lightly closed in a dry, cool and well -ventilated place. Keep away from
open flames, hot surfaces and sources of ignition. Metal containers must be lined. Freezing will affect the physical
condition but will not damage the material. Thaw and mix before using.
Storage Temperature Minimum 35'F12'C Maximum 95IF) 35°C
Storage Conditions Indoor X Outdoor Heated Refrigerated
Exposure Guidelines
Com onent
ACGIH Tl
OSHA PEL
NIOSH
Potye¢hyleae glycol
No data available
No data available
No data available
2,2-Oibromc-3-nildlopropionamide
No data available
No data available
No data available
Sodium bromide
No data available
No data available
No data availahle
Engineering Measures
Personal Protective Equipment
EyelFace Protection
Skin Protection
Respiratory Protection
General Hygiene Considerations
Physical State
Color
Appearance
Specific Gravity
Percent Volatile (Volume)
Vapor Pressure
Solubility
Chemical Stability
Conditions to Avoid
Incompatible Products
Hazardous Decomposition Products
Possibility of Hazardous Reactions
Use with local exhaust ventilation. Ensure adequate ventilation, especially in confined areas.
Tightly fitting saiety goggles. Face -shield.
Wear suitable protective clothing, Impervious gloves.
In case of inadequate ventilation wear respiratory protection.
Wear protective gloveslclolhing. Ensure that eyewash stations and safely showers are close to the workstation
location.
Liquid
Viscosity
Non viscous
Colorless - Brown
Odor
Mil
Transparent
pH
1.5
1.13
Evaporation Rate
e 1 (Butyl acetate=l}
40
VOC Content (%)
0
17.5 mmHg @ 68'F
Vapor Density
OL6 (Air = 1.0)
Completely soluble
Boiling PointitRange
> 158'F170 °C
Stable, Hazardous polymerization does not occur.
Heal, flames, and sparks
Strong oxidizing agents, Bases, Aluminum.
Carbon oxides, Nitrogen oxides (NOxI, Bromine, Fumes of bromine, Hydrogen
bromide, Hydrogen, by reaction with metals.
None under normal processing
i+tr6� 14 sfli9?nTOXICOLOGICAL`INF_ORMATION�1
Product information
LO50 Oral LOSe �armal
rat 3,115 mgAg rabbit > 2,00o mglkg
Component Information
Acute Toxicity
Com onent 1 Lose Oral Ll Dermal LC 50 1r, lion make Test Other
Polyethylene glycol I= 26 grkg { Ral } > 20 glkg (Rabbit y no data available no data available no data availahle
Page 214

I
1T2Z - ANCOCIDE 4050
Issuing Date 10-Feb-2012
2,2-Dibromo-3-nitrifopropionamide no data available no data available no data available no data evadable no data available
Sodium bromide = 3400 mgfkg (Rol I > 2000 n1glkg ( Rabbit j no data available no data available no data available
component
IAuta enieity
Sensitization
Developmental Toxicity
Reproductive Toxicity
Target Organ Etfects
Polyethylene glycol
no data available
no data available
no data available
no data available
no doll available
2,2-dibromo-3-nitdlopropionamide
no data available
skin sensilizaboin
no data available
no data available
tone marrow
Sodium bromide
no data available
no data available
no data available
no data available
CNS, kidney, cardiovascular
system
There are no known rarr-innri r-hemirals in this nirri
Component
ACGIH
'ARC
NTP OSHA
Dlher
Polyethylene glycol
not applicable
not applicable
not applicabin not applicable
not applicable
2,2-Dibromo-3,litritopmpienamida
not applicable
not applicable
not appiicable not applicable
not applicable
Sodium emni
not applicable
not applicable
net applicable not applicable
not applicable
Product information Toxic to aquatic organisms
r mm—nnf Information
Component
Toxlcl to Algae
Toxicity to Flsh
Microlox
water Flea
l.g Pew
Polyethylene glycol
no dal. available
LC5D > 5000 mi Carassius auratus 24 h I
EC50 = 100000 ni 15 min
no data available
NfA
2,2-Dibromo-3-nilrilopropionamide
no data available
no data available
no data available
no data available
N7A
Sodium bromidu
EC50 5800 - 24000 mglL
LC50 0,054 - 0.081 mglt- Cncorhynchus
no data available
EC50 5700 - 10800 mg1L 48 h
WA
Sunedesmus pannonicus 96
ri 96 h
EC50 5500 -48000 ri 48 h
h
LC50 15614 - 17428 m911. Pimephales
promelas 96 h
LC50 16000 - 24000 ni Poecilia
reticulala 96 h
LC50 240DO - 96000 ni Oryzias labpea
96 h
LC50 = 16000 mglL Poocilia mliculata 96 h
LC50 = 24000 ri Cryzias l ipes 96 It
C51) > 1000 mglL Lepomis macmchirus 96
In
LC51) > 1000 mi 8ncorhynchus ri
96 h
Persistence and Degradability No information available,
Bioaccumulation No information available.
Mobility No information avaitable.
aik1�4 �1`d4 a�a�"xfi°93.,lDISPOSAL',CONSIDERATI0NSif:w'rb
Product Disposal Dispose of in accordance with lecO regulations.
Container Disposal Empty containers should be taken for local recycling, recovery, or waste disposal. Do not re -use empty containers.
wrn.t 7 ; xT' , Y '" 1r { ;14: TR4NSPORT INF.ORME1TlON �'y" �nt,,
i
DOT
Proper Shipping Name
Corrosive liquid, acidic, organic, no.s,
Hazard Class
6
ti
UN3265
Packing Group
13
Description
UN3265, Corrosive liquid, acidic, organic, n.os.(2,2-dibromo-3-nitdlopropionamide), 8, PG III
TDG
Proper shipping name
Corrosive liquid, acidic, organic, nos.
Hazard Class
a
UN -No
UN3265
Packing Group
III
Description
Corrosive liquid, acidic, Drganic,n,o.s„(2,2-dibromo-3-nit6lopropionamide),B,UN3265,PG III
ICAO
UN -No
UN3265
Proper Shipping Name
Corrosive liquid, acidic, organic, n.o.s.
Hazard Class
8
Packing Group
III
Shipping Description
UN3265, Corrosive liquid, acidic, organic, n.u.s.(2,2-dibromo-3-nitrilopropionamide), 8, PG III
IATA
UN-i
UN3265
Proper Shipping Name
Corrosive liquid, acidic, organic, n.o.s.
Hazard Class
8
Page 3 14

1T2Z - ANCOCIDE 4050 Issuing Date 10-Feb-2012
Packing Group
III
ERG Code
8L
Shipping Description
UN3265, Corrosive liquid, acidic, organic, n.o.s.(2,2-(fibromo-3-nitrilopropienamide), 8, PG III
IMDG11MO
Proper Shipping Name
Corrosive liquid, acidic, organic, n.o,s.
Hazard Class
8
UN -No
UN3265
Packing Group
III
Ems No.
F-A, S-6
Shipping Description
UN3265, Corrosive liquid, acidic, organic, n.o.s,(2,2-dibromo-3-riitnlopropionamide), 8, PG III
'�# stkaft `• i �I# ?e a" <k a''.,7sa-dt154REGULrATARYiINF,ORMATIONM-T'n {'rt "'.m &;�'�:i'.I
Inventories
TSCA Complies
DSL Complies
U.S. Federal Regulations
SARA 313
Section 313 of Tltle III of the Superfund Amendments and Reaulhonzation Act of 1986 (SARA). This product does not contain any chemicals which are subject to ft
reporting requirements of the Act and and Title 40n of the Code of Federal Regulations, Part 372.
SARA 3111312 Hazardous Categorization
Acute Health Hazard
Chronic Health Hazard
Fire Hazard
dden Release of Pressure
Reactive Hazard
Hazard
Yes
Yes
Yes
No
No
CERCLA
Component
Hazardous Substances RQs
CERCLA EHS RQs
Polyethylene glycol
Not applicable
Nor applicable
2,2-D6bromo-3-nitrilo ro ionamide
Net applicable
Not applicable
Sodium bromide
Nat applicable
Not applicable
U.S. State Regulations
California Pro osition 65 This product does not contain any Proposition 65 chemicals,
Com anent CAS-Na California Prop. 65
Dibromoacetonibile 325243-5 carcinogen
Canada
This product may not be commercially placed on the market in Canada.
WHMIS Hazard Class
Not appiicable
Prepared By Dan Hollas
Supercedes Date 02/0712007
Issuing Date 02110/2012
Reason for Revision No informalion available.
Glossary No information available.
List of References. No information available.
CHEM-AQUA, INC assumes no responsibility for personal injury or property damage caused by the use, storage, or disposal of the product in a
manner not recommended on the product label. Users assume all risks associated with such unrecommended use, storage or disposal of the
product. The information provided on this MSDS is correct to the best of our knowledge, information and belief at the date of its publication. The
information given is designed only as a guide for safe handling, use, processing, storage, transportation, disposal and release and is not to he
considered as a warranty or quality specification. The information relates only to the specific material designated and may not be valid for such
material used in combination with any other material or in any process, unless specified in the text.
Page 4 14

� w
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
August 24, 2011
Ms. Rina Allen, Unit Manager
Weyerhaeuser Company
184 Gentry Road
Elkin, NC 28621
Subject: Genera! Stormwater Permit Inspection
Weyerhaeuser Company
Certificate of Coverage # NCG210115
Surry County
Dear Mrs. Allen:
On August 23, 2012, Gary Hudson of this office met with Billie Caudill to perform a
General Stormwater Permit Inspection at the Weyerhaeuser OSB facility located near Elkin.
This inspection evaluated the areas as designated on the attached inspection form.
Observations from each area are addressed below:
1. Permit
Weyerhaeuser Company holds Certificate of Coverage # NCG210115 for the discharge of
stormwater from the facility. The General Permit became effective August 1, 2008 and expires
July 31, 2013.
2. Records/Reports
All monitoring and laboratory records are maintained as specified by the permit.
3. Facility Site Review
The site appeared very clean and well managed. No concerns were noted.
4. Effluent/Receiving Waters
Stormwater runoff from the facility reaches the Yadkin River, Class "C" waters in the
Yadkin/Pee-Dee River Basin.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 WaugMown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] CustamerService: 1-877-623-6748
Internet: www,ncwaterquality.org
Nne
orthCarolina
An Equal Opportunity 1 Affirmative Action Employer

Mrs. Rina Allen, Unit Manager
Page 2
August 27, 2012
S
5. Monitoring Program
Part ill, Section B of the permit requires that semi-annual qualitative (visual) monitoring be
performed and documented once in the spring (April - June) and once in the fall (September —
November). A review of the facility files found that the qualitative monitoring has been
conducted as required.
Part III, Section C of the permit requires that analytical monitoring be performed. A review of
the facility files found that the analytical monitoring has been conducted as required.
The analytical monitoring for on -site vehicle maintenance listed in Section B of the permit is not
required since the Weyerhaeuser plant uses less than 55 gallons of new motor oil per month
when averaged over the calendar year.
Ms. Caudill has done an exceptional job of developing and implementing the stormwater
program. The Division thanks Ms. Caudill and the Weyerhaeuser Company for their efforts in
managing its stormwater program and for their part in safeguarding the natural resources of
North Carolina for future generations. Should you have any questions concerning this letter,
please contact Gary Hudson or me at [phone].
Sincerely,
W. Corey Basinger
Regional Supervisor
Surface Water Protection Section
cc: NPS Assistance and Compliance Oversight Unit
Central Files — SWP
WSRO

Compliance Inspection Report
Permit: NCG210115 Effective: 08/01108 Expiration: 07/31/13 Owner: Weyerhaeuser Nr Company
SOC: Effective: Expiration: Facility: Elkin facility
County: Surry 184 Gentry Rd
Region: Winston-Salem
Elkin NC 28621
Contact Person: Tommy E Glisson Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 08123/2012
Primary Inspector: Gary Hudson
Secondary Inspector(s):
Certification: Phone:
Entry Time: 10:30 AM Exit Time: 11:30 AM
Phone:
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Timber Products Stormwater Discharge COC
Facility Status: M Compliant ❑ Not Compliant
Question Areas:
Storm Water
(See attachment summary)
Page: 1

Permit: NCG210115 Owner - Facility: Weyerhaeuser Nr Company
Inspection Date: 08/2312012 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Page: 2

Permit: NCG210115 Owner - Facility: Weyerhaeuser Nr Company
Inspection Date: 08/23/2012 Inspection Type: Compliance Evaluation
Reason for Visit: Routine
Stormwater Pollution Prevention Plan
Yes No
NA
NE
Does the site have a Stormwater Pollution Prevention Plan?
■ ❑
❑
❑
# Does the Plan include a General Location (USGS) map?
a ❑
❑
❑
# Does the Plan include a "Narrative Description of Practices"?
■ ❑
❑
❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
0 ❑
❑
❑
# Does the Plan include a list of significant spills occurring during the past 3 years?
■ ❑
fl
❑
# Has the facility evaluated feasible alternatives to current practices?
■ ❑
Cl
❑
# Does the facility provide all necessary secondary containment?
■ ❑
❑
❑
# Does the Plan include a BMP summary?
■ ❑
❑
❑
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
■ ❑
❑
❑
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
■ ❑
❑
❑
# Does the facility provide and document Employee Training?
■ ❑
❑
❑
# Does the Plan include a list of Responsible Party(s)?
■ Cl
❑
❑
# Is the Plan reviewed and updated annually?
■ ❑
❑
❑
# Does the Plan include a Stormwater Facility Inspection Program?
■ ❑
❑
❑
Has the Stormwater Pollution Prevention Plan been implemented?
■ ❑
❑
❑
Comment: .
Qualitative Monitoring
Yes No
NA
NE
Has the facility conducted its Qualitative Monitoring semi-annually?
■ ❑
❑
❑
Comment: .
Analytical Monitoring Yes No NA NE
Has the facility conducted its Analytical monitoring? ■ ❑ ❑ ❑
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas? ❑ ❑ ■ ❑
Comment: .
Permit and Outfalls Yes No NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site? ■ ❑ ❑ ❑
# Were all outfails observed during the inspection? ■ ❑ ❑ ❑
# If the facility has representative outfall status, is it properly documented by the Division? ❑ ❑ ■ ❑
# Has the facility evaluated all illicit (non stormwater) discharges? ■ ❑ ❑ ❑
Comment:
Page:

n
by Weyerhaeuser
I'vtaic;h 11, 2011
Division of Water Quality
Stortnwater Permitting Unit
1636 Mail Service Center
Raleigh, NC 27699-1636
Attn: Bethany Georgoulias
Subject: Permitting Signature Authority
To Whom it May Concerti:
PO Box )777 '
Federal Way. INA 98W3
Tel [phone]
Fax [phone]
wm+w.iievelxom
As an appropriate signing official for Weyerhaeuser NR Company, Elkin NC facility as
designated by 15A NCAC 2T .0I06(c), I hereby delegate authority to sign and certify all permit
applications, reports or other permit related dUCn13L`[It5 to the fallowing staff for the following
permit types (sewer, spray, land application) and/or permit numbers:
Position
Person Currently in Position
Pertnit Type or Permit Number
Will Manager
Debbie Tadlock
NCG2101 15 (Stormwater permit)
If you have any questions, please contact me at the following;
Permitice/Applicant narrtc (l)lcase print): Cathy Slater
Title: Oriented Strand Board Vice President
Complete mailing address: 33663 Weyerhaeuser Way South, CI-12K32
City: Federal Way State: WA Zip: 98003
Telephone number: L253J 924-7502 Facsimile number: ( 253 ) 924-2999
Sincerely,
I
Cathy Sldrer- Sign anire
Cc: NCI)ENR - Division of Water Quality, Mr. Gary Hudson
585 Waughtown Street, Winston Salem, NC 27101
Billie Caudill, Weyerhaeuser, NR Company, Elk -in, NC
T

Georgoulias, Bethany
From: Caudill, Billie[bill [e-mail]]
Sent: Tuesday, March 29, 2011 11:22 AM
To: Georgoulias, Bethany
Subject: RE: Weyerhaeuser NR Company; Permit NCG210115
Thanks, address for Debbie is same as mine & mill.
Regards,
Billie Caudill
From: Georgoulias, Bethany[mailto;bethanyaeorgoulias(@ncdenr.gov]
Sent: Tuesday, March 29, 2011 11:12 AM
To: Caudill, Billie
Subject: RE: Weyerhaeuser NR Company; Permit NCG210115
Hi Billie,
The billing contact has been changed to Debbie now as well. I'll put a copy of the letter in the file.
Regards,
Bethany Georgoulias
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
512 N. Salisbury St, Raleigh, NC 27604
Phone: [phone]
Fax: [phone]
NEW Website: http://portal.ncdenr.org/web/wq/ws/su
E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
From: Georgoulias, Bethany
Sent: Tuesday, March 29, 2011 10:31 AM
To: 'Caudill, Billie'
Subject: RE: Weyerhaeuser NR Company; Permit NCG210115
Hi Billie,
I was able to make all the changes in our BIMS system except for the billing contact. I've requested that the person who
takes care of invoicing makes that change, and I'll confirm when I get word from her that it's changed. I assumed
Debbie's address, etc. was the same as yours?
Regards,
Bethany Georgoulias
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
512 N. Salisbury St, Raleigh, NC 27604
Phone: [phone]
Fax: [phone]

NEW Website: http://portal.ncdenr.or_q/web/wq/ws/su
E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third parties.
From: Caudill, Billie fmailto:[e-mail]
Sent: Monday, March 28, 2011 9:44 AM
To: Georgoulias, Bethany; Hudson, Gary
Subject: Weyerhaeuser NR Company; Permit NCG210115
RE: Weyerhaeuser NR company - delegation
General Stormwater (Stormwater Permitting Unit):
„ Permit: , NCO21011+5 Version: 3:0 . Status: � ctiVe:
Entity_
"Affiliation Tye
'.Nam .
Title
-.Phone'.Number
F.acilitp
Contact Pers66
Caudill, Billie A.
[phone]
Owner,
OWner
Fickdit2Jeffre V.,D.:
(33.6);�526 6462 i
O.wner
Has Permit Signature Authority
Fickett, Jeffrey D..
[phone]
Permit
Contact Person
Glisson; Tommy.E.
[phone]
Permit
jBilling .
Fickett, Jeffrey D.
i
[phone]
Please see attached delegation from Business VP. I remain facility contact, all other lines should be
changed to Debbie Tadlock, phone # [phone].
Thank you,
Billie A. Caudill
Environmental Management Representative
Weyerhaeuser NR Company - Elkin, NC
[phone]
2

Hudson, Gary
From: Hudson, Gary
Sent: Tuesday, May 26, 2000 10:23 AM
To:'[e-mail]'
Subject: NPIDEwS Permit # NCG500272
Hello Ms. Billie,
I hope that you are doing well. I do have some bad news. Steve Tedder said that we could not terminate outfalls 2
through 5 as discharge points. He said that the only thing that we would be able to do is the Representative Outfall
status that we have already granted you (for stormwater only).
He said that Raleigh would not allow a R.Q. status on that type of permit (General Wastewater). I apologize for the bad
news, and for taking so long to get back to you.
Best Regards,
Gary
Gary Hudson
NC DENR Winston-Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Voice: (336) 771-49.54
FAX: [phone]
E-mail correspondence to and from this address may be subject to the
North Carolina Public Records Law and may be disclosed to third parties.

Weyerhaeuser NR Company
184 Gentry Road, Elkin, NC 28621
by Weyerhaeuser
February 1 I, 2009-02-11
Mr. Mike Mickey
NCDENR DWQ
Surface Water Protection
Winston — Salem Regional Office
585 Waughtown Street
Winston Salem, NC 27101
Subject: Weyerhaeuser NR Company
NPDES Permit — Certificate of Coverage NCG500272
Surry County
Dear Mike:
RECEIVED
N.C. Dept. of ENR
FEB 13 2009
Winston-salom
Reglonat Office
With reference to the above permit certificate of coverage. This letter is a request to terminate discharge point
number 2 through 5 which have been documented as "discharge points" previously.
A complete inspection of each "point" has determined there is only one actual discharge point to be covered under
this permit, discharge point #l. Sources previously identified as discharging via discharge point numbers 2 through
5 do not discharge to the Yadkin River but are absorbed into the ground. These sources include non -contact cooling
water (fire water pump diesel engine), condensate (steam generator and HVAC) and exempt stormwater.
In December 2008 Gary Hudson and Rose Pruitt were on site for a stormwater inspection to determine if
Representative Outfall Status would be granted for our Storrnwater permit. During this inspection they also agreed
these points are not truly "discharge points".
If you have questions please contact Billie Caudill at [phone] or biillie.caudill(7Weyerhaeuser.Com. We
would appreciate confirmation and acceptance of this request.
Sincerely,
J frey . Ftckett
nit General Manager

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
August 23, 2010
Ms. Rina Allen, Unit Manager
Weyerhaeuser Company
184 Gentry Road
Elkin, NC 28621
Subject: General Stormwater Permit inspection
Weyerhaeuser Company
Certificate of Coverage # NCG210115
Surry County
Dear Ms. Allen:
On August 11, 2010, Gary Hudson of this office met with Billie Caudill to
perform a General Stormwater Permit Inspection at the Weyerhaeuser OSB
facility located near Elkin. This inspection evaluated the areas designated on the
attached inspection form. Observations from each area are addressed below:
1. Permit
Weyerhaeuser holds Certificate of Coverage # NCG210115 for the discharge of
stormwater from the facility. The General Permit became effective August 1,
2008 and expires July 31, 2013,
2. Records/Reports
Part II, Section A of the permit requires the development of a Stormwater
Pollution Prevention Plan (SPPP). A copy of the SPPP was available for review.
The plan contained all of the items required by the stormwater permit. Please
note that the permit requires the plan to be reviewed and updated on an annual
basis.
3. Facility Site Review
The site appeared clean and well managed. No concerns or problems were
noted. As part of this facilities ongoing commitment to this stormwater program,
several acres in the log storage area have recently been covered with 18" of
concrete. This office greatly appreciates the efforts of the Weyerhaeuser
Company in continual improvement in regards to the control of its stormwater
discharge.
North Carolina D+vision of Water Quality, Winston-Salem Regionat Office
Location: 585 Waughtown St. Winston-Salem, North Carolna 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
NorthCaroli
;Vatura!!

Ms. Rina Allen
Page 2
August 23, 2010
4. Effluent/Receivina Waters
Stormwater runoff from the facility reaches the Yadkin River, Class "C" waters in
the Yadkin/Pee-Dee River Basin.
5. Monitoring Program
Part li, Section B of the permit requires that semi-annual analytical monitoring be
performed and documented once in the spring (April - June) and once in the fall
(September — November). A review of the facility files found that the analytical
monitoring has been conducted as required. Part II, Section C of the permit
requires that semi-annual qualitative (visual) monitoring be performed and
documented once in the spring (April - June) and once in the fall (September --
November). A review of the facility files found that the qualitative monitoring has
been conducted as required.
The analytical monitoring for on -site vehicle maintenance listed in Section C of
the permit is not required since the Weyerhaeuser facility uses less than 55
gallons of new motor oil per month when averaged over the calendar year.
Should you have any questions concerning this letter, please contact Gary
Hudson or me at [phone].
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
cc: NPS Assistance and Compliance Oversight Unit
Central Files — SWP
(W S

■
by Weyerhaeuser
September 22, 2009
Water Quality Supervisor
North Carolina Department of Environment and Natural Resources
!Division of Water Quality
Winston Salem Regional Office
585 Waughtown Street
Winston Salem, NC 27107
Subject: Weyerhaeuser NR Company, Elkin, NC Facility
PO Box 9777
Federal Way, WA 98063-9777
253-924-2345
253-924-2999 R E C E IVC M
N.C. "Cent. o'
SEP 3 0 20M
Winator, 5 _
pegionaf'o-.
Weyerhaeuser NR Company hereby requests approval of designation of Edna Allen as Responsible Company Official
for the Elkin, NC Oriented Strand Board manufacturing facility. Ms. Allen is the Mill Manager at the Elkin facility.
This change will become effective September 28, 2009.
In the role of responsible official, Ms. Allen will execute all documents and do all acts as may be necessary or desirable
on behalf of Weyerhaeuser NR Company to administer operating permits, in accordance with the requirements of
permit numbers WQ0005555.. NCG 500272 and NCG 210115.
Should the more information be needed or there are questions or comments regarding this matter, please contact Ms.
Billie Caudill at [phone] or by e-mail (billie.caudill a,weyerhaeuser.com).
Sincerely,
C04A �d S/al"
Cathy Slater
EWP Vice President
C; Billie Caudill, Weyerhaeuser NR Company, Elkin, NC
Rina Allen, Weyerhaeuser NR Company, Elkin; NC

NODE R
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Jeffrey D. Fickett
Weyerhaeuser NR Company
184 Gentry Road
Elkin, NC 28621
Dear Mr. Fickett:
Division of Water Quality
Coleen H. Sullins
Dee Freeman
Director Secretary
March 20, 2009
Subject: NPDES General Permit NCG210000
Certificate of Coverage NCG210115
Weyerhaeuser NR Company
Formerly Weyerhaeuser Company
Surry County_
On December 2, 2008, Division personnel received your request to transfer your coverage under the General Permit.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained in the General Permit
remain unchanged and in full effect. This revised Certificate of Coverage is issued under the requirements of North
Carolina General Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S.
Environmental Protection Agency.
If you have any questions, please contact the Stormwater Permitting Unit at [phone].
Sincerely,
CJ
Coleen H. Sullins
cc: DWQ Central Files
Winston-Salem Regional Office
Stormwater Permitting Unit
Wetlands and Stormwater Branch
1617 Mail Service Cenler, Raleigh, NoM Carolina 27699 IM
Location: 512 N. Salisbury St. -Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Intemet: www.newalercluality.org
Ari Equal Opportunity IAfnrmotive Antivi Employer
One
NorthCarolina
Naturally

STA'CE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE No. NCG210115
STORM WATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Weyerhaeuser NR Company
is hereby authorized to discharge stormwater from a facility located at
Weyerhaeuser NR Company
184 Gentry Road
Elkin
Surry County
to receiving waters designated as the Yadkin River, a class C stream, in the Yadkin Pee -Dee
River Basin in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I,1I, III, IV, V, and VI of General Permit No. NCG210000 as
attached.
This certificate of coverage shall become effective March 20, 2009
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day March 20, 2009
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

O(C WATF Michael F. Easley, Governor
0� Stale of North Carolina
Cn WiIliatn G. Ross, Jr., Secretary
ti^ Department of Environment and Natural Resources
Coleen 1-1. Sullins., Director
Division of Water Quality
January 5, 2009
Mr. Jeffrey D. Fickett
Weyerhauser Company
184 Gentry Road
Elkin, NC 28621
Subject: NPDES Stormwater Permit
Permit No. NCGZ10115
Representative Outfall Status Request
Weyerhauser Company
Surry County
Dear Mr. Fickett:
The Winston-SaIem Regional Office staff have reviewed your request dated November 24th for a
determination that stormwater discharge outfall (SDO) 001 be granted representative outfall status for
stormwater outfalls 002, 003, 004, and 005. Based on the information and maps provided and the site
visit our office performed on December 10, 2008, we are approving this reques , In accordance with 40
CFR §122.21(g)(7), you are authorized to sample outfall number 001 as a representative outfall.- This
approval is effective with the next sampling event. We also want to remind you that the permit still
requires Qualitative Monitoring be performed at all SDOs, regardless of representative status.
Please remember that any actions you initiate in response to benchmark exceedences as directed in the
tiered response provisions of your permit must address all drainage areas represented by SDO 001, where
appropriate.
Please append this'letter to your Stormwater Pollution Prevention PIan (SPPP) or permit to document
that representative outfall status has been approved. If changes in drainage areas, structures,
processes, storage practices, or other activities occur that significantly alter the basis of this approval,
representative outfall status may no longer be valid. You should either resume sampling at all SDOs,
or reapply to this -office for representative outfall status based on updated information. If you have any
questions or comments concerning; this letter, please contact me at [phone].
Since ele.Tedder
eve 1�1
Regional Supervisor
cc: Winston Salem Regional Office
Central Office/Stormwater Permitting Unit
Central Files
I z
�a p n.
z
D r-i
!S d o ry
7 �
NMhCarolina
Naturally
North Carolina Division of'A'ater Quality 1617 Mail Service CenterRaleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: www.ncwatcroualitv.org Location: 512 N. Salisbury St. Raleigh, NC 27604 Fax [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

Weyerhaeuser NR Company
184 Gentry Road, Elkin, NC 28621
m
by Weyerhaeuser
November 24, 2008
NC DENR Division of Water quality
Surface Water Protection Section
585 Waughtown Street
Winston Salem, NC 27107
RE: Weyerhaeuser Company
Surry County
Stormwater Permit - COC Number NCG210115
Representative Outfall Status Request (ROS)
To Whom It May Concern:
>M.C, ko
0ont�afV#
AOV262M8
winstart•8i16m
mil°-�0Mc"
Enclosed you will find a completed Representative Outfall Status Request Form for the above referenced stormwater
certificate of coverage. This recently renewed permit requires sampling at each outfall identified by this permit. We
are requesting ROS as documented on the completed form for the reasons explained below.
We are requesting Outfall #1 be designated Representative Outfall Status for this facility as all industrial
activity that occurs at this facility does occur also in the areas that drain to Outfall 41. A map showing the
outfalls, direction of stormwater flow, roadways and activity areas is enclosed. Stormwater from these
areas enters into a series of detention ponds before being released to the Yadkin River.
Very little industrial activity occurs in the areas where stormwater originates that then discharges to outfalls
2, 3; 4 and 5 (see bulleted lists below) and the activity that does occur in these areas also occurs in the area
where stormwater for outfall 41 discharge originates.
Industrial activity that occurs in Outfall 41 area includes:
• Log truck loading / unloading
• Log storage
• Wood residual storage / loading /unloading
• Mobil Equipment use
• Fuel -loading 1 unloading
• Board truck traffic (finished product shipment)
• Building storm gutter drainage
Industrial activity occurring in areas that drain to outfall 92, 3, 4 & 5 includes:
• Board truck traffic (actual board truck loading occurs inside the building)
• Occasional mobile equipment traffic (not often)
• Building storm gutter drainage
Additionally, discharges from outfall 4s 2, 3, 4 and 5 actually drain into grassy / wooded areas (sheet flow) and the
water is typically absorbed into the ground before it reaches the Yadkin River. It is unusual for stormwater from

these sources to actually reach the river but any stormwater that does would have passed through grassy /wooded
areas before reaching the river. The nature of outfalls 2, 3, 4 and 5 will also make sampling difficult or require some
type of structure to be built to capture the discharge or add some type of pipe to the storm drain to facility sampling.
Please note the requirement to sample stormwater is new to this facility with this permit renewal and no sampling
has occurred to date as the renewed permit was not received by during October. Although the permit cover letter is
dated September 12, 2008 the package was actually mailed to our corporate office in the state of Washington. This
is a significant change and we have not had a lot of time to put systems in place to address the changes.
Based on conversation with the regional office we believe this is a legitimate request and we are requesting the ROS
be granted for the current semi-annual period (Oct — Dec 2008). Please advise ASAP if this is not possible as we are
currently only set up to sample at outfall #1 and if the request is not approved we will need to engineer some type of
capture devise and order a lab kits for additional samples before the end of the year.
If you have any additional questions please contact Billie Caudill at [phone] or
billie.caudillCaD.weyerhaeuser. com.
nit General Manager

NCDENR
f NY+r..­ ,T uu, Nsv±nr- Rr'�p,nrrl�
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
REPRESENTATIVE OUTFAIA, STATUS (ROS)
REQUEST FORM
FOR AGENCY USL ONLY
Date Received
5'ear
Ykmih
Day
If a facility is required to sample multiple discharge locations with very similar stormwater discharges, the
permittee may petition the Director for Representative Outfall Status (ROS). DWO may grant
Representative Outfall Status if stormwater discharges from a single outfall are established as
representative of discharges from multiple outfalls. Approved ROS will reduce the number of outfalls
where analytical sampling requirements apply.
If Representative Outfall Status is granted, ALL outfalls are still subject to the Qualitative monitoring
requirements of the facility's permit. After ROS is granted, the facility must notify DWO in writing if any
changes to the facility or its operations take place that would affect this status. The approval letter from
DWO must be kept on -site with the facility's Stormwater Pollution Prevention Plan.
For questions, please contact the DWO Regional Office for your area (see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
fV C' S R C G'% (�J
2) Facility Information:
Owner/Facility Name
Facility Contact
Street Address
City
County
Telephone No.
3) List the representative outfall(s) information (attach additional sheets if necessary):
Outfall(s) I is representative of Outfall(s) 3, 31_ H . S
Outfalls' drainage areas have the same or similar activities? -0-Yes ❑ No
Outfalls' drainage areas contain the same or similar materials?
�4 Yes
❑ No
Outfalls have similar monitoring results?
© Yes
❑ No
;S$o data*
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities?
❑ Yes
❑ No
Outfalls' drainage areas contain the same or similar materials?
❑ Yes
❑ No
Outfalls have similar monitoring results?
© Yes
❑ No
❑ No data*
Outfall(s) is representative of Outfall(s)
Outfalls' drainage areas have the same or similar activities?
❑ Yes
❑ No
Outfalls' drainage areas contain the same or similar materials?
❑ Yes
❑ No
Outfalls have similar monitoring results?
❑ Yes
❑ No
❑ No data*
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
Page t of 3
SWU-ROS-090508 Last revised 9/5/2008

Representative Outfall Status Request
4) Detailed explanation about why the outtalks above should be granted Representative Status:
(Or, altach a letter or narrative to discuss this information.) For example, describe how activities and/or
materials are similar. `1 Cf4
5) Certification:
North Carolina General Statute 143-215.6 l i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000).
hereby request Representative Outfall Status for my NPDES Permit. I understand that ALL outfalls are still
subject to the qualitative monitoring requirements of the permit. I must notify DWO in writing if any changes to
the facility or its operations take place after ROS is granted that may affect this status. If ROS no longer
applies, I understand I must resume analytical monitoring of all outfalls as specified in my NPDES permit.
cetlify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
-t~ i �- --I\ t < 1, t t
Printed Name of Person ning:
Title: n r �C �' i1 'n C2 r-1Q5
k 4zV,,%L[x�&!
(Date Signed)
Please note: This application for Representative Outfall Status is subject to approval by the
NCDFNR Regional Office. The Regional Office may inspect your facility for compliance with
the conditions of the permit prior to that approval.
Final Checklist for ROS Request
This application should include the following items:
H� This completed form.
El" Letter or narrative elaborating on the reasons why specified outfalls should be granted representative status,
unless all information can be included in question 4.
M-" Two (2) copies of a site map of the facility with the location of all outfalls clearly marked, including the
drainage areas, industrial activities, and raw materials/finished products within each drainage area.
0 Summary of results from monitoring conducted at the outfalls listed in Ouestion 3.
a Any other supporting documentation.
Page 2 of 3
SWU-ROS-090508 Last revised 9/5/2008

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30"X42" NTS E710C-WEY-001 I 2

184 Gentry Road, Elkin, NC 28621
■
TH
� A
by Weyerhaeuser
November 18, 2008
NC DENR — DWQ
Surface Water Protection Section
1617 Mail Service Center
Raleigh, NC 27699-1617
RECEIVED
N.C, Deot. of ENR
DEC_ p 1200�
Winttomsalem
Regional p'iice
Subject: Ownership and Name Changes for Weyerhaeuser Company
Elkin Facility
Stormwater Permit Certificate of Coverage NCG210115
To Whom It May Concern:
Effective January 1, 2009 (the "Effective Date"), Weyerhaeuser Company will assign substantially all of its
manufacturing assets and liabilities to Weyerhaeuser NR Company, a wholly owned subsidiary of
Weyerhaeuser Company. The above -referenced permit is included in the assets and liabilities being
transferred from Weyerhaeuser Company to Weyerhaeuser NR Company. As of the Effective Date,
Weyerhaeuser NR Company will assume and accept the rights and obligations associated with performing
the permit and its conditions. Weyerhaeuser is submitting applications for name and ownership changes
for its Elkin facility.
There will be no physical changes to operations at the facility as part of these applications. Weyerhaeuser's
desire is to have the changes completed by January 1, 2009, We appreciate the agency's willingness to
assist in accomplishing this goal.
Signed application forms for these changes are enclosed along with the required fee. If you have any
questions please contact Billie Caudill at [phone] or [e-mail]
Respectfully,
f r ckett
Unit General Manager
Weyerhaeuser
C: DWQ — Surface Water Protection Section - Winston Salem Regional Office

' Weyerhaeuser
184 Gentry Road, Elkin, NC 28621
■
um'"
by Weyerhaeuser
November 18, 2008
NC DENR — DWQ
Surface Water Protection Section
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Ownership and Name Changes for Weyerhaeuser Company
Elkin Facility
NPDES Permit Certificate of Coverage NCG500272
To Whom It Mav Concern:
Effective January 1, 2009 (the "Effective Date"), Weyerhaeuser Company will assign substantially all of its
manufacturing assets and liabilities to Weyerhaeuser NR Company, a wholly owned subsidiary of
Weyerhaeuser Company. The above -referenced permit is included in the assets and liabilities being
transferred from Weyerhaeuser Company to Weyerhaeuser NR Company. As of the Effective Date,
Weyerhaeuser NR Company will assume and accept the rights and obligations associated with performing
the permit and its conditions. Weyerhaeuser is submitting applications for name and ownership changes
for its Elkin facility,
There will be no physical changes to operations at the facility as part of these applications. Weyerhaeuser's
desire is to have the changes completed by January 1, 2009. We appreciate the agency's willingness to
assist in accomplishing this goal.
Signed application fonns for these changes are enclosed along with the required fee. If you have any
questions please contact Billie Caudill at [phone] or [e-mail]
Respectfully,
141�
e ckett
Unit General Manager
Weyerhaeuser
C: DWQ — Surface Water Protection Section - Winston Salem Regional Office

Stormwater Inspection Form
NCG �, 0
General Information:
� i � 1
Facility: \�V�Q�C���.,V�� _
Mailing Address:.
City; J ���,�� State: Zip: 6\
Telephone Number: ( �—O�-
■ ■ [ a ■ ■ a a a 1 a ■ ■ ■ ■ ■ ■ ■ ■ ■ / ■ ■ ■ ■ ■ ■ a ■ ■ a ■ ■ ■ [ ■ a 1 ■ a a is ■ a [ a a ■ a-/ a a a a ■ ■ ■ ■ ■ ■ [ ■ a ■ ■ / ■ a [ a ■ ■ ■
Facility Information:
Contact Person:\�.,c� Title:
Physical Address:
Permit Number: IN�.`.— County: J s
■ a a a / ■ a a ■ ■ ■ ■ ■ a ■ ■ ■ ■ a 1 [ [ ■ / ■ / ■ ■ ■ ■ a ■ a ■ ■ [ ■ . ■ [ 1 [ ■ ■ . 1 [ [ ■ ■ ■ ■ ■ . ■ ■ [ ■ a a ■ ■ ■ ■ 1 1 . ■ . [ a . 0
Key Permit Requirements:
Yes No NA
Yes No
Implement SPPP
w Analvtical Monitoring
'NA
Y QL Tz'
Q
Secondary Containment
1/ — —
_ _
Qualitative Monitoring
✓�
Comments: ��O. wtt�l'tlli�
1 �
Inspector: Date:

I
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Colcen H. Sullins, Director
Division of Water Quality
September 12, 2008
LegaIT epartFe t
Weyerhaeuser:Comp
33663 Weyerhaeuser Way,;S
Federal Vllay, WA 9800
Subject: NPDES Stormwater Permit Coverage Renewal
Weyerhatruser:Elkin Slructurwood
COC Number NCG210115
S ru County
Dear Permittee:
In response to your renewal application for continued coverage under stormwater General Permit NCG210000 the Division of
Water Quality (DWQ) is forwarding herewith the reissued stormwater General Permit. This permit has been reissued pursuant to
the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between the state of North
Carolina and the U.S. Environmental Protection Agency, dated October 15, 2007.
The following information is included with your permit package:
• A new Certificate of Coverage
• A copy of stormwater General Stormwater Permit NCG210000
• A copy of the Technical Bulletin for the General Permit
• Five copies of the Discharge Monitoring Report (DMR) Form
• Five copies of the Qualitative Monitoring Report Form
The General Permit authorizes discharges of stormwater only, and it specifies your obligations with respect to stormwater
discharge controls, management, monitoring, and record keeping. Please review the new permit to familiarize yourself with all
the changes in the reissued permit.
The more significant changes to the General Permit include the following:
• Permit cover page, second paragraph — The General Permit now may cover activities that DWQ determines to be similar in
either the process, or in the exposed materials, to the Timber Products Industry.
• Part I Section A — A new provision that facilities draining to 303(d) listed waters, or in watersheds with an approved TMDL,
may not be eligible for continued coverage at the next renewal of the General Permit.
• Part I Section B second paragraph — A new clarification that the permit does not authorize discharges that DWQ determines
are wastewaters.
• Part 11 Section A — The required contents of the Stormwater Pollution Prevention Plan have been expanded and clarified.
• Part I I Section B Table 1 — A new requirement to sample stormwater discharges twice per year for those facilities with
exposed piles of certain materials remaining on site longer than seven days.
• Part II Section B Tables 2 and 3 and following — For permittees with exposed piles, there are new provisions requiring the
permittee to execute Tier One and Tier Two response actions, based on the first benchmark exceedence (Tier One) and the
second consecutive benchmark exceedence (Tier Two). Tier Two requires that the permittee institute monthly monitoring
instead of twice -per -year monitoring, until three consecutive monitoring events show no benchmark exceedences.
+ Part II Section B — For permittees with exposed piles, a new provision that four exceedences of any particular benchmark
will trigger increased DWQ involvement in the permittee's stormwater management and control actions. DWQ may direct
the permittee to apply for an individual permit, or may direct the implementation or installation of specific stormwater control
measures.
• Part 11 Section C — Clarification that under the qualitative monitoring provisions of the permit, the permittee is obligated to
respond to repeated observations of stormwater pollution. DWQ may impose additional stormwater management
requirements if the permittee is non -responsive, or if the responses are ineffective.
Your coverage under the General Permit is transferable only through the specific action of DWQ.
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617
Internet h2o.enr.state.nc.uslsulstormwater.html 512 N. Salisbury St. Raleigh, NC 27604
An Eq4 OpportunitylAffirmative Acton Employer — 50% Recycledll0% Post Consumer Paper
a ` NfhCarolina
Naturally
Phone [phone] Customer Service
FAX [phone]

NPDES Stormwater Permit Coverage Renewal
Permit Number NCG210115
Page 2
This permit does not affect the legal requirements to obtain other permits which may be required by NCDENR, nor does it relieve
the permittee from responsibility for compliance with any other applicable federal, state, or local law, rule, standard, ordinance,
order, judgment, or decree.
If you have any questions regarding this permit package please contact Ken�Pickle of the Central Office Stormwater Permitting
Unit at [phone].
Sincerely,
It
for Coleen H. Sullins
cc: DWQ Central Files
Stormwater Permitting Unit Files
Winston=Salem Regional Office
1

I
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG21000_0
CERTIFICATE OF COVERAGE No. NCG210115
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and
the Federal Water Pollution Control Act, as amended,
is hereby authorized to discharge stormwater from a facility located at
Weyerhaeuser� EIkiwStructurw d
184 GOf"' ' Rd
Elkin
Surry County
to receiving waters designated as the Yadkin River, a class C stream in the Yadkin-Pee'Oee River Basin in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II,
III, IV, V, and VI of General Permit No. NCG210000 as attached.
This certificate of coverage shall become effective September 15, 2008,
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day September 12, 2008.
for Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

vtichael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen I . Sullins, Director
Division of Water Quality
March 12, 2008
Mr. Tommy E. Glisson, Unit Manager
Weyerhaeuser Company
184 Gentry Road
Elkin, NC 28621
Subject: General Stormwater Permit Inspection
Weyerhaeuser Company
Certificate of Coverage # NCG210115
Surry County
Dear Mr, Glisson:
On March 11, 2008, Gary Hudson of this office met with Billie Caudill to perform a
General Stormwater Permit Inspection at the Weyerhaeuser OSB facility located near Elkin.
This inspection evaluated the areas designated on the attached inspection form.
Observations from each area are addressed below:
1. Permit
Weyerhauser holds Certificate of Coverage # NCG210115 for the discharge of stormwater
from the facility. The General Permit became effective May 1, 2003 and expires April 30,
2008.
2. Records/Re orts
Part II, Section A of the permit requires the development of a Stormwater Pollution
Prevention Plan (SPPP). A copy of the SPPP was available for review. The plan contained
all of the items required by the stormwater permit. Please note that the permit requires the
plan to be reviewed and updated on an annual basis.
3. Facility Site Review
The site appeared clean and well managed. No concerns or problems were noted. As part
of this facilities ongoing commitment to this stormwater program, several acres in the log
storage area have recently been covered with 18" of concrete. This office greatly
appreciates the efforts of the Weyerhaeuser Company in continual improvement in regards
to the control of its stormwater discharge.
4. Effluent/Receiving Waters
Stormwater runoff from the facility reaches the Yadkin River, Class "C waters in the
Yadkin/Pee-Dee River Basin.
o `
NhCarolina
dValurrrllj
North Carolina Division of Water Quality 585 Waughtown Street Winston Salem, NC 27107 Phone [phone] Customer Service
inlemetwww.ncwaterauality.org FAX [phone]
AD Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

Mr. Tommy Glisson
Page #2
March 12, 2008
5._Monitoring Program
Part II, Section B of the permit requires that semi-annual qualitative (visual) monitoring be
performed and documented once in the spring (April - June) and once in the fall (September
— November). A review of the facility files found that the qualitative monitoring has been
conducted as required.
The analytical monitoring for on -site vehicle maintenance listed in Section C of the permit is
not required since the Weyerhaeuser facility uses less than 55 gallons of new motor oil per
month when averaged over the calendar year.
Should you have any questions concerning this letter, please contact Gary Hudson or
me at [phone].
Sincerely,
Steve W. Tedder
Water Quality Regional Supervisor
cc: NPS Assistance and Compliance Oversight Unit
Central Files — SWP
WSRO

Permit: NCG210115
SOC:
County: Surry
Region: Winston-Salem
Compliance Inspection Report
Effective: 05/01J03 Expiration: 04/30/08 Owner: Weyerhaeuser Company
Effective: Expiration: Facility: Weyerhaeuser Elkin Structurwood
184 Gentry Rd
Contact Person: Tommy E Glisson
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 03/1112008
Primary Inspector: Gary Hudson
Secondary Inspector(s):
Title:
Entry Time: 01:00 PM
Elkin NC 28621
Phone: [phone]
Certification
Exit Time: 03:00 PM
Phone:
Phone:
Reason for Inspection: Routine Inspection'Type: Stormwater
Permit Inspection Type: Timber Products Stormwater Discharge COC
Facility Status: ® Compliant ❑ Not Compliant
Question Areas:
® Storm Water
(See attachment summary)
Page: 1

Permit: NCG210115 Owner - Facility: Weyerhaeuser Company
Inspection Date. 03/11/2008 Inspection Type: Stormwater Reason for Visit. Routine
Stormwater Pollution Prevention Plan Yes No NA NE
Hoes the site have a Stormwater Pollution Prevention flan? a n n n
# Does the Plan include a General Location (USGS) map?
®
o
n
n
# Does the Plan include a "Narratve Description of Practices"?
®
n
n
n
# Does the Plan include a detailed site map including outfali locations and drainage areas?
rl
n
n
# Does the Plan include a list of significant spills occurring during the past 3 years?
®
u
n
n
# Has the facility evaluated feasible alternatives to Current practices?
®
r l
n
n
# Does the facility provide all necessary secondary containment?
®n
n
n
# Does the Plan include a BMP summary?
®
! i
n
n
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
m
n
n
n
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
®n
n
n
# Does the facility provide and document Employee Training?
no
n
n
# Does the Plan include a list of Responsible Party(s)?
n
n
n
# Is the Plan reviewed and updated annually?
®n
n
71
# Does the Plan include a Stormwater Facility Inspection Program?
®n
n
n
Has the Stormwater Pollution Prevention Plan been implemented?
®
n
n
n
Comment:
Qualitative Monitoring
Yes
No
NA
N
Has the facility conducted its Qualitative Monitoring semi-annually?
®
n
n
n
Comment:
Analytical Monitoring
Yes
No
NA
NE
Has the facility conducted its Analytical monitoring?
ri
n
lm
n
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
n
n
®
n
Comment: .
Permit and Outtalis
Yes
No
NA
NE
# Is a copy of the Permit and the Certificate of Coverage available at the site?
®
n
n
n
# Were all outfalls observed during the inspection?
®
n
n
n
# If the facility has representative outfall status, is it properly documented by the Division?
n
n
®
n
# Has the facility evaluated all illicit (non stormwater) discharges?
0
0
n
n
Comment:
Page. 3

� NJ A TF
9
Michael F. Easley, Governor
QG
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
`O'
Alan W. Klimek, P.E. Director
Division of Water Quality,
o �
RFCEnIVED
FHNS
N-C. DeP'. ,'
Jeffrey D. Fickett
Weyerhaeuser Elkin Structurwood
PO Box 590
Elkin, NC 28621
Dear Permittee:
April 28, 2003 APR 3 0 2003
Winston-Salem
Regional office
Subject: NPDES Stormwater Permit Renewal
Weyerhaeuser Elkin Structurwood
COC Number NCG210115
Surry County
In response to your renewal application for continued coverage under general permit NCG210000, the
Division of Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This
permit is reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between the state of North Carolina and the U.S. Environmental Protection
Agency, dated December 6, 1983.
The following information is included with your permit package:
• A new Certificate of Coverage
• A copy of General Stormwater Permit NCG210000
• A copy of the Analytical Monitoring Form (DMR)
A copy of the Qualitativel Monitoring Form
A copy of a Technical Bulletin for the general permit
Your coverage under this general permit is not transferable except after notice to DWQ. The Division
may require modification or revocation and reissuance of the Certificate of Coverage. This permit does
not affect the legal requirements to obtain other permits which may be required by the Department of
Environment and Natural Resources, or relieve the permittee from responsibility for compliance with any
other applicable federal, state, or local law, rule, standard, ordinance, order, judgment, or decree.
If you have any questions regarding this permit package please contact Bill Mills of the Central Office
Stormwater and General Permits Unit at [phone], ext. 548.
Sincerely,
b "I/ely —
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Stormwater & General Permits Unit Files
Winston-Salem Regional Office
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
AGA
NCDENOR
Customer Service
1 800 623-7748

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO, NCG210000
CERTIFICATE OF COVERAGE No, NCG210115
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Weyerhaeuser Company
is hereby authorized to discharge stormwater from a facility located at
Weyerhaeuser Elkin Structurwood
184 Gentry Road
Elkin
Surry County
to receiving waters designated as the Yadkin River, a class C stream, in the Yadkin - Pee Dee
River Basin in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, III, IV, V, and VI of General Permit No. NCG210000 as
attached.
This certificate of coverage shall become effective May 1, 2003.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 28, 2003.
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Michael F. Easley, Govemor
William G. Ross Jr., Secre;ary
North Carolina Department of Environment and Natural Resources
Alan W. Minnick, P,E., Director
Division of Water Quality
Septeinher 4, 2002
.1EITRfiY D. FICKETT
WEY[ RI•IAEUSFR/ SURRY
PO 130X 590
ELKIN. NC 28621
Subject: NPDES Sturrnwaler PCrn)ii Coverage Renewal
WCycrhaeuscr/ Sui-i-y
COC Number neg2101 15
Surry County
Dear Perwittee:
Your facility is currently covered for stormwater discharge under General Permit NCG210(XH). 'Phis perinit expires
on March 31. 2(X)3. The Division staff is currently in the process of rewrltin�- this permit and is scheduled to have
the: permit reissued by early spring of 2003. Once the perinil iS reissued, yoln- facility would he eligible lily
Continued covur)4fe under tic rcissuCcl pCrrllit.
In order to assure your continued CovcragC under tile; general permit, you must apply to tie Division of Water
Ou,tlity (DWQ) for roilowal of your permit Coverage. To make this renewal process casiar, we are informing YOU ill
advancethat your perilllt coverage will 11c expiring. Encloscd you will find a Perittit Coverage Renm.411
Application Form. The application nuist he completed and returned by October 2. 2(X)2 in order to assure
Continued Coverage under the general perinil. Due to staff arld budget constraints, letters conf7rining our receipt of
the Completed application will not he Scant.
Failure to request renewal within the lin)c periml specified. may resell in a civil assessment of at least $250.(X). .
Larger penalties may hC assessed dcpcnding on the dClinquCnry of the iuyuCSt. Di,scha, gC of stormwater from vottl'
facility without coverage under a valid siorniwalcr NPDES perinil would cnnstitule .r violation of NC:C;S !d3-215,
and could result in assess)nents of civil pena.116" of up to $10.10Ai() IXt- day.
PIC,1Sc notC Ihat rCCunl I'CLCra1 ICgisl.ltion has CxtcndC(l 111C "no exposure exclusion" to all operators of industrial
facilities ill any of the I I categories of "storin water discharges associated will) industrial activity." (except
construction activities). If you li el yuur facility can certify a condition of "no cxpoSure". i.e. the facility industrial
materials and operations :Ere not exposed to stormwater, you Can apply for the no exposure exclusion. For additional
information contact the Central Office Storntwalcr Staff incinher listed below or Check the Storinwalcr & General
I'crolils Unit WCh Site at hstp:/lh2o,cocast.ite.nc.uslsu/stut'ntwatcr.hlIll
If the Suhjcct slortnwalerdisehargC to waters of the state has becn terminated, please complete the enclosed
Rescission Request Form. NLkilitW irlstnlCtions ,tre lis1C(I on IhC bontorn of, the form. You will be notified when the
rescission process has been Completed.
ll'you have any tluCslions rcgardin�g the perrllit renewal procedures'plcasc eonlact Corey Basinger of the
Winston-Salem Reg=ional Office at 336-771-4600 or Bill Mills of, the Cuntnrl Off ice Sloriuwatcr Unit at' (919)
733-5083. exi. 54S
Sincerely,
Bradley B0111 tt. Supervisor
Stornlwaler and General Perrrlils Unit
cc: Central Files
Stormwaler and General 1'urn)its Unit Filcs
Wirlstull-Salem Regional Office
N. C. Division of Water Quaiity 1617 Maii Service Center Raleigh, NC 27699-1617 [phone]
d� A
NCDENR
Customer Service
1- 800-623.7748

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MAP COMPLIES WITH NATIONA{�MAP ACCURACY STANDARDS
BY U.S. GEOLOGICAL SURVEY, WASHINGTON. D. C. 20242
IISING 70PUGRAPHIC MAPS AND SYMBOLS IS AVAILABLE ON REQUEST
QUADRANGLE LOCATION
Primary highway,' Light -duly road,, hard or
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k N3615-­W8045/7.5
1971
AMS 4856 IV SE —SERIES V642

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Govemor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
May 1, 1998
DAVID L CRAFT
WEYERHAEUSER CO-SURRY
33663 WEYERHAEUSER WAY SOUTH
TACOMA, WA 98477
Subject: Reissued Stormwater General Permit for
Certificate of Coverage No. NCG210115
Surry County
Dear Permittee:
LT.8;qA1
[D E N R
In response to your renewal application for continued coverage under the General Permit
NCGO40000, the Division of Water Quality (DWQ) is forwarding herewith the General Permit
NCG210000 which is anew General Permit to cover most of the Timber Products Industry. You
have now been given coverage under NCG210000 and your coverage under NCGO40000 is hereby
terminated. This permit is issued pursuant to the requirements of North Carolina General Statute
143-215.1 and the Memorandum of Agreement between North Carolina and the US Environmental
Protection Agency dated December 6, 1983.
The following information is included with your permit package:
■ A copy of the stormwater general permit NCG210000.
■ A new Certificate of Coverage under general permit NCG210000.
■ A Stormwater Pollution Prevention Plan Certification Form. This form certifies that you have
developed and implemented the Stormwater Pollution Prevention Plan (SPPP) required in your
permit (both NCGO40000 and NCG210000). This form must be completed and returned to the
Division within 30 days of receipt of this letter. DO NOT send the SPPP with the signed form.
■ Five copies of Analytical Monitoring forms.
■ Five copies of Qualitative Monitoring forms.
w A copy of a Technical Bulletin on the stormwater program which outlines program components
and addresses frequently asked questions.
Your certificate of coverage is not transferable except after notice to DWQ. The Division of Water
Quality may require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by
DWQ or permits required by the Division of Land Resources, Division of Air Quality, Coastal Area
Management Act or any other Federal or Local governmental permits that may be required.
If you have any questions concerning this permit or other attached documents, please contact the
Stormwater and General Permits Unit at telephone number [phone],
Sincerely,
f" A. Preston Howard, Jr., P. E.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY '
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE NO. NCG210115
STORMWATER DISCHARGES
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and
the Federal Water Pollution Control Act, as amended.,
WEYERHAEUSER CO-SURRY
is herby authorized to discharge stormwater from a facility located at:
ROUTE 3, STATE ROAD 1141
ELKIN, NC
SURRY COUNTY
to receiving waters designated as Yadkin River in the Yadkin -Pee Dee River Basin
in accordance with the effluent limitations, monitoring requirements and other conditions set forth in Parts I,
1I, III and IV of General Permit No. NCG210000 as attached.
This Certificate of Coverage shall become effective May 1, 1998.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day May 1,1998
for A Preston Howard, Jr., F.E., Director
Division of Water Quality
By Authorization of the Environmental Management Commission

State of North Carolina
Department of Environment, Health and Natural Resources
Division of Environmental Management
512 North Salisbury Street - Raleigh, North Carolina 27604
James B. Hunt, Jr., Governor
March 19, 1993
David L. Craft
33663 Weyerhaeuser Way South
Tacoma, WA 98477
Jonathan B. Howes, Secretary
Subject: General Permit No. NCG040000
Weyerhaeuser ESP
COC NCG040115
Surry County
Dear Mr. Craft:
In accordance with your application for discharge permit received on September 21, 1992, we
are forwarding herewith the subject certificate of coverage to discharge under the subject state -
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina
General Statute 143-215 .1 and the Memorandum of Agreement between North Carolina and the
US Environmental Protection agency dated December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual
permit application. Unless such demand is made, this certificate of coverage shall be final and
binding.
Please take notice that this certificate of coverage is not transferable except after notice to the
Division of Environmental Management. The Division of Environmental Management may
require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be
required by the Division of Environmental Management or permits required by the Division of
Land Resources, Coastal Area Management Act or any other Federal or Local governmental
permit that may be required,
Pollution Prevention Pays
P.O. Boa 29535, Raleigh, North Carolina 27626.0535 Telephone [phone]
An Equal Opportunity A,f]lrmative Action Ernployer

If you have any questions concerning this permit, please contact Mr. Steve Ulmer at telephone
number 919n33-5083.
Sincerely,
Original Signed B
Coleen H. Sullins
A. Preston Howard, Jr.
Acting Director
cc: Winston-Salem Regional Office

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
STORMWATER DISCHARGES
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Weyerhaeuser Company
is hereby authorized to discharge stormwater from a facility located at
Weyerhaeuser ESP
SR 1141
Elkin
Surry County
to receiving waters designated as the Yadkin River in the Yadkin -Pee Dee River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I,11, III
and IV of General Permit No. NCGO40000 as attached.
This Certificate of Coverage shall become effective March 19,1993.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day March 19, 1993.
Original Sig"ed E.
Coleen H. Sullins
A. Preston Howard, Jr., RE., Director
Division of Environmental Management
By Authority of the Environmental Management Commission

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_E BY U. S. GEOLOGICAL SURVEY, WASHINGTON, D. C. 20242
:RIBING TOPOGRAPHIC MAPS AND SYMBOLS IS AVAILABLE ON REQUEST
w�y�IZHa�.usFrL ��KIN
NC.�
EQVADRANGLE LOCATION
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ELKIN NORTH, N. C.
N3615—WO045/7.5
1971
AMS 4856 IV SE —SERIES V942

FACILITY'5�
0.,
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5 Urry
NPDES
Afc- o 40115
MAP #
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sue ASIN
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EXPIRATION DATE.
0(6-3/-y7

16 LIN
Dec. 2008 001 Dec, 2008 002 Dec, 2008 003 Dec, 2008 004 Dec 2008 005
Dec, 2008 006 Dec, 2008 007 Dec, 2008 008 Dec, 2008 009 Dec. 2008 010
h
Dec, 2008 011 Dec, 2008 012 Dec, 2008 013 Dec. 2008 014 Dec, 2008 015
Dec. 2008 016 Dec, 2008 017 Dec 2008 018 Dec. 2008 019 Dec, 2008 020
Dec, 2008 021 Dec, 2008 022 Dec, 2008 023 Dec, 2008 024 Dec, 2008 025
Dec. 2008 026 Dec, 2008 027