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Home My WebLink AboutNCS000571_Rogers Energy Complex (Cliffside) Revised Form 1 Signed_20140918Please print or type in the unshaded areas only (fill-in areas are spaced forelite tvna i a 19 eharmrfn 1-1,l Fnr AnnrnVari r)KAR Pin 911An_nnRR Ann—.,..1 --- FORM U.S. ENVIRONMENTAL PROTECTION AGENCY I. EPA I.D. NUMBER 1 GENERAL INFORMATION S �^�E�� Consolidated Permits Program F NC0005088 D GENERAL Read the "General Instructions" before starting.) 1 2 13 LABEL ITEMS GENERAL INSTRUCTIONS I. EPA I.D. NUMBER If a preprinted label has been provided, affix it in the delig�gated s ce. Review the information carefully; ifan of it is III. FACILITY NAME incorrect cross through it and enter the correct data in the appropriate fill-in area below. Also, if any of the data is preprinted absent (the area to the left of the label V. FACILITY PLEASE PLACE LABEL IN THIS SPACE space fists the information that should MAILING LIST appear) please provide it in the proper fill - in areais) below. If the label is complete and correct you need not complete Items I, III, V, and VI (except VI-B which must be VI. FACILITY completed regardless). Complete all items LOCATION if no label has been roved. Refer to the instructions for detailed item descriptions and for the legal authorization under which this data is II. POLLUTANT CHARACTERISTICS collected. Complete A throughto determine whether you need to submit any permit application forms to the PA. you answer yes to any questions, you must submit this form and the supplemental from listed in the parenthesis following the question. Mark in the box in the third column if the supplemental form is attached. If you answer 'no" to each question, you need not submit any of these forms. You may answer *no" if your activity is from excluded Dermit requirements; see Section C of the instructions. See also Section D of the instructions for definitions of bold-faced terms. SPECIFIC QUESTIONS MARK 'X' SPECIFIC QUESTIONS MARK 'X' YES ❑ NO ® FORM ATTACHED. ❑ YES NO FORM ATTACHED A. s t is facility a publicly owns treatment worksDoes which results in a discharge to waters of the or Nn this facility(either exrstmg or proposed) include a concentrated U.S.? (FORM 2A) animal feeding operation or aquatic animal ❑ ® ❑ production facility which results in a discharge C. Is this facility which current y resu is in discharges to waters of the U.S. other than to waters of the U.S.? (FORM 2B) s this proposa as ity other than those escn 16 17 1s 19 20 1 21 those described in A or B above? FORM 2C r in A or B above) which will result in a discharge to waters of the U.S.? FORM 2D 22 ❑ 23 ® 24 ❑ 25 26 27 E. Does or wil t is aci treat, store, or dispose o hazardous wastes? (FORM 3) you or willyou Inject at this facility industrial or municipal effluent below the lowermost stratum ❑ ® ❑ containing, within one quarter mile of the well bore, underground sources of drinking water?28 G. o you or will you inject at this facility -any produced water other fluids which are brought to 29 30 FORM 4 o you or willyou inject at this aci ity fluids or 31 32 33 the surface in connection with conventional oil or natural ❑ ® ❑ special processes such as mining of suffer by the Frasch process, solution mining of minerals, in ❑ ® ❑ gas production, inject fluids used for enhanced recovery of oil or natural gas, or inject situ combustion of fossil fuel, or recovery of fluids for storage of liquid hydrocarbons? geothermal energy? (FORM 4) FORM 4 1. IS this tacility a proposed stationary —source which is one of the 28 industrial categories listed in the instructions J. is this ac ij a propose ata ovary source which is NOT one of the 28 industrial categories 34 ❑ 35 ® 36 ❑ 37 38 1 39 and which will potentially emit 100 tons per year of any air pollutant regulated listed in the instructions and which will potentially ❑ ® ❑ under the Clean Air Act and may affect or be emit 250 tons per year of any air pollutant regulated under the Clean Air Act and may affect 40 41 42 43 44 45 located in an attainment area? FORM 5 or be located in an attainment are? FORM 5 III. NAME OF FACILITY c SKIP Rogers Energy Complex 1 15 116 29 30 69 IV. FACILITY CONTACT A. NAME & TITLE last, first, & title B. PHONE larea code & no. 2 McGary, Mark / Lead Engineer 980 373 7898 1 46 48 49 51 s2 55 V. FACILITY MAILING ADDRESS 45 A. STREET OR P.O. BOX C P.O. Box 1006, Mail Coed EC13K D. ZIP CODE 15 18 45 B. CITY OR TOWN C. STATE 4 Charlotte NC 28201 15 16 VI. FACILITY LOCATION 40 41 42 1 47 s1 A. STREET, ROUTE NO. OR OTHER SPECIFIC IDENTIFIER C 573 Duke Power Road 15 1 16 45 B. COUNTY NAME Cleveland/Rutherford 46 70 C. CITY OR TOWN cEMooresboro D. STATE E. ZIP CODE F. COUNTY CODE NC 4 28114 034 15 1 16 40 41 42 47 51 1 1s2 sa EPA FORM 3510-1 (5-90) CONTINUED ON REVERSE CONTINUED FROM THE FRONT Vn. sic GUUES 4-dl It, in order ofpriority) A. FIRST B. SECOND c 4911 (specify) 7 (specify) Electric Services ,s 15 7a 19 C. THIRD D. FOURTH c (specify) 7 (specify) � 15 1s 17 15 116 18 VIII.OPERATOR INFORMATION A. NAME B. Is the name listed in Item s Duke Energy Carolinas, LLC (Attention: Mark McGary) VIII-A also the owner? 18 19 ® YES [:]NO C. STATUS OF OPERATOR Enter the appropriate letter into the answer box; if "Other's ci 55 D. PHONE area code & no. F = FEDERAL M = PUBLIC (other than federal or state) P (specify) 373 7898 S = STATE O = OTHER (specify) Electric UtilityFAP ��80 56 1e 19 2t 22 25 = PRIVATE 15 E. STREET OR PO BOX P.O. Box 1006, Mail Code EC13K 2s 55 F. CITY OR TOWN G. STATE H. ZIP CODE I IX. INDIAN LAND B Charlotte NC 1 28201 Is the facility located on Indian lands? 15 1 16 40 42 42 1 1 47 - 51 ❑ YES ® NO X. EXISTING ENVIRONMENTAL PERMITS A. NPDES (Discharges to Surface Water D. PSD Air Emissions from Proposed Sources NC0005088 e s N' 9 P 15 15 17 to 30 15 18 1 17 1 to 30 B. UI (Underpround hpiection of Fluids E. OTHER (specify) 1 (Specify) c T I s 1 U I T ° I 04044T39 Air Permit 151 18 1 17 1 18 30 15 16 17 1a 30 C. RCRA Hazardous Wastes E. OTHER (specify) (Specify) Landfill c 9 T R NCD043678986 ° e SWP 81-06/W00000452 5 Perm it/Distribution of 15 1 16 17 1 18 3p 16 17 18 1 1 Residual Solids Permit XI. MAP Attach to this application a topographic map of the area extending to at least one mile beyond property boundaries. The map must show the outline of the facility, the location of each of its existing and proposed intake and discharge structures, each of its hazardous waste treatment, storage, or disposal facilities, and each well where it injects fluids underground. Include all springs, rivers and other surface water bodies in the map area. See instructions for Drecise requirements_ F:011 Electric Gen a II. CERTIFICATION see instructions l certify under penalty of law that I have personally examined and am familiar with the information submitted in this application and all attachments and that, based on my inquiry of those persons immediately responsible for obtaining the information contained in the application, I believe that the information is true, accurate and complete. l am aware that there are significant penalties for submitting false information, including the possibft of fine and imprisonment NAME & OFFICIAL TITLE (type or print) I B._W. VATURE _ C. DATE SIGNED Rick R. Roper/General Manager II - Regulated Fossil Stations COMMENTS FOR OFFICIAL USE ONLY EPA FORM 3510-1 (8-90)