NCG030271_COMPLETE FILE - HISTORICAL_20141006

i
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV C� 03 0a� �
DOC TYPE
[�(, HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ `pia) 4 10 0
YYYYMMDD

a Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
a' Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
1- Article Addressed to:
Mr. Tom Thompson
Champion Industries, Inc.
3755 Champion Boulevard
Winston-Salem, INC 27105
❑ Agent
❑ Addressee
Is delivery address different from item 19 ❑ Yes
If YES, enter delivery address below: ❑ No
3. Type
Certified Mail ❑ Express Mail
Registered ❑ Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D.
4. Restricted Delivery? {Fxtre Fee) ❑ Yes
2. 7008 1140 110113 8505 6Q31 Its
PS Form 3811, February 2004 Domestic Return Receipt , 3 ` E O 102595-02-M-1540

UNITED STATES POSTAL. SERVICE
First -Class Mail
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box
NCDENR-Division► of Water Quality
_L - M-n u", 1) 14 -
585 Waug town Stre§t
Winston-Salem, NC 27107
II I I I I I I I I I I i i I ) I I i I I I I I I I I I I I i ? I I I I I4iIIIIIIIIIIjIiIlII111111

Taylor -Smith, Aana
From: t_aDonta Clark <[e-mail]>
Sent: Monday, October 06, 2014 11:02 AM
To: Tom Thompson([e-mail])
Cc: Keith Huff; John Spainhour; Taylor -Smith, Aana
Subject: Full Completion of the Champion Industries Inc. Inspection Package
Attachments: Champion Industries Inc. Inspection Package_final_completion_10-6_2014.pdf
Dear Mr. Thompson ,
This letter will serve as official notification that Champion Industries Inc. has successfully completed Part 4, Required
Actions to be completed by Facility, of the June 13, 2014 inspection report. A copy of my finished re -inspection form has
been enclosed for your documentary purposes. At this juncture Champion Industries Inc. has no outstanding inspection
compliance items to complete, A hard copy has been placed in the mail to your attention. 1 encourage you to contact
me with any questions or comments.
Ladonta Clark Oainal)
Stormwater Inspector
City of Winston Salcm
Stormwater/ l'rosion and
Sedimentation Control Program
Phone: [phone]
Cell: 336.416.2403
Fax: [phone]
City of Winston-Salem
ONE TEAM
Committed to Excellence
All a -mails including attachments sent to and from this address are subject to being released to the media and the public in accordance with the North Carolina
Public Records Law.

Public Works
Department
Stormwater/Erosion and
Sedimentation Control Program
Chy of insson-Salem
P.O. Box 2511
Winsoon.SAcrn.:VC 27102
GryiJ.k3it(336.727.8000)
Fax [phone]
uwnvror Ienman eom
Call 311 or 336-727-8000
[e-mail]
October 6, 2014
Mr. Tom Thompson
Facilities Manager
Champion Industries; Inc.
3765 Champion Blvd
Winston-Salem, NC 27105
Dear Mr. Tom Thompson:
The Stormwater Division of the City of Winston-Salem would like to thank
you for your time and professional courtesy regarding the submittal of
electronic documents of corrective actions due from Champion Industries
Inc.
Champion Industries Inc. has provided documentation that verifies the
successful completion of the corrective measures located in Part 4 —
Required Actions to be completed by Facility. At this time, Champion
Industries Inc. has no outstanding inspection compliance items to complete.
The Stormwater Division reserves the right to enter and inspect Champion
Industries Inc. as often as necessary to determine compliance with permit
requirements of NCG030271.
Thank you for your continued support and implementation of the City of
Winston-Salem's Stormwater Program. If you have any questions, please
feel free to contact me at [phone].
Sincerely; Lo_��
Ladonta " 3amal" Clark
Stormwater Inspector
Phone: [phone]
Cell: 336.416.2403
Fax: [phone]
atr Co —1 .%L ypr Allen Jninn; v,vo 11. Burke, Miyb No T mpom, Neah—, W rd; D=6L D. Adamc, Noah W—L Dm Bic, Soud— V.A knben C. dark. Wm %Int
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i4�11tti5'�fU
Stormwater/Erosion Control Division
Surface Water Re -inspection of Champion Industries, Inc.
Successfully
Completed?
Part 1-Required Actions_f am the June 13, 5614 inspection Yes No Notes
1) Has Champion Industries, Inc. replaced the leaking dumpster
at manufacturing building number two, in order to prevent
stormwater pollution, and ensured that the new dumpster has a
plug in it?
2) Did Champion Industries, Inc. denote that outfalls numbers
✓
three and four are not under analytical monitoring anymore in
the SPPP. Also, did they keep the records of proof in the SPPP?
3) Has Champion Industries, Inc. included the potential
f
pollutants that could be discharged, physical location of all
outfalls, and the latitude and longitude of all outfalls on the site
map?
4) Has Champion Industries, Inc. created a certification
✓
statement by the responsible corporate officer?
5) 4n the site map, has Champion Industries, Inc. listed that
Leaf Fork Creek is not a T'MDL stream?
5) Has Champion Industries, Inc. listed all major spills that have
+�
occurred within the past three years with corrective actions to
prevent future spills in the SPPP?
7) Has Champion Industries, Inc. updated the City of Winston
Salem, Storrnwater Division's contact information to Champion
Industries, Inc. Spill Notification List?
8) Did Champion Industries, Inc. update the feasibility study,
f
and the BMP summary? Have they shown effort to continue to
update its yearly?
9) Has the Spill Prevention and Response Procedure been
✓
updated and signed by the correct personnel for Champion
Industries, Inc.?
10) Did Champion Industries, Inc. provide documentation of the
res onsible party signature and dated material
11) Did Champion Industries, Inc. add the start and end time of
+�
each measurable rain event for the analytical monitoring and
qualitative monitoring:'
12) Has Champion Industries sampled for all discharge
characteristics concerning the analytical mortitorin ?
13) Did Champion Industries determine if they have to maintain
f
No solvent management
a solvent management plan in order to stay compliant to the
plan is needed
generalpermit?
2

14) Did Champion Industries maintain the semi-annual
✓
analytical monitoring throughout the monitoring schedule
located in the permit?
15) Has Champion Industries provided the pen -nit number for
✓
GP5000
the blower motor permit in SPPP?
Part 2 — Required Actions to be completed by Facility:.
1. None. Champion Industries Inc. has successfully completed all Required Actions to be completed
by the Facility of the June 13, 2014 inspection.
Signature of Stormwater Inspector: ze,5�.4�
Title: Stormwater Inspector
3

White, Sue
From: Torre Thompson<[e-mail]>
Sent: Thursday, September 25, 2014 8:13 PM
To: LaDonta Clark
Cc: White, Sue, Keith Huff; John Spainhour
Subject: Champion Industries Question/Guidance on Solvent Plan Requirements
Attachments: Parts Cleaner.jpg
Thank you LaDonta,
Dear Sue,
Champion Industries has a NPDES Stormwater General Permit: NCG030000 with a COC Number: NCG030271. During a
recent inspection by Mr. Clark, he asked me to determine if Champion Industries has to maintain a solvent management
plan and conduct Analytical Monitoring of Total Toxic Organics (TTO). Based on my knowledge, we have not been
required in the past but I wanted to ask your knowledge and guidance so we do the right thing if needed.
What I am unsure of is that we do have (2)small parts cleaning stations we call it for threading pipe on occasion. Please
see photo attached. These are used from time to time for assembling dish machines or plant maintenance. Whenever
the solvent gets too dirty (every'few years), the drum contents are recycled from a company called Nobel Oil.
Would you please review and provide guidance on whether we need to incorporate a solvent plan and test Analytically
for TTO?
Thank you,
Tom Thompson
Facilities/Safety
Champion Industries, Inc.
3765 Champion Blvd.
Winston Salem, NC 27105
Phone Direct: 336/201-4933
Cell: 336/655-6443
From: LaDonta Clark [mailto:ladontac(&cgofws.or j
Sent: Thursday, September 25, 2014 2:09 PM
To: Tom Thompson
Cc: sue.white ncdenr. ov; Keith Huff; John Spainhour
Subject: NCDNER Info
Sue White
Assistant Regional Engineer
Land Quality Section
Winston-Salem Regional Office
Division of Energy, Mineral, and Land Resources
Phone: [phone]
Fax [phone]
Ladonta Clary Qarnal)

Nceo-, -� 1
Public Vbdcs
Department
Stormwader/Fmsion and
Sedimentation Control Program
Cary of W=*O-W=
P.O. 5= 2511
wmunnA4=. NC 27moi
CirfUA 311 (33&727.N00)
r= 3,4C7483173
June 18, 2014
Mr. Tom Thompson
Facilities Manager
Champion Industries, Inc.
3765 Champion Blvd
Winston-Salem, NC 27105
Dear Mr. Tom Thompson:
The Stormwater Division of the City of Winston-Salem would like to: thank you for
your time and professional courtesy regarding the June 13, 2014 inspection of
Champion Industries, Inc.
As per your request, a copy of the completed surface water inspection form has
been enclosed to you. Part 4 of this report (Required Actions to be completed by
Facility) contains Annotations #1-#15 that Champion Industries, Inc..
must complete. Please provide documentation that verifies Champion Industries,
Inc.'s successful completion of the corrective measures to me by September 18,
2014. i
The Stormwater Division reserves the right to enter and inspect Champion
Industries, Inc. as often as necessary to determine compliance with permit
requirements of NCG030000.
i
Thank you for your continued support and implementation of the City of Winston-
Salem's Stormwater Program. If you have any questions, please feel free to contact
me at [phone].
Sincerely, 4Z C.4r —
Ladonta Clark
Stormwater Inspector
Phone: [phone]
Cell: 336.416.2403
Fax: [phone]
!ll_� L�lll i4q 1 O ! Clt7 C9mmih W" nn=1ohnm Yin H. eodm. Moor Pao Tanpwr-Nw6wr Wik DmW D. A6nm. Noah wan Dan 5M. Sm4 wcn VWA Babe G civic Wen Wad,
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Call 311 or 338 727-8400 o y �"' � ' Wan& Mas-M. Nm*- rt Wad; D~ L XS=gomer)s Em Vsr jmseTark4Jr. Sa,dww Wad; Chy Eg� D. Carriry
[e-mail]

Stormwater/Erosion Control Division
f
Surface Water Inspection for Industrial Sites
General Information
A) Official Company Name: Champion Industries, Inc.
B) Physical Address: 3765 Champion Blvd Winston — Salem, North Carolina 27105
C) Telephone Number: [phone] Office
D) Mailing Address, if different from above address:
E) Authorized contacts to represent company in environmental regulatory issues:
Primary contact: Tom Thompson
Title: Facilities Manager
Contact number(s): Phone: [phone] Office
Email address: Tom Thompson([e-mail])
Secondary contact: NIA
Title:
Contact number(s):
Email address:
F) SIC Code Number of business: 3589
G) NC Stormwater NPDES Permit Number: NCG030000
Permit Category: General fabricating metal products
G) Any other control authority permit(s) (air quality control, wastewater, hazardous waste) & number(s):
Blower permit
H) Brief description of industrial activities that occur on -site:
The industrial activities that occur on -site are the assembling of commercial dishwasher machines, and
the distribution of soft serve ice cream.
1) Ultimate Receiving Waters: Leak Fork Creek
TMDL stream 11Yes ®No
Part 1 - Stormwater Controls
1. Best Management Practices
a. List the non/structural controls emnloved bv.the facilitv:
1. Spill magnets have been placed on the doors at the fabrication building.

b. Are the BMPs reasonable & appropriate for the facility? ®Yes ONo
Comments Replace leaking dumpster at manufacturing building number 2, in order to prevent
stormwater pollution.
c. Are BMPs installed correctly, maintained, and effective operating condition? ®Yes ❑No
Comments I
Spill kit containers are placed in each building. I
2. Provide a brief description of other controls that manage/prevent/minimize stormwater
(e.g., erosion and sediment controls, inlet protection/control at storm drains, diversion:
All production is conducted inside of the facilities.
I
Part 2 — Miscellaneous
1. Any evidence of discharge to receiving waters/MS4? (e.g.: stormwater runoff, dry weather discharge, co -
mingling of process wastewater): ®Yes ❑No
Comments. All outfalls lead to Leak Fork Creek.
I
2) Do the stormwater outfalls on -site correspond with those listed on the site map and in SPl
®Yes ONo
Yes, the stormwater outfalls on -site correspond with those listed on the site map and in
SPPP, but outfalls 3 and 4 don't require analytical sampling anymore.

3) Summary of Stormwater Discharge Outfalls
SDO Identification
Potential Pollutants that
could be discharged
Physical Location
Latitude and Longitude
OutfallI
?
?
?
i
Outfall2
?
?
?
Outfall 3
?
?
?
Outfall4
?
?
?
Out -fall 5
?
?
?
Outfall b
?
?
?
1
Ir
Outfall7
?
?
?
r
[
{
Outfall 8
?
?
?
Site Overview
,Part 3- SPPP Review (can_be completed in office}
Yes No Notes
Is there a SPPP?
i
Does SPPP include a certification statement by the responsible
Please provide
cor porate officer?
Does the general map depict the facility's location on a USGS
+
quad map (or equivalent map) with receiving waters (or MS4)
listed?
Identification of impaired waters or watershed (if applicable)?
Not listed on general map
Narrative Description of these Industrial Activities:
'
Storage Practices
Unloading/Loading Activities
Outdoor Processes
Particulate Generating/Control Processes
Waste Disposal
Does site map denote drainage items: flow direction, boundaries,
V
Provide missing components for site
% impervious, and structures? Also includes SDOs, industrial
map, which are listed in action items
activity areas, and site topography?
I L
A list of major spills that have occurred within the past three years
Needs to be updated
with corrective actions to Rrevent futurespills)?
I
A signed, annual certification that the facility has been tested for non-
11
stormwater discharges from the site?
Comments:
NOTE: Please update the City of Winston Salem, Stormwater Division's eantact
information to Champion Industries, Inc. Spill Notification List. The contact for spill
notification is: Mr. Keith Huff, Stormwater Director [phone] = landline (336) 406-
3332 = cell phone number. Mr. Huff's email address is keithhl@cityofws:org for providi
written notification.

Stormwater Management Strategy
Yes No . Notes
Does SPPP incorporate the nine baseline controls:
Feasibility Study (technical &' economic review to minimize pollutant exposure)
Secondary Containment (table summary of tanks, stored materials, release records)
BMPSummary (listing of site structurallnonstructural practices)
SPRP & Procedures (identified, responsible personnel w/ signatures & dated)
PM & GH (inspection of material handling areas & regular cleaning schedules)
Facility Inspections (biannual inspections of facility and all stormwater systems)
Employee Training (annual basis for staff who perform SRP and PM functions)
Responsible Party (specific position(s)-developing, implementing, & revising SPPP)
Amendment & Annual Update (of major Spills, nonsw flows, BMPs, sampling data
V,
I Last updated 2010
NIA '
Please update the BMW summary.!
V
Please update and sign. the Spill
Prevention and Response
Procedures.
Provide responsible party sheet
Does SPPP contain completed routine inspection reports/records
regarding reportable implementation of the mine baseline controls
i.e. SPPP -Implementation)?
Analytical Monitoring
Yes No Notes
Are samples collected within 30 minutes of measurable rain events
✓
Please add the start and end
and at least 72 h_ours.since the last storm event?
time of each measurable
rain event.
Are sampling events 60 days a art? (EXCEPTION: Tier 2 & 3 responses)
NIA
Is analytical monitoring complete (including schedule) for each
✓
Outfalls # 3 and 4 are
SDO? (EXCEPTION: ROS)
exempt,
✓
Missing discharge
characteristics for Copper!
Zinc, aid possibly Total
Any exceedences of pollutant parameters when compared against the
Toxic Organics
permit benchmark values?
Has Facility implemented appropriate, selected actions to reduce
pollutant concentrations, in response to benchmark exceedences (if
applicable)?
Qualitative Monitoring
Yes No Notes
Is qualitative monitoring being performed during measurable storm
✓
Please add the start and end time
events?
of each measurable rain event
Is qualitative monitoring complete (including schedule) for each
✓
SDO?
Are monitorin 'events 60 days apart? (EXCEPTION: Tier 2 & 3 responses)
✓
NIA
Any observable, excessive amounts of pollutant indicators in
stormwater discharge at SDOs?
'
I

Part 4--Required Actions to be completed by Facility .
l . Replace leaking dumpster at manufacturing building number two, in order to prevent
stormwater pollution, and ensure that the new dumpster has a plug in it.
2. Denote that outfalls numbers three and four are not under analytical monitoring
anymore in the SPPP. Also, keep the records of proof in the SPPP.
3. On the site map, please include the potential pollutants that could be discharged,
physical location of all outfalls, and the latitude and longitude of all outfalis.
4. Create a certification statement by the responsible corporate officer.
5. On the site map, please list that Leak Fork Creek is not a TMDL stream.'
6. List all major spills that have occurred within the past three years with corrective
actions to prevent future spills in the SPPP.
7. Please update the City of Winston Salem, Stormwater Division's contact information
to Champion Industries, Inc. Spill Notification List.
8. Update the feasibility study, and the BMP summary on an annual basis.
9. Please update and sign the Spill Prevention and Response Procedure.
10. Provide documentation of the responsible party annually. The responsible party shall
identify a specific position or positions responsible for the overall coordination,
development, implementation, and revision of the SPPP.
11. At the start of all future analytical mouitoring.and qualitative monitoring, please add
Y
the start and end time of each measurable rain event.
12. Starting next sampling event, Champion Industries must sample for all discharge
characteristics concerning the analytical monitoring.
13. Determine if Champion Industries has to maintain a solvent management plan in
order to stay compliant to the general permit.
14. Maintain the semi-annual analytical monitoring throughout the monitoring schedule
located in the permit. If there is no discharge that occurs during the sampling period,
the permittee must submit a monitoring report indicating "No flow" or "No
discharge" within 30 days of the sampling period.
15. Provide the permit number for the blower motor permit in SPPP.
Company Representative(s) that participated in inspection: Tom Thompson
Title(s): Facilities Manager
Start of inspection: 9:00 am
Completion of Inspection: 1:30 pm
Date: 6/13/2014
Signature of Stormwater Inspector:
Title: Stormwater Inspector

Picture #1 Leaking dumpster at manufacturing building number two
Replace leaking dumpster at manufacturing building number 2, in order to prevent stormwater
pollution.

Compliance Inspection Report
Permit: NCG030271 Effective: 11/01/12 Expiration: 10/31/17 Owner: Champion industries Inc
SOC: Effective: Expiration: Facility: Champion Industries
County: Forsyth 3765 Champion Blvd
Region: Winston-Salem
Winston Salem NC 27105
Contact Person: Tom Thompson Title: Phone: [phone]
Ext.4933
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Certification: Phone:
Inspection Date: 0611312014 Entry Time: 09:00 AM Exit Time: 01:30 PM
Primary Inspector: Aana Taylor -Smith Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Metal Fabrication Stormwater Discharge COC
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
Storm Water
(See attachment summary)
Page: 1

Permit: NCG030271 Owner - Facility: Champion Industries Inc
Inspection Rate: 06113/2014 Inspection Type: Compliance Evalualion Reason for Visit: Routine
Inspection Summary:
See local program inspection letter.
Page: 2

Permit: NCG030271 Owner - Facility: Champion Industries Inc
Inspection Date: 0ti11312014 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 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?
# 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)?
# 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: See local program inspection letter.
Qualitative Monitoring
Has the facility conducted its Qualitative Monitoring semi-annually?
Comment:
Analytical Monitoring
Has the facility conducted its Analytical monitoring?
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
Comment: Facility has not conducted analytical monitoring for metals since the permit
update. Champion will begin sampling for metals at next sampling event.
Permit and butfalls
# 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:
Yes No NA NE
■pinn
np■p
Yes No NA NE
Page: 3

NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Accounts Payable
Champion Industries Inc
3769 Champion Blvd
Winston Salem, NC 27105
Dear Permittee:
Division of Water Quality
Charles Wakild, P. E.
Director
December 4, 2012
Dee Freeman
Secretary
Subject: NPDES Stormwater Permit Coverage Renewal
Champion Industries
COC Number NCG030271
Forsyth County
In response to your renewal application for continued coverage under stormwater General Permit NCG030000
the Division of Water Quality (DWQ) is forwarding herewith the reissued 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 October
15, 2007 (or as subsequently amended).
The following information is included with your permit package:
• A new Certificate of Coverage (COC)
• A copy of General Permit NCG030000
• A copy of the Technical Bulletin for the General Permit
• Two copies of the Discharge Monitoring Report (DMR) Form
• Two copies of the Qualitative Monitoring Report Form
The General Permit authorizes discharges of stormwater, and it specifies your obligations for discharge
controls, management, monitoring, and record keeping. Please review the new permit to familiarize yourself
with all the changes in the reissued permit. Your facility has six (6) months from the time of receipt of the
permit to update your current SPPP to reflect all new permit requirements.
The first sample period of your permit begins January 1, 2013. Your facility must sample a "measureable
storm event" beginning during the periods beginning January 1 and July 1 of every year (or, if applicable,
report "No Flow," as outlined in Part III, Section E). Also, please note that Tier 3 Actions in Part II of your
permit are triggered by benchmark exceedances on four occasions beginning on the effective date of this
permit and do not count prior exceedances.
The more significant changes in the General Permit since your last COC was issued are noted either in the
Draft Permit Fact Sheet that accompanied the public notice (http://portal.ncdenr.org/web/wg//ws/su/current-
notices), or in the Response to Comments / Summary of Changes and Technical Bulletin documents that are
pasted on the stormwater Permitting Unit's website with the new General Permit. Please visit
h_ttp://portal.ncdenr.orp/web/wci/ws/su/npdessw (click on 'General Permits' tab) to review that information
for your specific General Permit carefully.
1617 Maid Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone; 919$07-630" 1 FAX: [phone]
Internet; www.ncvja-,,,irauaIitv.orQ
One
Nk.wthCarolina
An Equal OpportuNty l., `,r-,abve Acbon Employer

r
Accounts Payable
December 4, 2012
Page 2 of 2
Some of the changes include:
Part II:
• Section A: The Stormwater Pollution Prevention Plan (SPPP) section, if applicable, has been updated
to the most current language of our permits. Additional conditions for specific industry sectors have
been added to the SPPP requirements in some cases.
• Sections B, C: Failure to perform analytical Stormwater monitoring may result in the Division requiring
that the permittee begin a monthly sampling scheme.
• Sections B, C: A lower TSS benchmark of 50 mg/I for HQW, ORW, PNA and Tr Waters applies to these
more sensitive waters.
• Sections B, C: The monitoring parameter Oil & Grease (O&G) has been replaced by the parameter
Total Petroleum Hydrocarbons (TPH) for vehicle maintenance areas, and in some cases, other
analytical monitoring requirements.
• Sections B, C, D: Inability to sample due to adverse weather must be recorded in the SPPP, or in
separate on -site records if your General Permit does not require an SPPP. Adverse weather is defined
in the "Definitions" section of the permit.
• Sections B, C: The term "Representative Storm Event" has been replaced by "Measurable Storm
Event." A measurable_ storm event is defined in the permit.
• Section D: If the permittee fails to respond effectively to problems identified by qualitative
monitoring, DWQ may require the permittee to perform corrective action.
Please review Parts III and IV to understand the Standard Conditions of your new NPDES General Permit,
including Compliance and Liability, Reporting, Monitoring and Records requirements; Operation and
Maintenance obligations; and Definitions. Please note that all samples analyzed in accordance with the terms
of this permit must be submitted to the Division on Discharge Monitoring Report (DMR) forms available on
the Stormwater Permitting Unit's website above. DMR forms must be delivered to the Division no later than
30 days from the date the facility receives the sampling results from the laboratory. Also note that existing
permittees do not need to submit a renewal request prior to expiration unless directed by the Division.
Your coverage under the General Permit is transferable only through the specific action of DWQ. This permit
does not affect the legal requirements to obtain other permits which may be required by DENR, 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 the Division's Stormwater Permitting Unit at [phone].
Sincerely,
I
for Charles Wakild, P.E.
cc: DWQ Central Files
Stormwater Permitting Unit Files
Winston-Salem Regional Office

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG030000
CERTIFICATE OF COVERAGE No. NCG030271
STORMWATER
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,
Champion Industries Inc
is hereby authorized to discharge stormwater from a facility located at:
Champion Industries
3765 Champion Blvd
Winston Salem
Forsyth County
to receiving waters designated as Leak Fork, a class C waterhody in the Yadkin River Basin in
accordance with the effluent limitations, monitoring requirements, and other conditions set
forth in Parts 1, II, I[[, and IV of General Permit No. NCG030000 as attached.
This certificate of coverage shall become effective December 4, 2012.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this 41h day of December, 2012,
for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

4�
NODE R
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
October 17, 2011
Tom Thompson
Champion Industries
3765 Champion Blvd.
Winston-Salem, NC 27105
Subject: Compliance Evaluation Inspections
NPDES General Stormwater Permit NCG030000
Certificate of Coverage NCG030271 &
NPDES General Wastewater Permit NCG500000
Certificate of Coverage NCG500075
Champion Industries
Forsyth County
Dear Mr. Thompson:
1. Gary Hudson of the Winston-Salem Regional Office of the NC Division of Water Quality (DWQ) conducted
compliance evaluation inspections (CEI) at the subject facility on the subject permits on September 30,
2011. Your assistance and cooperation during the inspection was greatly appreciated. Inspection
checklists are attached for your records and inspection findings are summarized below.
2. The facility is located at 3765 Champion Blvd., in Winston-Salem, Forsyth County, North Carolina.
Stormwater related to industrial activity is discharged to Lewis Creek, which is currently classified as Class
C waters in the Yadkin Pee Dee River basin.
General Stormwater Permit NCG030000, Certificate of Coverage NCG030271
Documentation & Monitorina Review
1. Permit
Champion Industries holds Certificate of Coverage # NCG030271 for the discharge of
stormwater from the facility. The General Permit became effective November 1, 2007 and
expires October 31, 2012.
2. Records/Reports
Part ll, Section A of the permit requires the development of a Stormwater Pollution Prevention
Plan. A copy of the SPPP for Champion Industries was available for review during the
inspection. The plan appeared thorough and complete.
3. Facility Site Review
The site appeared clean and well managed. No concerns or problems were noted.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Safem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
intemet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
NorthCarolina
Naturally

Champion Industries
Attn: Tom Thompson
Compliance Evaluation Inspections
NCG030271 and NCG500075
1011812011
Page 2 of 2
4. Effluent/Receiving-Waters
Stormwater leaves the Champion Industries property reaching Lewis Creek, Class "C waters in
the Yadkin Pee Dee River Basin.
5. Monitoring Program
Part II, Section C of the permit requires semi-annual qualitative (visual) monitoring to be
performed and documented once in the spring (April- June) and once in the fall (September --
November). A records review during the inspection showed that Champion Industries had
performed and documented the required qualitative monitoring in 2010 and 2011. Please note
that you are not required to submit these forms to the Division, however, the records must be
kept on file at the facility for a period of five years.
Part II, Section B 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 listed in Section. D of the permit for on -site vehicle maintenance
operations is not required since Champion Industries does not use more than 55 gallons of new
motor oil per month when averaged over the calendar year.
General Wastewater Permit NCG500000, Certificate of Coverage NCG500075
Documentation & Monitoring Review
All documentation and monitoring reports for this permit were complete and thorough.
Our office appreciates the efforts by Champion industries to comply with the NPDES General
Stormwater Permit. If 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..SWP -- WSRO-
Central Files
Stormwater Permitting Unit
NPDES Permitting Unit

.f
Compliance Inspection Report
Permit: NCG030271 Effective: 11/01/07 Expiration: 10/31/12 Owner: Champion Industries Inc
SOC: Effective: Expiration: Facility: Champion Industries
County: Forsyth 3765 Champion Blvd
Region: Winston-Salem
Winston Salem NC 27115
Contact Person: Malvern K Timm Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 09/3012011 -
Primary Inspector: Gary Hudson
Secondary Inspector(s):
Certification: Phone:
Entry Time: 10:00 AM Exit Time: 11:30 AM
Phone:
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Metal Fabrication Stormwater Discharge COC
Facility Status: ® Compliant ❑ Not Compliant
Question Areas:
Storm Water
(See attachment summary)
Page: 1

Permit: NCG030271 Owner -Facility: Champion Industries Inc
Inspection Date: E1913012011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Page: 2

Permit: NCG030271 Owner - Facility: Champion Industries Inc
Inspection Date: 0913012011 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 ❑ n
# Does the Plan include a General Location (USGS) map?
■
n
n
n
# Does the Plan include a "Narrative Description of Practices"?
■
n
n
n
# Does the Plan include a detailed site map including outfall locations and drainage areas?
■
n
n
n
# Does the Plan include a list of significant spills occurring during the past 3 years?
®
n
# Has the facility evaluated feasible alternatives to current practices?
■
n
n
n
# Does the facility provide all necessary secondary containment?
■
n
n
n
# Does the Plan include a BMP summary?
■
n
n
n
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
■
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?
p
n
n
n
# Does the Plan include a list of Responsible Party(s)?
■
n
n
n
# Is the Plan reviewed and updated annually?
®
n
n
n
# Does the Plan include a Stormwater Facility Inspection Program?
®n
n
Has the Stormwater Pollution Prevention Plan been implemented?
®
n
n
n
Comment:
Qualitative Monitoring
Yes
No
NA
NE
Has the facility conducted its Qualitative Monitoring semi-annually?
®
n
❑
n
Comment:
Analytical Monitoring
Yes
No
NA
NE
Has the facility conducted its Analytical monitoring?
®
n
n
In.
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
n
❑
M
❑
Comment:
Permit and Outfalis
Yes
No
NA
NE
# Is a copy of the Permit and the Certificate of Coverage available at the site? ®n n
# Were all outfails observed during the inspection? ®❑ n n
# If the facility has representative outfall status, is it properly documented by the Division? n n ® n
# Has the facility evaluated ail iliicit (non stormwater) discharges? ®n n n
Comment: .
Page: 3

United States Environmental Protection Agency
Form Approved.
EPA Washington. D.C. 20460
OMB No, 2040-OD57
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yrlmolday Inspection Type inspector Fac Type
i 1 N1 2 I `r 31 NCG500075 111 12I 11/09/30 117 15 rt 19I gl 20Ll
J I LJ
Remarks
I I I 1 I i I I I I I I 1 I 11 1 1 1 1 1 1 1 1 16
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 CIA ---------- -------_--
671 169 70 U1 71 I I 721 NJ 73 W 74 711 1 I I I I_U 80
Section S: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Dale
POTW name and NPDES permit Number)
10:00 AM 11/09/30
07/08/01
Champion Industries
Exit Time/Date
Permit Expiration Date
3765 Champion Blvd
'Ainsron Salem NC 27115
11:30 AM 11/09/30
12/07/31
Name(s) of Onsite Representative(syTitles(s)IPhone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Ofricial/Titlellohone and Fax Number
Contacted
Malvern x Timm, PO box 4199•Winston Salem NC
27115//919-661-1556/3367449673 No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit E Operations & Maintenance
Section D: Summary of Find in !Comments Attach additional sheets of narrative and checklists as necessa
(See attachment summary)
Name(s) and Signature(s) of Inspectors) AgencylMcelPhone and Fax Numbers Date
Gary Hudson WSRO WQ///
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPIDES yr/mohfay Inspection Type y
3` NCG500075 1 12 11/09/30 I 17 iBUJ
Section D: Summary of FindingJComments (Attach additional sheets of narrative and checklists as necessary)
All records were complete and accurate_
Page # 2

Permit: NCG500075
Inspection Date: 09/30/2011
Owner - Facility: Champion Industries
Inspection Type: Compliance Evaluation
)perations & Maintenance Yes No NA NE
Is the plant generaily clean with acceptable housekeeping? is 0
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge fl n ® it
Judge, and other that are applicable?
Comment: .
n-_-.1
(if the present permit expires in 6 months or less). Has the permittee submitted anew application?
Is the facility as described in the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Comment: .
Yes No NA NE
nn■n
nn■n
0000
0
■nnn
■nnn
Page # 3

CHAMPION INDUSTRIES,- Inc.
Of EMR
i
MAR 2010
iY 'ScCn.S,I,rn
Raamna! office
Storm Water Pollution
Prevention Plan
Updated
February 22, 2010
Prepared by
Tom Thompson
Facilities Manager

TABLE OF CONTENTS
PART I FORWARD
PART II GENERAL FACILITY INFORMATION
A: Mailing Address and telephone number of facility
B: Street Address of facility
C: Type of facility
D: Description of facility location (Figure 1: Property Layout)
E: Facility operation characteristics
F: Pollution prevention team
PART III DESCRIPTION OF STORAGE PRACTESES, LOADING AND
UNLOADING ACTIVITIES, OUTDOOR PROCESS AREAS, AND
WASTE DISPOSAL PRACTESES .
A: Storage Practices
B: Loading[Unloading Activities
C: Outdoor Processing Areas
D: Waste Disposal Practices
PART IV INVENTORY OF EXPOSED MATERIALS
PART V POTENTIAL POLLUTANT SOURCES/FAILURES AND PREDICTION
OF FLOW TO OUTFALLS
A: Potential significant sources of pollutants identified at site
B: Potential failures
C: Prediction of flow
D: Sediment and erosion control
E: Estimated quantity of material per release event (Table 1 Listing
Potential Pollutant Sources/Failures and Prediction of Flow to
Outfalls)
PART VI LIST OF SIGNIFICANT SPILLS
A: Purpose
B: Certification (ask about this)
Page 2 of 41

PART VII SITE MAP
A: General Information
1. Required Information
2. Hard copy worksheet(s) file location
3. Procedures to determine percentage of Impervious Area
(Table 1: Total Impervious Area for Champion Industries)
(Table 2: Percentage of Impervious Area Flow to each Outfall)
4. Site Map
PART VIII MEASURES AND CONTROLS TO PREVENT POTENTIAL
POLLUTANTS FROM CONTACTING STORM WATER AND CONFORMANCE
WITH APPLICABLE GUIDELINES AND BEST MANAGEMENT PRACTES
A: Description of structures and/or equipment
1. Waste / Recycling dumpsters
2. Loading docks
3. Bag house
4. Waste oil
5. Transformers
B: Feasibility study of changing the methods of operations to eliminate or
reduce exposure of materials and processes to storm water
1. Waste/Recycling Containers
2. Loading Docks
3. Bag House
4. Waste Oil Storage
5. Transformers
C: Description of activities to handle and prevent discharges
1. Spill control procedures
a. Spill control procedures
b. Notification requirements
Table 1. Emergency Telephone Numbers
2. Employee training
Table 2. Sample Employee Training Record
3. Facility security
a. Fencing and Gates
Page 3 of 41

b. Outside Lighting
4. Facility inspections
Table 3. Facility inspection form
D: Analytical Monitoring requirements
1. Permit Reference
2. Analytical Monitoring Requirements
Table 1. Analytical Monitoring Requirements
a. Monitoring for Total Toxic Organics (TTO)
b. Analytical Monitoring Samples
Table 2. Monitoring Schedule
c. If no discharge occurs
d. Benchmark Values
Table 3. Benchmark values for Analytical Monitoring
Requirements
Table 4. Tier One and Tier Two Requirements
e. If sampling results exceed benchmark value more than (4) times.
E: Qualitative Monitoring Requirements
1. Permit Reference
Table 4. Qualitative Monitoring Requirements
2. Representative outfall status on outfalls 3 and 4
PART IX SEMI-ANNUAL REVIEW
A: Purpose
B: Semi -Annual Blank Review Form
PART X ANNUAL REVIEW AND RECERTIFICATION
A: Purpose
B: Annual Blank Review Form
C: Annual Recertification
Page 4 of 41

PART I
FOREWORD
This Storm Water Pollution prevention (SWPP) Plan has been prepared in accordance with the
provisions of the Pollution Control Act, North Carolina General Statute 143-215.1, and with the
provisions of title 40 of the code of federal Regulations (CFR), part 122, EPA Administered
Permit Programs; The National Pollutant Discharge Elimination System, section 26, Storm
Water Discharges (40 CFR Part 122.26).
The specific guidelines that were followed in the preparation and implementation of this SWPP
Plan have been carefully thought out and prepared in accordance with good engineering
practices. This SWPP Plan has the full approval of management at a level with authority to
commit the necessary resources to implement this plan.
Inspection of the facility and all storm water systems shall occur at a minimum on a semi-annual
schedule, (January — June) and (July — December). The objective of these inspections is to
evaluate the facility for any conditions, which could have a significant impact on the potential for
the discharge of pollutants in the storm water runoff from the facility. The inspections and any
subsequent maintenance activities shall be documented and made a part. of the plan. The plan
shall be amended whenever there is a change in the design, construction, operation, or .
maintenance of the facility, which has a significant effect on the potential for the discharge
pollutants to surface waters. At a minimum, the plan shall be reviewed and updated on an annual
basis.
The plan including all documentation relating to monitoring, measurements, dike drainage,
inspections, maintenance activities, and training provided to employees, shall be kept on -site for
a period of 5 years.
Page 5 of 41

PART H
A.
F.
C.
10
GENERAL FACILITY INFORMATION
Mailing Address and telephone number of facility:
Champion Industries, Inc.
Post Office Box 4149
Winston — Salem, North Carolina 27115
[phone]
Street Address of facility:
Champion Industries, Inc.
3765 Champion Blvd.
Winston -Salem, North Carolina 27115
Type of facility:
Champion Industries, Inc.
3760 Industrial Dr.
Winston -Salem, North Carolina 27115
Manufacture of commercial dishwashers with SIC code 3589
Description of facility location:
The site consists of 17.44 acres and is occupied by three buildings with brick, Concrete
Block, or metal siding walls and concrete slab floors having a total area of approximately
129,350 square feet (2.97 ac). The site is located on industrial Drive within the city
limits of Winston-Salem in Forsyth County. U.S. Highway 52 borders the south side,
Patterson Avenue borders the west side, and Mineral Avenue borders the east side. Kapp
Street and several commercial businesses border the north side of the site. The site lies at
two distinct elevations. - An office building occupies the higher elevation. The lower
elevation contains the two manufacturing buildings. Strom water and any leaks or toxic
or hazardous pollutants flow toward Leak Fork Creek on the west side of the site. The
surrounding area is developed land consisting of residences, commercial businesses, and
light industry See Figure 1 (Property Layout) next page.
Page 6 of 41

=y Acres: 17.44
r RR r I rim
A GRF.A: 4AKG3 CNCYIICAL CORGOAAifln CiALPFNT
ate lkJ2f
" yyM67GN.$?Lpf, /fGRTH LAlem.@ea
AKC 6{012p1F6 �Z-2 iE
a10MC, s-Msa z r • ►o,
Page 7 of 41

E. Facility operation characteristics:
The facility operates 8 hours per day, 5 days per week. Approximately 100 people are
employed at the facility. The function of the facility is to manufacture commercial
dishwasher used by the food service industry. Manufacturing building number 1-became
operational in 1960. The office building was constructed in 1985 and manufacturing
building number 2 was constructed in 1988.
F. Pollution prevention team:
Tom Thompson, Facility Manager
Responsibilities:
■ Inspection, Monitoring, and maintenance of outside areas, material
Storage areas, loading and unloading areas, storage tanks and related equipment in
accordance with the SWPP Plan.
■ Maintenance of equipment required to diminish potential for pollutants to
impact storm water.
■ Oversee preventive maintenance program.
■ Record -keeping and reporting.
Freddie Culler (Manufacturing Manager), Tommy Hawkins (Traffic Manager), Garland
Fie (Fabrication Supervisor), Jon Hodges (Fabrication Supervisor), Perry Money (R&D).
Responsibilities:
■ Assignment of general housekeeping task.
■ Direct all unloading and loading of materials in such a manner as to
eliminate the potential for spills.
■ Assist in employee training.
■ Assist in inspections of outside areas and inside storage areas.
Page 8 of 41

174/1114
DESCRIPTION OF STORAGE PRACTESES, LOADING
AND UNLOADING ACTIVITIES, OUTDOOR PROCESS AREAS,
AND WASTE DISPOSAL PRACTESES
A. Storage Practices:
Materials stored inside office buildings and MFG 1 and 2, consist of trash receptacles,
and recycling (plastic, paper, cardboard, wood skids). Different types of solvents, cleaners and
lubricants used for operations, maintenance or janitorial are stored in designated areas,
containers/metal lockers or storage rooms.
B. Loading/Unloading Activities:
1. MFG 1: On the South East side of the building, there is a long raised dock with (8) roll
up doors with (3) dock plates for loading/unloading trucks. Only two dock plates are operational.
At this time, the third one is broken and not cost effective to fix since it's not been needed since
downsizing. The two operable dock plates are used to bring inventory to Champions Fabrication
Shop and the other is used from time to time to load and unload Champion Show Equipment and
Carpigiani (tenant) to bring in soft serve ice cream machines for distribution or repair. On the
North West side of the building, there is one raised dock used by Burlodge (tenant) for
distribution of new manufactured food serving carts. On the North East side of the building,
there are two ground docks. One belongs to Burlodge and not normally used since they mainly
use the raised dock. The other ground dock is used by Champion to deliver parts made in the
Fabrication Shop and delivered to Champion Receiving (MFG 2) by way of a Cushman type cart
pulling a trailer.
2. MFG 2: Unloading and loading activities consist of receiving inventory and
operational supplies by truck through the Receiving Department on the South side and shipping
dishwashing machines by truck through_ our. Shipping. Department. on -the -East -side.- Some -parts -- — are also made at MFG 1 and brought to MFG 2 by way of a cushman cart through the receiving
department. The receiving department has two high loading docks and one ground level dock.
The shipping department also has two high loading docks and one ground level loading dock.
C. Outdoor Processing Areas
BAG HOUSE: There is a closed dust collection system (Bag House) located on the North
West side of MFG 1. It is used to collect dust particles from stainless steel metal sanding and
glass beading operations. Particles are collected and emptied as needed by the day time janitor.
D. Waste Disposal Practices
1. Trash and Scrap Metals: There are a total of five trash/recycling dumpsters located
outside of the two manufacturing buildings.
Page 9 of 41

MFG I - There is one 40 yard closed trash compactor and two 40 yard open top
scrap metal containers. They are picked up and- emptied on -call through a contracting company.
MFG 2- There is one 8 yard closed trash compactor and one 40 yard open'top
container that holds wood skids. They are also picked up and emptied on -call through a
contracting company.
2. Paper/Cardboard: Recycled paper and cardboard is stored inside of MFG I and picked
up by a contracting company on a scheduled weekly basis.
3. Recycled plastic drink bottles and Cans are stored inside and taken to the city recycling
center by the day time janitor.
4. Solvents, Cleaners & Lubricants: Non toxic chemicals for cleaning office buildings are
disposed of through normal waste receptacles. Lubricants and solvents used for machine
equipment are disposed of on -call through a contracting company or maintenance service
company.
PART IV
INVENTORY OF EXPOSED MATERIALS
Five Waste Containers are located at the two manufacturing buildings #1 and #2
on the side. At MFG1, there are Two open top (30 yrd. Containers) containing
scrap metal shavings and One closed (30 yrd. Compactor) for general waste. At
MFG 2, there is One closed (S yrd. Compactor) for general waste and One open
top (40 yrd. Container) containing wood pallets.
• Five loading docks and nine roll -up doors located at various locations around the
two manufacturing buildings. An open dock runs almost the entire length of the
southeast side of Manufacturing Bldg. #1 .
• One bag house located on the northwest side of Manufacturing Bldg. #1
• One waste oil storage area is located on the northwest side of Manufacturing
Bldg. 41 near the bag house.
• Eight power transformers located at the three buildings on the side,
Page 10 of 41

PART V
POTENTIAL POLLUTANT SOURCESIFAILURES AND
PREDICTION OF FLOW TO OUTFALLS
A. Potentially significant sources of pollutants identified at the site area are
Construction / Remodeling
Due to the numerous underground piping that carries roof top and parking lot storm
water, it is conceivable to confuse piping since sanitary sewer also runs underground. It is
crucial that when conducting any modifications to Iocate proper fixtures before tying in.
Four trash dumpsters located at the two manufacturing buildings on the side. Two
dumpsters contain only scrap metal shavings and the other two contain wood and
miscellaneous manufacturing waste.
Five loading docks and nine roll -up doors located at various locations around the
two manufacturing buildings. An open dock runs almost the entire length of the
southeast side of Manufacturing Bldg. #I.
One bag house located on the northwest side of Manufacturing Bldg. #1
• One waste oil storage area (fenced and covered) is located on the northwest side
of Manufacturing Bldg. A near the bag house.
Eight power transformers located at the three buildings on the side.
B. Potential failures:
Leaks or spills would occur as a result of equipment failure or operator neglect. Major
Potential spills that may occur from a tank would result from seam failures, fitting
failures, valve failures, foundation failures, and/or corrosion leaks. Spills may also be
caused by operator neglect, poor housekeeping, pump or hose failure, and/or truck
leakage.
Spill quantities and rate of flow associated with the above failures would depend upon
which facilities failed. Table 1 lists the potentially significant sources of pollutants for
this facility's storm water, the storage capacities, types of failure, and availability of
secondary containment.
C. Prediction of flow:
The site lies at two distinct elevations with each section having a slight downward slope
toward leak Fork Creek. Storm water and any leaks or spills of toxic or hazardous
pollutants will drain through a storm water drainage system having 8 outfalls the west
side of the facility which drains the entire site including the roofs of the building. The
outfalls drain to Leak Fork Creek in the Yadkin -Pee River Basin.
Page 11 of 41

D. Sediment and erosion control:
There no storm water flows which have a significant potential for causing erosion. There
are also no areas which, due to topography, site activities, or other factors, have a high
potential for significant soil erosion.
E. Estimated quantity of material per release event:
Based on the preventive measures that have been taken, the volume of material that may
be released should be minimal. fn the event of a catastrophic failure, the worst case
release volume would be the maximum volume of any storage vessel on site. See Table 1
next page for (Listing Potential Pollutant Sources/Failures and Prediction of Flow to
Outfalls).
Page 12 of 41

Table 1 "Potential Pollutant Sources/Failures and Prediction of Flow to Outfalls"
MANUFACTURING BUILDING #2
3 ','I
T"� -
.Y''1<J.
�: i .6 ?�r , _ k .r r — d 'p r•_" j:UD
i,� �LM1 b% �>
_ ll1a}��,!r�, . :ra _� .�.�� r _ s"t ii..., :. r #' '�. -'r �'' POTENTIAI::,t aa, 7w f
•.l `Lr� �'�„_-,.� i:: j'k.' �'. �•.. T
iG- 1:}�-Y'a11`.�•y':jA7;�
�,�.;
S(117RG[w
:+ <sl:'"' .STi. 1'+:. >w•.._:.IP _-y.-�-�"i.
RAT((E.OF;'� SEE-OND'ARl' h'�DIRECTIC}N Cl :� , � ; "lNLE71' x PQTENTIAL ;
4 . 7. : i.�uw1.-i-.�'••t..cs.-5'-••. :'rx;ct. • »s-.:!w_r r .aa:.:ar :- , h `crS."r .rr; r..i .-�a-,�...m �,, ri . F: . aF":a .;,1 K - ..r,$.:u.' .>,.: •. t- h ,. ..h"
; <= �;,,;� ix.;� <.... , _,
P;r r ; ,:,,ThYiro�wj�tliLURC,..
?"' S {'1 'l R'M V�.�iri347
air. 4 ;:..,:;.
M� . ,' . ;.::' It . ,
:.!DISC?HAyiy1C,T, �Ul'SG1iAR(rC.�� SON CIA!(VMENT w F1jO.W � (Sti1i'm„lvslter � ,ROl1j{��;F;ALLS(s)�6.s;';
I.Gy'.,w'1 I i. m'3 "",-,Ci g
+
a 3...VI • i^ 4"'i'...'::, {.'. I
• �; f 1�'. �?� i't '43
�.
4i� I=,. " �L`r :�:�''
�W 4 •3. .i
. r+:°. -'r... : x . . + .1C{.!'4+ w. •
1-> �!fv '#. �• x �i�'�;T.yL�i'.: �'h�°g. �� sus r" �; �1I1t �'¢�x•t�l� r. � "�• �� h•l` ,�i<�r �< u � .;i$;i�:r.�:'t" r;y'arr�'f�t�ti,`{�n+r. :.,,� :,. ,1. n r 4�lr. f�,....,, � :�.
i1Y �ii+��*. ;� i.x.s^...F=::caE�a d�.l Xi'��+. .a.:�F _II �,4" ST'%+, rV< .if �. f, _'w"'.slc7.. 1:�� kAw. .,aG�:.�'>%a.x f,... ..:$L,w...:.,w+�:.r,...� _f3 _:s..ak tL�'; A1fC.�... ,iC {. ..3iM
1 1 Closed
1 i
Rupture1
1
Concrete/Asp 1
Trash 1 1
4) Operator Neglect
Ground
Vandalism
1) Structural fail re
Corrosion
1 1
t
Concrete/Asphalt
1 4
l
' Operator Neglect
Grt l
Vandalism
/ Poor Houskeep4n&_.;
Loading 1
ill Housekeeping
ConcreteIt 1
Building/Dock
s 1 1
,
Roll -Up Doors1
Trailer
l t
1) Structural failure
t
Corrosion
Rupture
-
t
ConcretePad l l
' Operator
Vandalism
Page 13 of 41

Table 1 (Con't.) "Potential Pollutant Sources/Failures and Prediction of Flow to Uutfalls"
MANUFACTURING BUILDING # 1
1) Structural failure
(1) 30 Yrd. Closed
2) Corrosion
3) Rupture
Varies
Varies
Concrete/Asphalt/Curb
Concrete/Asphalt to
None
6
Trash Compacted
4) Operator Neglect
Ground .
5 Vandalism
1) Structural failure
(2) Open Top
2) Corrosion
Scrap Metal
3) Rupture
Varies
Varies
Concrete/Asphalt/Curb
Concrete/Asphalt to
None
6
Containers (1 SIS &
4) Operator Neglect
Ground
1 Misc. Metal)
5) Vandalism
6 Poor Houskee in
(9) Loading Docks
1) Poor Housekeeping
Varies �
Varies
Concrete Floor of
Building/Dock or Truck
Concrete/Asphalt to
SE Side: None
W Side: 25
6,8
& Roll -Up Doors
2) Careless Handling
Trailer
Ground
NW Side: 23,24
1) Structural failure
(1) Waste Oil
2) Corrosion
3) Rupture
Varies
Varies
Concrete Floor
Concrete Pad to
23
8
Storage Area
4) Operator Neglect
Concrete
5 Vandalism
1) Structural failure
(3) Transformers
2) Corrosion
3) Rupture
Varies
Varies
None
Concrete Pad to
2
7
4) Operator Neglect
Ground
5 Vandalism
Page 14 of 41

Table 1 (Con't) "Potential Pollutant Sources/Failures and Prediction of Flow to Outfalls"(Copt.)
CORPORATE OFFICE BUILDING
Page 15 o F 41.

PART VI
LIST OF SIGNIFICANT SPELLS
A. Purpose: The permit requires a list of significant spills or leaks of pollutants that have
occurred at the facility during the three (3) previous years and any corrective actions taken to
mitigate spill impacts.
LIST OF SIGNIFICANT SPILLS
Location & Date l Material & Volume I Corrective Action Taken
B. Certification
This certification is made under Part II, paragraph 1.(d) of the National Pollutant
Discharge Elimination System (NPDS) General Permit (Permit) No. NCG030000 for Storm
Water Discharges Associated with Industrial Activity.
Champion certifies it has not had a significant spill in the past three (3) years
(February 1, 2007 —February 1, 2010).
Certification: I certify, under penalty of law that the statement above is, to the best of my
knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information, including the possibility of fines and iinprisoziment for
knowing violations.
1-1����
Name: Tom Thompson
Title: Facility Manager
Date
Page 16 of 41

PART VH
SITE MAP
A. General Information. The site reap for Champion Industries was provided by Aquatarian
Engineering and should be reviewed annually and updated if any upgrades to facilities or
changes in processes made concerning Industrial activities.
1. Required Information: The site map should include the following:
• A scaled drawing (1 inch =80 feet)
• Legend
• Property boundaries
• Stormwater discharge points (outfalls)
• Stormwater Grate Inlets
• All on -site and adjacent surface waters and wetlands
• Industrial activity areas such as;
o Storage of materials
o Disposal areas
o Process areas
o Loading and Unloading areas
a Haul roads
• Site topography
• All drainage features and structures
• Drainage areas for each outfall
• Industrial activities occurring in each drainage area
• Buildings
• Existing Best Management Practices (BMP)
• Impervious surfaces
• Percentage of Impervious area
2. Hard copy worksheets file location: Hard copy calculations that were made to
determine "percentages of impervious area are kept in Appendix: J of the (SWPPP)
binder.
Page 17 of 41

3. Procedures to determine Percentage of Impervious Area:
1. Determine Size of property in Acers.
2. Determine total SgFt. Of impervious Area on property (Buildings, sidewalks,
parking lots and road ways).
3. Convert total SgFt. Of Impervious Area to Acers (43,560 SgFt. = I Acer).
4. Multiply total Impervious Acers from step 2 by 100
5. Divide sum in step 4 by Total Property Acers.
6. The sum equals total % of impervious area verses pervious area.
See Table 1 page 18 (Total Impervious Area for Champion Industries)
See Table 2 page 19 (Percentage of Impervious Area Flow to each Outfall
Page 18 of 41

Table 1: Total Impervious Area for Champion Industries
Step 1
Step 2 & 3.
Step 4.
Step 6
Total property size in Acers: 17.44
Buildings
SgFt
Divide
Corp Office
MFG 1
MFG 2
9,000
1
54,975
/
64,000
1
Sidewalks, parking lots, & road ways
SgFt
Divide
Corp Office
MFG 1
MFG 2
33,628
/
83,638
/
70,588
1
Multiply total Impervious Acers
from step 2 by 100
SgFt
Multiply
7.25
x
Divide sum in step 4 by Total
Property Acers.
Sum from step 4
Divide
725
/
The sum equals total % of impervious area verses pervious area. (41%)
Note: References used to collect data.
1. Forsyth County Tax Records (web site "Geo-data explorer") for property Acreage information
2. Property map provided by Aquaterra Engineering dated 1998 for measuring data.
Page 19 of 41
1 Acer to SgFt.
43,560
43,560
43,560
1 Acer to SgFt.
43,560
43,560
43,560
100
1101H
Total Property Acers
17.44
Sum in Acers
0.21
1.26
1.47
Sum in Acers
0.77
1.92
1.62
Sum
725
Percentage
42 %

Table 2: Percentage of Impervious Area Flow to each Outfall
Oufall
% of
Impervious
Area Flow
Industrial Activity
1
13%
MFG I1,-Commercial Dishwashers, Waste/Recycling
2
11%
MFG 11, Commercial Dishwashers
3
7%
No Industrial Activity: Corp Office Building. Administration
4
2%
No Industrial Activity: Corp Office Building. Administration
5
10%
MFG I, Commercial Dishwashers Parking Lot,
6
15%
MFG 1, Commercial Dishwashers, Parking Lot, Waste/Recycling
7
30%
MFG I, Champion Commercial Dishwashers, Carpigiani Ice Cream Distribution, Burlodge
Food Cart Distribution
8
11%
MFG 1: Champion Training Rm., Carpigiani Training Rm., Burlodge Food Cart Warehouse,,
Parking Lots/Roads, and Bag House
Page 20 of 41

SITE MAP
Note: For full scaled size drawing, see in back of Storm Water Prevention Plan Binder.
Parr U9
MFG
-� �� � ' •w+rawe m � '�
� + ~''�` � wm,.0 � � ���` , u .\ it n.r. •.w / � ♦ � � J ♦ \ .... ` �� `'�
Cox
1t
MFG 2\\�
L••= FORK
.. �.• � tig.nd
art.uil�,
13 a , �.
• _ '� r', 2 alarm Rxler L7.3, I'
•data V.— PA..
i Impervious Are
to. outialZe
Page 21 of 41

PART VM
MEASURES AND CONTROLS TO PREVENT POTENTTA.L
POLLUTANTS FROM CONTACTING STORM WATER AND
CONFORMANCE WITH APPLICABLE GUIDELINES AND BEST
MANAGEMENT PRACTICES
A. Description of structures and/or equipment:
The following provides a description of the containment structures and /or equipment
utilized to prevent leaks or spills from the identified potential sources from contacting
storm .water.
1. Waste / Recycling dumpsters
There are four dumpsters located on campus.
• Waste: There is a 34 yard sealed container located at Manufacturing Bldg 91.
It is used for miscellaneous waist. It is sealed to prevent contact with storm
water. The other is a Byrd sealed container located at Manufacturing Bldg. 42.
It is used for miscellaneous waste. It is sealed to prevent contact with storm
water.
Recycling There are two 34 yard open top containers and one 40 yard open
top container. The two 34 yard containers are located at Manufacturing Bldg.
# 1: They contain scrap metal which are picked up approximately every two to
four weeks on average. - The 40 yard container is located at Manufacturing
Bldg 92. It' contains scrap wood which is picked up approximately twice a
month.
2. Loading docks
There are five loading docks and nine roll -up doors located at various locations
around the two manufacturing buildings. The loading docks have seals which help
prevent material spills from leaving the building. In addition, an open dock area
runs almost the entire length of the southeast side of Manufacturing Bldg. #1.
This area is partially covered which helps prevent contact with precipitation. Any
spills are promptly cleaned up. All dock and door areas are visually inspected
daily by the janitor for debris and are cleaned in order to maintain good
housekeeping.
3. Bag house
There is one bag house located on the northwest side of Manufacturing Bldg 41.
The bag house is part of a sand -blasting system at the facility which is used very
sparingly. 'The filtered materials, which contain traces of some metals including
chromium and lead, collect in a 20-gallon plastic drum at the base of the bag
house. It is emptied by the janitor approximately every three months.
Page 22 of 41

4. Waste Oil
There is a waste oil storage area (fenced and covered) located on the northwest
side of Manufacturing Bldg. #1 near the bag house.
5. Transformers
There are eight electrical transformers at the site. They are owned by Duke
Energy Company, the local electric utility. They are located at all three of the
buildings on site. The transformer fluids have been determined to be free of
polychlorinated biphenyls (PCBs). However, the transformers contain
hydrocarbon (oil) -based di -electric fluids that could be potential storm water
pollutants in the event of a failure of the transformer casting.
B. Feasibility Study
A review was made in Feb, 2010 to determine ways to eliminate or reduce exposure of
materials and processes to stormwater. Based on the technical and economical feasibility
changing methods of operation and/or storage practices, the following results were
determined. -
1. Waste / Recycling dumpsters
There are four dumpsters located on campus.
• Waste: There is a 34 yard sealed compactor located at Manufacturing Bldg 41
and a 8 yard sealed compactor at Manufacturing Bldg. #2. Both compactors
are used for miscellaneous waist. They are sealed to prevent precipitation
build up and contact with storm water.
Recycling: There are two 34 yard open top containers located at
Manufacturing Bldg. A. These two contains hold scrap metal. There is also
One 40 yard open top container at Manufacturing Bldg: 42 which holds
wooden pallets.
A study to attempt to seal these containers in some fashion was made back
in 2008 when we were having theft issues but not documented. During this study, we
looked at putting some type of cover on the containers that would reduce thefts as
well as precipitation build up in the containers. It was determined not technically or
economical feasible to do. Reason; most of the scrap is too large and has to be placed
in the containers with the use of a fork-lift. Technical systems such as large steel
plates with hydraulic lifts to cover the tops were thought to be too cumbersome,
expensive, and unsafe. A roof system was also looked at but not feasible or
economical because of the height requirements (35') so a forklift could still be used to
load the container from the high dock. The open top 40 yard container at
Manufacturing Bldg. #2 was also thought to be too difficult to cover for the same
reasons
2. Loading docks:
There are five loading docks and nine roll -up doors located at various
locations around the two manufacturing buildings. The loading docks have seals
Page 23 of 41

which help prevent material spills from leaving the building. In addition, an open
dock area runs almost the entire length of the southeast side of Manufacturing Bldg.
#1. This area is partially covered which helps prevent contact with precipitation.
Any spills are promptly cleaned up. All dock and door areas are visually inspected
daily by the janitor for debris and are cleaned in order to maintain good housekeeping
Bag House:
There is a bag house located on the northwest side of Manufacturing Bldg.
# 1. This area was studied back in 2009 but not documented. Previously, it had a
barrel under the hopper to collect particles but was rusting due to the elements. It was
determined we could remove the barrel and close the hopper which reduces the
possibility of a failure. It is now emptied as needed periodically by the janitor or
maintenance technician using a plastic tub that is kept inside the building.
4. Waste Oil Storage:
One waste oil storage area is located on the northwest side of
Manufacturing Bldg. #1 near the bag house. It has a fence surround and a roof structure
to minimize precipitation from entering. The barrels have closed lids.
5. Power Transformers:
There are eight power transformers located at the three buildings on the
side. They are sealed and on a concrete pad. No other measures are needed.
C. Description of activities to handle and prevent discharges:
The following provides a description of activities involved to handle and prevent leaks or
Spills from the identified potential sources from contacting storm water.
Spill control and notification procedures
a. Spill control procedures
Absorbent materials (sorbet booms, wipes, and over pack) are maintained
at both manufacturing buildings at the facility for use with spills. Site .
personnel will be used to stop, contain, and clean up small leaks and spills.
An outside cleanup contractor will be called in to clean up large leaks and
spills and disposed the waste. Should the need dictate, the designated
personnel will call local fire, police, and emergency units for additional
support. See Table 2 for telephone numbers to use in case of an
emergency.
b. Notification requirements
Immediately after calling local units to request their support, telephone
calls shall be made to the group identified in Table 1 to notify them of the
release of oil or other pollutants to the environment or storm water.
Page 24 of 41

Table 1, Emergency Telephone Numbers.
Phone
Facility Manager
Tom Thompson 336-993-6396 (home)
Manufacturing Manager
Freddie Culler 336-983-4176 (home)
Fire
Winston-Salem Fire Department
911
Police
Winston-Salem Police Department
911
Forsyth County Sheriffs Department
911
North Carolina State Highway Patrol
336-761-2441 (Local)
Ambulance
Forsyth County EMS
911
Hospital
Forsyth Memorial Hospital
336-718-5000 (Local)
Winston-Salem, North Carolina
National Response Center (EPA)
800-424-8802
North Carolina Department of Environment
919-733-5291
And Natural Resources (DENR)
800-662-7956 (after hours)
Winston-Salem Storm Water Division
336-748=3070 (Local)
Office of Emergency Management
Melton Sadler
911
Forsyth County
Outside Cleanup Contractor
Shamrock Environmental Corp
336-375-1989 (Local)
Greensboro, North Carolina
800-881-1098
Page 25 of 41

2. Employee training
Employee training program shall be developed to inform personnel responsible
for implementing activities identified in the SWPP Plan or otherwise responsible
for storm water management at all levels of the components and goals of the
S WPP Plan. Facility employees, temporary personnel, and contractor personnel
shall also be trained. This training shall be conducted at least annually.. The
topics to be covered include the following:
• The S WPP Plan
• Material management practices
• Good housekeeping
• Features of the facility designed to minimize or prevent discharges
• Leak and spill response
• Pollution control laws and regulations
• Designated person accountable for spill prevention in the facility and who
will set up necessary spill emergency procedures and reporting
requirements to isolate and contain spills before a discharge can occur.
• Notification procedures in the event of a spill
Note:
The remaining page left blank
See next two pages; Table 2 for "Sample Employee Training Record".
Make copies as needed
Page 26 of 41

Table 2
Spill Prevention / Response Training Record
By signing below, the employee certifies he/she is aware of this Storm Water Drain and
understands what immediate action to take should a spill occur without jeopardizing employee's
safety.
Location Print Name Sign Job Date
Description
.. Page 27 of 41

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3. Facility security
a. The area around the three dumpsters containing scrap metal shavings and
miscellaneous manufacturing waste - and the three transformers at
manufacturing building number 1 are fenced. The gates to these two areas
are closed and locked when the facility is not in operation. The fenced in
waste area can be monitored electronically from a remote computer. There
is also two security gates that protect the twd entrances to the property.
one located on Champion Blvd. and the other is located on our property
side of Industrial Drive.
b. Lighting around the facility is suitable for the type and location of the
facility giving consideration for 1) discovery of spills during hours of
darkness, by operating and non -operating. personnel and 2) prevention of
spills occurring through acts of vandalism.
4. Facility inspections
During the semi-annual facility inspections qualified personnel shall inspect areas
of the facility for leaks or conditions that could lead to discharges of pollutants
into storm water. The program shall be done according to the following
requirements:
• Visual inspection shall be performed of all storage tanks, dikes transfer
pumps, valves, piping; or any piece of equipment that could directly or
indirectly lead to a discharge (i.e. corrosion, foundation failure, etc.).
• Inspection procedures should follow facility standard operating procedures
and manufacturer specifications.
• If a leak of other condition is discovered during an inspection that could
lead to a discharge, action to stop the Ieak or otherwise prevent a discharge
shall be immediately taken, even if process or system shutdown is
required.
• Any leak or spill discovered during an inspection must be cleaned up
promptly and the contaminated material disposed of in accordance with
federal, state, and local regulations. A description of each such incident
shall be made a part of the SWPP Plan.
• Follow-up procedures shall be devised to ensure appropriate actions are
taken in response to inspections.
• Records of inspections shall be maintained. They shall be signed by a
supervisor and made a part of the SWPP Plan.
Note: See next two pages Table 3
"Semi -Annual Facility Inspection Form".
Page 29 of 41

Table 3
SEMI-ANNUAL FACILITY INSPECTION FORM
Date Started:
1. This forth is used to inspect facilities for potential hazards that could enter Lewis Creek
through stormwater drains, ground, streets or parking lots
2. Inspections should be carried out on a semi-annual basis in conjunction with employee
training on spill prevention and response procedures
MFG Bldg. #2
Task:
Comments
Material Handling ,Areas
Forklift (Stock Room)
Cushman (Stock Room)
Forklift(s)(Shipping Dept.)
All Door Areas (Dock/Entry Doors)
Air Compressor Room
Electrical Room
Boiler Room
Waste (Byrd Compactor,40 yrd Wood container
Parking Lot (loom for vehicles leaking fluids)
Electrical Transformer
Additional Comments:
TECH BLDG. (Fabrication)
Task:
Comments
Material Handling Areas
Forklift(s)
Air Compressor Room
Oil Room
All Door Areas (Dock/Entry Doors)
Loading Docks
Waste/Recycling Containers (fenced in area)
Bag House
Boiler Room
Parking Lot (look far vehicles leaking fluids)
Additional Comments:
Page 30 of 41

Table.3 (Con't)
TECH BLDG. (Carpigiani)
Task:
Comments
Material Handling Areas
Forklaft(s)
All Door Areas (Dock/Entry Doors)
Loading Docks
Parking Lot (look for vehicles leaking fluids)
Additional Comments:
TECH BLDG. (Buriodge)
Task:
Comments
Material Handling Areas
Forklift(s)
All. Door Areas (Dock/Entry Doors)
Loading Docks
Parking Lot (look for vehicles leaking fluids)
Additional Comments:
Inspector:
Date Completed:
Page 31 of 41

D. Analytical. Monitoring requirements:
1. Permit Reference: Under Part 11,' Section B, of the permit, this facility is required to
perform semi-annual analytical monitoring and semiannual qualitative (visual)
monitoring of its storm water discharges.
2. Analytical Monitoring Requirements: The analytical monitoring shall be performed as
specified in Table 1.
Table 1. Analytical Monitoring Requirements (during a storm event)
�a7� j � � � � i�.`�- �� ��. � �
Discharge Claracterishcs
� I�2 �i
�,
Units ��
Measurement
v - 4Sarnple
Typek3_
Sample
;
_Location_
Lead, Total
mg/l
semi-annual
Grab
SDO
H
standard
semi-annual
Grab
SDO
Oil and Grease
m
semi-annual
Grab
SDO
Total Suspended Solids
mg/1
semi-annual
Grab
SDO
Total Toxic Organics (TTO)
mg/1
semi-annual
Grab
Not-Rejr.
Total Rainfall
inches
semi-annual
Rain gauge
On -Site.
Total Flow
MG
semi-annual
Grab
SDO
Event Duration
(Date(s)/Time(s)
minutes
semi-annual
Standard
SDO
Temperature
Celsius
semi-annual
Grab
SDO
Footnotes: (Review during permit renewal for any change in regulations)
a. Monitoring for Total Toxic Organics (IT'O) is not required since the facility
does not meet the definition for performing metal finishing operations as found in 40
CFR 433.11. The requirement to perform annual analytical monitoring may be waived if
certain cut-off concentrations are shown on Table 2 in Section B. of the permit.
Regardless of cut-off concentrations conditions, analytical monitoring is required during
the first and last year of the permit term.
b. Analytical monitoring samples shall be completed in accordance with the
schedule specified in Table 2. A minimum of 60 days. must separate Period 1 and Period
2 sample dates.unless monitoring has been instituted under Tier Two response,
Table 2 Monitoring Schedule
Monitor_ xn peraEod
S ample= u`erH-6
r
Year 1 - Period 1
1
January 1, 2008
June 30, 2008
Year 1 - Period 2
2
July 1, 2008
December 31, 2008
Year 2 — Period 1
3
January 1, 2009
June 30, 2009
Year 2 — Period 2
4
July 1, 2009
December 31, 2009
Year 3 — Period 1
5
January 1, 2010
June 30, 2010
Year 3 —Period 2
6
July 1, 2010
December 31, 2010
Year 4— Period 1
7
January 1, 2011
June 30, 2011
Year 4 — Period 2
8
July 1, 2011
December 31, 2011
Year 5 — Period 1
.. 9
January 1, 2012
June 30, 2012 -
Year 5 — Period 2
10
July 1, 2012
December 31, 2012
Footnotes: (Review during peen it renewal for any, change in regulations)
Page 32 of 41

c. If no discharge occurs: If no discharge occurs during the sampling period, the
permittee must submit a monitoring report indicating "No Flow" within 30 days of the
end of the six-month sampling period.
d. Benchmark Values: Monitoring results shall be compared to the benchmark
values in Table 3. Exceedences of benchmark values require the permittee to increase
monitoring, increase management actions, increase record keeping, and/or install
stormwater Best Management Practices (BMP's) in a tiered program. See below the
descriptions of Tier One and Tier Two.
Table 3 Benchmark Values for Analytical Monitoring Requirements
Discharge Characteristics"
Benchmark Value
Lead, Total
0.033 mg/1
H
Within the range 6.0 — 9.0
Oil and Grease
30 m
Total Sus ended Solids
100 mg/1
Total Toxic Organics_
Not -Required
Footnotes: (Review during permit renewal for any change in regulations)
Table 4 Benchmark Values for Analytical Monitoring Requirements
WRTO
p y p
..1�.3� i...:xaa r . lF :il'Vfl1�411� y 1.1e11 O V I., i C�.�kI .F ��h I i -. tMC! 4AAt.;. .!F .�. �u• ' F
IF: The sampling results are above a benchmark value, or outside of the benchmark
-range, for any parameter at any outfall;
THEN: The permittee shall:
1. Conduct management inspection of the facility within two weeks of receiving
sampling results.
2. Identify and evaluate possible causes of the benchmark value exceedence.
3. Identify potential, and select the specific: source controls, operational controls, or
physical improvements to reduce concentrations of the parameters of concern, or to bring
concentrations to within benchmark range.
4. Implement the selected actions within two months of the inspection
5. Record each instance of a Tier One response in the Stormwater Polution Prevention
Plan. Include the date and value of the benchmark exceedence, the inspection date, the
personnel conducting the inspection, the selected actions, and the date the selected
actions, and the date the selected actions were implemented.
IF: During the term of the permit, the sampling results are above the benchmark value, or
outside of the benchmark range, for any specific parameter at a specific discharge outfall
two times in a row;
THEN:' The permittee shall:
1. Repeat all the required actions outlined above in Tier One.
2. Immediately institute monthly monitoring for all parameters at every outfall where a
sampling result exceeded the benchmark value for two consecutive samples. Monthly
(analytical and qualitative) monitoring shall continue until three consecutive sample
results are below the benchmark values, or within benchmark range.
3. If no discharge occurs during the sampling period, the permittee is required to submit a
monthly monitoring report indicating'"No-Flow" to comply with reporting requirements.
4. Maintain a record of the Tier Two response in the Stormwater Pollution Prevention
Plan.
Page 33 of 41

e. During the term of the current permit, if the sampling results exceed the
benchmark value, or are outside the benchmark range, for any specific parameter at any
outfall on more than four occasions, Review Section B, Part II, Page 7 of the permit and
contact DWQ.
E. Qualitative Monitoring Requirements:
1. Permit Reference: Under Part U, Section C, of the permit, Qualitative
monitoring requires visual inspections of each stormwater outfall regardless of
representative outfall status and shall be performed as specified in Table 4, and during
the analytical monitoring events. Qualitative, monitoring is for the purpose of
evaluating the effectiveness of the Stormwater Pollution Prevention Plan (SWPPP), and
assessing new sources of stormwater pollution.
Table 4 Qualitative Monitoring Requirements
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i'MonFt{}rgEf;
g -�'gV{u 4 s '` �6N ]lischarge Charactenstics ,�, �I;,`
�� Frequency1i„�
,;
.. - _,�K :
,s
Location, ;
Color
semi-annual
SDO
Odor
semi-annual
SDO
Clarity
semi-annual
SDO
Floating Solids
semi-annual
SDO
Suspended Solids
semi-annual
SDO
Foam
semi-annual
SDO
Oil Sheen
semi-annual
SDO
Erosion or de osition at the outfall
semi-annual
SDO
Other obvious indicators of stormwater pollution
semi-annual
SDO
2.- Per paragraph III D:6, sampling of all outfalls is not required if the permittee
reasonable believes the outfall sampled discharge substantially identical effluents to the
outfalls not sampled. The permit tee may petition for representative outfall status and, if
approved, a reduced number of outfalls may be sampled. Since outfalls 3 and 4 drain
areas of the site where no industrial activities occur, the NCDENR was petitioned on
March 4, 1998, for'representative outfall status for these two outfalls. Representative
outfall status was granted on March 23, 1998. Visual monitoring of these outfalls is still
required, however; Results of samples analyzed in accordance with the terms of the
permit must be submitted on Storm Water Discharge Outfall (SDO) Monitoring Report
forms (Form MRO3) no later than 30 days after receipt of the sampling results from the
laboratory. Visual monitoring results must be submitted on Storm Water Discharge
Outfall (SDO) Qualitative Monitoring Report forms either with the analytical monitoring
results for the first year and subsequent years or separately if no analytical monitoring is
required for a particular year. All forms must be filed with the NCDENR Central Files in
Raleigh, North Carolina.
Page 34 of 41

PART IX
SEMI ANNUAL REVIEW
A. Purpose: Champion will conduct a semi-annual review to help ensure procedures are
followed. The semi-annual review should be used as a tool to assist in completing the annual
review and included as an attachment. Blank review forms should be kept in Appendix G
(Current Calendar Year) in the S WPPP binder.
B. Semi -Annual Blank Review Form: See next page. Ensure monitoring periods are
changed annually so they are current on the form for the next monitoring period.
Page 35 of 41

Date of Review Year 3 - Period 1
(Jan.-Jun.2010)
Reviewer
Print: Signature:
Semi -Annual SWPPP Review Checklist
1). Is Facility General Information and SWPPP team information
current and accurate?
YES
NO
YES, DESCRIBE IN COMMENTS
2). Has the inventory of exposed material changed in any way such as;
increased or decreased?
YES
NO
YES, DESCRIBE IN COMMENTS
3). Is there a need to conduct a feasibility study?
YES
NO
(IF YES, DESCRIBE IN COMMENTS)
4). Is the Site Map current and accurate?
YES
NO
NO DESCRIBE IN COMMENTS
5) Has there been any spills in the past 6 months?
YES
NO
6) If a spill occurred, have they been recorded and reported in
accordance with regulations?
YES
NO NIA
7) Has a semi-annual em loyee training been conducted and recorded.
YES
NO
8 Has a semi-annual facility ins eetion been done?
YES
NO
9) Has corrective action noted in- the facility inspection been corrected
YES
NO
and documented?
10) Has Semi -Annual Analytical testing been performed, recorded
YES
NO
and filed in the SWPPP.
11) Has Semi -Annual Qualitative monitoring been performed, and
YES
NO
Filed in the SWPPP?
12) Has Scmi-Annual Analytical and Qualitative testing data been
�
mailed to Central Files. in Raleigh?
YES
NO
13) Do benchmark values for Analytical monitoring fall in line with
'.
requirements? See other side for Benchmark Values, and enter data.
YES
NO
YES, SKIP UESTION 14. IF NO, ANSWER QUESTION 14)
14) Has Tier One or Tier Two been implemented?
YES
NO
a). What Tier level was im lemented?
1
2
b) Have appropriate records been kept?
YES
NO
c) Was it necessary to notify DW ?
YES
NO
d) What is the status at the time of this review?
On -going Com feted
15) Has a semi-annual review of the SWPPP been conducted and
YES
NO
NIA
updated as needed.
16) Has the annual recertification that outfalls do not contain non-
YES
NO.
NIA
stormwater discharge been signed?
17) Has annual fees been aid?
YES
NO
NIA
1 S) Has Permit Renewal Request been made?
YES
NO
I NIA
Page 36 of 41

Semi -Annual SWPPP Review Checklist (Con't.)
enc° F ar Is 'or3I callVonxtor�ngg c urenents�
Lead, Total
0,033 mg/1
H
Within the range 6.0 — 9.0
Oil and Grease
30 mg/1
Total Suspended Solids
100 Mg/1
Total Toxic Organics not required)
1 Mg/1
Champion Results
Analytical- Test Results (Year 3 - Period 1) Test Date: ���� j
Out Fall
Lead Total
0.033 mg/I
pH
6.0 — 9.0
Oil and Grease
30 mg/1
Total Suspended
Solids
100 Mg/1
1
7,2r
6-
2
L_ D. o4S
t5
S
3
/V
4
5
©,
Z
(1 D
G�
6
0, o0
7, G
7
Go o
6,96,
5y
8
� D, ao�'
7 : Z /
Vl?�
Analytical Test Results (Year 3 - Period 1) Test Date:
Out Fall
Lead Total
mg/1
pH
6.0 �-- 9.0
Oil and Grease
30 mg/I
Total Suspended
Soli0.033
100 mail
I
2
3
4
5
6
7
8
Page 37 of 41

PART X
A. Purpose: The permit requires that the stormwater pollution prevention plan (SWPPP) be
reviewed at a minimum on an annual basis after it's developed and maintain written summaries
of the reviews. Based on the review, the SWPPP will be amended as needed to ensure continued
compliance with the terms and conditions of the permit. The review is to be filed in the (SWPPP)
binder in Appendix H (Archive Monitoring Records) at the end of the monitoring year and
records for the previous 5 years will be kept.
B. Annual Blank Review Form: See page 37. Ensure monitoring periods are changed
annually so they are current on the form for the next monitoring period,
C. Annual Recertification: Per reference Part II, Section A, (e), Certification that the
stormwater outfalls have been evaluated for the presence of non-sto=water discharges. The
certification statement will be signed in accordance with the requirements found in Part III,
Standard Conditions, Section B, Paragraph 5 of the permit. The Annual Recertification shall be
attached to the Annual Review and filed in Appendix H, Archive Monitoring records in the
StormwaterPpolution Prevention Plan (SWPPP) binder.
Page 38 of 41

Date of Review Year 3
(Jan. —Dee. 2014)
Reviewer
Print: Signature:
Annual SWPPP Review Checklist
1). Is Facility General Information and SWPPP team information
current and accurate?
YES
NO
YES, DESCRIBE IN COMMENTS
2). Has the inventory of exposed material changed in any way such as,
increased or decreased?
YES
NO
YES, DESCRIBE IN COMMENTS
3). Is there a need to conduct a feasibility study?
YES
NO
YES, DESCRIBE IN COMMENTS
4). Is the Site Map current and accurate?
YES
NO
(IF NO, DESCRIBE IN COMMENTS)
5 Has there been any spills in the past year?
YES
NO
6) If a spill occurred, have they been recorded and reported in
YES
NO NIA
accordance with regulations?
7) Has a semi-annual employee training been conducted and recorded.
YES
NO
8 Has a semi-annual facility inspection been done?
YES
NO
9) Has'corrective action noted in the facility inspection been corrected
YES
NO
and documented?
10) Has Semi -Annual Analytical testing been performed, recorded
YES
NO
and filed in the SWPPP?
11) Has Semi -Annual Qualitative monitoring been performed, and
YES
NO
Filed in the SWPPP?
12) Has Semi -Annual Analytical and Qualitative testing data been
mailed to Central Files in Raleigh?
YES
NO
13) Do benchmark values for Analytical monitoring fall in line with
requirements? See other side for Benchmark Values, and enter data.
YES
NO
YES SKEP QUESTION 14. IF NO ANSWER QUESTION 14
14) Has Tier One or Tier Two been im lemented?
YES
NO
a). What Tier level was implemented?
1
2
b Have appropriate records been kept?
YES
NO
c) Was it necessary to notify DWQ?
YES
NO
d) What is the status at the time of this review?
On -going
Completed
15) Has a semi-annual review of the SWPPP been conducted and
YES
NO
updated as needed.
16) Has the annual recertification that outfalls do not contain non-
YES
NO
stormwater discharge been signed?
17) Has annual fees been paid?
YES
NO
18 Has Permit Renewal Request been made?
YES
NO NIA
Page 39 of 41

Annual SWPPP Review Checklist (Con't.)
B�nc%m �a s 'fo �. Y
af, , o � � tone
�
Lead, Total
0.033 mg/1
H
Within the range 6.0 — 9.0
Oil and Grease
30 mg/1
Total Suspended Solids
100 Mg/1
Total Toxic Or anics not required)
1 m /l
Champion Results
Analytical Test Results (Year 3 - Period 2) Test Date:
Out Fa11
Lead Total
0.033 mg/1
pH
6.0 — 9.0
Oil and Grease
30 mg/1
Total Suspended
100 Mg/1Solid
1
2
3
4
5
6
7
S
Page 40 of 41

2010Annual Recertification of Evaluation for the Presence of
Non -Storm Water Discharges Champion Industries, Inc.
Winston Salem, North Carolina
This certification is made under Part II, Section A: 1 (e) of the National Pollutant Discharge
Elimination System (NPDES) General Permit (Permit) No. NCG030000 for Storm Water
Discharges Associated With Industrial Activity. The Permit was issued by the North Carolina
Department of Environment and Natural Resources (NCDENR), after Champion Industries, Inc.
in Winston — Salem, North Carolina, filed a notice of Intent (NOI) and, later, a renewal form to
be covered by the permit (see Appendix A). This Certification is a part of the Storm Water
Pollution Plan of Champion for its facility located on Industrial Drive.
Champion certifies that it has evaluated its discharge for the presence of non -storm water
discharges. Champion has concluded that no non. -storm water discharges are present in its storm
water drainage discharges except as permitted under Part VI, (3) of the permit. Champion does
not use detergents or other compounds in the wash down of buildings or parking areas.
Certification: I certify, under penalty of law, that this document and all attachments were
prepared under my direction or supervision in accordance with a system designed to assure -that
qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false information, including the possibility of fines and imprisonment for knowing violations.
Name: Tom Thompson
Title: Facility Manager
Date
Page 41 of 41

2010
Annual Monitoring
` 1ENR
Calendar NAR'e i zoio
4uinston•Saiern
liegional Rftrce
January Analytical / Qualitativec,�� �--
� February
0
'W March Qualitative
I April Analytical / Qualitative (Train Assistant)
May Employee Training / Inspection
(Train Assistant)
June Semi -Annual Review
(Go over w/assistant)
July Qualitative (Train Assistant)
N
August
';.4
September
Analytical / Qualitative (Train Assistant)
October
Employee Training 1 Inspection
(Train Assistant)
November
Annual Review
December
(Conduct three analytical monitorings to build back up data missed)

Champion Industries, Inc.
(P.O. Box 4149
Winston Salem, NC 27115
Tel. 336f661-1556
Fax: [phone]
February 23, 2010
EMAR
ED
ENR2010Mr. Steve W. Tedder 8Mle@
Water Quality Regional Supervisor
Division of Water Quality
North Carolina Department of Environment and Natural Resources
585 Waughtown Street
Winston-Salem, NC 27107-2241
Enclosures: A).Storm Water Pollution Prevention Plan "Updated 15 February, 2010
B) Annual Monitoring Calendar
C).Copy of Analytical Data Results dated: January 25, 2010
D) Site Maps showing drainage areas and percentage of impervious area for
each Outfall
Dear Mr. Tedder:
In response to the inspection conducted by Mr. Steve Mauney on January 6, 2010, please allow me
to pass along actions taken and future procedures we are implementing to ensure we never again
find ourselves in noncompliance.
Below I will list Compliance Issues discovered, cause of non-compliance, and corrective actions
taken.
Compliance Issue #11: (SWPPP) Failure to include an Annual Recertification that outfalls do not
contain non-stormwater discharge.
Cause of Non -Compliance: This was strictly an oversight on my part. I have been reviewing
the SWPPP annually but did not catch this in the permit as I should have.
Corrective Action: Recertification has been updated to the plan (See Part X SWPPP). I have also
implemented a Semi -Annual and Annual check -list to insure this oversight does not happen again
(See Part IX and X SWPPP).
Compliance Issue #2: (SWPPP) The map does not list the drainage areas to each outfall nor
the percentage of impervious area.
Cause of Non -Compliance: I think possibly that I did not show Mr. Mauney the full scaled map
of our property which illustrates drainage areas and all other items required except percentage of
impervious area which is an oversight on my part. The map Mr. Mauney saw was a 8 Y2 x17 copy of
the full scaled map which is hard to read.

Corrective Action: I have added several tables and maps to the new (SWPPP) that includes
Total Impervious area on the property and Percentage of Impervious Area Flow to each outfall (See
Pan V11 SWPPP). I have also enclosed maps and tables showing percentage of impervious flow to
each outfali (See Enclosure D),
Research Problem: Although Mr. Mauney was very helpful on the phone with me during my
research of this issue, I had a difficult time using ENR's website
(http:11h2o.enr.state.nc.us/su/Manuals_ Factshpets.htm). I could not find this site page and believe
there's possibly an issue with ENR's new website conflicting with its previous site.
Compliance Issue #3: (SWPPP) A feasibility study of changing the methods of operation to
eliminate or reduce exposure should be added to the plan.
Cause of Non -Compliance: All though we have done this in the past, adding to the SWPPP
was an oversight on my part.
History: We conducted a research back in early 2007 when we added the open top wood
container for recycling wood skids with Republic Waste Services (open top verses closed compactor
or roof). We also researched the waste/recycle fenced in area located at MFG I back in 2006. Back
then, we replaced the open top waste container with a closed compactor because the previous open
top would hold water and smell during heavy rain fall. During this same study, another option we
looked at was to put a roof system over the entire fence area which would have been very costly. We
looked at this again as recently as 2009 when we were having theft issues with our stainless scrap.
Corrective Action: A feasibility study is now added to the SWPPP (See Part Vlll, paragraph B
SWPPP).
Compliance Issue #4: Data was not submitted for this facility in 2009 and only (1) set of data
was submitted in 2008.
Cause of Non -Compliance: This issue has troubled me the most. I did realize I missed one of
two data testing's in 2008 during my annual review. We received the new permit earlier that year.
knew I was supposed to conduct (2) testing's when 2009 began and noted so in my binder. The only
thing I can say is that 2009 was a very difficult year for our company and many others as I'm sure.you
know. Between increased responsibility loads, periods of work layoffs and shutdowns of, my
attention to details failed.
2009
During Mr. Mauney's inspection, I had test kits on -site that I received back in early December
Corrective Action:
1). Data was collected on January 25, 2010 and mailed to Central Files (See Enclosure C).
2). 1 have developed a Semi -Annual inspection form that will assist in maintaining
compliance (See Part 1X SWPPP).
3). 1 have developed a better Annual Monitoring Calendar and placed on my read board
instead of maintaining in the SWPPP manual. This way, I see it every day (See Enclosure B).
4). 1 am going to train an assistant to help me this year. He will also have a copy of the
annual schedule. This will be a great asset to ensure we get our testing done.
2

Re -inspection: I am ready for re -inspection at your convenience.
hope the information and corrective actions provided will help in recouping confidence in us to better
comply with regulations.
Sincerely,
Tom Thompson
Facilities Manager
Cc: Mr. Steve Mauney Environmental Engineer Division of Water Quality, NCDENR
3

Postal
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CERTIFIEDRECEIPT
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Restricted Nl"ry Fee
(Endorsement Required)
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Total Postacle & Fees
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CO Mr. Tom Thompson
ms � Champion Industries, Inc.
_dW 3765 Champion Boulevard ""'"
Winston-Salem, NC 27105

I;A
.2==
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Division of Water Qual}ty
Coleen H. Sullins
Director
January 15, 2010
CERTIFIED MAIL70081140 0003 8505 6031
RETURN RECEIPT REQUESTED
Champion Industries, Inc.
Tom Thompson, Facilities Manager
3765 Champion Bled.
Winston-Salem, North Carolina 27105
Subject: NOTICE OF VIOLATION
Storm«°ater Inspection
Champion Industries, Inc,
Permit No, NCG030271
Forsyth County
Dear Mr. Thompson:
Dee Freeman
Secretary
Enclosed please find a copy of the Inspection Report from the inspection conducted January 6, 2009.
The Stormwater Inspection was conducted by Steve Mauney of the Division of Water Quality,
Winston-Salem Regional Office.. The inspection consisted of two parts: an on -site inspection of the
facility and a limited file review. The following are the findings from the subject inspection.
The facility was found to be in Violation of permit NCG030271 for the following:
Inspection Area
Compliance Issues
Storm Water Plan
Failure to include an annual Recertification that outfalls do not
contain non-stormwater discharges
StormWater Plan
The niap does not list the drainage areas to each outfall nor the
percentage of impervious area.
Storm Water Plan
A feasibility study of changing the methods of operation to eliminate
or reduce exposure should be added to the plan. .
Stormwater Data
Data vas not submitted for this facility in 2009 and only one (1) set
of data was submitted in 2008.
1. Permit
The Certificate of Coverage NCG030271 for the Champion Industries, Inc. -Winston Salem facility
became effective November 1, 2007 and expires on October 31, 2012. The permitted facility is
Mortis Carolina Division of N.'ater Quality, Winston-Salem Regional office
Location: 585 4Vaughiown St. Winston-Salem, North Carolina 27107 Phone: [phone] FAX: [phone] Customer Service 1-877�Mlle23-6748 011C Noi-thCa Ohna
Internet: wwvv.nor aterquality.org Wi`all�
Art Equal Opportunity 1 Afronative nct6n Employer

Champion Industries, Inc.
authorized to discharge stormwater from a facility located at 3765 Champion Blvd., Winston Salem,
North Carolina to receiving waters designated as Leak Fork Creek, 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 General Permit No. NCG030000.
Any other point source discharge to surface waters of the state from this facility is prohibited unless
it is an allowable non-stormwater discharge or is covered by another permit, authorization or
approval.
The permit identifies two monitoring requirements that apply to this facility:
Qualitative Monitoring for Stormwater Discharge Outfalls per Part H, Section C.
Analytical Monitoring for Stormwater Discharge Outfall per Part 11, Section B.
Copies of the NCG030000 general permit documents can be accessed from the following web page:
h:tt :/p /h2o_enr:state.n_e.us/su/Forms Documents. htm4StormwaterGP
II. RecordslRenorts
General Permit NCG030000 requires certain monitoring to be documented and the records
maintained at the facility.
The following records are required at this site per the NPDES permit:
Stormwater Pollution Prevention Plan as specified per Part I1, Section A.
2. Stormwater Discharge Outfalls (SDO) shall have Qualitative monitoring performed as
described in Part I1, Section C and Table 4 and shall be conducted during the analy-tical
monitoring event. Page 18 of the plan should be corrected in this regard,
3. Stormwater Discharge Outfalls (SDO) shall have Analytical monitoring performed as
described in Part II_ Section B and Tables 1 & 2.
A review was made of the supplied records and reports for the Champion Industries. Inc. facility
frofor the period November 2007 through the present.
This review indicated deficiencies in the followinE records:
• The Stormwater pollution prevention plan -,vas incomplete.
o The plan has been reviewed annually since 2004 but it did not include, " re-
certification that the stormwater outfalls have been evaluated for the presence of non-
stormwater discharges."
o The percentage of impervious area draining to each outfall and the total drainage area
for each outfall must be listed on the map.
o The North Carolina spill reporting requirements include any spills that reach surface
waters; any spills that exceed 25 gallons, any spills that are closer than 100 feet from
surface waters and any spills that are not cleaned up within 24 hours of the discharge.
Attached is GS 143-215.85 (b).
• The Quantitative data has not been submitted to this Division in the recent past.
The semi-annual data through mid 2008 was in the plan and indicated general
compliance with benchmark values. However, the second set of samples was not collected in
2008 nor were any collected and submitted in 2009.

Champion Industries, Inc.
Y
III. Facility Site Review
At the time of the inspection the two (2) open top waste bins for scrap metal were inspected as well
as the enclosed garbage bin at Building 2 and the enclosed trash compactor at Building 1. The
outfalls were observed to be free of industrial litter or debris.
Please refer to the enclosed Inspection Report for any additional observations and comments.
Carefullv rev_ieiv these violations and deficiencies and respond in writing, to this office within
thirty (30) workinF, day of receipt of this letter. You should address the causes of
noncompliance and all actions taken to prevent the recurrence of similar situations. Your
response should include the following:
➢ Describe steps taken to satisfy the requirements of the NPDES General Permit, as listed
above, immediately. Please explain your failure to implement these requirements and
discuss how these requirements will be met in the future.
➢ Provide this office with the updates to your completed Stormwater Pollution Prevention Plan
within the required response time noted above. A guidance document to assist you in
developing the updates to your Stormwater Pollution Prevention Plans for Stormwater
Runoff at Industrial Activities is available at the Division website.
http://h2o.enr.state.nc_us/su/Manuals Factsheets.htm
➢ Provide any other relevant factors, which you believe, should be considered.
Thank you for your attention to this matter. Please be advised that violations of the Stormwater
Permit may be subject to civil penalty assessments of up to $25,000.00 per day, per violation. Your
above -mentioned response to this correspondence will be considered in this process. If you should
have any questions, please do not hesitate to contact Steve Mauney at [phone].
Sincerelv.
Steve W. Tedder
Water Quality Regional Supervisor
Attachments
Cc: S«'P-Central Files
WSRO
NPS Assistance and Compliance Oversight
Keith Huff, City of WS Stormwater Division

.... ...� .. ........�.. ,� .._.__...- .. _. .._.. .. .S...i, i, �w....... .. �, _-._.. .. ..._.-.- ....
§ 143-215.85. Required notice.
(a)Except as provided in G.S- 143-215.94E(al) and
subsection (b) of this section, every person owning or having
control over oil or other substances discharged in any
circumstances other than pursuant to a rule adopted by the
Commission, a regulation of the U. S, Environmental Protection
Agency, or a permit required by G.S. 143-215.1 or the Federal
eater Pollution Control Act, 13pon notice that such discharge has
occurred, shall immediately notify the Department, or any of its
agents or employees, of the nature, location and time of the
discharge and of the measures which are being taken or are
proposed to be taken to contain and remove the discharge, The
agent or employee of the Department receiving the notification,
shall immediately notify the Secretary or such member or members
of the permanent staff of the Department as the Secretary may
designate. If the discharged substance of which the Department
is notified is a pesticide regulated by the ?worth Carolina
Pesticide Board, the Department shall immediately inform the
Chairman of the Pesticide Board. Removal operations under this
Article of substances identified as pesticides defined in G.S-
143-460 shall be coordinated in accordance with the Pesticide
Emergency Plan adopted by the North Carolina Pesticide Board;
provided that, in instances where entry of such hazardous
substances into waters of the State is WMinent, the Department
may take such actions as are necessary to physically contain or
divert such substance so as to prevent entry into the surface
waters.
(b) As used in this subsection, "petroleum" has the same
meaning as in G.S. 143-215.94A. A person who owns or has control
over petroleum that is discharged into the environment shall
immediately take measures to collect and remove the discharge,
report the discharge to the Department within 24 hours of the
discharge, and begin to restore the area affected by the
discharge in accordance with the requirements of this Article if
the volume of the petroleum that is discharged is 25 gallons or
more or it the petroleum causes a sheen on nearby surface water
or if the petroleum is discharged at a distance of 100 feet or
less from any surface water body. if the volume of petroleum
that is discharged is less than 25 gallons, the petroleum does
not cause a sheen on nearby surface water, and the petroleum is
discharged at a distance of more than 100 feet from all surface
water bodies, the person who owns or has control over the
petroleum shall immediately take measures to collect and remove
the discharge. If a cischarge of less than 25 gallons of
petroleum cannot be cleaned up within 24 hours of the discharge
or if the discharge causes a sheen on nearby surface water, the
person who owns or has control over the petroleum shall
immediately notify the Department. (1913, c. 534, s. 1; c. 1252,
s. 23; 1937, c. 771, s. 4; c. 858, s. 1; 1039, c, 535, ss. 16,
11; 1981, c. 827, ss- 154, 194; 2000-54, s. l-)
1 of 1 1/4/2005 11:43 i+i%

Compliance Inspection Report
Permit: NCG030271 Effective: 11/01/07 Expiration: 10/31/12 Owner: Champion Industries Inc
SOC: Effective: Expiration: Facility: Champion Industries
County: Forsyth 3765 Champion Blvd
Region: Winston-Salem
Winston Salem NC 27115
Contact Person: Malvern K Timm Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
Orn-Site Representative(s):
24 hour contact name Tom Thompson Phone: [phone]
Related Permits:
Inspection Date: 01/0612010 Entry Time: 01:00 PM Exit Time: 02:30 PM
Primary Inspector: Max S Mauney Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Metal Fabrication Stormwater Discharge COC
Facility Status: 0 Compliant ® Not Compliant
Question Areas:
® Storm Water
(See attachment summary)
Page: 1

Permit: NCGO30271 owner - Facility: Champion Industries Inc
Inspection Date: 01/06/2010 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
This facility has an office building and two (2) manufacturing buildings. The older building (##I) is partially occupied by
Champion (30%) with 2 tenants - Carpigiani (produces soft -serve ice cream equipment) and - Burlodge (produces carts
for food trays that are used at hospitals and other institutions). An adjacent building, occupied by CINTAS has been the
source of PCE and other VOC contaminants which have impacted the Champion site.
Page: 2

Permit: NCG030271 Owner - Facility: Champion Industries Inc
Inspection Date: 01/06/2010 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
n
n
# Does the Plan include a "Narrative Description of Practices"?
n
n
n
# Does the Plan include a detailed site map including outfall locations and drainage areas?
®n
n
n
# Does the Plan include a list of significant spills occurring during the past 3 years?
Q
0
®
n
# Has the facility evaluated feasible alternatives to current practices?
n
M
n
n
# Does the facility provide all necessary secondary containment?
®
n
n
0
# Does the Plan include a BMP summary?
0
n
C
n
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
n
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
®
rl
n
n
# Does the facility provide and document Employee Training?
®
n
❑
n
# Does the Plan include a list of Responsible Party(s)?
®
n
n
n
# 1s the Plan reviewed and updated annually?
m
n
n
# Does the Plan include a Stormwater Facility Inspection Program?
®
❑
f 1
Has the Stormwater Pollution Prevention Plan been implemented?
®
❑
n
n
Comment: There were no spills in the last 9 years, The 34 yard dumpster that collects
miscellaneous scrap metal would appear to be a potential site for spill or runoff if some
equipment containing liquids or other residue is deposited there. The scrap stainless
steel sheets are placed in a dumpster and if that is the only material placed in the
dumpster, it should not contribute to runoff, unless contaminants from former uses of the
dumpster are present. While the site is known to contain 17.52 acres there are
additional off site sources of runoff to the outfall #4. The potential for offsite
contributions to outfall #2, #3, and even #6 may be worth evaluating_
Qualitative Monitoring Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? ® n
Comment: The inspection forms for the last 4 years were inspected and found to be
complete and orderly.
Analytical Monitoring Yes No NA NE
Has the facility conducted its Analytical monitoring? Q M n
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas? n n ® n
Comment: The semiannual monitoring was skipped in 2009 and only one sample was
collected in 2008. Mr. Thompson indicated that a sample would be collected during an
appropriate rain event in the near future.
Permit and Outfatls Yes No NA NE
Page: 3

Permit. NCG030271 Owner - Facility: Champion Industries Inc
Inspection Date; 01/06/2010 Inspection Type; Compliance Evaluation Reason for Visit; Routine
# Is a copy of the Permit and the Certificate of Coverage available at the site? ■ 0 Q 0
# Were all outfalls observed during the inspections? ■ 0 1 11
# If the facility has representative outfall status, is it properly documented by the Division? ®n ❑ n
# Has the facility evaluated all illicit (non storrnwater) discharges? n ® ❑ n
Comment: All outfalls were observed during the visit (#1, 2, 5, 6, 7 & 8). Outfall #3
and #4 were removed from sampling requirements on 3-23-98 by Tony Evans, DWQ.
The boiler blowdown ties into outfall #1 and is sampled at a storm grate where the
outfall line crosses the parking lot. An annual certification that no non-stormwater
discharges exist (Part II,A, 7-page 3of 9) has not been documented since 2004.
Page: 4

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P-E., Director
Division of Water Duality
)%w,us1 73. 2002
MALVERN K TIMM
CHAMPION INDUSTRIES
PO BOX 4149
WINSTON SALEM. NC 27115
Subject: NPDES Stormwater Permit Renewal
CHAMPION INDUSTRIES
COC Number NCG030271
Forsyth County
Dear Permittee:
In response to your renewal application for continued coverage under general permit NCG030000. 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 NCG030000
* A copy of the Analytical Monitoring Form (DMR)
* 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 DENR 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,
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Stormwater & General Permits Unit Files
Winston-Salem Regional Office
exA
NCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1-800-623-7748

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG030000
CERTIFICATE OF COVERAGE No. NCG030271
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,
CHAMPION INDUSTRIES
is hereby authorized to discharge stormwater from a facility located at
CHAMPION INDUSTRIES
3760 INDUSTRIAL. DR
WINSTON SALEM
FORSYTH COUNTY
to receiving waters designated as Leak Fork Creek, 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,11, I1I,
IV, V, and VI of General Permit No. NCG030000 as attached.
This certificate of coverage shall become effective September 1, 2002.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 23, 2002.
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Michael F. Easley, Governor
Wllllam G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J, Thorpe, Ph.D.
Acting Director
Division of Water Quality
December 27, 2001
MALVERN K TIMM
CHAMPION INDUSTRIES
PO BOX 4149
WINSTON SALEM, NC 27115
Sul*ct NPDES Stormwater Permit Renewal
CHAMPION INDUSTRIES
COC Number NCG030271
Forsyth County
Dear Permittec:
Your facility is currently covered for stormwater discharge under General Permit NCG030000. This permit expires
on August 31, 2002. 'Me Division staff is currently in the process of rewriting this permit and is scheduled to have
the permit reissued by late summer of 2002. Once the permit is reissued, your facility would be eligible for
continued coverage under the reissued permit.
In order to assure your continued coverage under the general permit, you must apply to the Division of Water
Quality (DWQ) for renewal of your permit coverage. To make this renewal process easier, we are informing you in
advance that your permit will be expiring. Enclosed you will Find a General Permit Coverage Renewal
Application Form. The application must be completed and returned by March 4. 2002 in order to assure continued
coverage under the general permit.
Failure to request renewal within this time period may result in a civil assessment of at least $250.00. Larger
penalties may be assessed depending on the delinquency of the request. Discharge of stormwater from your facility
without coverage under a valid stormwater NPDES permit would constitute a violation of NCGS 143-215.1 and
could result in assessments of civil penalties of up to $10,000 per day -
Please: note that recent federal legislation has extended the "no exposure exclusion" to all operators of industrial
facilities in any of the I I categories of "storm water discharges associated with industrial activity," (except
construction activities). If you feel your facility can certify a condition of "no exposure", i.e. the facilty industrial
materials and operations are not exposed to stormwater, you can apply for the no exposure exclusion, For additional
information contact the Central Office Stormwater Staff member listed below or check the Stormwater & General
Permits Unit Web Site at http:f/h2o.enr.,,tate.nc.us/su/stormwater.html
If the subject stormwater discharge to waters of the state has been terminated, please complete the enclosed
Rescission Request Form. Mailing instructions are listed on the bottom of the form. You will be notified when the
rescission process has been completed,
If you have any questions regarding the permit renewal procedures please contact Corey Basinger of the
Winston-Salem Regional Office at 336-771-4600 or Bill Mills of the Central Office Stormwater Unit at (919)
733-5083, ext. 548
Sincerely,
Bradley Bennett. Supervisor
Stormwater and General Permits Unit
cc: Central Files
Winston-Salem Regional Office
NCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1- 800.623-7748

T. T 2010 12:14PM CHAMPION ITOCK ROOM
No.0675 P. 2
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Champion Industries, Inc.
Attn.: Mr. David Hill
P.O. Box 4149
Winston Salem, NC 27115
March 23, 1998
VLFC
MAR 2 5 1998
_ Subject: Representative Outfall Status Petition
Champion Industries, NCG030271
Forsyth County
The purpose of this letter is to respond to a representative outfall request made for your
facility in a letter dated March 4,1998 from Aquaterm Engineering.
Your request was to exclude outfalls 3 and 4 from the sampling requirements of the permit.
From our review it appears that these outfalls drain office and employee parking areas
.which are not subject to the NPDES Stormwater permit requirements. Therefore your
request to exclude these two outfalls is appropriate,
It you have any questions concerning the contents of this letter, contact me at (919) 733.-
5083 x 584.
Sincerely,
Antoni . Evans, PE
Environmental Engineer
S tormwater and General Permits Unit
cc:
Central Files
Winston Salem Reional Office
Aquaterra Engineering, Inc.; Attn.: David C. McDaniel, P.O. Box 37579, Raleigh, North
Carolina 27627-7579
P.O. Box 29535. Raleigh, North Carollna 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity ANirmative Action Employer 50% recycled/ 10% post -consumer paper

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}
March 4, 1998
North Carolina Department of Environment
and Natural Resources
Division of Water Quality
Stormwater Group
Post Office Box 29535-
Raleigh, North Carolina 27626-0535
Reference: Representative Outfall Status Petition
Champion Industries, Inc.
Winston-Salem, Forsyth County, North Carolina
General Permit No. NCGO30000
Certificate of Coverage No. NCG030271
Aquaterra Engineering Job No. 3101200
Dear Sir or Madam:
Aquaterra Engineering, Inc. (Aquaterra) has been retained by Champion Industries, Inc.
(Champion) to prepare the Storm Water Pollution Prevention (SWPP) Plan for their facility located
in Winston-Salem, Forsyth County, North Carolina (see Figure 1), This petition is based on
information obtained during a site visit on February 25, 1998, and subsequent data collection and
conversations with site personnel.
The Notice of Intent dated February 2, 1994, stated that seven outfalls at the site are associated
,with industrial activity. A subsequent site investigation for preparing the SWPP Plan shows there
are actually 8 outfalls at the site. figure 2 from the Plan presents the site plan with the 8 outfall
locations.
On behalf of Champion, Aquaterra is petitioning that outfalls 3 and 4 not be included in the
sampling requirements of the general permit issued to Champion. No industrial- activities occur in
the drainage areas corresponding to these outfalls. The two outfalls drain an area containing only
an office building and a parking lot. All industrial activities would drain to the other outfalls as
indicated by the storm water flow arrows on the site plan,
If you have any questions concerning this letter, or need additional information, please call me at
[phone],
Sincerely,
QUATERRA E
N
GINEERING, INC.
• i t 1G� a�n�
David C. McDaniel
Project Engineer
cc: Mr. David Hill — Champion Industries, Inc., Winston-Salem, North Carolina
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J;A, I, 1010 i2:1hFM CHAMNON QJIOCK KOOM
N4 06 /� F. 5
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Champion Industiies, Inc.
Attn.: 1MSr. David Hill
P.O. Box 4149
Winston Salem, NC 27115
March 23, 1999
Subject: Representative Outfall Status Petition
Champion Iftdv.gtries,. NCG030271
Forsyth County
The purpose of this letter is to respond to a representative outfall. request made for your
facility in a letter dated March 4, 1998 from Aquaterra Engineering.
Your request was to exclude outfalls 3 and 4 from the sampling requirements of the permit.
From our review it appears that these outfalls drain office and employee parking areas
,which are not subject to the NPDES Stormwater permit iequirements. Therefore your
request to exclude these two outfalls is appropriate.
If you have any questions concerning the contents of this letter, contact me at (919) 733-
5083 x 584.
Sincerely,
0��tc
Anton . Evans, PE
Environmental Engineer
Stormwater and General permits Unit
W
Central Files
Winston Salem Reionai Office
Aquaterra Engineering, Inc., Attn.: David C. McDaniel, P.O. Box 37579, Raleigh, North
Carolina 27627-7579
P.O. Box 29535, Fialelgh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
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State of North Carolina
Department of Environment, !MAI
Health and Natural Resources
I.
Division of Water Quality 1 •
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary ®C
A. Preston Howard, Jr., P.E., Director CC F�
September 24, 1997
DAVID E. HILL
CHAMPION INDUSTRIES
PO BOX 4149
WINSTON-SALEM, NC 27115
Subject: Reissued Stormwater General Permit for Certificate of Coverage No. NCG030271
Forsyth County
Dear Pen-nittee:
In response to your renewal application for continued coverage under the subject permit, 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 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.
■ 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. 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.
■ A copy of a Technical Bulletin on the stormwater program with outlines program components
and addresses frequently asked questions.
■ A corrected Certificate of Coverage if you indicated a name or address change on the Renewal
Form returned to the Division.
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 Group at telephone number [phone]
Sincerely, !�
foA_ 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,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
March 25, 1994
Mr. Henry Holt III
Champion Industries
P.O. Box 4149
Winston Salem, NC 27115
Subject: General Permit No. NCG030000
Champion Industries
COC NCG030271
Forsyth County
Dear Mr. Holt:
In accordance with your application for discharge permit received on February 3, 1994, we are
forwarding herewith the subject certificate of coverage tp 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.
If you have any questions concerning this permit, please contact Mr. Bill Mills at telephone number 919/733-
5083.
Sinc r g6 Signed By
Coleen H. Sullins
A. Preston Howard, Jr., P. E.
cc: Winston Salem Regional Office
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, HEALTH, AND NATURAL RESOURCES
DMSION 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,
Champion Industries
is hereby authorized to discharge stormwater from a facility located at
Champion Industries
3760 Industrial Drive
Winston-Salem
Forsyth County
to receiving waters designated as Leak Fork Creek in the Yadkin - Pee Dee River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, II, III
and IV of General Permit No. NCG030000 as attached.
This certificate of coverage shall become effective March 25, 1994
This Certificate of Coverage shall remain in effect for the duration of the General Permit
Signed this day March 25, 1994
Original Signed By
Coieen H. Sullins
A. Preston Howard, Jr., P.E.
Division of Environmental Management
By Authority of the Environmental Management Commission

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