NCG240021_COMPLETE FILE - HISTORICAL_20190405

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v p Oct[
DOC TYPE
0, HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ CEO! CI © 4- 05
YYYYMMDD

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Interim Director
City of Reidsville
Attn: Preston Mitchell
230 West Morehead Street
Reidsville, NC 27320
NORTH CAROLINA
Environmental Quality
April 5, 2019
Subject: Compliance Inspection
Permit No. NCG 240021
Reidsville Yard Waste & Material Recovery Facility
Rockingham County
Dear Permit Holder:
On April 3, 2019, Brandon Wise, inspector with the North Carolina Department of
Environmental Quality (NCDEQ) -- Division of Energy, Minerals, and Land Resources met with
site contacts at the facility located at 407 Broad Street in Reidsville, to conduct a compliance
inspection as part of the comment period for a new permit application. The inspection consisted
of review of the Stormwater Pollution Prevention Plan (SWPPP) and each of its components,
review of the facility outfalls. as well as the review of the overall site conditions.
The compliance inspection was conducted to ensure all site practices and facilities are in
working order. The inspection was also conducted as assistance to the City of Reidsville should
there be any questions about the implementation of the permit NCG240021.
Permit:
This facility has General Stormwater Permit NCG240021 to discharge stormwater from
industrial activity associated with Composting Operations [SIC 2875 and/or 28791 under the
National Pollutant Discharge Elimination System (NPDES). The permit was not yet effective at
the time of the inspection, as the inspection was completed as part of the comment period.
Records/Reports:
This facility is required to develop and maintain a SWPPP in accordance with Part II of
the permit. All qualitative and analytical monitoring records are required to be maintained with
the SWPPP for a minimum of five (5) years. Under this permit, analytical monitoring is required
under current operating procedures. The facility records do not include any reports as the facility
was not actively permitted prior to the inspection. The SWPPP for this facility had been put
together prior to arriving on site. The SWPPP looked very good and contained all required
components. Outfall locations need to be updated to the locations that were discussed on site
rather than the creek sample locations previously chosen. The facility is required to maintain
employee training records in accordance with Part I1, Item 6 of the permit. Ensure that these
records are added to the SWPPP when training is completed.
EQ"A North Carolina Department of Environmental Quality I Division of Energy. Mineral and Land Resources
Winston-Salem Regional Office 1450 Hanes Mill Road, Suite 3001 Winston-Salem. North Carolina 27103
•JUi1M GSACYiNh �^\ �
336,776,9800

Facility Site Review:
This facility operates as a storage yard for natural debris prior to being mulched along
with storage for composting operations performed by the city. The facility is primarily flat with
a slight slope towards the southwest. A diversion ditch is located at the south side of the facility
that directs stormwater to an existing depression that is believed to have been a sediment basin at
one point. The stormwater discharge from this depression will be one of the sampled and
maintained outfalls. This outfall collects the stormwater from primarily the composting area. A
second outfall is located where stormwater is discharged to the unnamed iributary near a sewer
line access. The stormwater discharging to this area will come from the composting area along
with the natural debris storage area. A small area on the southeast side of the facility has been
designated for three roll off containers. This area of the facility will need to be inspected
regularly to ensure potential pollutants are not making it to the stormwater. General
housekeeping was very good while on site, as discussed while on site continued upkeep of the
grass areas between the industrial activity and outfalls is recommended to reduce pollutants.
Effluent Receivin Waters:
Effluent from this facility drains into an unnamed tributary of Little Troublesome Creek,
class "WS-V; NSW" waters of the Cape Fear River Basin.
Self-Monitorinjz Program:
This facility is required to provide Qualitative and Analytical Monitoring quarterly. The
outfalls discharging from the facility are expected to be properly maintained and sampled.
Should any issues arise please contact NCDEQ for assistance.
There are no comments about any changes to the issued permit. If you have any
questions or need additional information, please contact Brandon Wise at [phone] or
[e-mail].
ncdenr.gov.
Sincerely,
FKa
on Wise
tormwater Specialist
Land Quality Section
Winston-Salem Regional Office
Enclosures: Inspection Report
cc: NCDEQ - DEMLR (WSRO) w/o enclosure
FM
�N North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
:> Winston-Salem Regional Office 1450 Hanes Mill Road, Suite 300 I Winston-Salem, North Carolina 27103
°*'^�� 336.770.9800

DUKE
ENERGY
March 12, 2019
NC DEQ-DWR Water Quality Permitting Section - NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Duke Energy Carolinas - East
._Dan_Riveri:omkin I,Cycle Station
Erl'Jll onnientaI h4hl§ 9dgewood Rd
Received EdenNC27288
li`iinaton-s3leiil
Subject: Revision to Delegations of Authority for Duke Energy Carolinas, LLC
NC NPDES Stormwater- Permitted Facility — Dan River Combined Cycle Station- NC000572
Dear Sir or Madam:
Duke Energy Carolinas, LLC, submits this correspondence as a revision to documentation for your
records of responsible corporate officers ("Responsible Officials") and designation of duly authorized
representatives ("Delegated Authorities") for the NPDES-Stormwater Permit for the Dan River Combined
Cycle Station..
Duke Energy
Carolinas LLC
NPDES Permit
Number
Responsible Official
Name - Title
Delegated Authorities
Name -Title
Dan River Combined
NC000572
Michael Lanning -
1. Chad Stevens -
Cycle Station
Station Manager
Superintendent Operations
2. Antonio Price - Maintenance
and Technical Superintendent
3. Jeff Dunovant- Superintendent
CT Operations and
Maintenance
If there are any questions, please contact either:
• Dana Newcomb, Environmental Professional for Dan River Combined Cycle and Rockingham
CT; phone [phone] or e-mail Dana. Newcomb@ duke-energy.com; or
• Joyce Dishmon, Environmental Specialist at our North Carolina Regional Headquarters, phone
[phone] or email Joyce.DishmonQduke-energy.com.
Sincerely,
Michael Lanning
Station Manager
cc: Winston Salem Regional Office — NCDEQ DEMLR

Public Works Department
1100 Vance St., Reidsville, NC 27320
Phone: [phone] Fax:[phone] sl
November 28, 2019
Stormwater Program
Division of Energy, Mineral, and.Land Resources
1612 Main Service Center
Raleigh, NC 27699-1612
Re: Notice of intent — Permit item Response
To Whom It May Concern:
'i` 111., c1l'Y OF
ReidsvMe
NORTH CAIOl.1NA
This letter is in response to item sixteen of the permit application requesting documentation as to
why the'City of ReidsAlle Wastewater Treatment Plant (WQ Permit NCo024881) will not be accepting
wastewater from the Reidsville Yard Waste & Recovery Facility. As per NC Department Environmental
Quality requirements, the City of Reidsville staff is tasked with eliminating and/or limiting the volume of
inflow and infiltration into the treatment works. Not only is inflow and infiltration costly to treat, but
heavy rains from storm events could inundate the plant which could lead to sewerage spills and
environmental tragedy.
A collection system at the Reidsville Yard Waste & Recovery Facility that discharges to the City of
Reidsville Wastewater Treatment Plant would allow not only receive runoff from the vegetative debris
but also stormwater runoff from the Iarge site. This could be viewed as a permit violation by NC DEQ
Water Quality Permitting staff.
Last but certainly not least, there would be an unnecessary financial burden placed on the citT for
treating stormwater runoff, in additional to, constructing and maintaining a collection system for the
Reidsville Yard Waste & Recovery Facility.
Please contact me if there are any questions.
Respectfully,
&L4-9 4(—�—
Chuck Smith
Public Worlds Director

NCIG,2Lf002.1
Division of Energy, Mineral and Land Resources
Stormwater Program
National Pollutant Discharge Elimination ,System
Fr�er-yy, lvfrflc>r'tll
UM.l Land Resootx- es NCG24aaoo
FtV!;: CINMF,NTnL QJAL.IT'y
NOTICE OF INTENT
q 5 P_
FED, 0 1 201,11
National Pollutant Discharge Elimination System application for coverage under General Permit
N CG 240000: DE-NR-1.AND QUALITY
STQRlOWA I ER PERRN11TTIhG
STORMWATER AND PROCESS WASTEWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification)Code: 2875 -Compost facilities, and like activities
This NOI maybe an application to discharge process wastewater. NCG240000 contains effluent limitations
fui piuti ss wdslewdlel disiLlidlyes, Wdslewalat cll5cltatyti6 Inusl tnaal ilia rec{ullr�lnellls t,f Lliese
effluent limitations. An exceedance of any of these limitations will result in a violation of the permit
conditions.
For questions, contact the DEMLR Central Office or Regional Office in your area, (See page 8)
(Please print or type)
1) Mailing address of owner/operator (official address to which all permit correspondence will be
mailed :
Legal Company Name City of Reidsville
(Please attach the most recent Annual Report to the NC Secretary of State showing the current legal name, Alternatively this
permit can be given to an individual.)
Signee's Name (as signed for in question 28 below) Preston Mitchell, City Manager
Street Address 230 W. Morehead St.
City Reidsville State NC ZIP Code 27320
Telephone No. 336 349-1040 Email [e-mail]
Alternate Contact Name Charles Smith Email, (if different) csmith@rPidsvillenc,gov
Alternate Contact Telephone (if different) 336-349-1070
2) Location of facility producing discharge:
Fa( ilily Naitie.
Street Address
C ity
County
Facility Contact
Telephone No.
Reidsville Yard Waste & Material Recovery Facility
407 Broad St,
Reidsville State NCZIP Code 27320
Rockingham
Pat Knowles
336 379-1
3) Physical location information:
Email [e-mail]
Please provide narrative directions to the facility (use street names, state road numbers, and distance and
direction from a roadway intersection). From US HWY 29 and US HWY 87 intersection, travel west on HWY 87t to the S. Scales St. intersection, turn rigFt. Travel north to the Broad St intersection, turn right. 407 Broad St is at
(A Sy onf c'u AQV ClSGS quad sheet with facility clearly located on the map is a required part of this application.)
4) Latitude
N: 36.323949 °
Longitude W: -79.660056
(deg., min, sec or decimal)
Pdye 1 cif 8
SWU-NCG24-NOI Last revised 10/02RO17

� r
NCG240000 N.O.T.
5) This NPDES Permit Application applies to the following (check all that apply):
® New or Proposed Facility Date operation is to begin January 2019
❑ Existing Facility Date operation began
6) Consultant's application information:
Consultant: Janine Sehre aek PE
Consulting Firm: _JMS Engineering, PLLC
Mailing Address: _6509 Fayetteville Road, Suite 245
City: _Durham
State: NC Zip Code: 27713
Phone: [phone]
Finail, janine@jms-engineering com
(Optional)
Staple Business Card Here:
7) Provide the 4 digit Standard Industrial C'las5ification Codp (.SIC Codp)that dpscrihes the primary
industrial activity at this facility:
SIC Code: 9199
8) Provide a brief description of the types of industrial activities and products produced at this facility,
including the DWM compost facility classification: (Attach a site diagram showing the process areas
present at this facility.)
_Large, Type I Yard Waste Composting Facility with Mulching operation
Stormwater Discharge, Wastewater Treatment & Discharge and Permitting Information
9) Discharge points / Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stermwater
and/or wastewater discharges will end up in? Jordan Lake Watershed
To find the waterbody, please.see the "MAPS" tab on
httQs:/Incdenr,maps.arcgjs .coma s eba viewer index.html?id=6e125ad7628f494694e259c80dd64
265 for a map of NC Surface Waterbody Classifications.
Receiving water classifications) for the waters: WS-V, NSW
if the site will discharge to a separate storm sewer system, name the operator of the separate storm sewer
system (e.g. City of Raleigh municipal storm sewer).
Note: Discharge of process wastewater to receiving waters classified as public water supply WS-U
to WS-V must be approved by the Public Water Supply Section of the Division of Water
Resources. If DWR does not approve, coverage under NCG 240000 cannot be granted. No new
discharges of process wastewater are permitted in receiving waters classified as WS-I or
freshwater ORW. Slrrillarly, the Dlvislon of Erivironmental HealLh Shellfish Sanitaftri Prograrn
must approve process wastewater discharges to SA shellfish waters.
Page 2 of 8
SWU-NCG24-NO] Last revised 10/02/2017

N C G 240000 N.O.I.
Will this facility discharge to:
Shellfishing waters (Classified SA)?
TiouLwateis (Classified Ti)?
High Quality Waters (Classified HQW)?
Outstanding Resource Wags (Classified ORW)?
Primary Nursery Area waters (Classified PNA)?
Nutrient Sensitive Waters (Classified NSW)?
❑ Yes X No
❑ Yes X No
❑ Yes X No
❑ Yes X No
❑ Yes X No
X Yes ❑ No
Water Supply Watershed Waters (Classified WS I— WS V)? X Yes ❑ No
`zero -flow' streams (as described in 15A NCAC 2B .0206)? ❑ Yes X No
List discharge points (outtalls) that convey discharge from the site (both on -site and off -site) and
location coordinates. Attach additional sheets if necessary, or note. that this information is specified
on the site plan.
Be sure to indicate a type for each outfall listed below as Stormwater only, Wastewater only or
Wastewater Commingled with Stormwater
OutfallNo._SDO#1_ Stormwater only® Wastewateronly ❑ Wastewater Commingled with Stormwater
Latitude (deg rees/mi nutes/seconds): 36 Deg. 19 Min. 17.40 Sec. N
Longitude (degrees/minutes/seconds): = 079 Deg. 39 Min. 38.70 Sec. W
Outfall No. _PWDO#2 Stormwater only ❑ Wastewateronly ® Wastewater Commingled with Stormwater ❑
Latitude (degrees/minutes/seconds): 36 Deg. 19 Min. 15.61 Sec.
Longitude (degrees/minutes/seconds): -079 Deg. 39 Min. 34.08 Sec. W
Outfall No. Stormwater only ❑
Latitude (degrees/minutes/seconds):
Longitude (deg rees/mi nutes/seconds):
Outfall No. Stormwater only ❑
Latitude (degrees/minutes/seconds):
Longitude (degrees/minutes/seconds):
Outfall No. Stormwater only Cl
Latitude (deg rees/minutes/seconds):
Longitude (degrees/minutes/seconds):
Wastewateronly ❑ Wastewater Commingled with S tormwater ❑
N
W
Wastewateronly ❑ Wastewater Commingled with Stormwater ❑
N
W
Wastewateronly ❑ Wastewater Commingled with Stormwater ❑
N
W
Outfall No. Stormwateronly ❑ Wastewateronly ❑ Wastewater Commingled with Stormwater ❑
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
You must show all discharge points clearly on the submitted site plan. Be advised that
NCDEQ may require you to apply for an individual permit, based on proposed discharge
rates and receiving stream conditions (low flows, impairments, etc.)
Page 3 of 8
SWU-NCG24-NOI �astrevised 10/02/2017

NCG240000 N .O.I.
EdC.I I dippliwi EL SI ldll PtWide the fUIIUWii ly i Ifu Indtioi 1 (dLLd(.I1 dddlLiondl SI IeeLS dS i iecessdl y):
• Two (2) site plans depicting the facility or site with numbered outfalls which indicate stormwater and wastewater
outfalls. The plans shall legibly show. at a minimum, (existing or proposed):
o Outline of drainage areas with topographical lines and features (Schnabel Eng.)
o Stormwater/wastewater treatment structures (Schnabel Eng.)
o Location of numbered stormwater/wastewater outfalls (Schnabel Eng.)
o Delineation of drainage areas to each discharge point (JMS Eng.)
o Runoff conveyance structures (Schnabel Eng.)
o Areas and acreage where materials are stored (Schnabel Eng.)
• Location of the various composting activities with identifying labels (]MS Eng.)
o Impervious area acreages (Schnabel Eng.)
U Lw-aLlon(s) or sti eai ns a11d/ui wetlands LI ie slLe Is dial 11i 1g Lo, and al iy applicable buffei s (Sc.l 11 Sabel Ei ig.)
o Site property lines, North Arrow, and bar scale (Schnabel Eng.)
o If applicable, the 100-year floodplaln line (Schnabel Eng.)
o Acreage of each stormwater and wastewater topographical area (Schnabel Eng.)
o Each of the facilities' wastewater or stormwater source and discharge structures and each of its
o hazardous waste treatment, storage, or disposal facilities (Schnabel Eng.)
o Notation of the water quality classification of the receiving water that site waters eventually discharge to
c Site location (insert)
Site plans shall be.24" x 36" in size.
• Line drawing and description: A line drawing of the water flow through the facility. A pictorial
description of the nature and amount of any sources of water and any collection and treatment measures.
A narrative description and identification of the compost manufacturing sequence at the applicant's
site, the general feedstocks, the determination of whether the site's final product qualifies as'finished
compost' as referenced in the General Permit text (NCG240000) and as determined by the DWM
permitting process, identification of the stormwater BMPs employed, and the general nature of the
wastewater treatment system utilized to meet process wastewater discharge limits.
11) Does the facility use any of the following on site?
❑ Liquid, granular, or other materials added for their concentrated phosphorus compounds content?
❑ Liquid, granular, or other materials added for their concentrated nitrogen compounds content?
12) Does the applicant have any unresolved Notice of Violations (NOVs)?
N No ❑ Yes
Process Wastewater (Process wastewaters are defined in Part III Section D of the General Permit text.):
13) Will your facility discharge process wastewaters to surfacewateFs? ---
X Yes ❑ No
14) Are wastewater treatment facilities planned in the 100-year flood plain?
XNo ❑Yes
*�m,af 15) Will your facility build a closed -loop recycle system (CLRSs) that meets design requirements in 15A
02T .1000 and hold your facilities' working volume?
❑ Yes X No YYes, STOP COMPLETION of this NOI. ContactDWR Non -Discharge Permitting
Program for permitting requirements.
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NCG240000 N.O.I.
16) A wastewater treatment alternatives review is required by 15A NCAC 21-1.0105 (c)(2) for any new or
expanding water pollution control facility's discharge in North Carolina. You may attach additional sheets.
ILI
a) What wastewaters were considered for this alternatives review? ❑ VE ❑ RM ❑ MD
b) Connection to a Municipal or Regional Sowor Colleotion Systom:
i) Are there existing sewer lines within a one -mile radius'? ..................................... ® Yes ❑ No
(1) If Yes, will the wastewater treatment plant (WWTP) accept the wastewater? .... ❑ Yes IN No
(a) If No, please attach a letter documenting that the WWTP will not accept the wastewater.
(b) If Yes, is it feasible to connect to the WWTP? Why or why not?*
c) Surface or Subsurface Disposal System (e.g., spray irrigation):
1) Is a surface or subsurface disposal technologically feasible (posslbley? .................... LJ Yes D8 No
Why or Why not? The city doesn't have property to apply the runoff and capturing the runoff would
be cost prohibitative.
ii) Is a surface or subsurface disposal system feasible to implement?* ........................... ❑ Yes N No
Why or Why not? Spray irrigation is not a feasible option for this site due to the proximity of adjacent
properties, land use constraints, and location of on site streams.
iii) What is the feasibility of employing a subsurface or surface discharge as compared to a direct
discharge to surface waters?* Options other than direct discharge to surface waters would be cost
prohibitive. The site allows for natural filtration of runoff,
d) Direct Discharge to Surface Waters: is discharge to surface waters the most environmentally sound
alternative of all reasonably cost-effective options of the wastewaters being considered?*... N Yes ❑ No
i) If No, contact DEMLR's Land Application Unit to determine permitting requirements.
`Per NC rules at 15A NCAC 2N .0105(c)(2). You maybe asked to provide further information to support your answers
to these questions after the initial review. Feasibility should consider initial and recurring costs.
Process wastewater treatment system performance
You are applying for coverage under NCG 240000 which enforces process wastewater effluent limitations on
the pollutants HOD, I S S , pH, and fecal coliform. Except as specifically provided in the General Permit text,
or DP MLR compliance schedule, any exceedances of the process wastewater effluent limitations are a
violation of the terms and conditions of the permit, and may be the basis for DE MLR enforcement action.
Also please note: NC rule I SA NCAC 2H .0139 requires that wastewater treatment system design be
accomplished by a North Carolina Professional Engineer.
Stormwater:
17) Does this facility employ any best management practices for Stormwater control? X No ❑ Yes
If yes, please briefly describe: mere are no structural BMPs, however we do have stormwater pollution
prevention plan that we will follow.
18) Does this facility have a Stormwater Pollution Prevention Plan? ❑ No
Y yes, when was it implemented? December 2018
XYes a
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NCG240000 N.O.I.
19) Are vehicle maintenance activities (VMA) occurring or planned at this facility? X No ❑Yes
If yes, does your VMA area discharge into your wastewater treatment device? ❑ No ❑ Yes
Other/Permitting :
20) Does this facility have a Division of Land Resources Erosion & Sedimentation Control (E&SC) Permit?
X No ❑ Yes
If yes, list the permit numbers for all current E&SC permits for this facility:
21) Does this facility have a Division of Waste Management permit?
❑ No ®Yes
If Yes,Permit number(s)-Large Type I Solid Waste Compost Facility Permit 7908
22) Is your facility subject to Phase II Post -Construction Area? X No ❑ Yes
If yes, who is the permitting authority?
23) Is your facility located in one of the 20 Coastal Counties? Yes XI No
Is your facility adding more than 10,000 ft2 of built -upon area or CAMA Major Permit? ❑ Yes X No
24) Is your facility discharging wastewater (treated or untreated) such as water from wetting of aggregate piles,
drum rinse -out, or vehicle and equipment cleaning to a stormwater BMP? X No ❑ Yes
If yes, please attach your approval from the permitting authority to do so.
25) Does this facility have any other NPDES permits? X No ❑ Yes
Yyes, listthe permitnumbers forall currentNPDES permits forthis facility:
26) Does this facility have any Non -Discharge permits (ex: recycle permits)? X No ❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
27) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
X No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
XNu ❑Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
d)
X No ❑ Yes
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport/ disposal vendor:
Vendor address:
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SWU-NCG24-NOI Last revised 10102/2017

N C G 240000 N .0 .I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
X Check for $100 made payable to NCDEQ.
X This completed application and all supporting documentation. See Question 10.
rlr ❑ If an Erosion & Sedimentation Control (E&SC) Plan is required from Division of Land Resources (DLR)
or local designee: documentation verifying applicant has developed and submitted that Plan to the
governing agency (required per 15A NCAC 02H .0138).
X Two (2) site plans depicting the site plan with numbered outfalls which indicate stormwater and wastewater
1 - outfalls. See Question 10.
X A county map or USGS quad sheet with location of facility clearly marked.
28) Signatory Requirements (per 40 CFR 122.22)
All applications, reports, or information submitted to the Director shall be signed and certified.
a. All notices of intent to he covered tinder this Gmoral PPumit shall he signed as follows:
(1) For a corporation: by a responsible corporate officer. For the purpose of this permit, a responsible corporate officer moons: (a) a president,
seOelary, ltedSurel ur vlc.e president or ute corporation In cllarye urd ptinclual buslness runChUH, or any uUwr person who performs s1mllar
policy or decision making functions for the corporation, or (b) the manager of one or more manufacturing production or operating facilities
employing more than 250 persons or having gross annual sales or expenditures exceeding 25 million (in second quarter 1980 dollars), if
authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures,
(2) For a partnership or sole proprietorship: by a general partner or the proprietor, respectively; or
(3) For a municipality, state, federal, or other public agency: by either a principal executive officer or ranking elected official.
Certification: North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, orother document
filed or required t4 be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statementof a material
factin a rulemaking proceeding or contested case underthis Article; orwho falsifies, nmpers with, orknowingly renders inaccurate any recording
or monitoring device ormethod required to be operated ormaintained underthis Article orrules of the [Environmental Management]Commiss"on
implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit will
constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an individual
pen -nit.
I certify that I am familiar with theinformation contained in this application and that to the beat of my knowledge
and belief such information is true, complete, and accurate.
Printed Name. of Person Signing:
Me: C,'+ti
(Signature of Applicant)
I - 30- l
(Date Signed)
DE',IIR.LAND QUALITY
-3T0Rfv `v%.t',TER PERff; —HNG
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S W U-NC G 24-N O I Last revised 10/02/2017

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