NCG060351_COMPLETE FILE - HISTORICAL_20161109

M 1)Zv.
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
HISTORICAL FILE
0 MONITORING REPORTS
DOC DATE
❑ I �O l i t) J
YYYYMMDD

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
RECEIVED
o09Mb
pWTL FILES
R SECTION
Mr. Bert Hilliard
Mann & Hummel Filtration Technology
P.O. Box 1901
Gastonia, NC 28053
Dear Mr. Hilliard:
PAT MCCRORY
Goventor
DONALD R. VAN DER VAART
October 31, 2016
Secretary
TRACY DAVIS
Director
Subject: NPDES Stormwater Permit NCG060351
Mann & Hummel Filtration Technology
Formerly Wix Filtration
Gaston County
Division personnel received your request to revise your stormwater permit Certificate of'
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate.of Coverage. The terms and conditions contained
in the General Permit remain unchanged and in full effect. This revised Certificate of
Coverage is issued under the requirements of North Carolina General Statutes 143-215.1 and
the Memorandum of Agreement between North Carolina and the U.S. Environmental
Protection Agency.
If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sincerely,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land
Resources
cc: Mooresville Regional Office
Stormwater Permitting Program Files
w'Central Files
Slate ol'North Carolina' Environmenml Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1 512 North Salisbury Street I Raleigh, North Carolina 27699-1612
919 707 9220 'r

.,
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060351
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,
Mann & Hummel Filtration Technology
is hereby authorized to discharge stormwater from a facility located at:
Master Distribution Center
1551 Mount Olive Church Road
Gastonia
Gaston County
to receiving waters designated as an unnamed tributary to Long Creek, a class WS-II; HQW
waterbody to Catawba River South Fork, Catawba River Basin; in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I. II, 111, and IV of
General Permit No. NCG060000 as attached.
This certificate of coverage shall become effective October 31, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 31, 2016.
for, Tracy E. DWis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

N
Energy, Mineral
and Land Resources
ENWRONMENTAL QUALITY
RECEIVED
NOV 3 2016
DENR-DEMLR
Land Quality Section
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
October 31, 2016
Mr. Bert Hilliard
Mann & Hummel Filtration "Technology
P.O. Box 1901
Gastonia, NC 28053 Subject
Dear Mr. Hilliard:
Secretary
TRACY DAVIS
Director
NPDES Stormwater Permit NCG060351
Mann & Hummel Filtration Technology
Formerly Wix Filtration
Gaston County
Division personnel received your request to revise your stormwater permit Certificate of
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained
in the General Permit remain unchanged and in full effect. This revised Certificate of
Coverage is issued under the requirements of North Carolina General Statutes 143-215.1 and
the Memorandum of Agreement between North Carolina and the U.S. Environmental
Protection Agency.
If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sincerely,
ORIGINAL SIGNED BY
BETHANY GEORGOULIAS
for Tracy E. Davis. P.E., CPM, Director
Division of Energy, Mineral and Land
Resources
cci�Mooresville Regional Office
Stormwater Permitting Program Files
Central Files
State of -North Carolina I FnvirmunCnlal Quality 3 E•nergy, Mineral and Land Resources
1612 Mail Servicc Center 1 512 North Salisbury Street I Raleigh, North Carolina 27699-1612
919 707 9220 T

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060351
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.
Mann & Hummel Filtration Technology
is hereby authorized to discharge stormwater from a facility located at:
Master Distribution Center
1551 Mount Olive Church Road
Gastonia
Gaston County
to receiving waters designated as an unnamed tributary to Long Creek, a class WS-1I; HQW
waterbody to Catawba River South Fork, Catawba River Basin; in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts 1, 11, II1, and IV of
General Permit No. NCG060000 as attached.
This certificate of coverage shall become effective October 31, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 31, 2016.
ORIGINAL SIGNED BY
BETHANY GEORGOULIAS
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

t A
_K;A Division of Energy, Mineral & Land Resources
/ Land Quality Section/Stormwater Permitting
NCDENRNational Pollutant Discharge Elimination System
R. N�,�Gh�W�No ..o.
PERMIT NAME/OWNERSHIP CHANGE FORM
Fr,vir+w+�ewr •r.o NA'uRll Re�nCe5
FOR AGENCY USE ONLY
Date Received
Year
I Month Da
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C S 0 N I G 10
lI. Permit status prior to requested change.
a. Permit issued to (company name): i on
b. Person legally responsible for permit: 1
First Ml Last
Title
Q L% Permit Holder Mailing Address
G Z$ 0
pF 2��6 City State Zip
U Phone Fax
c. Facility name (discharge): S i ' C- 1 S "tiLI
d. Facility address: is lzo(�
Address n p
)(-
City State Zip
e. Facility contact person: mcn000 D di tYlML( (70q ) SO-
First / M1 / Last Phone
111. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ hange in ownership of the facility
Name change of the facility or owner
!f other please erplabz:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
!_
First Ml Last
Title
TO r OX N^01
Permit Holder Mailing Address
- {_ems l�l L Z�s d �3
City state Zip
Phone E-mail Address
NI a5ff ys-frt +i or, Cl1��-Ir
1551 t- l — Ur, Rem
Address
tG yj (_ M05-Q-
City State Zip
First Ml Last
� ) S�qi- 3910G _
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan. 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Pennit contact: nna C,- �_ C �v7'im 1
First M I Last
Title
Mailing Address
Ga4o(",s, _ K� (- ; Yo s 3
City r State Zip
r0
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to th' ownership or name change?
Yes
❑ No (please explain)
V1. Required Items: TIIIS APPLICATION WILL 13E RETURNED UNPROCESSED 1F ITEMS
ARE,INCOMPLETE OR MISSING:
This completed application is required for both name change and/or ownership change
lquests.
egal documentation of the transfer of ownership (such as relevant pages of a contract decd,
or a bill of sale) is required for an ownership change request. Articles of incorporation arc
not sufficient for an ownership change.
..................................................................................................................
"fhe certifications below must be completed and signed by both the pennit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting infonmation is not included, this application package will be
returned as incomplete.
; 6f10 R6
Signature Date
APPLICANT CERTIFICATION
I, A( , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that ifall re ed supporting information is not included, this application package will be
returned as incomple
Signature bate
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014

State of Delattiare
secretan. of State
Dhisiou of corporalloa5
Delh-ered 09:27 AM 05�0412016
FILED 09:27 a110 j04NI6
SR 20162810605 - Flle\umber 3840671
STATE OF DELAWARE
CERTIFICATE OF AMENDMENT
1. Name of l.inlited Liability Company: Wix Filtration Corp LLC
2. The Certificate of' Forrnalion of the fimited liability company is hereby amended
as follows:
Paragraph I k hereby amended and restated in its entirety to read as follo+vs:
"I . The manic of the limited liability winpany is MANN+IiUMMEL Filtration Technology US
LLC."
IN WITNESS WHEREOF, the undersigned have executed this Certificate on
the -- �/�1, _day of a r _. A.E. 2016 -
By: s�
Authorized Person(s)
Name: Davit! Sturgcss, Secretary
Print or Type
DFUR:. 0511 P11y17 PI Syv-IMI...

r NORTH CAROLINA
3
-. Department of the Secretary of State
AMENDED CERTIFICATE OF AUTHORITY
I, ELAINE F. MARSHALL, Secretary of State of the State of North
Carolina, do hereby certify that
MANN+HUMMEL FILTRATION TECHNOLOGY US LLC
is hereby issued an Amended Certificate of Authority evidencing its name change
from WIX FILTRATION CORP LLC. A copy of the application for an amended
certificate of authority conforming to the requirements of the general statutes of
North Carolina is attached.
IN WITNESS WHEREOF, I have hereunto set
my hand and affixed my official seal at the City
of Raleigh, this 22nd day of June, 2016,
Scan to verify online.
Certification# C201617400315-1 Reference## C201617400315-1 Secretary of State
Verify this certificate online at http://www.sosnc.gov/verification

SOSID: 0925937
Date Filed: 6/22/2016 1:05:00 I'M
Elaine F. Marshall
North Carolina Secretary of Slate
C201 G ] 74 00315
State oj'i•orlh Carolina
Department or the Secretag of .State
APPLICATION FOR A1.1ENDED CERTWICATE OF AUTHORf.TY
FOR L INUTED L.IAB11,ITY CO:NIPAINY
Pursuanl.to OvnCral Statutes of `;orh Caroiina, the under:;i4md limited IiabiIiIv cornpuny hereby applies for an
Amended CcrtiFie aic o,^, Authority to transact business in the Statc of Non$ Caroiiaa. and for that purpose subinitA the following
sutletncnt.
I. Namc of Limited Liability Company
a. The name of the limited liabili!y company exactly as it appcat:s on the Certificate of Authority currently on file with the
North Carolina Department of the Secretary of State:
Wix Filtration Corp LLC
b. The ftclitious name, ifany, orthc limited liability company currently on file with the NC Department ofthe Secretary of
Staic is:
2... The state or country of formation is:Delaware
1. 7'tie date the limited iiability company was am.ori'rcd to transact business in the State of North Cacolina is:
4. The changes being made are as follows: 1Sce insilvcrion; for rlra spr-cific use's of INS docto,rent)
Change of narttc fiunt "Wi.x Filtration Corp LL.C" iu "MANN t-I IUMMEL Filtration Technology US LLC"
S. Attached is a certificate of existence (or document of similar import), duly authenticated by the Seerectry of State or other offtcial
having'custody of limited liability company records in the state or country of formation, The certificate of existence must be less
than six months old. A pltotocopy.ofthv cettilicatiun cannot be accepted.
6. This application will be effective upon filing, unless a future date andlor time is specified:
Tbis the 13 11,� day of,__-jt�t 1 �_--._-- .20 16,
MANNrHUMNIF1, Filtration Technology US 11C
Name of Limited tabilit any
. — -
Signature
Keith Wilsoo, President nrMANNrI1UNIMP.1. Filtration Trchnulogy Group Inc. - Solc Member
Type or Print Name and Title
Notes:
I. Fling fee is $Sit. ThIt appllcatiort must he Cued with the Seerctary of State.
COR,PbRATIONS DIVISION 11, G BOX 29622 RALEIGH, NC 27626.0622
(r&:r1crrfJururpm2014) (Form L-10}

ijelaware
Page 1
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY THAT THE SAID "WIX FILTRATION CORP
LLC", FILED A CERTIFICATE OF AMENDMENT, CHANGING ITS NAME TO
"MANNtHUMMEL FILTRATION TECHNOLOGY US LLC" ON THE FOURTH DAY OF
MAY, A.D. 2016, AT 9:27 O'CLOCK A.M.
771
3840671 8320 �' �; .. f� Authentication: 202529906
SR# 20164563530 Date: 06-21-16
You may verify this certificate online at corp.delaware.gov/authver.shtml

Delaware Page
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY THE ATTACHED IS A TRUE AND CORRECT
COPY OF THE CERTIFICATE OF AMENDMENT OF "WIX FILTRATION CORP
LLC", CHANGING ITS NAME FROM "WIX FILTRATION CORP LLC":,,TO
"MANN+HUMMEL FILTRATION TECHNOLOGY US LLC", FILED IN THIS,
OFFICE ON THE FOURTH DAY OF MAY, A.D. 2016, AT 9:27 O'CLOCK
tag
A. M.
3840671 8100 ' m
SR# 20162810605Y�
You may verify this certificate online at corp.deiaware.gov/authver.shtmk
1
J�fInY WaVllo[�. SlGf�1�ry M Stir
Authentication: 202257061
Date: 05-04-16

_ _ F •w
��1�
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM
Director
November 27, 2013
Mr. Karl Westrick, Facilities Manager
Wix Filtration
P.O. Box 1901
Gastonia, North Carolina 28052
Pat McCrory, Governor
John E. Skvarla, ill, Secretary
Subject: General Permit No. NCG060000
Wix Master Distribution Center
COC No. NCG060351
Gaston County
Dear Mr. Westrick:
In accordance with your application for a discharge permit received on November 6, 2013,
we are forwarding herewith the subject certificate of coverage (COC) to discharge under the subject
state - NPDES general permit. This permit is issued pursuant to the requirements of North Carolina
General Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
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 Energy, Mineral and Land Resources (Division). The Division may require
modification or revocation and reissuance of the Certificate of Coverage. This permit does not
affect the legal requirements to obtain other permits which may be required by the Division or
permits required by the Division of Water Resources, Coastal Area Management Act or any other
federal, state or local governmental permit that may be required.
If you have any questions concerning this permit, please contact Bill Diuguid, Stormwater
Program Planner at telephone number [phone].
Sincerely,
ORIGINAL SIGNED 13)
KEN PICKLE
for Tracy E. Davis
cc: Mooresville Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 • Telephone [phone] FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: hUp: riportal.ncdenr.orglwebllMan d-Quality
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled l 10% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060351
S T ORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-21 5.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Wix Filtration
is hereby authorized to discharge stormwater from a facility located at
Wix Master Distribution Center
1551 Mount Olive Church Road
Gastonia
Gaston County
to receiving waters designated as an urmamed tributary to Long Creek, a.Class WS-I1; HQW waterbody to Catawba
River South Fork, Catawba River Basin; in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, I1, I]1, 1V, V and Vl of General Permit No. NCG060000, as attached.
This Certificate of Coverage shall become effective November 27, 2013.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day November 27, 2013.
ORIGINAL Q� ICK E
for Tracy E. Davis, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission

Map Name: GASTONIA NORTH Scale: 1 inch = 2.000 ft.
Print Date: 10/25/13 Map Center: 035* 16'5&44" N 081* 13'38.47" W
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Diuguid, Bill
From:
Hood, Donna
Sent:
Friday, November 22, 2013 8:26 AM
To:
Diuguid, Bill
Cc:
Khan, Zahid; Bou-ghazale, Samar
Subject:
Wix Filtration/NCG060351
Hello Bill,
Please issue this permit as requested. I have previously visited the site when they asked for no -exposure. They were
denied no exposure and asked to submit for the appropriate stormwater permit. A new site visit was not performed
because there is no reason to duplicate efforts already expended. If you have any questions, do not hesitate to contact
me.
Thanks,
Donna f
jar 3r�f7
Donna Hood - Donna. [e-mail]
North Carolina Dept. of Environment & Natural Resources
610 E. Center Ave.
Mooresville, NC 28115
Ph:704,663,1699 Fax:[phone]
Email correspondence to and from this address is subject to the North Carolina Public Records law and may be disclosed
to third parties unless the content is exempt by statute or other regulation
------------------------------------------------------------------------

Diuguid, Bill
From: Diuguid, Bill
Sent: Thursday, November 21, 2013 3:20 PM
To: Khan, Zahid; Bou-ghazale, Samar
Subject: NCG060351 Wix Master Distribution Center N01 Gastonia
Attachments: NCGO60351 Wix Master Distribution Center Gastonia N01 Nov 21 2013.pdf
Zahid Khan, Samar Bou-ghazale, Mooresville Regional Office:
Please review the attached N01 application with the objective of responding to me with a recommendation to issue the
permit, l recognize that you may not visit each new permittee during this N01 review, but it affords you the opportunity
to log the permit into your regional database and add the facility to a future monitoring and compliance visit schedule.
Therefore, your recommendation now to issue the permit serves as your acknowledgement that (1) the facility is located
in your region, (2) that there are no current complaints outstanding about the facility that have not been dealt with, and
(3) that the facility may ultimately be inspected by the regional staff. I've also attached a scanned copy of the NOI and a
location map for your review.
JCOC # I Facility 11-ocation City/County
INCGO60351 Wix Master Distribution Center 115S1 Mount Olive Church Road IGastonia/Gaston
If you need any more info, give me a call. If you could send me a recommendation to issue the permit by 12/21/2013,
I'd appreciate it, so I can issue their COC. 1 cannot issue the permit until the respective regional office reviews and
comments back to me with a recommendation to issue the permit.
Thanks.
Bill
Bill Diuguid, AICP, Planner
Stormwater Permitting
Land Quality Section
Division of Energy, Mineral and Land Resources I NCDENR
1617 Mail Service Center (Mail)
512 N. Salisbury St, Raleigh, NC 27604 1 9th Floor (Location & Parcels)
Raleigh North Carolina 27699-1617
Phone: [phone] Fax: [phone]
Website: http://taortal.ncdenr.org/web/wq/ws/su
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties.

2012 North Carolina 303(d) List -Category 5
Catawba River Basin 10-digit Watershed 030SO10113 Dutchrnans Creek
> AU Number Name Description Length or Area Units Classification Category
Category Rating Use Reason for Rating Parameter Year
> 11-119-2-3 Forney Creek From source to Killian Creek
8.4 FW Miles
5 Impaired Aquatic Life Fair Bioclassification Ecological/biological Integrity FishCom 2010
Catawba River Basin 10-digit Watershed 0305010114 Mountain Island Lake -Catawba River
12-digit Subwatershed 030501011405 Fite5 Creek -Catawba River
> 11-(117) CATAWBA RIVER (Lake From Mountain Island Dam to Interstate Highway 85 Bridge at Belmont 375.3 FW Acres WS-IV;CA
Wylie below elevation
570)
5
Impaired Aquatic Life
Standard Violation Low pH
2O08
12-digit Subwatershed 030501011403
Long Creek
> 11-120-(2.5)
Long Creek
From a point 0.6 mile downstream of Mecklenburg County 5R 2074 to a 11.3
point 0.4 mile upstream of Mecklenburg County SR 1606
FW Miles WS-IV 5
5
Impaired Aquatic Life
Standard Violation Copper
2008
12-digit Subwatershed 030501011402
Mountain Island Lake
> 11-113-(2)
Johnson Creek
From a point 0.6 mile upstream of mouth to Mountain Island Lake, 3.0
Catawba River
FW Miles WS-IV;CA 5
5 Impaired Aquatic Life Standard Violation Turbidity 2010
Catawba River Basin 10-digit Watershed 0305010115 Lake Wylie -Catawba River
12-digit Subwatershed 030501011502 Catawba Creek
> 11-130a Catawba Creek From source toSR2446, Gaston
5.6 FW Miles
5 Impaired Aquatic Life Fair Bioclassification Ecological/biological Integrity Benthos 1998
> 11-130b Catawba Creek From SR2446, Gaston to SR2439, Gaston 3.1 FW Miles C 5
5 Impaired Aquatic Life Fair Bioclassification Ecological/biological Integrity Benthos 1998
Page 30 of 177
Thursday, March 29, 2012 For EPA Review Submitted March 30, 2012

NCG060000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
B Check for $100 made payable to NCDENR. Must be included with this application (not sent separately).
El This completed application and all supporting documents.
E) A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
loaded, and unloaded, (f) impervious areas, (g) site property lines.
0 Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee coverage under the General Permit.
For questions, please contact the DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office ... [phone]
Mooresville Office ... [phone]
Raleigh Office ........ [phone]
Washington Office ...[phone]
Wilmington Office ... [phone]
Winston-Salem ...... [phone]
Central Office .........[phone]
Page 4 of 4
5WU-221 Lasi revised 11/15/12

OY
Notice to Purchaser -In the event that this check is lost, misplaced or
stolen, a swcm statement and 90-day waiting period will he required
prior to repiacement. This check should be negotiated within 90 days,
UNION RD
0044 6290400 0059
Cashier's Check - Customer Copy
Void After 90 Days
Pa ���BO-
y AMERICAokURER ERn PCTSCTS
n To The NCDENR
Order Of
a
0
Remitter (Purchased By): WIX FILTRATION
Bank of America, N.A.
SAN ANTONIO, TX
Sank of Ame ca a Cashier's Check
No.1145500035
30-111140 Date 10/31/13 02:43:46 PM
NTX
***$100.00
Not -Negotiable
Customer Copy
Retain for your Records
001641000710
No.1145500035
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S[ottcalq Purchaser. iri the <veal;that t�riYstieik i�iJos>, mt3plaQed or _1-✓` ,--" tZiO1C�I`f�, i,9"%I.'jay o. ,% 3�%][4{I ./ I3�t�;1�/ 1/1J ��2.. [t- '4�.�1�,�-' �:•
stolen sawpm fatement i'ad.90,day wyiLng period-tl beYe`q�itred - ti ti \ \ �1. -
�riartoicpfaceinen[ Thr6 Che�K ghqudbe negatraied iiwthth 9Qdays d {l-'� i r _ �,E t r/:i 'a t j-X
yI L r.
UNION RDA
Od44 6290400 ,0059
Q ;+ BANK `
�. �=
OF
Pay.. AMER�CAo1�E Ea �o/CTSGTSlOO OO;
.:r
To The" ' NCDENR
%0rderOf
Remitter (P,uschased By): WIX'FILTRATION ,
•'
Hank of America; N.A.,
SAN ANTONI0, TX :' AUTHORIZED SIGNATURE
11'
IHE,ORIGINAL DOCUMENT HAS A REFLECTIVE • WATERMARK ON THE BACK. Lj HOLD AT AN -ANGLE TO VIEW WHEN CHECKING THE ENDORSEMENTS. '