NC0088919_First Permit + EAA 2010_20100326

NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Ernie Rhymer
Quality Oil Company, LLC
P.O. Box 2736
Winston - Salem, North Carolina 27102 -2736
Dear Mr. Rhymer:
Division of Water Quality
Coleen H. Sullins
Director
March 26, 2010
Dee Freeman
Secretary
Subject: Issuance of NPDES Permit NCO088919
Former Coliseum Shell Station
Forsyth County
Division personnel have reviewed and approved your application for renewal of the subject permit.
Accordingly, we are forwarding the attached NPDES discharge 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 U.S. Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
This final permit includes no major changes from the draft sent to you on January 5, 2010.
If any parts, measurement frequencies or sampling requirements contained in this permit are unacceptable
to you, you have the right to an adjudicatory hearing upon written request within thirty (30) days following receipt
of this letter. This request must be in the form of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes, and filed with the Office of Administrative Hearings (6714 Mail Service Center, Raleigh,
North Carolina 27699- 6714). Unless such demand is made, this decision shall be final and binding.
1617 Mail Service Center, Ralegh, North Carolina 27699 -1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 One
Phone: [phone] FAX: [phone] Customer Service: 1- 877 -623 -6748 North Carolina
Internet: www.ncwaterquality.org N� //�
�An Equal Opportunity 1 Affirmative Action Employer �atu` l

Please note that this permit is not transferable except after notice to the Division. The Division may
require modification or revocation and reissuance of the permit. This permit does not affect the legal requirements
to obtain other permits which may be required by the Division of Water Quality or permits required by the
Division of Land Resources, the 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 Sergei Chernikov at
telephone number (919) 807 -6393.
Sincerely,
— / 'viladI17-1
C een H. Sullins
,r
cc: NPDES Files
Central Files
Winston -Salem Regional Office- Surface Water Protection
Aquatic Toxicology Unit (e -copy)
Ryan D. Kerins (e -copy: rdkerins @terraquestpc.com)
1617 Mail Service Center, Raleigh, North Carolina 27699 -1617
Location: 512 N. Salisbury St. Ralegh, North Carolina 27604 One
Phone: [phone] FAX: [phone] Customer Service: 1- 877 -623 -6748 NorthCarolina
Internet: www.ncwaterquality.org , Naturally '
An Equal Opportunity 1 Affirmative Action Employer

Permit NCO088919
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
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,
Quality Oil Company
is hereby authorized to discharge wastewater from a facility located at the
Former Coliseum Shell
3009 University Parkway
Winston -Salem
Forsyth County
to receiving waters designated as an unnamed tributary to Silas Creek in the Yadkin River
Basin in accordance with effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, III, and IV hereof.
The permit shall become effective May 1, 2010.
This permit and the authorization to discharge shall expire at midnight on June 30, 2014.
Signed this day March 26, 2010.
It Eileen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO088919
i
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby
revoked. As of this permit issuance, any previously issued permit bearing this number is no longer
effective. Therefore, the exclusive authority to operate and discharge from this facility arises under the
permit conditions, requirements, terms, and provisions included herein.
Quality Oil Company is hereby authorized to:
1. Upon receiving an Authorization to Construct from the Division of Water Quality,
construct a 0.036 MGD groundwater treatment plant located at Former Coliseum
Shell Company, 3009 University Parkway, Winston - Salem, Forsyth County.
2. After submitting an Engineer's Certification, discharge from said treatment works at
the location specified on the attached map into unnamed tributary to the Silas Creek,
a class C water in the Yadkin River Basin.

I �-? I .
f."ll MA,t
Ji.
Vyl Fig.' r Z,
folm

Permit NCO088919
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS
Beginning on the effective date of this permit and lasting until expiration, the Permittee is authorized
to discharge treated groundwater from Outfall 001. Such discharges shall be limited and monitored
by the Permittee as specified below:
EFFLUENT
C14ARACTERISTICS
EFFLUENT
LIMITATIONS
MONITORING REQUIREMENTS
Monthly
Average
Daily
Maximum
Measurement
Frequency
Sample Type
Sample
Location
Flow'
0.036 MGD
Continuous
Recording
Effluent
Total Suspended Solids
30.0 mg /L
45.0 mg /L
Monthly
Grab
Effluent
Ethylbenzene
97.0 pg /L
Monthly
Grab
Effluent
Xylenes
670.0 ug /L
Monthly
Grab
Effluent
MTBE
690.0 pg/ L
Monthly
Grab
Effluent
Isopropyl Ether
Quarterly
Grab
Effluent
Naphtalene
330.0 pg /L
Monthly
Grab
Effluent
Isopropyl Benzene
320.0 pg /L
Monthly
Grab
Effluent
Tetrachloroethylene
3.3 pg /L
Monthly
Grab
Effluent
Acetone
2,000.0 pg /L
Monthly
Grab
Effluent
Trimethylbenzene 1,2,4
390.0 pg /L
Monthly
Grab
Effluent
Trimethylbenzene 1,3,5
Quarterly
Grab
Effluent
Toluene
11.0 pg /L
Monthly
Grab
Effluent
Benzene
51.0 pg /L
Monthly
Grab
Effluent
2- Butanone
Quarterly
Grab
Effluent
1.2 cis -
Dichloroeth lene
Quarterly
Grab
Effluent
Lead
25.0 pg /L
67.0 ug /L
Monthly
Grab
Effluent
Chronic Toxicity2
Quarterly
Grab
Effluent
Notes:
1. Flow may be measured using a totalizing flow meter.
2. Chronic Toxicity (Ceriodaphnia) limit at 90% with testing in January, April, July and
October (see A. (2) ).
There shall be no discharge of floating solids or visible foam in other than trace amounts.
Quarterly samples for monitored parameters shall coincide with the chronic toxicity test.

Permit NCO088919
A. (2) CHRONIC TOXICITY PERMIT LIMIT (Quarterly)
The effluent discharge shall at no time exhibit observable inhibition of reproduction or significant
mortality to Ceriodaphnia dubia at an effluent concentration of 90 %.
The permit holder shall perform at a minimum, quarterly monitoring using test procedures outlined in
the "North Carolina Ceriodaphnia Chronic Effluent Bioassay Procedure," Revised February 1998, or
subsequent versions or "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure"
(Revised - February 1998) or subsequent versions. The tests will be performed during the months of
January, April, July and October. Effluent sampling for this testing shall be performed at the
N`PDES permitted final effluent discharge below all treatment processes.
If the test procedure performed as the first test of any single quarter results in a failure or ChV
below the permit limit, then multiple - concentration testing shall be performed at a minimum, in
each of the two following months as described in "North Carolina Phase II Chronic Whole
Effluent Toxicity Test Procedure" (Revised- February 1998) or subsequent versions.
The chronic value for multiple concentration tests will be determined using the geometric mean of the
highest concentration having no detectable impairment of reproduction or survival and the lowest
concentration that does have a detectable impairment of reproduction or survival. The definition of
"detectable impairment," collection methods, exposure regimes, and further statistical methods are
specified in the "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -
February 1998) or subsequent versions.
All toxicity testing results required as part of this permit condition will be entered on the Effluent
Discharge Monitoring Form (MR -1) for the months in which tests were performed, using the
parameter code TGP3B for the pass/ fail results and THP3B for the Chronic Value. Additionally, DWQ
Form AT -3 (original) is to be sent to the following address:
Attention: North Carolina Division of Water Quality
Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699 -1621
Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Section no later
than 30 days after the end of the reporting period for which the report is made.
Test data shall be complete, accurate, include all supporting chemical/ physical measurements and all
concentration/ response data, and be certified by laboratory supervisor and ORC or approved designate
signature. Total residual chlorine of the effluent toxicity sample must be measured and reported if
chlorine is employed for disinfection of the waste stream.
Should there be no discharge of flow from the facility during a month in which toxicity monitoring is
required, the permittee will complete the information located at the top of the aquatic toxicity (AT) test
form indicating the facility name, permit number, pipe number, county, and the month /year of the
report with the notation of "No Flow" in the comment area of the form. The report shall be submitted
to the Environmental Sciences Section at the address cited above. Should the permittee fail to monitor
during a month in which toxicity monitoring is required, monitoring will be required during the
following month. Should any test data from this monitoring requirement or tests performed by the
North Carolina Division of Water Quality indicate potential impacts to the receiving stream, this permit
may be re- opened and modified to include alternate monitoring requirements or limits. if the Permittee
monitors any pollutant more frequently then required by this permit, the results of such monitoring
shall be included in the calculation & reporting of the data submitted on the DMR & all AT Forms
submitted.
NOTE: Failure to achieve test conditions as specified in the cited document, such as minimum control
organism survival, minimum control organism reproduction, and appropriate environmental controls,
shall constitute an invalid test and will require immediate follow -up testing to be completed no later
than the last day of the month following the month of the initial monitoring.

DENR / DWQ / NPDES
' FACT SHEET FOR NPDES PERMIT DEVELOPMENT
NPDES Permit No. NCO088919
Facility Information
Applicant /Facility Name
Quality Oil Company LLC /Former Coliseum Shell
Station
Applicant Address
P.O. Box 2736, Winston - Salem, NC 27102 -2736
Facility Address
3009 University Parkway, Winston - Salem, NC 27105
Permitted Flow (MGD)
0.036
Type of Waste
Groundwater
Facility Class
NR
County
Forwyth
Facility Status
New
Regional Office
WSRO
Stream Characteristics
Receiving Stream
UT to Silas
Creek
Stream
Classification
C
Drainage Area (sq. mi.)
Drainage basin
Yadkin
Summer 7Q 10 (cfs)
0
Subbasin
03 -07 -04
Winter 7Q 10 (cfs)
NA
Use Support
N/A
30Q2 (cfs)
NA
303(d) Listed
No
Average Flow (cfs)
NA
State Grid
IWC ( %)
100
USGS Topo Quad
C 17SE
Summary
Quality Oil Company LLC applied for a groundwater remediation permit at their
facility in Winston -Salem to remove numerous volatile organic compounds that
have been found in the groundwater.
The treatment system will consist of reciprocating compressor, liquid ring pump,
oil /water separator, air stripper, 1,500 gallon settling tank with baffles, sand filter,
particulate filters, and 6 liquid phase carbon adsorption vessels. Approximately
36,000 gallons per day will be discharged through the outfall to the treatment
receiving stream.
Whole Effluent Toxicity (WET) Test
WET requirement is a Quarterly Chronic Toxicity Pass /Fail using Ceriodaphnia at
90 %.
Reasonable Potential Analysis (RPA)
RPA analysis (please see attached) was based on the assumption that system will
operate with 95% removal efficiency.
Proposed Schedule of Issuance
Draft Permit to Public Notice:
Permit Scheduled to Issue:
January 5, 2010 (est.)
March 1, 2010 (est.)
Fact Sheet
Renewal -- NPDES Permit NCO088692
Page 1

NPDES UNIT CONTACT
If you have questions regarding any of the above information or on the attached
permit, please contact Sergei Chernikov at (919) 807 -6393.
REGIONAL OFFICE COMMENTS:
WSRO recommends issuance of the permit.
Name:
Fact Sheet
Renewal -- NPDES NCO088692
Page 2
Date

Winston -Salem Journal
Advertising Affidavit
Winston -Salem Journal
P.O Box 3159
Winston - Salem, NC 27102
NCDENR /DWQ /POINT SOURCE BRANCH
ATTN: DINA SPRINKLE
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699 -1617
Account Number
3376309
Date
January 08, 2010
Date Category Description Ad Size Total Cost
01108/2010 Legal Notices PUBLIC NOTICE North Carolina Environment
2 x 36 L 256.83
KIMALETJOHNSON
NOTARY PUBLIC
My Commission expires , �� lot t+ FOR3YTH COUNTY
STATE OF NORTH CAR IbIA41
MY COMMISSION EXPIRE
THIS IS NOT A BILL. PLEASE PAY FROM INVOICE. THANK YOU
Media General Operations, Inc.
PUBLIC NOTICE
North Carolina Environmental
Publisher of the
Management Commission/NPDES Unit
1617 Mail Service Center
Raleigh NC 276931617
Winston -Salem Journal
Notice o� Intent to Issue a
NPDES Wastewater Permit
Forsyth County
The North Carolina Environmental Manage-
ment Commission proposes to issue a NPDES
wastewater discharge permit to the person(s)
listed below.
Before the undersigned, a Notary Public of Forsyth County, North Carolina, duly
Written comments regarding the proposed per-
mit will be accepted until 30 days after the pub-
commissioned, qualified, and authorized by law to administer oaths, personally appeared
lish date of this notice. The Director of the NC
Division of water Quality (DWQ), mayy hold a
hearing should there be a sigmfican[ de-
S.A. Bragman, who by being duly sworn deposes and says: that she is the Assistant
public
gree of public interest Please mail comments
Controller of the Winston -Salem Journal, engaged in the publishing of a newspaper known
and/or information requests to DWQ at the
above address. Interested persons may visit
as Winston -Salem Journal, published, issued and entered as second class mail in the City of
the DWQ at 512 N. Salisbury Street, Raleigh, NC
to review information on file. Additional infor-
Winston - Salem, in said County and State: that she is authorized to make this affidavit and
mation on NPDES permits and this notice may
be found on our website: www.ncwaterquality
sworn statement: that the notice or other legal advertisement, a true copy of which is
.org, or by calling (919) 807 -6304.
attached hereto, was published in the Winston -Salem Journal on the following dates:
The Quality oil Company, LLC requested a new
permit NCO088919 for Former Coliseum Shell
Station in Forsyth County; this facility dis-
charge Is treated groundwater to unnamed
01 /08/2010
tributary to Silas Creek, Yadkin River Basin.
WSJ: January 8, 2010
and that the said newspaper in which such notice, paper document, or legal advertisement
was published was, at the time of each and every such publication, a newspaper meeting all
the requirements and qualifications of Section 1 -597 of the General Statutes of North
Carolina and was a qualified newspaper within the meaning ui Section 1 -597 of the General
Statutes of North Carolina.
This 8th day of January, 2010
c
(signature of pens making affidavit)
Sworn to and subscribed before me, this 8th day of January, 2010 �1
KIMALETJOHNSON
NOTARY PUBLIC
My Commission expires , �� lot t+ FOR3YTH COUNTY
STATE OF NORTH CAR IbIA41
MY COMMISSION EXPIRE
THIS IS NOT A BILL. PLEASE PAY FROM INVOICE. THANK YOU

REASONABLE POTENTIAL ANALYSIS
Quality Oil Company LLC
NCO088919
Time Period
0
STANDARDS &
Ow (MG0)
0.036
WWTP Class II
7Q10S "c /s)
0
IWC (o) Q 7Q10S 100
7Q10W (c /s)
0
Q 7Q10W 100
3002 (c1s)
0
Q 3002 100
Avg. Stream Flow, QA (c /s)
0
Q QA NIA
Rec'ving Stream
UT to Silas Creek
Stream Class C
Outfall 001
Qw = 0.036 MGD
Legend: " Freshwater Discharge
C = Carcinogenic
NC = Non - carcinogenic
A = Aesthetic
88919 -RPA- 2009.x15, rpa
12/3/2009
STANDARDS &
PARAMETER
TYPE
CRITERIA (2)
POL
Units
REASONABLE POTENTIAL RESULTS
RECOMMENDED ACTION
Nc was/ %FAV/
Chronic A-f.
n 41M R.P dCr ANowbM Cw
111
Acute'. N/A
Ethylbenzene
NC
97
ug /L
16 5
1140.3
add a limit
Chronic: 97
Acute N/A
Xylenes
INC
670.0
ug/L
16 10
5807.2
_
add a limit
Chronic: 670
Acute: N/A
MTBE
NC
690 15
ug /L
16 11
31070.0 '_ -6-96 _
add a limit
Chronic:
Acute: N/A
no limit
Isopropyl Ether
NC
13000 1,022
ug /L
16 9
1506.8_ __ _ _
—'—'—'—'—'—'—'—'---'---_—'---
Chronic: 13,000
Acute: N/A
add a limit
Naphtalene
NC
330 AL 7.3
ug.4
16 2
1990.0
--330
—_— --- _--- - -_ - - -—
Chronic:-
I Acute:
add a limit
Isopropyl Benzene
NC
320 N 22
ug/L
16 2
413.0 _ —_320—
Chronic
Acute. N/A
add a limit
Tetrachloroethylene
NC
3
,(;It
16 5
6,185.0
Chronic:------------------------------------------
3.3
Acute: N/A
add a limit
Acetone
NC
2000 N 33 6
ug'L
16 1 19775.0
Chronic: 2,000
Acute: NIA
add a limit
Trimethylbenzene 1,2,4
NC
390
2.0000
ng/L
16 8
1152.7500
--3� —
--------------- - -- --
�6hronlc:-
NIA
no limit
Trimethylbenzene 1,3,5
NC
63U
ugiL
16 3
85.5
�&Ar:uite-
_
_ —_—
nic: 630
..............................
Acute: N/A
add a limit
Toluene
NC
11 261
ug,L
16 2
10,342.5
_
Chronic. _ —_11__
Acute: NIA
add a limit
Benzene
NC
51 N
ug /L
16 11 5357.0
Chronic :_ —_51_—
Acute: N/A
2- Butanone
NC
200000 56
ug /L
16 2 585.0
no limit
---
chronic: 20,000
------- - - -_ —_
Acute: 1
no limit
cis - Dichloroethylene
NC
4900.00 AL 1 23
uyl
16 1
385.5
_
Chronic. 4.900
— _______— ___— ___— ___— _____ —_
Acute: 67
add a limit
Lead
NC
25 AL 67
ug/L
12 9 36.2
Chronic 25
--- .- -- ---- _ —_ - --
Legend: " Freshwater Discharge
C = Carcinogenic
NC = Non - carcinogenic
A = Aesthetic
88919 -RPA- 2009.x15, rpa
12/3/2009

REASONABLE POTENTIAL ANALYSIS
- 1 -
88919- RPA- 2009.xis, data
12/3/2009
Ethylbenzene
Xylenes
Date
Data
BDL =1 /2DL
Results
Date Data
BDL =1 /2DL
Results
1
<
1.00
0.50
Std Dev.
25.8539
1
0.37
0.37
Std Dev.
166.8997
2
<
25.00
12.50
Mean
9.7319
2
<
75.00
37.50
Mean
69.8406
3
1.65
1.65
C.V.
2.6566
3
26.00
26.00
C.V.
2.3897
4
<
1.00
0.50
n
16
4
0.34
0.34
n
16
5
<
25.00
12.50
5
<
75.00
37.50
6
<
1.00
0.50
Mult Factor =
10.8600
6
<
3.00
1.50
Mult Factor =
9.7600
7
<
1.00
0.50
Max. Value
105.0 ug /L
7
<
3.00
1.50
Max. Value
595.0 ug/L
8
6.50
6.50
Max. Pred Cw
1140.3 ug/L
8
370.00
370.00
Max. Pred Cw
5807.2 ug/L
9
<
25.00
12.50
9
<
75.00
37.50
10
<
1.00
0.50
10
0.63
0.63
11
<
1.00
0.50
11
<
3.00
1.50
12
<
1.00
0.50
12
0.21
0.21
13
<
1.00
0.50
13
0.61
0.61
14
1.00
1.00
14
6.95
6.95
15
0.06
0.06
15
0.34
0.34
16
105.00
105.00
16
595.00
595.00
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
25
25
26
26
27
27
28
28
29
29
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
47
47
48
48
49
49
50
50
51
51
52
52
53
53
54
54
55
55
56
56
57
57
58
58
59
59
60
60
61
61
62
62
63
63
64
64
65
65
66
66
67
67
68
68
69
69
70
70
- 1 -
88919- RPA- 2009.xis, data
12/3/2009

REASONABLE POTENTIAL ANALYSIS
71
71
72
72
73
73
74
74
75
75
76
76
77
77
78
78
79
79
80
80
81
81
82
82
83
83
84
84
85
85
86
86
87
87
88
88
89
89
90
90
91
91
92
92
93
93
94
94
95
95
96
96
97
97
98
98
99
99
100
100
101
101
102
102
103
103
104
104
105
105
106
106
107
107
108
108
109
109
110
110
111
111
112
112
113
113
114
114
115
115
116
116
117
117
118
118
119
119
120
120
121
121
122
122
123
123
124
124
125
125
126
126
127
127
128
128
129
129
130
130
131
131
132
132
133
133
134
134
135
135
136
136
137
137
138
138
139
139
140
140
141
141
142
142
143
143
144
144
88919- RPA- 2009.xls, data
2- 12/3/2009

REASONABLE POTENTIAL ANALYSIS
-4-
88919- RPA- 2009.xls, data
12/3/2009
MTBE
Isopropyl Ether
Date Data
BDL =1 /2DL
Results
Date Data
BDL =1 /2DL
Results
1
0.80
0.80
Std Dev.
1084.3936
1
<
1.00
0.50
Std Dev.
56.2972
2
3150.00
3150.00
Mean
462.8344
2
75.00
75.00
Mean
26.6138
3
<
10.00
5.00
C.V.
2.3429
3
<
10.00
5.00
C.V.
2.1153
4
20.00
20.00
n
16
4
1.00
1.00
n
16
5
27.50
27.50
5
1.75
1.75
6
0.50
0.50
Mult Factor =
9.5600
6
<
1.00
0.50
Mult Factor =
8.6100
7
2.05
2.05
Max. Value
3250.0 ug/L
7
0.22
0.22
Max. Value
175.0
8
3250.00
3250.00
Max. Pred Cw
31070.0 ug/L
8
175.00
175.00
Max. Pred Cw
1506.8
9
120.00
120.00
9
8.50
8.50
10
38.00
38.00
10
2.80
2.80
11
<
1.00
0.50
11
<
1.00
0.50
12
<
1.00
0.50
12
<
1.00
0.50
13
<
1.00
0.50
13
<
1.00
0.50
14
39.50
39.50
14
155
3.55
15
<
1.00
0.50
15
<
1.00
0.50
16
750.00
750.00
16
150.00
150.00
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
25
25
26
26
27
27
28
28
29
29
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
47
47
48
48
49
49
50
50
51
51
52
52
53
53
54
54
55
55
56
56
57
57
58
58
59
59
60
60
61
61
62
62
63
63
64
64
65
65
66
66
67
67
68
68
69
69
70
70
-4-
88919- RPA- 2009.xls, data
12/3/2009

REASONABLE POTENTIAL ANALYSIS
88919- RPA- 2009.xis, data
3 12/3/2009

REASONABLE POTENTIAL ANALYSIS
88919- RPA- 2009.xis, data
- 7 - 12/3/2009
Naphtalene
Isopropyl
Benzene
Date Data
BDL =112DL
Results
Date
Data
BDL =1 /2DL
Results
1
<
5.00
2.50
Std Dev.
62.4904
1
<
1.00
0.50
Std Dev.
2
<
120.00
60.00
Mean
31.8500
2
<
25.00
12.50
Mean
3
3.60
3.60
C.V.
1.9620
3
0.50
0.50
C.V.
4
<
5.00
2.50
n
16
4
<
1.00
0.50
n
5
<
120.00
60.00
5
<
25.00
12.50
6
<
5.00
2.50
Mult Factor =
7.9600
6
<
1.00
0.50
Mult Factor =
ug/L
7
<
5.00
2.50
Max. Value
250.0 ug/L
7
<
1.00
0.50
Max. Value
ug/L
8
28.50
28.50
Max. Fred Cw
1990.0 ug /L
8
1.75
1.75
Max. Fred Cw
9
<
120.00
60.00
9
<
25.00
12.50
10
<
5.00
2.50
10
<
1.00
0.50
11
<
5.00
2.50
11
<
1.00
0.50
12
<
5.00
2.50
12
<
1.00
0.50
13
<
5.00
2.50
13
<
1.00
0.50
14
<
50.00
25.00
14
<
10.00
5.00
15
<
5.00
2.50
15
<
1.00
0.50
16
<
500.00
250.00
16
<
100.00
50.00
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
25
25
26
26
27
27
28
28
29
29
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
47
47
48
48
49
49
50
50
51
51
52
52
53
53
54
54
55
55
56
56
57
57
58
58
59
59
60
60
61
61
62
62
63
63
64
64
65
65
66
66
67
67
68
68
69
69
70
70
88919- RPA- 2009.xis, data
- 7 - 12/3/2009

71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
REASONABLE POTENTIAL ANALYSIS
8-
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
88919- RPA- 2009.xls, data
12/3/2009

REASONABLE POTENTIAL ANALYSIS
88919- RPA- 2009.xis, data
-10- 12/3/2009
Tetrachloroethylene
Acetone
Date Data
BDL =112DL
Results
Date Data
BDL =112DL
12.6060
1
<
1.00
0.50
Std Dev.
123.4806
1
<
50.00
25.00
6.2031
2
<
25.00
12.50
Mean
40.7250
2
<
1200.00
60000
2.0322
3
<
10.00
5.00
C.V.
3.0321
3
<
500.00
250.00
16
4
<
1.00
0.50
n
16
4
<
50.00
25.00
5
<
25.00
12.50
5
<
1200.00
600.00
8.2600
6
<
1.00
0.50
Mult Factor =
12.3700
6
<
50.00
25.00
50.0 ug/L
7
47.00
47.00
Max. Value
500.0 ug/L
7
<
50.00
25.00
413.0 ug/L
8
< 1000.00
500.00
Max. Fred Cw
6185.0 ug/L
8
90.00
90.00
9
<
25.00
12.50
9
<
1200.00
600.00
10
<
1.00
0.50
10
<
50.00
25.00
11
0.06
0.06
11
<
50.00
25.00
12
0.19
019
12
<
50.00
25.00
13
4.40
4.40
13
<
50.00
25.00
14
<
10.00
5.00
14
<
500.00
250.00
15
0.45
0.45
15
<
50.00
25.00
16
<
100.00
50.00
16
<
5000.00
2500.00
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
25
25
26
26
27
27
28
28
29
29
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
47
47
48
48
49
49
50
50
51
51
52
52
53
53
54
54
55
55
56
56
57
57
58
58
59
59
60
60
61
61
62
62
63
63
64
64
65
65
66
66
67
67
68
68
69
69
70
70
88919- RPA- 2009.xis, data
-10- 12/3/2009

REASONABLE POTENTIAL ANALYSIS
-g-
88919- RPA- 2009.xls, data
12/3/2009

REASONABLE POTENTIAL ANALYSIS
88919- RPA- 2009.xls, data
-13- 1213/2009
Trimethylbenzene
1,2,4
Trimet
Results
Date Data
BDL =1 /2DL
Results
Date Data
Std Dev.
623.6197
1
0.14 1.00
Std Dev.
38.7444
1
<
1.00
Mean
319.6875
2
<
25.00 12.50
Mean
19.7813
2
< =
25.00
C.V.
1.9507
3
145.00 145.00
C.V.
1.9586
3
4.40
n
16
4
0.17 1.00
n
16
4
< -
1.00
5
<
25.00 12.50
5
<
25.00
Mult Factor =
7.9100
6
<
1.00 1.00
Mult Factor =
7.95
6
<
1.00
Max. Value
2500.0 ug/L
7
<
10.00 5.00
Max. Value
145.0 ng/L
7
<
10.00
Max. Pred Cw
19775.0 ug/L
8
65.00 65.00
Max. Fred Cw
1152.8 ng/L
8
19.00
9
<
25.00 12.50
9
<
25.00
10
0.15 1.00
10
<
1.00
11
<
1.00 1.00
11
<
1.00
12
<
1.00 1.00
12
<
1.00
13
0.07 1.00
13
<
1.00
14
0.90 1.00
14
<
10.00
15
<
1.00 1.00
15
<
1.00
16
55.00 55.00
16
12.00
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
25
25
26
26
27
27
28
28
29
29
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
47
47
48
48
49
49
50
50
51
51
52
52
53
53
54
54
55
55
56
56
57
57
58
58
59
59
60
60
61
61
62
62
63
63
64
64
65
65
66
66
67
67
68
68
69
69
70
70
88919- RPA- 2009.xls, data
-13- 1213/2009

71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
REASONABLE POTENTIAL ANALYSIS
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
88919- RPA- 2009.xls, data
14- 12/3/2009

REASONABLE POTENTIAL ANALYSIS
thylbenzene
1,3,5
Toluene
BDL =1 /2DL
Results
Date Data
BDL =1 12DL
Results
Date Da
0.50
Std Dev
6 18
1
<
5.00
2.50
Std Dev.
294.2607
1
<
12.50
Mean
5.43
2
<
120.00
60.00
Mean
122.0313
2
4.40
C.V.
1 ii
3
<
50.00
25.00
C.V.
2.4114
3
<
0.50
n
16
4
<
5.00
2.50
n
16
4
12.50
5
<
120.00
60.00
5
0.50
Mull Factor =
4.5000
6
<
5.00
2.50
Mult Factor =
9.8500
6
<
5.00
Max. Value
19.0 ug /L
7
<
5.00
2.50
Max. Value
1050.0 ug/L
7
<
19.00
Max. Fred Cw
85.5 ug/L
8
650.00
650.00
Max. Pred Cw
10342.5 ug /L
8
12.50
9
<
120.00
60.00
9
0.50
10
<
5.00
2.50
10
0.50
11
<
5.00
2.50
11
<
0.50
12
<
5.00
2.50
12
0.50
13
<
5.00
2.50
13
5.00
14
<
50.00
25.00
14
0.50
15
<
5.00
2.50
15
12.00
16
1050.00
1050.00
16
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
25
25
26
26
27
27
28
28
29
29
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
47
47
48
48
49
49
50
50
51
51
52
52
53
53
54
54
55
55
56
56
57
57
58
58
59
59
60
60
61
61
62
62
63
63
64
64
65
65
66
66
67
67
68
68
69
69
70
70
16-
88919- RPA- 2009.xls, data
12/3/2009

REASONABLE POTENTIAL ANALYSIS
15-
88919- RPA- 2009.xis, data
12/3/2009

0
REASONABLE POTENTIAL ANALYSIS
88919- RPA- 2009.xls, data
- 19 - 12/3/2009
Benzene
2- Butanone
1
to
BDL =1 /2DL
Results
Date Data
BDL =1 /2DL
Results
Date Da
1.00
0.50
Std Dev.
145.6636
1
<
10
5.0
Std Dev.
48.6098
1
<
140.00
140.00
Mean
61.0825
2
<
250
125.0
Mean
41.1250
2
<
10.00
5.00
C.V.
2.3847
3
<
100
50.0
C.V.
11820
3
<
1.00
1.00
n
16
4
<
10
5.0
n
16
4
<
6.00
6.00
5
<
250
125.0
5
<
1.00
0.50
Mult Factor =
9.7400
6
<
10
5.0
Mult Factor =
4.6800
6
<
1.00
0.50
Max. Value
550.0 ug /L
7
<
10
5.0
Max. Value
125.0 ug/L
7
<
235.00
235.00
Max. Pred Cw
5357.0 ug/L
8
48
48.0
Max. Pred Cw
585.0 ug/L
8
20,50
20.50
9
<
250
125.0
9
<
6.00
6.00
10
<
10
5.0
10
<
1.00
0.50
11
<
10
5.0
11
<
0.17
017
12
<
10
5.0
12
<
0.35
0.35
13
<
10
5.0
13
<
11.00
11.00
14
<
100
50.0
14
<
0.30
0.30
15
<
10
5.0
15
<
550.00
550.00
16
90
90.0
16
<
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
25
25
26
26
27
27
28
28
29
29
30
30
31
31
32
32
33
33
34
34
35
35
36
36
37
37
38
38
39
39
40
40
41
41
42
42
43
43
44
44
45
45
46
46
47
47
48
48
49
49
50
50
51
51
52
52
53
53
54
54
55
55
56
56
57
57
58
58
59
59
60
60
61
61
62
62
63
63
64
64
65
65
66
66
67
67
68
68
69
69
70
70
88919- RPA- 2009.xls, data
- 19 - 12/3/2009

REASONABLE POTENTIAL ANALYSIS
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
-20-
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
88919- RPA- 2009.xls, data
12/3/2009

I
REASONABLE POTENTIAL ANALYSIS
1.2 cis - Dichloroethylene
Lead
to
BDL =1 12DL
Results
Date Data
BDL =1 /2DL
Results
1
0.5
Std Dev.
12.4916
1
0.27
0.3
Std Dev
1.6451
25
12.5
Mean
6.5656
2
0.16
0.2
Mean
1.3167
10
5.0
C.V.
1.9026
3
6
6.0
C.V.
1.2494
1
0.5
n
16
4
< 2.5
1.3
n
12
25
12.5
5
< 2.5
1.3
1
0.5
Mult Factor =
7.7100
6
0.32
0.3
Mult Factor =
6.0400
1
0.5
Max Value
50.0 ug/L
7
0.55
0.6
Max. Value
6.0 ug/L
3.05
3.1
Max. Pred Cw
385.5 ug/L
8
0.33
0.3
Max. Pred Cw
36.2 ug/L
25
12.5
9
5
2.5
1
0.5
10
0.75
0.8
1
0.5
11
0.47
0.5
1
0.5
12
1.95
2.0
1
0.5
13
10
5.0
14
1
0.5
15
100
50.0
16
17
18
19
20
21
22
23
24
25
26'
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
88919- RPA- 2009.xls, data
-22- 12/3/2009

REASONABLE POTENTIAL ANALYSIS
88919- RPA- 2009.xls, data
-21 - 12/3/2009

cc: Central Files
• Keith Huff (City of Winston -Salem Stormwater Division, P.O. Box 2511, Winston - Salem, NC 27102 -2511)
WSRO
NPDES STAFF REPORT AND RECOMMENDATION
APPLICATION # NCO088919
To: Point Source Branch - SWP
Attention: Sergei Chernikov, Ph.D.
County: Forsyth
PART I -GENERAL INFORMATION
1. Permittee Address: Quality Oil Company, LLC
(former Coliseum Shell Station)
P.O. Box 2736
Winston- Salem, NC 27102 -2736
2. Date of Investigation: November 25, 2009
3. Report Prepared by: Mike Mickey, Environmental Specialist
4. Contact Person: Ryan Kerins, Terraquest Environmental Consultants, (919) 563 -9091.
Ernie Rhymer, Quality Oil Company, (336) 722 -3441
5. Directions to Site: The proposed groundwater remediation system will be located on the
former Coliseum Shell service station property at 3009 University Parkway in Winston -
Salem.
6. Discharge Points(s), List for all discharge points:
Latitude: 360 07' 54" Longitude: 80° 15' 47" U.S.G.S. Quad Name: Rural Hall, NC
7. Site size and expansion area consistent with application? Service station lot is 0.41 acre.
8. Topography: The lot is adjacent to University Parkway at Baity Street and is approximately
950 feet from the U.T. to Silas Creek.
9. Location of nearest dwelling: The property is located in a business district and this parcel
NPDES Permit Staff Report
Version 10/92
Page 1

plus several others are slated for re- development.
10. Receiving stream or affected surface waters: U.T. to Silas Creek
a. Classification: C
b. River Basin and Subbasin No.: 03 -07 -04
C. Describe receiving stream features and pertinent downstream uses: The effluent from
the groundwater remediation system will discharge via a 1" pipe into a NCDOT
storm water catch basin where it then flows in a culvert approximately 950 feet to the
stream. The discharge is upstream the Old Town Golf Course.
Part II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of Wastewater to be permitted: The system is designed for 36,000 GPD.
b. What is the permitted capacity of the system? NA
C. Actual treatment capacity of the current facility? NA
d. Date(s) of AtC's issued in the previous two years. NA.
e. Please provide a description of existing or substantially constructed wastewater
treatment facilities: NA.
f. Please provide a description of proposed wastewater treatment facilities. The
groundwater remediation system will consist of the following: oil/water separator, air
stripper, settling tank, sand filter, particulate filters and liquid phase carbon
adsorption.
g. Possible toxic impacts to surface waters: None known.
h. Pretreatment Program (POTWs only): NA
2. Residuals handling and utilization/disposal scheme: NA.
PART III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant Funds (municipals only)? NA.
2. Special monitoring or limitations (including toxicity) requests: NA.
3. Important SOC, JOC or Compliance Schedule dates: NA.
NPDES Permit Staff Report
Version 10/92
Page 2

4. Alternative Analysis Evaluation: An NPDES discharge is the only feasible option available
since; 1) The City of Winston -Salem does not accept treated groundwater from petroleum
contamination incidents, and ; 2) insufficient land is available for spray /drip irrigation and/or
subsurface disposal.
PART IV - EVALUATION AND RECOMMENDATIONS
This NPDES permit application is for the treatment of contaminated groundwater at the
former Coliseum Shell Station. An unknown amount of gasoline was released from the UST system.
Groundwater at the site is also contaminated with chlorinated solvents from a former adjacent dry
cleaner requiring an individual permit instead of a general permit.
The underground storage tanks and some contaminated soil have already been removed.
Only the closed building remains. The plume volume is estimated to consist of more than 5,000
gallons of free product. The Corrective Action Plan (CAP) approved by the NCDWM -UST specifies
the removal of free product and contaminated groundwater via a pump and treat system. The free
product recovery time is estimated at six to ten months and the groundwater treatment phase could
last one to five years (Note: the treatment goals of the CAP focus only on the petroleum release
from Coliseum Shell and not treatment of chlorinated solvents from the neighboring property).
WSRO recommends issuance of the permit to Quality Oil Company for the operation of the
proposed groundwater remediation system.
Report Preparer & Date
1(12- Jrl-01
S�ff Regional Supervisor & Date
NPDES Permit Staff Report
Version 10/92
Page 3

ERRA uest
��_ — 1469 1 �_rM - u
ENVIRONMENTAL CONSULTANTS, P.C.
November 17, 2009
Dina Sprinkle
NPDES Permits Unit
NCDENR - Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699 -1617
Re: Submittal of NPDES Permit Application and Check
Coliseum Shell — Quality Oil Company, LLC
Winston - Salem, NC
NCDWM -UST Incident No. 15260
Terraquest Project No. 01195
Dear Ms. Sprinkle:
Per our phone conversation today, I am forwarding you two additional copies of the NPDES
Permit Application for the above referenced project. A check in the amount of $860 has also
been enclosed.
Please contact me at (919) 563 -9091 with any other questions or concerns. Thank you.
Sincerely,
TERRAQUEST ENVIRONMENTAL CONSULTANTS, P.C.
Ryan D. Kerins
Project Manager
Enclosures: NPDES Permit Applications (2)
Check to NCDENR
NOV 1 ° 2009
DENR -Wh ER QUALITY
POINT SOU ,'-,,CE BLANCH
100 E. Ruffin Street • Mebane, North Carolina 27302
Telephone [phone] • Facsimile (919) 563 -9095
www.terraquestpc.com

NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
Mail the complete application to:
N. C. Department of Environment and Natural Resources
Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699 -1617
NPDES Permit Number NC00 ''/
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
3. Operator Information:
Name of the firm, consultant or other entity that operates the facility. (Note that this is not referring to the
Operator in Responsible Charge or ORC)
Name facility is currently vacant
Mailing Address A groundwater treatment system will be delivered to the site in the
future. That system will be operated by Terraquest Environmental
Consultants, P.C. whose contact information is listed above.
Page 1 of 3 C -GW 03/05
Consultant: Terraquest Environemntal Consultants, P.0
Owner Name
Applicant: Quality Oil Company, LLC
Facility Name
Former Coliseum Shell
Consultant: 100 E Ruffin St
Mailing Address
Applicant: PO Box 2736
Consultant: Mebane
City
Applciant: Winston -Salem
Consultant: NC 27302
State / Zip Code
Applicant: NC 27102 -2736
Telephone Number
(919)563 -9091 consultant
Fax Number
(919)563 -9095 consultant
e -mail Address
[e-mail] (consultant)
2. Location of facility producing discharge:
Check here if same as
above ❑
3009 N Cherry St (older Forsyth Co. recognized address)
Street Address or State Road 3009 University Pkwy (address recognized by Mapquest,
Google, etc.)
City
Winston -Salem
State / Zip Code
NC 27105
County
Forsyth
3. Operator Information:
Name of the firm, consultant or other entity that operates the facility. (Note that this is not referring to the
Operator in Responsible Charge or ORC)
Name facility is currently vacant
Mailing Address A groundwater treatment system will be delivered to the site in the
future. That system will be operated by Terraquest Environmental
Consultants, P.C. whose contact information is listed above.
Page 1 of 3 C -GW 03/05

NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
City
State / Zip Code
Telephone Number
Fax Number
4. Ownership Status:
Federal ❑
5. Products recovered:
State ❑
Private
Gasoline ® Diesel fuel ❑ Solvents ® Other
6. Number of separate discharge points: 1
Outfall Identification number(s)
7. Frequency of discharge: Continuous ❑ Intermittent
Public ❑
If intermittent:
Days per week discharge occurs: 7 Duration: varies based on
groundwater recovery given by aquifer
8. Treatment System Design flow 0.036 (36.000 gpd) MGD
9. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitude):
Silas Creek
10. Please list all additives to the treatment system, including chemicals or nutrients, that
have the potential to be discharged.
No additives.
11. Is this facility located on Indian country? (check one)
Yes ❑ No
12. Additional Information
All applicants (including renewals):
A USGS topographical map (or copy of the relevant portion) which shows all outfalls
> A summary of the most recent analytical results (effluent data, if available) containing the
maximum values for each chemical detected
NEW Applicants only:
Engineering Alternative Analysis
Page 2 of C -GW 03105

NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
Description of remediation treatment system components, capacities, and removal
efficiency for detected compounds.
If the treatment system will discharge to a storm sewer, written approval from the
municipality responsible for the sewer.
A list of any chemicals found in detectable amounts at the site, with the maximum
observed concentration reported for each chemical (the most recent sample must be
collected less than one year prior to the date of this application)
For petroleum- contaminated sites — Analyses for Volatile Organic Compounds (VOC) should
be performed. Analyses for any fuel additives likely to be present at the site and for phenol
and lead should also be performed.
For sites contaminated with solvents or other contaminants - EPA Method 624/625
analysis should be performed.
13. Applicant Certification
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Ryan D. Kerins Pro'ect Manager
Printed name of erson Signin Title
Signature of A licant Date
North Carolina General Statute 143 -215.6 (b)(2) provides that: Any person who knowingly makes any false
statement representation, or certification in any application, record, report, plan, or other document files or
required to be maintained under Article 21 or regulations of the Environmental Management Commission
implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or
monitoring device or method required to be operated or maintained under Article 21 or regulations of the
Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable
by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section
1001 provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both,
for a similar offense.)
Page 3 of 3 C -GW 03/05

J�CEIVED
Attachment A. Local Government Review Form OCT 2 3 2009
General Statute Overview: North Carolina General Statute 143 -215.1 (c)(6) allows input from local governz60fs•in the issuance
of NPDES Permits for non - municipal domestic wastewater treatment facilities. Specifically, the Environniental Management
Commission (EMC) may not act on an application for a new non - municipal domestic wastewater discharge facility until it has
received a written statement from each city and county government having jurisdiction over any part of the lands on which the
proposed facility and its appurtenances are to be located. The written statement shall document whether the city or county has a
zoning or subdivision ordinance in effect and (if such an ordinance is in effect) whether the proposed facility is consistent with the
ordinance. The EMC shall not approve a permit application for any facility which a city or county has determined to be
inconsistent with zoning or subdivision ordinances unless the approval of such application is determined to have statewide
significance and is in the best interest of the State.
Instructions to the Applicant: Prior to submitting an application for a NPDES Permit for a proposed facility, the applicant
shall request that both the nearby city and county government complete this form. The applicant must:
• Submit a copy of the permit application (with a written request for this form to be completed) to the clerk of the city and
the county by certified mail, return receipt requested.
• If either (or both) local government(s) fail(s) to mail the completed form, as evidenced by the postmark on the certified
mail card(s), within 15 days after receiving and signing for the certified mail, the applicant may submit the application to
the NPDES Unit.
• As evidence to the Commission that the local government(s) failed to respond within 15 days, the applicant shall submit a
copy of the certified mail card along with a notarized letter stating that the local government(s) failed to respond within the
15 -day period.
Instructions to the Local Government: The nearby city and /or county government which may have or has jurisdiction over
any part of the land on which the proposed facility or its appurtenances are to be located is required to complete and return this
form to the applicant within 15 days of receipt. The form must be signed and notarized.
Name of local government C;+y o'P —<l—,
(City/County)
Does the city/county have jurisdiction over any part of the land on which the proposed facility and its appurtenances are to be
located? Yes [,/rNo [ ] If no, please sign this form, have it notarized, and return it to the applicant.
Does the city/county have in effect a zoning or subdivision ordinance? Yes [,J'No [ ]
If there is a zoning or subdivision ordinance in effect, is the plan for the proposed facility consistent with the ordinance? Yes
Date G / G Signature
(City Manager /Coup anager)
State of A/04 #t 00/_0X;A2_ County of �o 4
On this 41st- day of ochlbeR Z09. personally appeared before me, the said
name e. to me known and known to me to be the person described in
and who executed the forego, document and he (or she) acknowledged that he (or she) executed the same and being duly sworn
by me, made oath that the statements in the foregoing document are true.
My Commission expires 12, 1. a08 .(Signature of Notary Public 'G LG�4G/l�
Notary Public (Official Seal)
9OFFICML SEAL
'� itoom I L VIATU M
Notary Pubk -NO M1 CS(Ol"
COUNTY OF FORSYTH
`�- My CwwisOw E=Wta: 0*Wrbr N10
EAA Guidance Document Version: June 23, 2005
Page 8 of 8

TERRACluest
October 27, 2009 ENVIRONMENTAL CONSULTANTS, P.C.
' Charles Weaver
NPDES Permits Unit
' NCDENR - Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699 -1617
' Re: Submittal of NPDES Permit Application —Short Form C —GW
Coliseum Shell — Quality Oil Company, LLC
' Winston - Salem, NC
NCDWM -UST Incident No. 15260
' Terraquest Project No. 01195
Dear Mr. Weaver:
tOn behalf of the applicant, Quality Oil Company, LLC, Terraquest Environmental Consultants,
P.C. hereby submits the enclosed NPDES Permit Application — Short Form C — GW. The
' application is being submitted for the former Coliseum Shell Service facility located at 3009
University Parkway in Winston -Sale, Forsyth County, NC (location on Figure 1 *).
(The presence of supporting attachments are indicated by an asterisk * throughout this correspondence)
This application has multiple components to it and is time consuming both in its generation and
in its review. Terraquest greatly encourages the reviewer to contact the generator with any
questions or concerns that may hold up the review process. The Applicant generator, Ryan
' Kerins, can be reached via e -mail at rdl<erins terraquestpc.com or by phone at (919) 563 -9091.
Terraquest and Quality Oil are hopeful that an NPDES permit can be issued quickly.
BACKGROUND AND PURPOSE:
An underground storage tank system previously released an unknown amount of gasoline into
the site's subsurface. That UST system and the underlying contaminated soil have been
removed and transferred offsite for proper disposal /treatment. The location of the former UST
system, the future treatment system, and the site's general layout are shown on Figure 2 *.
The NCDWM -UST approved a Corrective Action Plan for this release incident in a
correspondence dated April 29, 2009 *. The CAP specifies the cleanup of groundwater via
removal and onsite treatment in a remediation system detailed on Figure 3 *. A separate
release incident, from an adjacent former dry cleaner, has also impacted the subsurface with
chlorinated solvents. While not the goal, during remediation of petroleum- contaminated
water, recovery of some of the chlorinated contamination will also occur (forcing the submittal
100 E. Ruffin Street • Mebane, North Carolina 27302
Telephone [phone] • Facsimile (919) 563 -9095
www.terraquestpc.com

' Page 2'of 9
Coliseum Shell
' NPDES Perrnit Application
10/27/09
of this Individual request and not the General). The NPDES permit is requested to allow for the.
' discharge of treated groundwater into the stormwater drain along University Parkway that
terminates at a tributary of Silas Creek. An NCDOT right -of -way encroachment agreement* has
previously been obtained to allow access to the stormwater drain. Figures 4 and 5* show the
' discharge route from the site's stormwater drain to.the surface water body on both aerial and
topographic maps, respectively.
RESPONSES TO PERMIT QUESTIONS /REQUESTS:
From NPDES Permit Application - Short Form C - GW "9. Name of receiving stream: ":
' I be discharged to a tributary of Silas Creek. The discharge location will be at
.Treated water will g ry g
36.1318N 80.26310W (36 deg 7' 54.36" N 80 deg 15' 47.17" W): The attached Figures 3 and 4
' show the discharge from the onsite treatment system, through the storm sewer, and to its
eventually discharge at the Silas Creek tributary on aerial and topographic maps, respectively.
From NPDES Permit Application - Short Form C - GW "12. Additional Information
Requested: A USGS topographical map (or copy of the relevant portion) which shows all
outfalls.
' Terraquest has provided such-maps in Figures 1 and 5 *.
A summary of the most recent analytical results (effluent data; if available) containing the
' maximum values for each chemical detected.
' In addition to the full analytical report*, groundwater data from the most recent sampling
event is summarized on Table 1 *. That data represents the.contamination within the aquifer.
Following removal by the onsite treatment system; the following concentrations that will be
1 discharged to Silas Creek:
Treatment Requirement
/L
Treatment Requirement
Compound_ /L
,Compound
Benzene
<1
-rr- propytbenzene nro
<1
Toluene
<1
n- butylbenzene
<1
Ethylbenzene
<1
Tetrachlorethylene (PCE)
<1
Xylenes
<1
Acetone
<750
MTBE
G <10
1,2,4- Trimethylbenzene
<1
IPE I �$)
���
. ' .1 <1
1,3,5- Trimethylbenzene
<1
-Naphthalene
<1
2- Butanone MEK
<250

' Page 3 of 9
Coliseum Shell
NPDES Permit Application
10/27/09
New applicants only: Engineering Alternative Analysis
Page 2 of 8 last paragraph:
-As requested in the EAA, Terraquest has received and is submitting a Low Flow report
from the USGS *. Terraquest has also- inquired of the local zoning and /or subdivision
' ordinances and submits the enclosed Local Government Review Form *.
Page `3 of 8 bullet 1:
' A description of the project and its phases follows:
An underground storage tank system, which was operated at the facility by Quality,
released an unknown quantity of unleaded gasoline into the soil and groundwater. Soil
contamination has been removed via excavation and offsite disposal. The release has
' impacted an area of groundwater approximately 41,500 square feet in extent at
concentrations greater than the NCDWM -UST's Gross Contamination Levels, and free
' product covers an area approximately 32,700 square feet square feet and has an
estimated volume of greater than 5,000 gallons. Based upon its origination and current
location, groundwater contamination and the free product plume are spreading to the
' east and west. Quality has received approval from the NCDWM -UST to implement a
CAP that involves the removal of free product and GCL- contaminated groundwater via
pumping the water out of the aquifer, treating it in an onsite system, and discharging
' the treated water under an NPDES permit. As part of the treatment, Terraquest will
direct the recovery of free product during the initial operation of the treatment system.
The goal of this phase is free product abatement and while groundwater will be
' recovered that is not the main goal. Terraquest anticipates that this phase will last from
six to ten months. - During that time, it is possible that only half of the volume the
' system is rated for will be recovered as influent water. That volume is 18,000 gallons
per day. Once free product has been largely removed, the second phase of
groundwater treatment will be the recovery of GCL- contaminated groundwater. The
full 36,000 gallons per day volume will be realized during that time period which may
last from one to five years. Once GCL violations have been removed from the site, the
'treatment system will be shut down and a period of groundwater monitoring will be
conducted. If no GCL violations are reported during four consecutive quarterly
groundwater sampling event, petition will be made to lower the risk ranking of the site
to Low and site closure will be requested. Note that the treatment goals of the
petroleum UST release incident do not focus on the retrieval and treatment of the
chlorinated solvent release incident that has been documented for a neighboring
' property.

' Page 4 of 9
Coliseum Shell
' NPDES Permit Application
10/27/09
' Provide the applicant name, mailing address, phone number, contact person.
See "applicant" information provided in "1. Contact Information" on the enclosed
' N PDES Permit Application —Short Form C — GW *.
Provide the facility name, address, county, phone number, and contact person.
See enclosed NPDES Permit Application — Short Form C - GW *.
Provide the EAA preparer's name, mailing address, phone number, and contact
person.
See "consultant" information provided in "1. Contact Information" on the enclosed
' NPDES Permit Application —Short Form C — GW *.
Page 3 of 8 Step 2 Residential Population Projections
' The "wastewater" that is generated by the recovery of contaminated groundwater is
not linked to the population of a given area. These projections are not applicable. A
maximum volume of 36,000 gallons per day has been arrived at by design
considerations.
Page 4 of 8 Step 3 Evaluate technologically feasible alternatives
' An August 13, 2009 telephone conversation with Sherry Bagwell a Utility Plant
Supervisor for the City of Winston - Salem's Wastewater Division confirmed that the City
of Winston Salem / Forsyth County does not allow the release of treated water from
' UST release cleanup sites into the POTW. A letter confirming this is enclosed *.
The feasibility of subsurface disposal (including nitrification field, infiltration gallery,
' injection wells, etc.) is prohibited by the setback requirements of the stated subsurface
disposal methods and the location of the groundwater contaminant plume. Also, the
discharge of water back into the aquifer would cause migration of the contaminant
' plume in an uncontrollable and unacceptable manner. Furthermore, there is not
affordable open -space land nearby that could be purchased for use of these methods.
Spray irrigation is also not feasible /practical at this site. due to the land's use
(construction of multi -story buildings over the next few years), the lack of any

' Page 5 of 9
Coliseum Shell
' NPDES Permit Application
10/27/09
infiltration points (site is covered by either asphalt or concrete), and setback restrictions
' with respect to the property lines.
Page 6 of 8 Step 4 Evaluate economic feasibility of alternatives
Since the local POTW will not accept the wastewater and any injection of the treated
' water back into the aquifer onsite will cause -an un- allowed migration of the
contaminant plume, performing a PVCA is not applicable. The only option for discharge
of the treated water is offsite to a surface water body under an NPDES permit. Note
' that there is no nearby open -space land that could be purchased and used for re-
injection of treated water due to the populated commercialized nature of the site's
vicinity. The cost of purchasing nearby property would be prohibitive. Recent sale of
' the site equated to a cost of $1.6M /acre.
From NPDES Permit Application — Short Form C — GW Description of remediation treatment
system components, capacities, and removal efficiency for detected compounds.
The groundwater remediation system will consist of a reciprocating compressor, a liquid ring
pump, an oil /water separator, an air stripper, a settling tank, a sand filter, particulate filters,
and liquid phase carbon adsorption.
The specific models /brands that will be used are as follows:
Reciprocating compressor:
Ingersoll rand 2475N7.5 FP compressor
With 80 gallon receiver tank, air line regulator, coalescing filter, particulate filter
Liquid ring pump:
Tuthill A -600 Fully packaged oil sealed liquid ring pump (545ACFM @21 "Hg)
40Hp 480V 3 phase TEFC motor
With high and low level oil switches, temperature control valve, inlet Erdco flowmeter,
PRM Model MS200 Moisture Separator with a clean out port, intrinsically safe three
float stem mounted in the sight tube to control the transfer pump, 1" Manual Drain
Valve, Solberg FT -275P -400 inline filter, inlet vacuum gauge, inlet /outlet sample port, 2"
manual dilution valve with filter /silencer, Kunkle vacuum relief valve, 6" discharge stack
with silencer, Continental CP56 progressive cavity transfer pump coupled to a 1 HP 480V
3ph TEFC motor
Oil /water separator:
PRM model OWS -30 Oil Water Separator, 30gpm

' Page 6 of 9
Coliseum Shell
NPDES Permit Application
10/27/09
' With 150 gallon sump, 2" inlet /outlet, (2) 1" air vents, 2" adjustable oil skimmer, outlet
on both sides, 2" wide gasketed lid w/ easy turn retainers, 3 level float stem mounted in
a clear PVC sight tube for interlock with pumps, 500 gallon double -wall steel product
' tank set outside building, high level switch installed for product high level shut off,
Myers Model CT -10 centrifugal pump coupled to a 1 HP 480V 3ph TEFC motor
' Air stripper:
PRM Model AST -625 air stripper, 5 trays, 5 HP, 3 Phase, TEFC blower, 900cfm
With low pressure switch with alarm, sump pressure gauge, manual sump drain valve, 3
' float stem mounted in a 2 clear PVC sight tube to control the transfer pump, inlet and
outlet sample ports and pressure gauges, vent stack, discharge pressure gauge, Myers
model CT -15 centrifugal pump coupled to a 1.5Hp 3ph TEFC motor
Settling Tank:
' 1,500 gallon, baffled, settling tank - (poly)
With floating heating element to prevent water from freezing (non classified), unit will
sit outside of enclosure plumbed in /out of building, with heat trace and insulation foam,
(2) 2" ball valves, 3 float stem mounted in a 2" clear PVC sight tube to control the
transfer pump, Myers model CT -10 centrifugal pump coupled to a 1Hp 3ph TEFC motor
' Sand filter:
Hayward 5200 Sand filter
' With (2) 1" Ball valves, camlock connections, pressure rated transfer hose, pressure
switch on inlet of filter
' Particulate filters:
(2) Krystil Klear model M -88 Bag Filters
With 2" 1/0, 100 psi rating, 100 gpm rating, bolt down lid with o -ring, epoxy paint inside
' and out, 2" ball control valves, 0 -60 psi liquid filled pressure gauges (before and after
units), and sample ports before and after units
' Liquid -phase carbon adsorption:
(6) HP90 liquid -phase carbon vessels
With 90 Ibs of carbon each, pressure rated transfer hose, (6) 1" Solenoid valves to
control backwashing, camlock connections, (4) pressure gauges, and an anti - siphon unit

Page 7 of 9
Coliseum Shell
NPDES Permit Application
10/27/09
The required removal efficiencies are listed along with the subject contaminants:
Compound
Stripper discharge (ppb)
Removal efficiency (as %)
Benzene
<1
99.9
Toluene
<1
99.9
Ethylbenzene
<1
99.9
Xylenes
<1
99.9
MTBE
<10
99.9
I PE
<1
99.9
Naphthalene
<1
99.9
n- propylbenzene
<1
99.9
n- butylbenzene
<1
99.9
Tetrachlorethylene (PCE)
<1
99.9
Acetone
<130
94.8
1,2,4 -Trim ethyl benzene
<1
99.9
1,3,5 - Trimethylbenzene
<1
99.9
2- Butanone (MEK)
<53
97.1
Note that the above cleanup requirements are only for the air stripper. Further treatment will
occur in the carbon vessels. The above values are not discharge concentrations.
if the treatment system will discharge to a storm sewer, written approval from the
municipality responsible for the sewer.
Access to the NCDOT storm sewer drain was provided in an NCDOT Right -of -Way Encroachment
Contract* executed in August of 2003.
A list of chemicals found in detectable amounts'-at the site, with the maximum observed
concentration reported for each chemical (the most recent sample must be collected less than
one year prior to the date of this application)
See Table 1 *.
For petroleum- contaminated sites- Analyses for Volatile Organic Compounds (VOC) should
be performed. Analyses for any fuel additives likely to be present at the site and for phenol
and lead should also be performed.
The November 2008 groundwater samples were submitted for laboratory analysis per EPA
Method 6200B and per MADEP VPH, both of which target volatile organic compounds. In
accordance with the regulatory policy of the agency governing the petroleum UST release
incident, the NCDWM -UST, groundwater samples were submitted for lead analysis during the

Page 8. of 9
Coliseum Shell
NPDES Permit Application
10/27/09,
first sampling of each well. The analytical results of Lead samples collected at the site for select
wells follow:
Well IQ
Date Collected
Lead (ug/L)
Mwi
10/12/1998
5.4
MW3
10/12/1998
3.2
MW4
10/12/1998
120
MW5
10/12/1998
<2 *5
MW6
10/12/1998
<2.5
MW7
10/12/1998
6.3
MW8
10/12/1998
11
MW9
10/12/1998
6.6
MW11
5/10/1999
<5
MW17
10/13/1999
15
MW18
10/13/1999 -
9.3
MW19
10/13/1999
39
2L Standard
1S
For sites contaminated with solvents or other contaminants — EPA Method 6241625 analysis
should be performed.
Since assessment and remediation of the chlorinated solvent release incident is not the focus of
the gasoline release incident, analysis by this method has not been conducted. The
concentrations of compounds reported as part of the VOC analyses have been accounted for in
the remedial process.
Thank you for your time in this request. Please. contact me at (919) 563 -9091 or
rdkerins @terraquestpc.com with any questions or concerns.
Sincerely,
TERRAQUEST ENVIRONMENTAL CONSULTANTS, P.C.
�J
Ryan. D. Kerins
Project Manager

Page 9 of 9
Coliseum Shell
NPDES Permit Application
10/27/09
Enclosures:
TABLES
Table 1— Summary of Groundwater Sampling Results (11/8/08)
FIGURES
Figures 1— Site Location
Figure 2 — Site Layout Map
Figure 3 — Remediation System Layout
Figure 4 - Surface Water Discharge Point (aerial)
Figure 5 —Surface Water Discharge Paint (topo)
APPENDIX A
NPDES Permit Application — Short Form C - GW
Includes request for and completed: Attachment A. Local Government Review Form
APPENDIX B
NCDWM -UST Notice of Regulatory Requirements Approving CAP
APPENDIX C:
NCDOT Right -of -Way Encroachment Contract
APPENDIX D
Analytical Report
APPENDIX E
USGS Low Flow Report
APPENDIX F
Winston -Salem / Forsyth County, City /County Utilities Correspondence

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' NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
' Mail the complete application to:
N. C. Department of Environment and Natural Resources
' Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699 -1617
NPDES Permit Number INCOO Y q(
If you are completing this form in computer use the TAB key or the up - down arrows to move from one
field to the next. To check the boxes, click your mouse on top of the box. Otherwise, please print or type.
1. Contact Information:
2. Location of facility producing discharge:
Check here if same as above ❑
Street Address or State Road
City
State / Zip Code
County
3009 N Cherry St (older Forsyth Co. recognized address)
3009 University Pkwy (address recognized by Mapquest,
Google, etc.)
Winston -Salem
NC 27105
Forsyth
3. Operator Information:
Name of the f rm, consultant or other entity that operates the facility. (Note that this is not referring to the
Operator in. Responsible Charge or ORC)
Name facility is currently vacant
Mailing Address A groundwater treatment system will be delivered to the site in the
future. That system will be operated by Terraquest Environmental
Consultants, P.C. whose contact information is listed above.
Pagel of 3
C -GW 03105
Consultant: Terraquest Environemntal Consultants, P.0
Owner Name
Applicant: Quality Oil Company, LLC
Facility Name
Former Coliseum Shell
Consultant: 100 E Ruffin St
Mailing Address
Applicant: PO Box 2736
Consultant: Mebane
City
Applciant: Winston -Salem
Consultant: NC 27302
State / Zip Code
Applicant: NC 27102 -2736
Telephone Number
(919)563 -9091 consultant
Fax Number
(919)563 -9095 consultant
e -mail Address
[e-mail] (consultant)
2. Location of facility producing discharge:
Check here if same as above ❑
Street Address or State Road
City
State / Zip Code
County
3009 N Cherry St (older Forsyth Co. recognized address)
3009 University Pkwy (address recognized by Mapquest,
Google, etc.)
Winston -Salem
NC 27105
Forsyth
3. Operator Information:
Name of the f rm, consultant or other entity that operates the facility. (Note that this is not referring to the
Operator in. Responsible Charge or ORC)
Name facility is currently vacant
Mailing Address A groundwater treatment system will be delivered to the site in the
future. That system will be operated by Terraquest Environmental
Consultants, P.C. whose contact information is listed above.
Pagel of 3
C -GW 03105

• NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
City
State / Zip Code
Telephone Number
Fax Number
4. Ownership Status:
Federal ❑
State ❑
S. Products recovered:
Gasoline ® Diesel fuel ❑
Private
Solvents
Other
Public ❑
6. Number of separate discharge points: 1
Outfall Identification number(s)
7. Frequency of discharge: Continuous ❑ Intermittent
If intermittent:
Days per week discharge occurs: 7 Duration: varies based on
groundwater recovery given by aquifer
8. Treatment System Design flow 0.036 (36,000 gpd) MGD
9. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including
latitude and longitude):
Silas Creek
10. Please list all additives to the treatment system, including chemicals or nutrients, that
have the potential to be discharged.
No additives.
11. Is this facility located on Indian country? (check one)
Yes ❑ No
12. Additional Information
All applicants (including renewals):
A USGS topographical map (or copy of the relevant portion) which shows all outfalls
A summary of the most recent analytical results (effluent data, if available) containing the
maximum values for each chemical detected
NEW Applicants only:
Engineering Alternative Analysis
Page 2 of 3 C -GW 03/05

• NPDES PERMIT APPLICATION - SHORT FORM C - GW
For discharges associated with groundwater treatment facilities.
• ➢ Description of remediation treatment system components, capacities, and removal
efficiency for detected compounds.
If the treatment system will discharge to a storm sewer, written approval from the
' municipality responsible for the sewer.
A list of any chemicals found in detectable amounts at the site, with the maximum
observed concentration reported for each chemical (the most recent sample must be
collected less than one year prior to the date of this application)
For petroleum - contaminated sites — Analyses for Volatile Organic Compounds (VOC) should
be performed. Analyses for any fuel additives likely to be present at the site and for phenol
and lead should also be performed.
For sites contaminated with solvents or other contaminants - EPA Method 624/625
analysis should be performed.
13. Applicant Certification
I certify that I am familiar with the information contained in the application and that to the
best of my knowledge and belief such information is true, complete, and accurate.
Ryan D. Kerins
Printed name of
Signature of
Title
Date
�(a9
North Carolina General Statute 143 -215.6 (b)(2) provides that: Any person who knowingly makes any false
statement representation, or certification in any application, record, report, plan, or other document files or
required to be maintained under Article 21 or regulations of the Environmental Management Commission
implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or
monitoring device or method required to be operated or maintained under Article 21 or regulations of the
Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable
by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section
1001 provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both,
for a similar offense.)
IPage 3 of 3
C -GW 03/05

Attachment A. Local Government Review Form OCT 2 3 2009
General Statute Overview: North Carolina General Statute 143 -215.1 (c)(6) allows input from local govemjriciifs•in the issuance
of NPDES Permits for non - municipal domestic wastewater treatment facilities. Specifically, the Environrfi n l -management
Commission (EMC) may not act on an application for a new non - municipal domestic wastewater discharge facility until it has
received a written statement from each city and county government having jurisdiction over any part of the lands on which the
proposed facility and its appurtenances are to be located. The written statement shall document whether the city or county has a
' zoning or subdivision ordinance in effect and (if such an ordinance is in effect) whether the proposed facility is consistent with the
ordinance. The EMC shall not approve a permit application for any facility which a city or county has determined to be
inconsistent with zoning or subdivision ordinances unless the approval of such application is determined to have statewide
significance and is in the best interest of the State.
Instructions to the Applicant: Prior to submitting an application for a NPDES Permit for a proposed facility, the applicant
shall request that both the nearby city and county government complete this form. The applicant must:
' Submit a copy of the permit application (with a written request for this form to be completed) to the clerk of the city and
the county by certified mail, return receipt requested.
• If either (or both) local government(s) fails) to mail the completed form, as evidenced by the postmark on the certified
mail card(s), within 15 days after receiving and signing for the certified mail, the applicant may submit the application to
' the NPDES Unit.
■ As evidence to the Commission that the local government(s) failed to respond within 15 days, the applicant shall submit a
copy of the certified mail card along with a notarized letter stating that the local government(s) failed to respond within the
15 -day period.
Instructions to the Local Government: The nearby city and /or county government which may have or has jurisdiction over
any part of the land on which the proposed facility or its appurtenances are to be located is required to complete and return this
form to the applicant within 15 days of receipt. The form must be signed and notarized.
IName of local government C;4 .4p
(City/County)
Does the city/county have jurisdiction over any part of the land on which the proposed facility and its appurtenances are to be
' located? Yes [✓rNo [ ] If no, please sign this form, have it notarized, and return it to the applicant.
Does the city/county have in effect a zoning or subdivision ordinance? Yes [, J'No [ ]
' If there is a zoning or subdivision ordinance in effect, is the plan for the proposed facility consistent with the ordinance? Yes [
No [ ]
Date G / U Signature
' (City Manager /Coon anager)
State of ND,ewt Ca 01(;&k_ County of
On this osf- day of nuhhep- personally appeared before me, the said
fname Lee to me known and known to me to be the person described in
and who executed the forego' document and he (or she) acknowledged that he (or she) executed the same and being duly sworn
by me, made oath that the statements in the foregoing document are true.
My Commission expires 1662. 7. =3 .(Signature of Notary Public
Notary Public (Official Seal)
' OFFICK SEAL
Room hL VATS"
Nolsry'PubHOJ0cltl Cs OWMS
emy Can6t&ian Exoror D*W11W7-aor3
roUNTY OF FORSYTH
EAA Guidance Document Version: June 23, 2005
' Page 8 of 8

TERRAc yest,
October 12, 2009 ENVIRONMENTAL CONSULTANTS, P.C.
' Forsyth County Manager
201 N. Chestnut St.
Winston- Salem, NC 27101
CERTIFIED MAIL ARTICLE NUMBER: 7009 1410 0000 1049 6701
Re: Signature Request - NPDES Permit Application — Short Form C — GW
Coliseum Shell —Quality Oil Company, LLC
Winston- Salem, NC
NCDWM -UST Incident No. 15260 Terraquest Project No. 01195
' To Whom It May Concern:
On behalf of Quality Oil Company, LLC, Terraquest Environmental Consultants, P.C. has
prepared 'a Permit Application for the Coliseum Shell facility that requires your involvement.
An underground storage tank system previously released an unknown amount of gasoline into
the site's subsurface. The NC Department of Environment and Natural Resources has approved
a Corrective Action Plan for this release incident. That Plan specifies the cleanup of
' groundwater via removal and onsite treatment in a remediation system.' The, attached NPDES
Permit Application — Short Form C — GW, is required to allow for the discarge of treated
groundwater into a tributary of Silas Creek.
' As Y
required, b the Permit Application (attached), Terraquest.is providing you with Attachment
q
A;. the Local Government Review Form. That Form requires your notarized signature. Please
sign and notarize the document and return it to Terraquest at the letterhead address..
Please contact the Permit Application reviewer, Charles Weaver of NCDENR, at (919) 807 -6391
or at charles.weaver @ncdenr.gov- with any questions or concerns you may have. Thank you.
' Sincerely,
TERRAQUEST ENVIRONMENTAL CONSULTANTS, P.C.
1 >
Ryan D. Kerins
' Project Manager
Enclosures: NPDES Permit Application —Short Form C - GW
Attachment A. Local Government Review Form
100 E. Ruffin Street , Mebane, North Carolina 27302
' Telephone [phone] • Facsimile (919) 563 -9095
www.terraquestpc.com

10/27/2009 USPS - Track & Confirm
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' Your item was delivered at 7:47 AM on October 16, 2009 in WINSTON
SALEM, NC 27102. o
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• Complete items 1, 2, and 3. Also complete A. Signature
item 4 if Restricted Delivery is desired. Agent
• Print your name and address on the reverse X ,ss.�e
so that we can return the card to you. B. Receive e Date of livery
• Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is address different from Ite 7 Yes
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(Transfer from service label) 0 0 9 1410 0 0 RR 1049 6 7 01
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October 12, 2009
TE, luest
ENVIRONMENTAL CONSULTANTS, P.C.
' Winston -Salem City Manager
P.O. Box 2511
Winston- Salem, NC 27102
CERTIFIED MAIL ARTICLE NUMBER: 7009 1410 0000 1049 6879
Re: Signature Request - NPDES Permit Application —Short Form C GW
Coliseum Shell — Quality Oil Company, LLC
' Winston- Salem; NC
NCDWM -UST Incident No. 15260 Terraquest Project No. 01195
To Whom It May Concern:
On behalf of Quality Oil Company, LLC, Terraquest Environmental Consultants, P.C. has
prepared a Permit Application for the Coliseum Shell facility that requires your involvement.
An underground storage tank system previously released an unknown amountof gasoline into
' the site's subsurface. The NC Department of Environment and Natural Resources has approved
a Corrective. Action Plan for this release incident. That Plan specifies the cleanup of
groundwater via removal and onsite treatment in a remediation system. The attached NPDES
' Permit Application — Short Form C — GW, is required to allow for the discharge of treated
groundwater into a tributary of Silas Creek.
As required by the Permit Application (attached), Terraquest is providing you with Attachment
A, the Local Government Review Form. That Form requires your notarized signature. Please
sign. and notarize the document and return it to Terraquest at the letterhead address.
Please contact the Permit Application reviewer, Charles,Weaver of NCDENR, at (919) 807 -6391
' or at charles.weaver ncdenr.gov with any questions or concerns you may have. Thank you.
Sincerely,
TERRAQUEST ENVIRONMENTAL CONSULTANTS, P.C.
Ryan D. Kerins
' Project Manager
Enclosures: NPDES Permit Application— Short Form C - GW
Attachment A: Local Government Review Form
100 E. Ruffin Street s Mebane, North Carolina 27302
' Telephone [phone] • Facsimile (919) 563 -9095
www.terraquestpc.com

' Reply not received from Winston -Salem City Manager after a 1S -day waiting period.
Attachment A. Local Government Review Form sent via certified mail article number 7009 1410 0000
1049 6879. That correspondence was received on October 16, 2009 at 6:37AM as documented on the
attached United States Postal Service Track & Confirm printout.

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Label /Receipt Number: 7009 1410 0000 1049 6879
Service(s): Certified MaiITM
Status: Delivered
Your item was delivered at 6:37 AM on October 16, 2009 in WINSTON
SALEM, NC 27102.
Track & Confirm
(Enter Label/Receipt Number.
I
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• Complete items 1, 2, and 3. Also complete gent
item 4 if Restricted Delivery is desired. X 0 Addressee
• Print your name and address on the reverse . Date of Delivery 1
so that we can return the card to you. B.* e
• Attach this card to the back of the mailpiece,
or on the front if space permits. D. ery address different from it-- 1? Yes
Q , enter delivery addres 4elow: No
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STATE* or NORM CAROLINA
DEPARTMENT OF TRANSPORTATION:
AB EL F. EAazy UNDO T. PPM
�i.
' Division 9, Dis&c>: 2
Environmental �atemec
Rmjecr Descrigtiara:
i, fit. �r- i�u��S , 'the developer ofxhiS➢e=dry that
0 eavimrmmenW re0atibna, both Stagy and .federal, wig be followed- I vatil ins� tha
the rift uf'way i3 surveyed for Amain, wethmd, fined =d znd=gpmd species, and
' historical prdpenies prior to emmurtion, and if any = found., i wM nntif NCDOT prior
to constuction. 3 XmT1 be Tespenstfale for obuiming A State and se&ral -pemiks including,
Corgis. of Ergineera 404 and Department of Env�mnmen$ and Nsmi-A Rasow-:= water
' QUARY 40:1: permi s and Land Quality Perms prior to censtaction. I w5l fo1Pow Izd
Quaittyrs regttlaEcros for erosion card�'a
Signed:
' � � 'QJa"�'i �svNly f�e+nrrnt�tt�tr (�on5eeaA•+� j � �•
DIVISICN9— DISTRICT? 2125 CLOVER UALEAVENUE, 1I UiN=N- SALEM,,UC27143
Telephone: [phone] raze 336- 761 -2247

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w�,
USG -
science far a changing wnrlr!
'U.S. Geological Survey North Carolina Water Science Center
3916 Sunset Ridge Road
Raleigh, North Carolina 27607
IDate: October 2, 2009
To: Mr. Ryan Kerins, Project Manager
Terraquest Environmental Consultants, P.C.
100 East Ruffin Street
Mebane, NC 27302
Dear Mr. Kerins,
'In response to your inquiry about low -flow characteristics (7Q10, 30Q2) for Silas Creek tributary at University Parkway at
Winston -Salem (station id 0211575750, drainage area 0.52 sqmi) in Forsyth County, the following information is provided:
A check of the low -flow files here at the USGS North Carolina Water Science Center does not indicate a previous
determination of low -flow characteristics for your point of interest at the location provided via your email dated September
04, 2009. No USGS records of discharge are known to exist for your point of interest. Low -flow characteristics were
' previously determined for several downstream locations in the Silas Creek basin in 1970, 1979, 1983, and 1990.
Where no or insufficient data is available for a low -flow analysis, a determination of low -flow characteristics is based on
assessment of low -flow yields (expressed as flow per square mile drainage area, or cfsm) at nearby locations where such
'statistics have previously been determined. The low -flow characteristics that are provided have been computed by
correlating the runoff characteristics of a nearby stream in vicinity of the request site.
'Please note the flow estimates do not account for the presence of any diversions or regulation, present or future, which
may occur upstream of the request site.
Previously published low -flow information for streams in your area of interest...
For streams in Forsyth County, the most recently published low -flow information is a statewide report completed in the
early 1990's. It is USGS Water - Supply Paper 2403, 'Low -flow characteristics of streams in North Carolina" (Giese and
'Mason, 1993). An online version of the report is available through http: // pubs. er .us_qs.gov /usgspubs /wsp /wsp2403. The
report provides the low -flow characteristics (based on data through 1988) via regional relations and at -site values for sites
Ryan Kerins
From:
John C Weaver Ucweaver @usgs.gov]
Sent:
Friday, October 02, 2009 4:47 PM
Ryan Kerins
'To:
Cc:
Curtis Weaver; Rose D Pinnix; James C Finnerty
Subject:
SPAM -LOW: Low -flow characteristics for Silas Creek tributary at Winston -Salem in Forsyth
County... Re: 7Q10 and 30Q2 request
'
Attachments:
Bill for Collection Kerins 20091002144946133.pdf
w�,
USG -
science far a changing wnrlr!
'U.S. Geological Survey North Carolina Water Science Center
3916 Sunset Ridge Road
Raleigh, North Carolina 27607
IDate: October 2, 2009
To: Mr. Ryan Kerins, Project Manager
Terraquest Environmental Consultants, P.C.
100 East Ruffin Street
Mebane, NC 27302
Dear Mr. Kerins,
'In response to your inquiry about low -flow characteristics (7Q10, 30Q2) for Silas Creek tributary at University Parkway at
Winston -Salem (station id 0211575750, drainage area 0.52 sqmi) in Forsyth County, the following information is provided:
A check of the low -flow files here at the USGS North Carolina Water Science Center does not indicate a previous
determination of low -flow characteristics for your point of interest at the location provided via your email dated September
04, 2009. No USGS records of discharge are known to exist for your point of interest. Low -flow characteristics were
' previously determined for several downstream locations in the Silas Creek basin in 1970, 1979, 1983, and 1990.
Where no or insufficient data is available for a low -flow analysis, a determination of low -flow characteristics is based on
assessment of low -flow yields (expressed as flow per square mile drainage area, or cfsm) at nearby locations where such
'statistics have previously been determined. The low -flow characteristics that are provided have been computed by
correlating the runoff characteristics of a nearby stream in vicinity of the request site.
'Please note the flow estimates do not account for the presence of any diversions or regulation, present or future, which
may occur upstream of the request site.
Previously published low -flow information for streams in your area of interest...
For streams in Forsyth County, the most recently published low -flow information is a statewide report completed in the
early 1990's. It is USGS Water - Supply Paper 2403, 'Low -flow characteristics of streams in North Carolina" (Giese and
'Mason, 1993). An online version of the report is available through http: // pubs. er .us_qs.gov /usgspubs /wsp /wsp2403. The
report provides the low -flow characteristics (based on data through 1988) via regional relations and at -site values for sites

with drainage basins between 1 and 400 sqmi and not considered or known to be affected by regulation and /or diversions.
'If you access the report, please note the online report files are provided in the ".DJVU" format and require a particular
Lizardtech plug -in, also available through a link displayed on the page. Or you can click an adjacent link that will allow
you to view the report as a group of images without the need for a plug -in.
ISeveral pieces of information to consider...
(1) A drainage area of 0.52 sqmi was determined for your point of interest on Silas Creek tributary at University Parkway
' at Winston - Salem.
(2) In Table 1 of the above referenced report, there are three partial- record sites in central and eastern Forsyth County in
vicinity of your point of interest for which low -flow discharge estimates are provided. Expressing these estimates as low -
flow yields (again, flow per square mile of drainage area, or cfsm) provides some indication of the yield ranges that could
potentially be applicable to your point of interest. The 7Q10 low -flow yield range is from about 0.14 to 0.15 cfsm (with an
average of about 0.14 cfsm). The 30Q2 low -flow yield range is from about 0.3 to about 0.33 cfsm (with an average of
' about 0.32 cfsm).
(3) The regional low -flow relations presented in the above referenced report for this hydrologic area (HA9) results in 7Q10
'and 30Q2 low -flow estimates with yield values of about 0.14 cfsm and 0.18 cfsm, respectively. While the 7Q10 yield is
consistent with the above 7Q10 yields, the 30Q2 yield based on regional relations is substantially lower than the above
30Q2 yields.
' (4) Mean annual runoff for streams in this area is mapped in the above referenced report as being 1.0 to 1.1 cfsm.
(5) In response to a low -flow request during summer 2000 for a site on Peters Creek at Winston -Salem (station id
'02115845, drainage area 5.18 sqmi), an assessment of low -flow yields at nearby discontinued streamgaging stations
resulted in 7Q10 and 30Q2 low -flow yields at about 0.13 and 0.36 cfsm, respectively.
(6) Considering the above information, please be aware of the following: The data provided in the above referenced
report are based on periods of record ending in advance of the drought conditions that have occurred since publication of
the report. In some North Carolina basins, the low -flow conditions observed during the recent droughts (1998 -2002,
2007 -09) have resulted in lower low -flow statistics. No formal statewide investigation has been completed to document
the changes in low -flow statistics since the droughts. However, where updated analyses have been completed for
selected stations, the changes in pre- drought versus updated 7Q10 discharges have shown varying percentage changes
of decline.
For instance, at the nearby long -term gaging station on South Yadkin River near Mocksville in Davie County (station id
02118000, drainage area 306 sqmi, records since October 1939), the 7Q10 declined about 25 percent between the 1998
and 2006 climatic years.
Note: The climatic year is the standard annual period used for low -flow analyses at continuous - record gaging stations. It
runs from April 1 through March 31 and is designated by the year in which the period begins. For example, the 2006
climatic year is from April 1, 2006, through March 31, 2007.
Putting together the above pieces of information...
Applying the above low -flow yields (in items #2 and #5) to a drainage area of 0.52 sqmi results in 7Q10 flow estimates
ranging from 0.07 to 0.08 cfs (average about 0.07 cfs). Similarly, 30Q2 flow estimates range from about 0.16 to 0.19 cfs
(average about 0.17 cfs).
In making use of these estimates, please consider the following: One cause of uncertainty in low -flow estimates is the
effect of urbanization on low -flow characteristics. The USGS has not conducted any formal studies in North Carolina that
document the effects of urbanization / developed basins on low flows. However speculation among the hydrologic
community is that low -flow characteristics decrease as a result of development. Because low flow (or base flow) is
sustained by discharge from the surficial aquifers into streams during extended dry periods, the magnitude of low flows
are thus dependent on the storage of water in the surficial aquifer. And because the presence of impervious areas in a
developed basin reduce the opportunity of infiltration into the surficial aquifers, then it's possible low -flow characteristics
may also decrease. The estimates provided in this response do not account for the effects of urbanization and

Idevelopment on the flow characteristics.
'/charge of $250.00 for accessing and processing information has been assessed to partially offset these costs. An
electronic invoice covering processing costs for these data is attached to this email as a .PDF file. Instructions for
sending your payment are shown on the invoice.
This information is considered preliminary and subject to revision pending further analysis as further data were to become
available, and is made available through our cooperative program of water - resources investigations with the North
Carolina Department of Environment and Natural Resources.
' Hope this information is helpful. If you have any questions regarding this information, please contact me at the phone
number listed below.
Thank you.
Curtis Weaver
J. Curtis Weaver, Hydrologist, PE
'USGS North Carolina Water Science Center
3916 Sunset Ridge Road
Raleigh, NC 27607
Telephone: [phone] // Fax: [phone]
'E -mail address -- jcweaver @usgs.gov
Internet address -- http: / /nc.water.usgs.gov/
1
'From: 'Ryan Kerins" <rdkerins @terraquestpc.com>
To: <jcweaver @usgs.gov>
Date: 09104/2009 11:03 AM
Subject: 7Q10 and 30Q2 request
ICurtis:
Thank you for your time on the phone with me this morning. As I said, Terraquest is preparing a NPDES permit for the discharge of
treated water to a tributary of Silas Creek in Winston - Salem, NC.
The discharge location will be at 36.1318N 80.26310W (36 deg 7' 54.36 " N 80 deg 15' 47.17" W). I have attached a map showing
'the starting point of our treatment system effluent water through the storm sewer to its eventually discharge at the Silas Creek
tributary.
I am requesting that you provide the 7C110 and 30C12 information for the tributary at that location. That information is required for
'the Engineering Alternatives Analysis that must be performed for the NPDES permit. Specifically, NPDES applicants must ensure that
the discharge point is not subject to zero flow restrictions. I have attached a copy of the Engineering Alternatives Analysis. I don't
expect you to complete that document by any means, I just thought it might be helpful for you to see what I need. Refer to the first
' bullet point on page 2 of 8 and to the last paragraph on page 2 of 8.

' I authorize the $250 fee associated with your calculations toward determining the 7Q10 and 30Q2 information of the tributary
located at or near 36.1318N 80.26310W.
IPlease contact me via phone or e -mail with any questions or comments you may have. Thank you for your help.
'Ryan Kerins
Project Manager
Terraquest Environmental Consultants, P.C.
'100 E Ruffin St, Mebane, NC 27302
ph. (919) 563 -9091 fax [phone]
[attachment "EAAGuidance06232005 (1).doc" deleted by John C Weaver /WRD /USGS /DO1] ( attachment "20090904110019159.pdf"
deleted by John C Weaver /WRD /USGS /DOIJ
4

Winston-Salem • Forsyth County
Uli
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Mamon Meads Complex 0 Vate Sewer e Solid Waste Disp§sal
2799 Griffith Road • Winsron-Ucm, NC 27103 i T8 336.765.0130 3 3 6.659.4320
Aupst !1-, 401
■ Mr. Ryan Kerins
PT,6jeo t maftagot
' reit4q qst. EI VfroM.ent4l Consultants
100 8'gufflp $tm.0
Mebane, NC 27302
Dear Mr, Kotps-
This correspondence serves to suinmM±6 our Au&$t 1-3, 20-09 tolophoUe conversation. During
City of Wj�sjog-_S' ale. r " County does p9t accept
that OfWdfsaftf! 1,�J$Afirmed fbAt tho Q; al .4 /For A
votod,groiffdwater from peitolOUM underground storage release incidents into the publicly
■ owned} treatment works.
Sirwetely,
v
ghd, Bagwell
Utility PIAO Supervisor/ IWC
City / County Utilities
Oriffith Road
Winston- Sale??? NC 27103
sherrvbO,cftvofws.org
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GRAPHIC SCALE
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SITE LOCATION MAP
TaRm �e COLISEUM SHELL SERVICE
WINSTON- SALEM, NC
QUALITY OIL COMPANY, LLC WINSTON -SALEM NC
ENVIRONMENTAL CONSULTANTS, P.C. PROJECT NO. 01195 DRAWN BY: RDK DATE: 8/12/09
SCALE: 1" = 2,000' CHECKED BY: MJB FIGURE NO. i

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1. All electrical components shown
inside main area of shed shall be Class
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2. All float switches and motor controls
shall be integrated with the main controal
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3. Power supply will be 3 phase 480V
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8/19/2009
Figure 4— Surface Water Discharge Point (aerial)
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Disclaimer: Forsyth County cannot guarantee the accuracy of this information, and the Map Scale
County hereby disclaims all warranties, including warranties as to the accuracy of this 1 inch = 352 feet
information.
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