NC0060321_Permit Issuance_20030918

OF WA Michael F. Easley
�
Q +�� Governor
O sa William G. Ross, Jr., Secretary
co NCDENR North Carolina Department of Environment and Natural Resources
ow, Alan W. Klimek, P.E., Director
Division of Water Quality
September 18, 2003
Mr. Edward Riggs, Jr.
First Craven Sanitary District
P.O. Box 608
Bridgeton, North Carolina 28519
Subject: Issuance of NPDES Permit NCO060321
First Craven Sanitary District WTP
Craven County
Dear Mr. Riggs:
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 May 9, 1994 (or as subsequently amended).
This final permit includes no major changes from the draft permit sent to you on July 23, 2003:
This permit includes a TRC limit that will take effect on May 1, 2005. If you wish to install dechlorination
equipment, the Division has promulgated a simplified approval process for such projects. Guidance for approval of
dechlorination projects is attached.
Discharges from water -treatment plants are currently being studied by the Division. Concerns have been
raised about potential local impacts if your facility's discharge expands any further. Future renewals of this permit
may include a flow limit and increased monitoring frequencies for parameters of concern.
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.
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 Charles Weaver at [phone],
extension 511.
cc: Central Files
Washington Regional Office/Water Qualit}, Section
NPDES Unit
N. C. Division of Water Quality / NPDES Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
Internet: h2o.enr.state.nc.us
Sincerely,
ORIGINAL SIGNED BY
Tom BeIn1C
Alan W. Klimek, P.E.
Phone: [phone]
fax: [phone]
DENR Customer Service Center: 1 800 623-7748

Permit NCO060321
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
INNE&.INN
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, the
First Craven Sanitary District
is hereby authorized to discharge wastewater from a facility located at the
First Craven Sanitary District WTP
NC Highway 55
New Bern
Craven County
to receiving waters designated as an unnamed tributary to Duck Creek in the Neuse
River Basin in accordance with effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, II, III and IV hereof.
This permit shall become effective November 1, 2003.
This permit and authorization to discharge shall expire at midnight on June 30, 2008.
Signed this day September 18, 2003.
ORIGINAL SIGNED BY
M Tom BeInick
Alan W. Klimek, -P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit N C0060321
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.
The First Craven Sanitary District is hereby authorized to:
1. Continue to operate an existing drinking -water treatment plant with a discharge of
filter -backwash wastewater. This facility is located at 560 NC Highway 55 East
near New Bern in Craven County.
2. Discharge from said treatment works at the location specified on the attached map
into an unnamed tributary to Duck Creek, classified class SC -Swamp NSW waters
in the Neuse River Basin.

NUR 1 H UARULINA
7.5 MINUTE $FRIES (TOPOGRAPHIC) tp5 `
SE/4 NEW BERN 15' QUADRANGLE �p
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OLYMF
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ire r o ping • • • n • 1 a -- _. FEET
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lNew Bern
loa �Li ht��Union Point Sandy Point tf n —
\ 3e85
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Aree•L =_
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rea
_ 4 Foul '. 51
LBM 14 '. \\, �••, _Area
Latitude. 35°OT 09'
Longitude. 77W OT N C 0 0 6 0 3 21
(quad # G30SE
Receiving Stream L]P Duck Creek
First Craven Sanitar)
Stream Class: SC -Swamp NSW - District
Subbasin: 30410
Facility
x y� z '
Location
`�'
N®rtih
SCALE 1 :24000

Permit NCO060321
A. (1.) EFFLUENT LIMITATIONS AND MONITORING REgUIREMENTS
During the period beginning on the effective date of the permit and lasting until expiration, the
Permittee is authorized to discharge from outfall 001. Such discharges shall be limited and monitored
by the Permittee as specified below for each outfall:
Effluent
Characteristics
LIMITS
MONITORING REQUIREMENTS
Monthly ,
Auerage
Daily
Maximum
Measurement
Frequency
Sample Type
Sample'Location
Flow
Weekly
Estimate
Effluent
Total Suspended Solids
30.0 mg/L
45.0 mg/L
2/Month
Grab
Effluent
Settleable Solids
0.1 ml/L
0.2 ml/L
Weekly
Grab
Effluent
Turbidity
50 NTU
Weekly
Grab
Effluent
Iron
Weekly
Grab
Effluent
Total Residual Chlorinel
17 yg/L
Weekly
Grab
Effluent
Total Monthly Flow 2
Monitor & Report
(million gallons/month)
Monthly
Calculated
Effluent
Total Nitrogen (TN) 2
Monitor & Report (mg/L)
Monthly
Grab
Effluent
Nitrate/Nitrite Nitrogen2
(NO2 + NO3)
Monitor & Report (mg/L)
Monthly
Grab
Effluent
Total Kjeldahl Nitrogen (TKN)2
Monitor & Report (mg/L)
Monthly
Grab
Effluent
TN load (pounds/month) 2
Monitor & Report
(pounds per month)
Monthly
Calculated
Effluent
TN load (pounds/year) 2
Monitor & Report
(pounds per year)
Annually
Calculated
Effluent
Total Phosphorus
Monitor & Report (mg/L)
Monthly
Grab
Effluent
Footnotes:
1. Limit takes effect May 1, 2005. Until the limit takes effect, the permittee shall monitor TRC (with no effluent
limit).
2. See A. (2) for Total Nitrogen monitoring and reporting requirements.
All samples collected should be from a representative discharge event.
There shall be no discharge of floating solids or visible foam in other than trace amounts.
There shall be no discharge of waste or chemicals not directly resulting from the responsible
treatment of raw water.

Permit NCO060321
A. (2) CALCULATION OF TOTAL NITROGEN LOADS
a. The Permittee shall calculate monthly and annual TN Loads as follows:
L Monthly TN Load (pounds/month) = TN x TMF x 8.34
where:
TN = the average TN concentration (mg/L) of the samples collected during the month
TMF = the Total Monthly Flow of wastewater discharged during the month (MG/month).
If all discharges are not recorded at the facility, document the calculation(s)
used to determine total monthly flow
8.34 = conversion factor, from (mg/L x MG) to pounds
ii. Annual TN Load (pounds/year) = Sum of the 12 Monthly TN Loads for the
calendar year
b. The Permittee shall report monthly Total Nitrogen results (mg/L and pounds/month) in
the discharge monitoring report for that month. The Permittee shall report each year's
annual results (pounds per year) in the December report for that year.

U),
AFFIDAVIT OF PUBLICATION
NORTH CAROLINA.
Wake County. ) Ss.
Before the undersigned, a Notary Public of Johnston
Pusuc NOTICE STATE OF NORTH CAROLINA County North Carolina, duly commissioned and authorized to
ENVIRONMENTAL67 MAIL SERVICE MANAGEMENT
CEN
TER
ROWNPDES UNIT administer oaths, affirmations, etc., personally appeared Ivy
9-1617
NOTIFICATION OF INTEENTTTTOI IISSSUE A NPDES WASTEWATER PERMIT Marsch, who, being duly sworn or affirmed, according to law,
On the basis of thorough staff review and application of NC General Statute 143.21, Public
low 92-500 and other lawful standards and regulations, the North Carolina Environmental Cloth depose and say that she is Billing Manager -Legal
Management Commission proposes to issue a National Pollutant Discharge Elimination i
System (NPDES) wastewater discharge permit to the Person(s) listed below effective 45 Advertising of The News and Observer a corporation
days from the publish date of this notice.
Written comments regarding the proposed permit will be accepted until 30 days after the; organized and doing business under the Laws of the State of
Publish date of this notice. A�I comments received prior to that date are considered in the North Carolina and publishing a newspaper known as The
final determinations regarding the proposed permit. the Director of the NC Division of
Water Quality may decide to hold a public meeting for the proposed permit should the
Division receive q significant degree of public interest. News and Observer, in the City of Raleigh Wake
Copies of the draft permit and other supporting information on file used To determine'' County and State aforesaid, the said newspaper in which such
conditions present in the draft permit are available upon request and Payment of the costs
of reproduction. Mail comments and/or requests for information to the NC Division of, notice, paper, document, or legal advertisement was published
Water Quality at the above address or call Ms. VoleryStephensat(919)733-5083,extension p I) erg p
520. Please include the NPDES permit number (attached) in any communication.
Interested persons may also visit the Division of Water Quality at 512 N. Salisbury Street, was, at the time of each and every such publication, a
Raleigh, NC 27604-1148 between the hours of 8:00 a.m. and 5:00 P.m. to review information'
on file. newspaper meeting all of the requirements and qualifications
The Town ofFuquoyVorino'sTerrible Creek WWTP(NCW66516),hosappueaforrenewal
' of Section 1-597 of the General Statutes of North Carolina and
of its permit discharging to Terrible Creek In the Neuse River Basin. Currently, BOD,
ammonia nitrogen, total nitrogen and total phosphorus are water quality limited. this
discharge may affect future allocations in the receiving stream. was a qualified newspaper within the meaning of Section I -
Heater Utilities, Inc. has applied for renewal of NPDES permit NC0055701 for the 597 of the General Statutes of North Carolina and that as such
Nottingham Forest WTP. This permitted facility discharges filter -back wash wastewater
to an unnamed tributary to Swift Creek in the Neuse River Basin. Currently total residual , she makes this affidavit, that she is familiar with the books,
chlorine is water quality limited. This discharge may affect future allocations in this
portion of swift creek. files and business of said corporation and by reference to the
Heater Utilities, Inc. has applied for renewal of NPDES permit NC0086690for the STonsTead
Well #2 WTP. This Permitted facility discharges fitter -backwash wastewater to an files of said publication the attached advertisement for NC
unnamed tributary to Basal Creek in the Meuse River Basin. Currently total residual I)
chlorine iswaterquality limited. thisdischarge may affect future allocations inthis Portion DIVISION OF WATER UALITY was inserted in the
of Basal Creek. Q
Heater Utilities, Inc, has applied for renewal of NPDES permit NC0073679 for the Oak aforesaid newspaper on dates as follows: 07/25/03
Hollow WTP. This permitted facility discharges filter -backwash wastewater to an
unnamed tributary to Middle Creek int he Meuse River Basin. Currently total residual
chlorine is water quality limited. This discharge may affect future allocations in this'
portion of Middle Creek. Account Number: 73350831
Heater Utilities, iNc. has -applied for renewal of NPDES Permit NC00829% for the
Hollybrook WTP. This Permitted facility discharges filter -backwash wastewater to an'
unnamed tributary to Middle Creek in the Meuse River Basin. Currently total residual,
chlorine is waterAuality limited. this discharge may affect future allocations in this portion
of Middle Creek.
Mr. Joseph Thompson (9520 Penny Road, Raleigh, NC 27606) has applied for renewal of
NPDES Permit NCO083747 for the Twin Lake WTP. This Permitted facility discharges
filter -backwash wastewater to an unnamed tributary to Basal Creek in the Meuse River'.
Basin. Currently total residual chlorine is water quality limited. Th isdischarge may affect
future allocations in this portion of Basal Creek.
Carolina Water Service, Inc. of NC has applied for renewal of NPDES Permit NC0086266for
the Woodtrace Water System WTP. This Permitted facility discharges filter -backwash
wastewater to an unnamed tributary to Little River in the Neuse River Basin. Currently
total residual chlorine is water quality limited. This discharge may affect future
allocations in this portion of the Little River.
First Craven Sanitary District has applied for renewal of NPDES Permit N00060321 for its
WTP. This permitted facility discharges filter -backwash wastewater to an unnamed
tributary to Duck Creek in the Neuse River Basin. Currently total residual chlorine Iswater
quality limited. This discharge may affect future allocations in this portion of Duck Creek.
The City of Havelock has applied for renewal of NPDES Permit NC0002917 for its a books and files of the aforesaid Corporation and publication.
Lynnwayne WTP. This permitted facility discharges filter -backwash wastewater to the
Southwest Prong of Slocum Creek in the Neuse River Basin. Currently total residual
chlorine is water quality limited. This discharge may affect future allocations in this
Portion of Slocum Creek.
The City of Havelock has applied for renewal of NPDES permit NCO078131 for its Brown
Boulevard WTP. This permitted facility discharges filter -backwash wastewater to
McCotter Canal (to Hancock Creek) in the Meuse River Basin. Currently total residual
chlorine is water quality limited. This discharge may affect future allocations in this - -- - -- - -
portion of Hancock Creek.
N&O: July 25, 2W3 I ! Billing Manager -Legal Advertising
SEAL Sworn or affirmed to, and subscribed before me, this
28 day of JULY , 2003 AD
In Testimony Whereof, I have hereunto set my hand
and affixed my official seal, the day and year aforesaid.
Notary Public
My commission expires 2nd day of July, 2005.

To: Point Source Branch SOC Priority Project:
NPDES Unit
Water Quality Section If "Yes", SOC No.
Attn: Charles Weaver
Date: January 31, 2003
NPDES STAFF REPORT AND RECObMNDATION
Permit No. NCO060321
PART I - GENERAL INFORMATION
Yes No
1. Facility and Address: First Craven Sanitary District WTP
P.O. Box 608
Bridgeton, NC 28519
2. Date of Investigation: January 30, 2003
3. Report Prepared by: Stephen Lane
4. Person Contacted and Telephone Number: Mr. Edward Riggs 252-633-6500
5. Directions to Site:
Follow Hwy 17 to the town of Bridgeton, turn onto Hwy 55 and head
East towards the town of Bayboro. Go approximately 2.0 miles and
the WTP will be on the south side of the road.
6. Discharge Point(s); List for all discharge points:
Latitude: 35' 07' 22" N Longitude: 77' 00' 12" W
Attach USGS map extract and indicate treatment facility site and
discharge point on map.
USGS Quad Name: New Bern
7. Site size and expansion area consistent with application? X Yes No
If "No", explain:
8. Topography (relationship to flood plain included):
Site is flat and has an approximated elevation of 10 feet.
9. Location of nearest dwelling: Approximately 100 feet.
10. Receiving stream or affected surface waters:
Unnamed tributary to Duck Creek
a. Classification: SC Sw NSW
b. River Basin and Sub -basin No. 03-04-10
C. Describe receiving stream features and pertinent downstream uses:
UT is a drainage ditch for storm water. Duck Creek is used for
boating, fishing, and other recreational uses.

PART II - DESCRIPTION OF DISCHARGE AND TREATMENT WORKS
1. a. Volume of Wastewater to be Permitted: 0.075 MGD
b. Current Permitted Capacity: No limit on flow in current permit.
C. Actual Treatment Capacity: Maximum design discharge is 0.200 MGD.
d. Date(s) and construction allowed by Authorizations to Construct
issued past two years: It should be noted that the N.C. Division
of Environmental Health/Public Water Supply Section issued an
Authorization to Construct for the facility to double its water
treatment capacity on October 13,1998 and the construction was
completed in February 2000.
e. Description of existing or substantially constructed wastewater
treatment facilities: N/A- No treatment at facility.
f. Description of proposed wastewater treatment facilities: N/A
g. Possible toxic impacts to surface waters: Water softeners
are recharged with a brine solution. Chlorinated product
water is occasionally used during backwashing.
2. Residuals Handling and Utilization Disposal Scheme: N/A - No treatment.
3. Treatment Plant Classification ' (attach completed rating sheet):
N/A- No treatment.
4. SIC Code(s):4941
Wastewater Code(s): Primary 22
Main Treatment Unit Code: 000 0
PART III - OTHER PERTINENT INFORMATION
1. Is this facility being constructed with Construction Grant Funds or are
any public monies involved (municipals only)? Yes, a loan was obtained
from the State Revolving Fund and a grant was obtained from the Rural
Center, with the District funding the rest of the costs for the
expansion.
2. Special monitoring or limitations (including toxicity) requests:
The Washington Regional Office requests that an additional limit
be placed in the permit for flow.
PART IV - EVALUATION AND RECOMMENDATIONS
This facility expanded its water treatment and discharge capacity from
two water softeners and two filters to four water softeners and four water
filters between 1998 and the year 2000. The District currently has not
increased the volume treated at the water treatment plant above the 0.075MGD
level indicated in the last staff report and does not foresee exceeding that
level of discharge for this permit renewal. It is recommended that this permit
be renewed with a flow limit specified in the permit to limit future expansion

of the discharge volume until further study can be done of the impacts of the
discharge and possible alternatives to the discharge.
Signature of report preparer
/'C �
Water -Quality Regional Supervisor
Date
NPDES Permit Staff Report
Version 10/92

APPLICATION FOR PERMIT TO DISCHARGE - SHORT FORM A
''. For municipal discharges <1 MGD (or similar privately owned discharges <1MGD)
N. C. Department of Environment and Natural i Resources ; : ,, :
Division of Water Quality / NPDES Unit. rt
1617 Mail Service Center, Raleigh,'NC 27699-161'7";'
` -
NPDES Permit NC00 (o O 3 a 1 ' ��•� �� • JAN 7 2003,
i
I i
Please print or type
Name of applicant/permittee_ ;
1 RS'i C2rwEN SIN LTA 2`?
Address, location, and telephone number of facility producing discharge:
A. Facility Name 'F1 RS ► CSzn►%-% S N SQLN 11 A 9_4 D 1S 1 SZtCr'T
B. Mailing address of applicant / permittee:
Address 1P O %o x 608
City 1�. i� �OCYE'`O V'1 County C_2AQ F rV
State N C. ZIP_ A gs 19
Telephone # 633•- 6j 00 Fax# 6163- 6S 60
e=Mail address:
C. Physical Location of facility to be permitted:
Street address S60 VAZ$ wa:�t S S 'Eo� s-r
City NIEw QE 2vy County___.!2 As F- N
State i13 L Zip Code a$ J b0
Telephone # 633- 6'Spo Fax# 633-6.Sp o
Type of wastewater treatment:
X None Primary Intermediate Secondary n Advanced
Design flow of facility
Percent BOD removal (actual):
® 0-29.9 ❑ 30-64.9
MGD. Average monthly flow 1 • g MGD
❑ 65-84.9 85-94.9 95 or more
Population served:
❑ 1-199 200-499 ❑ 500-999 1,000-4,999 0 5,000-9,999 ❑ 10,000 or more
Number of separate discharge points:
® 1 ❑ 2 3 ❑ 4 or more (give number)
Description of wastewater volume discharged to receiving stream.
Discharge per
Flow, MGD (million gallons per operating day)
Volume treated before
operating day
discharging (percent)
Average
Maximum
p. ao 0
-
1 of 2 12/30/02

APPLICATION FOR PERMIT TO DISCHARGE - SHORT FORM A
For municipal discharges <1 MGD (or similar privately owned discharges <1MGD)
If any wastewater, treated or untreated, is discharged to places other than surface waters, check
below as applicable.
Wastewater is
discharged to
Flow, MGD million
gallons per operating day)
0-0.0099
0.01-0.049
0.05-0.099
0.1-0.49
0.5-0.99
Deep well
Evaporation lagoon
Subsurface percolation
system
Other, specify:
Is any sludge ultimately returned to a waterway?
Fj Yes 0 No
Do you receive industrial waste? Yes 5� No
If yes, enter approximate number of industrial dischargers into system.
Type of collection sewer system: QoNE 'i-rt,S is wgT62 SISTr_ O-1 , 'Ftrku ljoa-i %5
A. Separate sanitary P Ro a'4C 6 „ d o mj - S dqc tX....► As"
B. Combined sanitary and storm
C. Both separate and combined sewer systems
Name of receiving stream(s) Duct'. C-YLFE 1c
Does your discharge contain (or is it possible for your discharge to contain) any of the following
substances (circle all that apply):
Ammonia cyanide aluminum beryllium cadmium chromium
Lead mercury nickel copper selenium zinc phenols
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.
IF -�w P 2VM R k&U S J 2.
Printed name of Person Signing
Signature of Applicant
�N1AN�GE�?
Title
-- /// /03
Date Application Signed
North Carolina General Statute 143-215.6 (b)(2) states: 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 knowly
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 $10,000, 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 $10,000 or imprisonment not more than 5 years, or both, for a similar
offense.)
2of2
12/30/02
C.U1Z2E,r.�-C �r�,�, i �cP, ft.� S Tuv`►2. �003 ,

Please pent or type in the unshaded areas only
mur-tn Arpac arp .,zngrprY fnr PlirP fvnp i P 19 rhararfPccZ4nrhl
For Approved. OMB No. 2040-0086. Approval expires 5-31-92
FORM
U.S. ENVIRONMENTAL PROTECTION AGENCY
I. EPA I.D. NUMBER
1
j^
GENERAL INFORMATION
T/A
C
S
F
D
Consolidated Permits Program
1
2 13
14
15
GENERAL
Read the "General Instructions" before startin
LABEL ITEMS
GENERAL INSTRUCTIONS.
If a preprinted label has been provided,
affix it in the designated space. Review the
I. EPA I.D. NUMBER
information carefully; if any of it is
incorrect, cross through it and enter the i
III_ FACILITY NAME
correct data in the appropriate fill-in area
below. Also, if any of the data is
preprinted
absent (the area to the left of the label
V. FACILITY PLEASE
PLACE LABEL IN THIS SPACE
space lists the information rear should
appear), please provide it in the properfill -
MAILING LIST
pp
and cor(rre beyou need notcel is omplete�terrns
I, III, V, and VI(except VI-B which must be
completed regardless). Complete all items
V{ . FACILITY
if no label has been proved. Refer to the I
LOCATION
instructions for detailed item descriptions
and for the legal authorization under which
this data is collected. I
II. POLLUTANT CHARACTERISTICS
INSTRUCTIONS: Complete A through J to determine whether you need to submit any permit application forms
to the EPA. I you answer "yes to any
questions, you must submit this form and the supplemental from listed in the parenthesis following the question.
Mark ")C in the box in the third column if
"no"
the supplemental form is attached. If you answer
"no" to each question, you need not submit any of these forms.
You may answer if your activity is
excluded from permit requirements; see Section C of
the instructions. See also, Section D of the instructions for
definitions of bold-faced terms.
SPECIFIC QUESTIONS
MARK "X'
SPECIFIC QUESTIONS
MARK "X„
FORM
YES
NO
FORM
YES
NO
ATTACHED
ATTACHED
A Is this facility a publicly owned treatment works
which results in a discharge to waters of the
§<
❑
❑
B. Does or will this facility (either exisbng or
proposed) include a concentrated animal
❑
X
I ❑ I
U.S.? (FORM 2A)
feeding operation or aquatic animal
production facility which results in a discharge
to waters of the U.S.? (FORM 28)
16
17
18
19
20
1 21
C. Is this facility which currently results in
❑X
D. Is this proposal facility (other than those described
El
g
i ❑
discharges to waters of the U.S. other than
in A or B above) which will result in a discharge
22
23
24
25
26
27
those described in A or B above? FORM 2C
to water; of the U.S.? FORM 2D
E Does or will this facility treat, store, or dispose of
hazardous wastes? (FORM 3)
❑
9
❑
F. Do you or will you inject at this facility industrial or
municipal effluent below the lowermost stratum
❑
®
❑
containing, within one quarter mile of the well
bore, underground sources of drinking water?
I
28,
29
30
(FORM 4)
1 31
32
33
G Do you or will you inject at this facility any
produced water other fluids which are brought to
H. Do you or will you inject at this facility fluids for
special processes such as mining of sulfer by the
minerals, in
❑
❑
the surface in connection with conventional oil or
natural inject fluids used for
❑
®
❑
Frasch process, solution mining of
situ combustion of fossil fuel, or recovery of
gas production,
enhanced recovery of oil or natural gas, or inject
geothermal energy? (FORM 4)
fluids for storage of liquid hydrocarbons?
34
35
36
37
36
FORM 4
I. Is this facility a proposed stationary source
J. Is this facility a proposed stationary source
which is one of the 28 industrial categories listed
in the instructions and which will potentially emit
❑
®
❑
which is NOT one of the 28 industrial categories
listed in the instructions and which will potentially
❑
❑
100 tons per year of any air pollutant regulated
under the Clean. Air Act and may affect or be
emit 250 tons per year of any air pollutant
regulated under the Clean Air Act and may affect
ao
41
42
43 1
44 I 45
located in an attainment area? FORM 5
or be located in an attainment are? FORM 5
111. NAME OF FACILITY
SKIP J=-% L�Llgv�+�
SAN �T RCtY `�.S-ZQ k 't '
R.
15 1 16-29 1 30
- 69
IV. FACILITY CONTACT -
A. NAME & TITLE (last, first, & title) B. PHONE (area code & no.)
75 FowF,2.o
MaNAc ft
�Sa- 63'�
46 481 1 49 51
l�oo
52 55
15
16
45
V. FACILITY MAILING ADDRESS .
A. STREET OR P.O. BOX
D. ZIP CODE
2f
47 51
3
? C %OYL 60%
15 1
16
45
B. CITY OR TOWN
C. STATE
%
N-1L.
a
15
16
40
41 42 1
VI. FACILITY LOCATION
A. STREET, ROUTE NO. OR OTHER SPECIFIC IDENTIFIER
Slob N w S 5 F /�► ST
5
5
16
45
B. COUNTY NAME
4c
- 70
C. CITY OR TOWN
D. STATE
E. ZIP CODE
F. COUNTY CODE
Iv F w E 2�►
1
1
to C-
D ?s 6 o
6
'.5
16
40
41 42
47 61
52 54

CONTINUED FROM THE FRONT
V II. SIC CODES (4-digit, in order of priority)
A FIRST B. SECOND
(specify) 777
(specify)
7
15
16 17
C. THIRD D. FOURTH
? (specify) 7 (specify)
15 1 16 17 15 16 19
V III. OPERATOR INFORMATION
A NAME B. Is the name listed in Item
g �DvJA2� �t(S S2 VIII-A also the owner?
El YES & NO
a 1s 55
C. STATUS OF OPERATOR (Enter the a ro riate letter into the answer box; if "Other,"specify.)
D. PHONE (area code 6 no.
F = FEDERAL M = PUBLIC (other than federal or state)
(specify)
c
S = STATE O = OTHER (specify)
P = PRIVATE
17�j
Asa
33
15
16 18
19 21
22 25
E. STREET OR PO BOX
p O C3o � ba$
26 55
F. CITY OR TOWN
G. STATE H. ZIP CODE
IX. INDIAN LAND
c
B
32-',DCrGT0 w
11.3 C
1 42 42
, tj
Is the facility located on Indian lands?
❑YES NO
15 1
16 40
1 47 51
X. EXISTING ENVIRONMENTAL PERMITS
A. NPDES (Discharges to Surface Water)
D. PSD (Air Emissions from Proposed Sources)
-
9
N
I
tJC. O O lob'.. (
g
P
e
15
16
17
1 18 30
15
18
1 17
1 18 30
B. UIC Underground Injection of Fluids
E. OTHER spec'
(Specify)
C
T
I
I
C IT
1 8
9
U
g
15
16
17
1 18 30
15 1
16
1 17
1 18 30
C. RCRA (Hazardous Wastes)
E. OTHER (specify)
(Specify)
C
T
I
C T a
9
R
11
g
15 16 17
18 30
1 15 1 16 17 1 18 30
X I. MAP
Attach to this application a topographic map of the area extending to at least one mile beyond property boundaries. The map must
show the outline of the facility, the location of each of its existing and proposed intake and discharge structures, each of its
hazardous waste treatment, storage, or disposal facilities, and each well where it injects fluids underground. Include all springs,
rivers and other surface water bodies in the map area. See instructions for precise requirements.
XII. NATURE OF BUSINESS provide a brief description)
i
TF•ttS �/-1Ct�.11'� lS %�1 vJFIT�Q•TTLEptSM�NT p�.AN'i which. Set��G—S p+ �o�1�EiO,f�t �
O� �4'�PRotc J; �O •
i
i
XIII. CERTIFICATION (see instructions)
I certify under penalty of law that I have personally examined and am familiar wish the information submitted in this application and
all attachments and that, based on my inquiry of those persons immediately responsible for obtaining the information contained in
the application, 1 believe that the information is true, accurate and complete. 1 am aware that there are significant penalties for
submitting false information, including the possibilff of fine and imprisonment.
A. NAME & OFFICIAL TITLE (type or print) B. SIGNATURE
C. DATE SIGNED
�OWr�2t� R L( L'rT 3-,L MAn3PsC—r CL
111143
COMMENTS FOR OFFICIAL USE ONLY
C
C
15
1 16 55