NCG030703_Application_20190710

NCC- 0Z-)0 -703
Division of Energy, Mineral and Land Resources
Ki - r-0- Land Quality Section
National Pollutant Discharge Elimination System
Environmental NCG030000
Quality
I► IQ9C99*10I:Ili:1:"
FOR AGENCY USE ONLY
Date Received
Year
I Month
Da
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LV
Certificate of Coverage
N C G 0 3I-ZIC13
Check #
1 Amount
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Permit Assigned to
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG030000:
STORMWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) 335 Rolling, Drawing, and Extruding of Nonferrous Metals
SIC 3398 Metal Heat Treating
IF
SIC 34 Fabricated Metal Products t-> !��• ,� s.-�O
SIC 35 Industrial and Commercial Machinery
SIC 36 Electronic and Other Electrical Equipment JUL 10 20113
SIC 37 Transportation Equipment DENR-LAND QUALITY
SIC 38 Measuring, Analyzing, and Controlling Instruments STORNIVATER PrMMiTi"ING
WE, I For questions, please contact the DEMLR Regional Office for your area. Seepage 4.
_ _ . _.._ .-- --
(Please print or type)
1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed):
Name DuBose National Energy Services, Inc.
Street Address
City
Telephone No.
900 Industrial Drive
Clinton
[phone]
2) Location of facility producing discharge:
Facility Name
DuBose National Energy Services, Inc.
Facility Contact
Tom Wilson
Street Address
900 Industrial Drive
City
Clinton
County
Sampson
Telephone No.
[phone] Ext. 127
Email
[e-mail]
3) Physical Location Information:
State NC ZIP Code 28328
Fax: [phone]
State NC ZIP Code 28328
Fax: [phone]
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). Traveling via 1-40 E, take exit 343 for US-701 toward
Clinton, take the exit towards US-421 N/Dunn and turn right onto North Blvd, turn right onto Industrial Drive in 500 ft,
the facility will be on the left in 0.8 mil.
(A copy of a county map or USGS quad sheet with the facility clearly located must be submitted with this application.)
4) Latitude 35' 1'36.47"N
Longitude 78°20'13.68"W
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
F71 Existing
(deg, min, sec)
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NCG030000 N.O.I.
6) Standard Industrial Classification:
Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility.
SIC Code: 3 4 9 8
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: Cutting and machining.
8)
Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? one
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Williams Old Mill Branch to Great Coharie Creek
Receiving water classification: c; sw
Is this a 303(d) listed stream? No Has a TMDL been approved for this watershed? No
the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer). NA
List discharge points (outfalls) that convey discharge from the site (both on -site and off -site) and location
coordinates. Attach additional sheets if necessary, or note that this information is specified on the site plan.
Stormwater Outfall No. of
Latitude (degrees/minutes/seconds): 35' 132-32" N
Longitude (degrees/minutes/seconds): 78`Wl9.W W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
9) Does this facility have any other NPDES permits?
P No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
If
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NCG030000 N.O.I.
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
11 No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
11) Does this facility employ any best management practices for stormwater control?
11 No
❑ Yes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe:
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
11 Yes
If yes, when was it implemented? .June 1, 2019
13) Are vehicle maintenance activities occurring at this facility?
11 No ❑ Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
IN No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
11 No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
11 No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
d No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
15) Certification:
North Carolina General Statute 143-215.613 (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report,
plan, or other document filed or required to be maintained under this Article or a rule implementing this Article; or who
knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Article; or
who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be
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NCG030000 N.O.I.
operated or maintained under this Article or rules of the Commission implementing this Article shall be guilty of a Class 2
misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: Tom Wilson
Title: Materials Manager
(Signature of Applicant)
�/S/6
(Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDEQ
(7,F!\/
Jul 0
GENR-LAND QUALITY
STORIAWATER PERiVIFF[ING
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NCG030000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NCDEQ.
❑ This completed application and all supporting documents.
❑ A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
(f) impervious areas, (g) site property lines.
❑ Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map.
Mail the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee coverage under the General Permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMUR Regional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office ... [phone]
Mooresville Office ... [phone]
Raleigh Office ........ [phone]
Washington Office ...[phone]
Wilmington Office ... [phone]
Winston-Salem ...... [phone]
Central Office ......... [phone]
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SWU-218-071408 Last revised 7/2/14

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North Carolina Secretary of State Search Results
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Business Corporation
Legal Name
Dubose National Energy Services, Inc.
Information
Sosld: 0276985
Status: Current -Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 10/18/1990
Fiscal Month: December
Registered Agent: CT Corporation System
Addresses
Reg Office
160 Mine Lake Ct Ste 200
Raleigh, NC 27615
Officers
Reg Mailing Mailing Principal Office
160 Mine Lake Ct Ste 200 350 S. Grand Ave, Suite 5100 350 S. Grand Ave, Suite 5100
Raleigh, NC 27615 Los Angeles, CA 90071 Los Angeles, CA 90071
Treasurer
Arthur Ajemyan
350 S. Grand Ave., Suite 5100
Los Angeles CA 90071
President
Richard M. Rogers
900 Industrial Drive
Clinton NC 28328
Stock
Class: COMMON
Shares: 100000
Par Value 0
Vice President
Arthur Ajemyan
350 S. Grand Ave., Suite 5100
Los Angeles CA 90071
Vice President
William A. Smith II
350 S. Grand Ave ... Suite 5100
Los Angeles CA 90071
Secretary
Karla R. Lewis
350 S. Grand Ave., Suite 5100
Los Angeles CA 90071
Vice President
Silva Yeghyayan
350 S. Grand Ave, Suite 5100
Los Angeles CA 90071
Vice President
Karla R. Lewis
350 S. Grand Ave., Suite 5100
Los Angeles CA 90071
https://www.sosnc.gov/online_services/search/Business ReRistration_Results 7/12/2019