NCS01179_2019Permit_Initial

2019
Permit and Registration

R & R Pumping Service
is hereby issued a Septage Management Firm Permit, Permit Number NCS-01179
And by virtue of completing the annual training
requirements is hereby registered as a Septage Management Firm
in the State of North Carolina.

This permit to operate a Septage Management Firm is issued to the above named person, business or entity alone and is not transferable to any other person, business or entity. Firm operation shall be in accordance with the provisions of N.C. General Statute 130A-291.1 - 130A-291.3, Title 15A of the N.C. Administrative Code 13B .0800 et.seq.,
conditions of the permit, and representations made in the application and accompanying documents for a permit.
The permit holder is authorized to discharge septage only at the locations(s) listed below: 1. Rocky River Regional WWTP, Concord NC

This permit does not entitle the permit holder to operate a Septage Land Application Site, a Septage Detention or Treatment Facility, or any other solid waste management facility
not specified herein. Failure to operate as permitted may result in the Department suspending or revoking this permit, initiating action to enjoin the unpermitted operation, imposing administrative
penalties, or invoking any other remedy as provided in Chapter 130A, Article 1, part 2 of the North Carolina General Statutes. This permit and registration expires on
December 31, 2019.

__________________________________________________
Adam Ulishney, Environmental Compliance Branch Head
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��Pl IC 't10N F°O an.t;�°" l:t p R 1'1T TO OPERATE A S PTAG -MA.MAG M -NT t=\RM ,,.,
StalB ___ Z!J) _______ _
Fa.it: 7o<1-?3K-$1.-l-C>
Mailing address (if different):
City: ______________ .State: ____ Zip: _________ _
Phona: _____________ Fax: _______________ _
(4.) Type(s) of septage pumped: Write in the number of gallons pumped in 2017 (Examp\e: Oomesfic: fi:l,\j$j).
>omestic Portable Toilet Waste Grease (Restaurant) Treatment P\ant \ndustt\a\lCommerc\a\
�� ,�./� . -�� I
(5.) N.C. Counties of Operation: ....,.,-A�l-::..;L=-----------------------
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated:-�/ ____ _
Number used for: Domestic Septage:____ Grease (restaurant): ___.I ___ _
Other.________ Portable Toilet Waste: ___ _
Vehicle Information: (use additional paper if needed)
Vehicle Identification # , ... ---� . '. --.,� .... ·�· __ ,::;. ... �
APPLICATION CONTINUED ON PAGE 2
\
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT F\RM
(CONTINUED FROM PAGE 1)
(7 .J Sep� Disposal Method: (c::heck one)
a) �ed wastewater Int�� yes ( ) no. If y-. &Ubmil Wastewater Trea�\ Au\rot\vat\Ofleach plant, as indlcatad In .0833(c)(14) of the Seplage Manage�\ Rule&.
b) Septage laid AppOcation Site (SI.AS) f>8nnit Numbefs: (use additional sheets if needed)
Si.AS#: ____ Expiration Date:____ SL.AS#: ____ Expiration Date: ____ _
c) Septage Detention or Treatn,ent Facility (SDTF) Permit Numbers: (use additional sheets if needed)SOTF#: ____ Expiration Date:____ SOTF#: ____ Expiration Date: ____ _
(&.) Septage Man�ment Firm �ator Training Compl�/, • ! I t..L Date: .� :Za/� Location: ���;zi-�&f.:.11../fe-.'-=:;;_.---Hours:_.:c::_
Training Sponsored or Provided by: _______________________ _
(9.) Septage Land Application Site Operator Training Completed:
Date: _______Location: ________ _
Training Sponsored or Provided by:
(10.) Registration type requested: CHECK ONE
Registered Portable Sanitation Finn: __ / Registered Septage Management Firm: _:;..V_ Registered Portable Sanitation and Septage Management Rrm: __ _
Cf:, tification Statement
Hours: --
I certify that the information and representations in this ap plication for a permit are 1rue, comp\e-, and accurate wthe best of my knowledge and belief. I am aware that a permit may be suspended or revoked upon a finding \hat\$
issuance was based upon incorrect or inadequate in for11tation that materially affected the dec\sion U> issue tt\e
pennit and that there are criminal penalties for knowingly making a false statement, representation. or certit\cation.
'3-)S:--20 /7
¥official required)
Lo Title
Other Comments:
5.JSdd_ 8
PAGE2
PayPoint
Payment Receipt
Application: Solid Waste
Merchant: NDENR-Solid Waste
Merchant City/State: Raleigh, North Carolina
Payment Status: Settled
Result Message: Payment completed and settled successfully.
Payment Date: 11/16/2018
Posting Date: 11/16/2018
Billing Information: R & R PUMPING SERVICE 1933 MICHELLE DRIVE KANNAPOLIS, NC 28083 7049853707 [e-mail]
Payment Amount: 550.00 USD
Page 1 of 1
Reference Information: NCS-01179-2019,28083,R&R Pumping Service,1933 Michelle Dr,Kannapolis,NC,NCS-01179,$550.00
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https ://admin. thepayplace.com/epayadmin/paymentreceipt.aspx 11/19/2018