3412-CDLF-1995 Winston-Salem, City of Old Salisbury Road SW019-0098 PARF & Invoice 10-10-19

PERMIT APPLICATION REVIEW FORM
Review Requested by: Ming Chao
Date Requested: 10/7/2019
Facility Name and Permit ID Winston-Salem, City of Old Salisbury Road CDLF, 3412-CDLF-1995
Applicant (Owner) Name Winston-Salem/Forsyth County City/County Utility Commission
Description of Permit Request [This is the action the applicant
is requesting in accordance with NCGS 130A-295.8(b)]
(1)a. New – New Facility(1)b. New – Expand Facility Boundary
(1)c. New – Expand Waste Boundary(1)d. New – Substantial Amendment(2)a. Amendment – Next Phase of the Approved Facility Plan
(2)b. Amendment – Renewal/Review LOS 10YR (2)c. Amendment – Change in Ownership(3)a. Modification – Change to Approved Plans (No CHR)(3)b. Modification – Subsequent Permit to Operate (No CHR)(3)c. Modification – Five-year Limited Review(4)Major Permit Modification
Permitted Annual Tonnage 105,000 ton/year
Permit Fee NA
Date Application Received 10/7/2019
Contact Name, Title & Phone # Jan McHargue, Solid Waste Administrator, 336-747-7310
Email Address [e-mail]
Company Old Salisbury Road C&DLF
911 Address 3336 Old Salisbury Road, Winston-Salem, NC 27127
Mailing Address PO BOX 2511,
City/State/Zip Winston-Salem, NC 27102
Parent Company City of Winston-Salem/Forsyth County
Known Subsidiaries unknown
Other known names business has operated under NA
Known Counties of Operation Forsyth
Does the applicant have a past
or current solid waste permit?
Yes No Unknown
Facility Type: MSWLF Permit #: 34-02
Did the permit applicant submit Financial Assurance cost estimates?
Yes No Not Needed
Other notes
SW019-0098
P0708
North Carolina Department of Environmenal QualityDivision of Waste ManagementSolid Waste Section
INVOICE
Invoice #:SW019-0098
Date:10/10/2019
Payment Options:
Division of Waste ManagementSolid Waste Section1646 Mail Service CenterRaleigh, NC 27699-1646phone: [phone] fax: [phone]email: [e-mail]
To:Stevie DulinWinston-Salem, City of Old Salisbury Road CDLFPO Box 2511Winston-Salem, NC 27102
More information available on the web:
North Carolina Department of Environment and Natural Resources (DENR) - http://portal.ncdenr.org/North Carolina Solid Waste Program - http://portal.ncdenr.org/web/wm/swNorth Carolina Electronics Management Program - http://portal.ncdenr.org/web/sw/electronics
E-check -Available online at http://go.ncdenr.gov/swpayRequires bank account and routing information. You will need to use the zip code in the description box and the invoice number shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
Credit Card -Available online at http://go.ncdenr.gov/swpayAccepts MasterCard, Visa, and Discover cards. You will need to use the zip code in the description box and the invoice number shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.*Convenience Fee of 2.65% added to amount invoiced.]
Paper check -Make checks payable to N.C. Division of Waste Management, Solid Waste Section, include Permit Number and invoice number on check. If you are paying by electronic transfer, include the invoice number with your electronic transfer. Please return a copy of this invoice with your payment.
[G.S. 25-3-506: A $25.00 processing fee will be charged on all returned checks.]
Remit paper checks to:
N.C. Division of Waste ManagementSolid Waste Section1646 Mail Service CenterRaleigh, NC 27699-1646
Description Amount Due
Facility-Application: Winston-Salem City of, Old Salisbury Road CDLF (3412-CDLF-1995)3336 Old Salisbury RoadWinston-Salem, NC 27127Permit Renewal Application (Amendment- Five-Year Renewal) received on 10/7/2019
$0.00
$0.00Total Amount Due
11/9/2019Date Due
Pursuant to North Carolina General Statute 130A-295.8 you are required to pay fee(s) based on your solid waste management activities. The fee(s) shall be used to support the solid waste management program. An application is deemed incomplete until all fees are received.
Explanation of Invoice Amount is Based on Facility's Current Permit Application:
Billing process: Mary H. Johnson [phone] Ed Mussler [phone]
Solid Waste Contacts:
Regulations and Technical Assistance: Ed Mussler [phone] Landfills, Transfer Stations Adam Ulishney [phone] Land Application Sites, Compost Facilities
NC Solid Waste Invoice Form I-2014