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Home My WebLink AboutNCS00790_2021Permit_Initial 2021 Permit and Registration Shamrock Environmental Corporation is hereby issued a Septage Management Firm Permit, Permit Number NCS-00790 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. Septage Detention or Treatment Facility, SDTF-41-03 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, 2021. __________________________________________________ Adam Ulishney, Environmental Compliance Branch Head State of North Carolina Environmental Quality Waste Management Application for Permit to Operate a Septage Management Firm For questions regarding this form or the online application process, please contact Jeffrey Bullard (919-707-8285) or Chester Cobb (919- 707-8283). Firm name** Septage Management Firm permit number (NCS #)** Street address of office** County** Mailing address same as street address of office?** Phone**Fax Email** Firm owner's name** Mailing address same as street address of office?** Phone**Fax Firm operator's name**Firm operator's title Mailing address same as street address of office?** Firm Info Shamrock Environmental Corporation The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-00790 Enter the five digits following the NCS # City Browns Summit State / Province / Region NC Postal / Zip Code 27214-9700 Country United States Street Address Shamrock Environmental Address Line 2 6106 Corporate Park Dr Guilford Yes No 8008811098 3368751801 jhollingsworth@shamrockenviro.com Owner Info Shamrock Environmental/Greg Kiser President Yes No 3363751989 3363751801 Operator Info Greg Kiser President Yes No Phone**Fax Amount in gallons * DomesticDomestic Portable Toilet WastePortable To ilet Waste Grease (Restaurant)Grease (R estaurant) Treatment PlantTreatment Plant Industrial/CommercialIndustrial/Co mmercial List each county you plan to do business in:** Do you plan to operate pumper vehicles?** "I certify, under penalty of law, that the pumper vehicle or vehicles listed in the submitted permit application meets the requirements for safe and sanitary transportation of septage as required by 15A NCAC 13B .0844(a) and vehicle lettering as required by 15A NCAC .0844(b). Furthermore, I also certify that a log is maintained of each septage pumping event as required by 15A NCAC 13B .0839(a). I am aware that there significant penalties for false certification including the possibility of fine and imprisonment." Signature Date** Title** Choose how to add vehicle descriptions** Pumper Vehicles Usage*License Tag #*Vehicle Identification #*Tank Capacity* 3363751989 3363751801 Type and amount of septage pumped in the last 12 months 0 0 0 0 537,435 North Carolina counties of operation All NC Counties Vehicle Info Yes No 1/11/2021 HSE Director Add vehicles individually Upload List Other LR-5183 1XPFDR9XXSN377409 3,500 Other LT-3226 1NP5LR0X0WN483637 3,500 Other LR-5175 1NP5LU0X83D803680 3,500 Other ND-4298 2M2N179Y3HC008033 3,500 Other ND-4297 1XPGDB9X84D827451 3,500 Approved wastewater treatment plant ** Septage Land Application Sites (SLAS)** Septage Detention or Treatment Facility (SDTF)** If you are not the permit holder for the septage detention/treatment facility, you must have a signed detention/treatment authorization form for each site. SDTF #*Expiration Date*Authorization Other disposal method** Date**Hours** Location** Training Sponsored or Provided by** Date Hours Location Training Sponsored or Provided by Select one** Comments or notes Other AH-78473 5HTNA422095E23572 6,000 Other AH-78474 1PMA14228B1037913 6,000 Other AH-82792 1A9114123Y1005065 6,000 Septage Disposal Method For each method, indicate whether you plan to use it by checking yes or no. Yes No Yes No Yes No SDTF-4103 8/31/2023 Yes No Septage Management Firm Operator Training Completed 10/20/2020 4 Greensboro NC Septic Tank Association Septage Land Application Site Operator Training Completed 0 Registration Type Registered Portable Sanitation Firm Registered Septage Management Firm Registered Portable Sanitation and Septage Management Firm Comments and Notes Signature Date Print Name**Title** Pmt made Conf #21011122836577 Certification Statement I certify that the information and representations in this application for a permit are true, complete, and accurate to the best of my knowledge and belief. I am aware that a permit may be suspended or revoked upon a finding that its issuance was based upon incorrect or inadequate information that materially affected the decision to issue the permit and that there are criminal penalties for knowingly making a false statement, representation, or certification. 1/11/2021 12:11:40 PM Jim Hollingsworth HSE Director PAID INVOICE #: NCS‐00790‐2021 PERMIT #: NCS‐00790 AMOUNT: $800 PAYMENT METHOD: e‐card DATE: 1/12/2021 Chester Cobb