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HomeMy WebLinkAboutNCS01515_2021Permit_Initial 2021 Permit and Registration Express Jet Services is hereby issued a Septage Management Firm Permit, Permit Number NCS-01515 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-98-08 2. Septage Detention or Treatment Facility, SDTF-92-12 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?** Mailing Address** Phone**Fax Email** Firm owner's name** Mailing address same as street address of office?** Mailing Address** Firm Info Express Jet Services The "Firm name" must be exactly as it is shown on your vehicle(s). NCS-01515 Enter the five digits following the NCS # City Oxford State / Province / Region North Carolina Postal / Zip Code 27565 Country United States Street Address 1111 Martin Luther King, Jr Ave Address Line 2 Granville Yes No City Oxford State / Province / Region North Carolina Postal / Zip Code 27565 Country United States Street Address P.O. Box 1399 Address Line 2 919-892-7107 919-690-1157 admin@expressjetnc.com Owner Info Jason Smith Yes No Phone**Fax Firm operator's name**Firm operator's title Mailing address same as street address of office?** Mailing address** 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 City Oxford State / Province / Region North Carolina Postal / Zip Code 27565 Country United States Street Address P.O. Box 1399 Address Line 2 919-892-7107 919-690-1157 Operator Info Matthew Foster Supervisor Yes No City Oxford State / Province / Region North Carolina Postal / Zip Code 27565 Country United States Street Address P.O. Box 1399 Address Line 2 919-892-7107 919-690-1157 Type and amount of septage pumped in the last 12 months 0 0 1,200,000 0 0 North Carolina counties of operation all 100 counties Vehicle Info Yes No 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* 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** 12/15/2020 Owner Add vehicles individually Upload List Grease (restaurant)JT5224 1GBG6H1C3XJ102079 1,000 Grease (restaurant)AK48152 1T9TA4325C1867661 5,500 Grease (restaurant)AK14251 1M92M4025HT690079 4,500 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-92-12 6/23/2023 92-12 Authorization Form 2021.pdf 462.39… SDTF-98-08 12/31/2021 98-08 Authorization Form 2021.pdf 436.19… Yes No Septage Management Firm Operator Training Completed Date**Hours** Location** Training Sponsored or Provided by** Date Hours Location Training Sponsored or Provided by Select one** Comments or notes Signature Date Print Name**Title** 9/11/2020 4 Morganton, NC NC Pumper Group & NC Portable Toilet Group 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 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. 11/25/2020 11:08:24 AM Jason Smith Owner AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT OR STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSETF (This form is used by a detention or treatment facility permit holder to indicate that permission has been given to a permitted Septage Management Firm to discharge septage into the permit holders detention or treatment facility.) 5ce r/hntSc/#r Lk (Facility Operator) (Operator Address) doherebyauthorize: - .lq,aln -S.ni.Hn -..__. ._ _ (Owner of Septage Management Firm) f-' if;X(YZ6i , \€{ ,Sbruice;., LL C *., o' (Name of Septage Managemeni f irm) o\bl5 ' I I I rru K,' J' ty#= **::1,,#*.r3"oa'ft 6Po'--&*l 3?d to utilize septage detention or treatment facility # septage *7)-t>for the treatment or storage of in zatZl-. The facility will be operated in accordance with the Septage Management Rules ** nate, .ll-:3-). O * As defined ln G.S. 130.A-290(a)(32)** As defined in 15A NCAC 138 .0900 Return the properly completed form to: North Carolina Department of Environmental euality Division of Waste Management Solid Waste Section 1546 Mail Service Center Raleigh, NC 27599-1646 (Facility Operator) : C. p-76 o AUTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT OR STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF(This form is used by a detention or treatunent facility permit holder to inrJicate that permission has been given to a permittedSeptage Management Firm to discharge ieptage into the permit holders detention or treatmeni facility.) Daniel L Newsome t, (Facility 0perator) 44'l Buck Newsome Rd, Fremont, NC 27830 (Operator Address) do hereby authorize: Jason Smith (Owner of Septage Management Firm) Express Jet Services 01515 (Name of Septage Management Firm) NCS # (Address of Septage Management Firm) (00e53) 9B-08 to utllize septage detention or treatment facility #for the treatment or storage of septage * in 2021-. The facility will be operated in accordance with the septage Management 1 0-01-20 Date:Signed * As defined in G.S. 130A.290(a)(32)** As defined in 1SA NCAC 138 .0g00 Return the properly completed form to: North carolina Department of Environment and Natural Resources Division of Waste Management Solid Waste Section 1646 Mail Service Center Raleigh, NC 27699-1040 1 Cobb, Chester From:G M <gm@greaseoutlet.com> Sent:Wednesday, December 30, 2020 12:31 PM To:Cobb, Chester; Wylie, Connie; Chip Haskell Subject:[External] 2021 Authorization to discharge forms for Grease Outlet.com Attachments:2021 permitted septage management firms using Grease Outlet.com LLC.pdf CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to  Report Spam.      PAID INVOICE #: NCS‐01515‐2021  PERMIT #: NCS‐01515  AMOUNT: $800  PAYMENT METHOD: e‐card  DATE: 1/15/2021    Chester Cobb