NCS00790_2023Permit_Initial

2023
Permit and Registration
Shamrock Environmental Corporation
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00790
o and registered as a
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-�� Septage Management Firm ��en� f� w� nmenta�llty
NORTH CAROLINA (PUMPER)
Environmental Quality
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, 2023.
Wm Perry Digitally signed by
Wm Perry Sugg
Sugg 114:1438— 7 05''00'
Perry Sugg, Environmental Compliance Branch Head

For questions regarding this form or the online application process, please contact Jeffrey Bullard (919-707-8285) or Chester Cobb (919-707-
8283).
Firm Info
Firm name*
Shamrock Environmental Corporation
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00790
Enter the five digits following the NCS #
Street address of office*
Street Address
6106 Corporate Park Dr
Address Line 2
City
State / Province / Region
Browns Summit
NC
Postal / Zip Code
Country
27214
United States
County*
Guilford
Mailing address same as street address of office?*
• Yes No
Phone*
Fax
3364781202
Email*
[e-mail]
Owner Info
Firm owner's name*
Jim Hollingsworth
Mailing address same as street address of office?*
• Yes No
Phone* Fax
8008811098 3363751801
Operator Info
Firm operator's name* Firm operator's title
Terry Healy CFO
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
3363751989 363751801
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic 0
Portable Toilet Waste 0
Grease (Restaurant) 0
Treatment Plant 0
Industrial/Commercial 71 , 675
North Carolina counties of operation
List each county you plan to do business in:
All Counties
Vehicle Info
Do you plan to operate pumper vehicles?*
• Yes No
"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 .0835(a) and vehicle lettering as required by 15A NCAC .0835(b).
Furthermore, I also certify that a log is maintained of each septage pumping event as required by 15A NCAC 13B .0836(a). I am aware that
there significant penalties for false certification including the possibility of fine and imprisonment."
Signature
Date*
11/27/2022
Title*
HSE Director
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper Vehicles
Usage*
License Tag #*
Vehicle Identification #*
Tank Capacity*
Other
NE-6872
1XPFDR9XXSN377409
3,500
Other
LT-3226
1NP5LROXOWN483637
3,500
Other
NE-6897
1NP5LUOX83D8O368O
3,500
Other
ND-4298
2M2N179Y3HC0O8O33
3,500
Other
ND-4297
1XPGDB9X84D827451
3,500

Other
AH-78473
5HTNA422095E23572
6,000
Other
AH-78474
1PMA14228131037913
6,000
Other
DA-40607
1A9114123Y1005065
6,000
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
Yes • No
Septage Land Application Sites (SLAS)*
Yes ' No
Septage Detention or Treatment Facility (SDTF)
• Yes No
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 #*
SDTF-4103
Other disposal method*
Yes • No
Expiration Date*
8/31/2023
Authorization
Septage Management Firm Operator Training Completed
Date* Hours*
10/19/2022 4
Location*
Greensboro
Training Sponsored or Provided by*
NC Septic Tank Association
Septage Land Application Site Operator Training Completed
Date Hours
0
Location
Training Sponsored or Provided by
Registration Type^
Select one*
Registered Portable Sanitation Firm
• Registered Septage Management Firm
Registered Portable Sanitation and Septage Management Firm
Comments and Notes^

Comments or notes
SDTF used for Septage Management is Company owned site/facility.
Certif cation 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.
Signature
Date
11/27/2022
11:01:12 PM
Print Name* Title*
Jim Hollingsworth [e-mail]