NCS00942_2023Permit_Initial

2023
Permit and Registration
64 Portables Inc.
is hereby issued a Septage Management Firm Permit,
STATE,,
Permit Number NCS-00942
o and registered as a
e:,e D
NORTH
EQ�J
%L 12. 9*
-�� Septage Management Firm�� �� w� ��nffii�utr
E,%r Q'M
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. Carolina Compost (2911-COMPOST), Thomasville, NC
2. Lexington Regional WWTP, Lexington, 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, 2023.
Wm Perr Digitally signed
Perryby Wm Perry Sugg
Date: 2023.02.23
Sugg 11:43:10-05'00'
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*
64 Portables, Inc
The "Firm name" must be exactly as it is shown on your vehicle(s).
Septage Management Firm permit number (NCS #)
NCS-00942
Enter the five digits following the NCS #
Street address of office*
Street Address
280 Cunningham Brickyard Road
Address Line 2
City
State / Province / Region
Lexington
NC
Postal / Zip Code
Country
27292
United States
County*
Davidson
Mailing address same as street address of office?*
• Yes No
Phone*
Fax
3364741436
Email*
[e-mail]
Owner Info
Firm owner's name*
Jason GIbson
Mailing address same as street address of office?*
• Yes No
Phone* Fax
3364741436
Operator Info
Firm operator's name* Firm operator's title
Jason Gibson CEO/Operator
Mailing address same as street address of office?*
0 Yes No

Phone* Fax
3364741436
Type and amount of septage pumped in the last 12 months
Amount in gallons*
Domestic
1,000,000
Portable Toilet Waste
900,000
Grease (Restaurant)
85,000
Treatment Plant
0
Industrial/Commercial
0
North Carolina counties of operation
List each county you plan to do business in: *
Davidson Forsyth Davie Guilford Randolph Rowan
7Vehicle 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*
12/2/2022
Title*
CEO/Operator
Choose how to add vehicle descriptions*
• Add vehicles individually Upload List
Pumper
Vehicles
Usage*
License Tag #*
Vehicle Identification #*
Tank Capacity*
Grease (restaurant)
YA148297
3HAEKTAT8ML166345
2,250
Domestic
Septage
YA-162148
3HAEUTAN3ML153790
4,000
Portable
Toilet Waste
RD 5482
3C7WRMDL4NG256143
300
Portable
Toilet Waste
RD 5477
3C7WRMBL9NG256142
1,100
Portable
Toilet Waste
JX 1189
3HAEUMMLOML072195
1,100

Portable Toilet Waste JR 1862 3HAEUMML8LL808749 1,100
Portable Toilet Waste JF 3052 JALC4W169H70002958 400
Septage Disposal Method
For each method, indicate whether you plan to use it by checking yes or no.
Approved wastewater treatment plant*
• Yes No
If yes, list the facilities below and upload or submit by mail a copy of Wastewater Treatment Authorization for each plant as indicated in
subparagraph .0833(c)(14) of the Septage Management Rules.
Mail forms to:
NC DEQ
Division of Waste Management - Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
Wasterwater Treatment Facility Name*
City of Lexington
Septage Land Application Sites (SLAS)*
Yes • No
Septage Detention or Treatment Facility (SDTF)
Yes • No
Other disposal method*
• Yes No
Description *
Carolina Compost for Grease
Expiration Date* Authorization
12/31 /2023 Handwritten-... 608.14...
12-
02_103657.pdf
Authorization
2022-12- 411.15...
02_104317.pdf
Septage Management Firm Operator Training Completed}
Date* Hours*
9/15/2022 6
Location*
Lexington, NC
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
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
12/2/2022
10:57:32 AM
Print Name*
Jason Gibson
Title*
CEO/Operator

► UTHORIZATION TO DISCHARGE SEPTAGE AT A SEPTAGE TREATMENT OR
STORAGE FACILITY PERMITTED TO SOMEONE OTHER THAN YOURSELF
{This form is used by a detention or treatment facility permit holder to indicate that permission
has teen given to a permitted Septage Management Hrm to discharge septage into the permit
molders detention or treatment facility.}
I, Jason Gibson
(Facility Operator)
888 Free Pilgrim Church Rd. Thomasville, IBC 27360
(operator Address)
Jason Gibson
do here -by authorize:
(owner of Septage Management Firm)
64 Portables. inc
NCS
(name of Septage Management Firm)
280 Cunningham Brickyard Rd
(Address of Septage Management Firm)
to utilize Septage detention or treatment facility V
septage ;:
00942
SWCD-29-10
,for the treatment or storage of
in Z{} 23 The faciaty will be Qperated in accordance with the Septage r ii agesZ)enr Rules **_
Date:
11/11/2022
Signed
{ ac3lity Operator)
x As defined in G.S. 1.30A-290(a){32}
"* As defined in 15A NCAC 138 -08 0
Return the pf-aperly completed form to:
Borth Carolina Department of Environmental Quality
Division of Waste Management
solid Waste Section
164E Mall Service Center
Raleigh, NC 27699-1646

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER TREATMENT FACILITY
North Carolina Department of Environmental Quality
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27695-1646
Fee assessments and waste determinations will be required at the discretion of the wastewater
treatment facility. The facility has the ultimate prerogative to deny discharges of any wastes to the
incoming wastewater stream,
[Plant operator in Responsible Charge (DRC),
License NumbW, Name of Plant)
�t N C-
) ' —9 -<4
�33 r-J; �Q- J 6 Q—Zdo hereby authorize 6-1b C i.-
(Phone Number) (flw er/Qperator of Septage Management Firm)
'�-W eQ,4
(Address)
of
(Septage Management Firrn Name and NCS number)
to dispose of; domestic septage portable toilet waste
VIT-1
grease septage (grease trap purnongs) commercial/industrial septage from
tc� v-i6
C:�(�'-4
(County or of Q Geographic Ar )
at the above named wastewater treatment facility. Septage shall be discharged at:
C.
(Location)
between the hours of („''_ C'0 a" .- k, r
Reintroducing partially treated liquid into a grease trap is acceptable YesNe
This authorization small be valid until J '20 2
(Usually December 31, Year)
Signed L
- Date Ll 2 �_
A` {Facility Operator)
Subscribed and affirmed before me this day of I[�ff�l3)�20
• r p
r My Commission expires:
(Notary Pubflic) y Jamie
Notary
Notary Pahk (OFFICIAL SEAL)
Davidson County, NG
Note, Falsification of this document by the septage management firm sha11 lead to permit revocation.
S:/Solid_Waste/CLA/SEPTAGE/FORMS/2018 Firm APPHCation/WWTP Authoritatian Farm 2018
2—