NCS01048_2023Permit_Initial

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NORTH CAROLINA
Environmental Quality
2023
Permit and Registration
B-Line Portable Restrooms Rentals Inc.
is hereby issued a Septage Management Firm Permit,
Permit Number NCS-01048
and registered as a
Septage Management Firm
(PUMPER)
in the State of North Carolina.
PlORTH CAROLiNA �EQ
wll�pl
Department of Environmental Quality
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. City of Hickory WWTP, Hickory, 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 Perry Digitallysigned by
Wm Perry Sugg
Date:2023.02.23
S u a a 14 0-05'00'
Perry Sugg, Environmental Compliance Branch Head

APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
DIVISION OF WASTE MANAGEMENT - SOLID WASTE SECTION -1646 MAIL SERVICE CENTER, RALEIGH, NC 27699-1646
(1.) Firm name: (The "Firm name" must be jKjO& as it is shown on your vehicle(s)).
Street address of office:
City:ins. !� 1L�..",,/
y_
r State: Zip:
Mailing address (if different):
City: S ,,
State: Zip
Phone:���`
4 7 Fax:
E-Mail:
Septage Management Firm permit number: NCS # XV_A6'v r
County:
(2.) Firm owner's name:
Mailing address (if different):
City: CAf> R ., p
State: ti ! _Zil) Z -
Phone:_�.2-�6/--
(3.) Firm operators name:
1 �t 4- Firm operator's title:
Mailing address (if different):
762 — —
City:
State: ZiP:
Phone:
Fax:
(4.) Type(s) of septage pumped: Write in the number of gallons oumoed in last 12 months (Example: Domestic: 50,000).
able Toilet WasteGrease (Restaurant) TreatmentDomestic Pow Plant Ind al/Gommerciai
(5.) N.C. Counties of Operation:./4ti AEX 2pVy £i2
(List each county you are authorized to do business in)
(6.) Total Number of Pumper Vehicles Operated: Grease restaurant):
Number used for: Domestic Septage: �' — Other:_ portable Toilet Waste: _
/D/��
Vehicle Information: (use additional paper if needed)
APPLICATION CONTINUED ON PAGE 2
PAGE 1
CK. NO.
DATE Z- /7.2.1.
BCQ Da

PAGE 1
APPLICATION FOR PERMIT TO OPERATE A SEPTAGE MANAGEMENT FIRM
(CONTINUED FROM PAGE 1)
(!.) Septage Disposal Method: (check one)
a) Approved wastewater treatment plant: (yes ( ) no. If yes, submit Wastewater Treatment Authorization
for each plant, as indicated in Subparagraph .0833(c)(14) of the Septage Management Rules.
b) Septage Land Application Site (SLAS) Permit Numbers: (use additional sheets if needed)
c) Septage Detention or Treatment Facility (SDTF) Pemnit Numbers: (use additional sheets 4 needed)
SDTF#: _Expiration Date: SDTF#. Expiration Date.,
(S.) Septege Management Firm Operator Training Completed:
Date: S`E41' AZ .Zj L on: 41 Hours:
Training Sponsored or Provided by: aRrg CMgAgWA.,c
(9.) Septage land Appiica' n Site Operator Training Completed:
Date: B Location: _�—_................... _....._
Training Sponsored or Provided by:-
1
(10.) Registration type requested: CHECK ONE
Registered Portable Sanitation Firm: _i_
Registered Septage Management Finn:
Registered Portable Sanitation and Septage Management Firm:
Certification 8tatament
1 certify that the 1. ftination and represe adons In this application for a permit are true, complete, and accurate to
Ore best of my knowledge and bdtef. I am aware that a pemdt may be suspended or revoked upon a finding that its
Issuance was based upon fnorrect or insdequaW Information that matefl* affected the decision to issue the
pemdt and that there am criminal penalties for knowingly making a false statement, representation, or certification,
Sign (Soniture ofcompgWoftW mq do olj
Print Name
Other Comments:
Date
Title
&Go1Cw Al5EPTAGW0RMS+Z018FrmAPPka5w*hrPwWppftdonW18
PAGE 2

NC SIIPTAGE MANAGEMENT FIRM
Recertification of Pumper Vehicle(s)
Septage Firm Permit #: NCS-
Number of Pumper Vehicles:
CERTIFICATION:
"I certify, under penalty of law, that the pumper vehicle or vehicles listed in the
submitted permit application meet the requirements for safe and sanitary
transportation of septage as required by15A NCAC 13B .0844 (a) and vehicle
lettering as required by 15A NCAC 13B .0844 (b). 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 are significant penalties for false certification including
the possibility of fine and imprisonment."
e
Signatu!e. (Signature of company officialAquired)
Print Name
Date
Title
S:ISolid WastelclalseptagelformslPumper Vehicles Cetification.doc

AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of Waste Management - Solid Waste Section
1646 Mail Service Center, Raleigh, NC 27699-1646
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.
Shawn Pennell. Cit of Hicko.
(Plant Operator and Name of Plant)
4014 River Rd Hickory, NC 28602
(Address)
828-323-7427 do hereby authorize James A Jana
(Phone Number) (OwnedOperator of Septage Management Firm)
of B-Line Portable Restroom Rentals Inc NCS # 01048
(Septage Management Firm Name and NCS number)
to dispose of: domestic septage
grease septage (grease trap pumpings) _
, portable toilet waste X ,
commercial/industrial septage
Alexander. Burke. Catawba Caldwell Iredell and Lincoln
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Old Brookford Plant _
(Location)
between the hours of 7:00am and 7:00pm
Reintroducing partially treated liquid into a grease trap is acceptable Yes X No
This authorization shall be valid until December 31. 2023
(Usually December 31, Year)
Signed
(FiNZY Operator)
Sworn to and ubscribed before me this a
czzt
r Ir i
(Notary Public)
Date /Z, 2.i
, from
�r
My Commission expires:
Note: Falsification of this document by the septage management firm shall lead to permit revocation.
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