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Home My WebLink AboutNCG030638_COMPLETE FILE - HISTORICAL_20160302STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /V CCU O�O �0 30 DOC TYPE VHISTORICAL FILE 1_1 MONITORING REPORTS DOC DATE ❑ �j C� �a YYYYMMDD EMSL Analytical, Inc 200 Route 130 North, Cinnaminson, NJ 08077 Phone t8561 303 2500 Fax t8561 858-4571 Email EnvChemrstry2{memsl com Kent Hebert Paladin 230 Perry Road Kernersvllle, NC 27284 Phone (336) 996-2796 Fax 3/2/2016 The following analytical report covers the analysis performed on samples submitted to EMSL Analytical, Inc on 2/17/2016 The results are tabulated on the attached data pages for the following client designated project Storm Water Run -Off The reference number for these samples Is EMSL Order #011600813 Please use this reference when calling about these samples If you have any questions please do not hesitate to contact me at (856) 303-2500 Reviewed and Approved By Phillip Worby Chemistry Laboratory Manager A � The test results contained within this report meet the requirements of NELAP andfor the specific certification program that is applicable unless otherwise noted NELAP Certification NJ 03036 NY 1 OB72 PA 68 00367 B EMSL Analytical does not hold NPW certification in the state of North Carolina The samples associated with this report were received in good condition unless otherwise noted This report relates only to those items tested as received by the laboratory The QC data associated with the sample results meet the recovery and precision requirements established by the NELAP unless specifically Indicated All results for sod samples are reported on a dry weight basis unless otherwise noted This report may not be reproduced except in full and without written approval by EMSL Analytical Inc Page 1 of 3 Page 1 of 12 EMSL Analytical, Inc EMSL Order 011600813 200 Route 130 North Cinnaminson NJ 08077 CustomerlD CustomerPO Kent Kent PhonelFax (956) 303 2500 / (856) 85a-4571 htto hvvww EMSL.com EnvChem istrv20emsl cam Pro}ectlD AIM Kent Hebert Phone (336) 996 2796 Paladin Fax 230 Perry Road Received 02117/16 9 20 AM Kernersvllie, NC 27284 ct Storm Water Run Off Analytical Results Client Sample Description 1A 1B 1C 1D 1E Collected 2116/2016 Lab ID 0001 8 00 00 AM Prep Analysis Method Parameter Result RL Units Date Analyst Date Analyst 2007 Copper NO w 20 pg1L 2/2512016 SM 3/1/2016 BE 2007 Lead NO - - 10 �- pg1L - 2/25/2016 - SM - 3/1/2016 - BE 200 7 Zinc t 49 20 pglL T— 2125/2016 SM 3/1/2016 BE _ SM 2540D 11 Total Suspended Solids 25 50 _ mglL ?123120113 TO 2/23/2016 TO ISM 4500 H B-11 pH- - 756 WA ph Unds _ - 2119l2016- TD 2119I2016 TO � Sample received outside of the regulatory hold f time Time Analyzed_14 29 Subcontract Analytical See Attached NIA- Laboratory Services Inc Client Sample Description 2A 2B 2C 2D 2E Method Parameter 12007 Copper 2007 Lead 2007 Zinc SM 2540D 11 Total Suspended Solids '5M 4500 H B 11 _- pH �- _ - --- - Sample received outside of the regulatory hold `me Time Analyzed 14 30 - Subcontract Analytical See Attached Laboratory Services Inc Client Sample Description 3A 313 3C 30 3E Method Parameter 2007 - Copper- 2007 Lead 2007 Y Zinc SM 2540D 11 Total Suspended Solids SM 4500 H B 11 _ pH 1 Sample received outside of the regulatory hold time Time Analyzed 14 32 _ — -- —_ Subcontract Analytical See Attached Laboratory Services Inc Collected 2/16/2016 Lab ID 0002 8 00 00 AM Prep Analysis Result RL Units Date Analyst Date Analyst 26 20 p91L 212512016 SM 3/1/2016 BE ND 10 pg1L _ 2/25/2016 SM 3/1/2016 BE 78 20 pg1L 2/25/2016 SM 3/1/2016 BE ~28 5 0 mg1L 212312016 TD 2/23/2016 TD 736 NIA ph Units 2/19/2016 TD w2/19/2016 TD NIA Collected 2/16/2016 Lab ID 0003 B 00 00 AM Prep Analysis Result RL Units Date Analyst Date Analyst NO - -- 20 pglL- - --212512016 SM 31112016- BE ) NO 10 pg1L 212512016 SM 3/112016 BE - - -� 64 - 20 pg1L 212512016 SM 3/112016 - BE 30 50 mglL 2/23/2016 TO 2/23/2016 yTO 729 NIA ph Units 2119/2016 _ TO 2-/1912016 TO ChemSmptw/RDUNELAC 7 21 0 Printed 312/2016 8 01 13 PM Page 2 of 3 Page 2 of 12 EIVISL Analytical, Inc EMSL Order 011600813 CustomerlD PLAD42 200 Route 130 North Cinnaminson NJ 08077 PhonelFax (B56) 303 2500 / (856) 85B-4571 CustOmerPO Kent http IAvww EMSL.com E=nvChemistry2aemsl.com ProfectlD Attn Kent Hebert phone (336) 996 2796 Paladin Fax 230 Perry Road Received 02/17/16 9 20 AM Kernersvllle, NC 27284 Storm Water Run Off Analytical Results Client Sample Description 4A 46 4C 4D 4E Collected 2/16/2016 Lab ID 0004 8 00 00 AM Prep Analysts Method Parameter Result RL Units Date Analyst Date Analyst 200 7 Copper Nd 20 pglL Y 212512016 SM 311/2016 BE - 2007 Lead ND 10 Ug1L 2/25/2016 —SM 311/2016 BE 2007 Zinc 55 20 pg1L _ 2/2512016 SM 3/1/2016 - BE SM 2540D 11 Total Suspended Solids 57 50 mg1L 2/23/2016 TO 2/23/2016 TO SM 4500 H B 11~ pH - - - T- 731 _ NIA ph Units� 211912015 TO 2/19/2016 TD� - Sample received outside of the regulatory hold time Time Analyzed 14 33_ _ _ _ _ Subcontract Analytical See Attached NIA Laboratory Services Inc Definitions NO indicates that the analyse was not detected at the reporting limit RI_ Reporting Limit ChemSmplwlRDUNELAC 7 21 0 Printed 3/2/2016 8 01 13 PM Page 3 of 3 Page 3 of 12 AA1, Enulronmental 34 Dogwood Lane ■ Middletown, PA 17057 a Phone 717 944 5541 ■ fax 717 944 1430 ■ www alsglobaf tom NELAP Certifications NJ PA010 NY 11759 PA 22 293 DOD E1_AP A21-A 0818 01 State Certifications DE ID 11 MAPA0102 MD 128 VA460157 WV 343 February 29 2016 Ms Debbie Kreider EMSLAnalytical Inc 200 Route 130 North Riverton NJ 08D77 Certificate of Analysis Protect Name SUBCONTRACT PRICING T EFF Workorder 2125249 Purchase Order 43627-01B. Workorder ID 011600813 Dear Ms Kreider Enclosed are the analytical results for samples received by the laboratory on Friday, February 19 2016 The ALS Environmental laboratory in Middletown Pennsylvania is a National Environmental Laboratory Accreditation Program (NELAP) accredited laboratory and as such certifies that all applicable test results meet the requirements of NELAP If you have any questions regarding this certificate of analysis please contact Mr Brad W Kintzer (Project Coordinator) at (717) 944-5541 Analyses were performed according to our laboratory s NELAP-approved quality assurance program and any applicable state requirements The test results meet requirements of the current NELAP standards or state requirements, where applicable For a specific list of accredited analytes refer to the certifications section of the ALS website at www alsglobal com/en/Our-Services/Life-Sciences/Environmental/Downloads This laboratory report may not be reproduced except in full without the written approval of ALS Environmental ALS Spring City 10 Riverside Drive Spring City PA 19475 610-948-4903 CC Mr Travis Albert This page is included as part of the Anatytrcat Report and Mr Brad W Kintzer (must be retained as a permanent record thereof Project Coordinator ALS Environmental Laboratory Locations Across North America Canada. eurlington Calgary Centre of Excellence Edmonton Fort McMurray Fort St John Crande Prairie London Missrssauga Rkhmond Hill Saskatoon Thunder Bay Vancouver Waterloo Winnipeg Yellowknife United States Cincinnati Everett Fon Collins Holland Houston Middletown Salt Lake City Spring City York Wxko Monterrey Reparl ID 2126249 212912016 Page 4 of 12 Page 1 of 9 AALSEnuironmental 34 Dogwood Lane ■ Middletown PA 17057 ■ Phone 717 944 5541 ■ Fax 717 944 1430 ■ www alsglobal com I ! 5 NE LAP Cernfication5 NJ PAO10 NY 11759 PA 22 293 DoD E LAP A2LA 0818 01 State Certifi canons DE ID 11 MAPA0102 MD 128 VA460157 WV 343 SAMPLE SUMMARY Workorder 2125249 011600813 Lab ID Sample ID Matrix Date Collected Date Received Collected By 2125249001 011600813 0001 Waste Water 2/16/2016 08 00 2/19/2016 08 43 Collected by Client 2125249002 011600813 0002 Waste Water 2/16/2016 08 00 2/19/2016 08 43 Collected by Client 2125249003 011600813 0003 Waste Water 2/16/2016 08 00 2/19/2016 08 43 Collected by Client 2125249004 011600813 0004 Waste Water 2/16/2016 08 00 2/19/2016 08 43 Collected by Client Notes Samples collected by ALS personnel are done so in accordance with the procedures set forth in the ALS Field Sampling Flan (20 Field Services Sampling Plan) — All Waste Water analyses comply with methodology requirements of 40 CFR Part 136 — All Drinking Water analyses comply with methodology requirements of 40 CFR Part 141 — Unless otherwise noted all quantitative results for soils are reported on a dry weight basis The Chain of Custody document is included as part of this report All Library Search analytes should be regarded as tentative identifications based on the presumptive evidence of the mass spectra Concentrations reported are estimated values Parameters identified as analyze immediately require analysis within 15 minutes of collection Any analyze immediately parameters not listed under the header Field Parameters are preformed in the laboratory and are therefore analyzed out of hold time Method references listed on this report beginning with the prefix S followed by a method number (such as S2310B 97) refer to methods from Standard Methods for the Examination of Water and Wastewater For microbiological analyses the Prepared value is the date/time into the incurbator and the Analyzed value is the date/time out the incubator Standard Acronyms/Flags J Indicates an estimated value between the Method Detection Limit (MDL) and the Practical Quantitation Limit (PQL) for the analyte U Indicates that the analyte was Not Detected (ND) N Indicates presumptive evidence of the presence of a compound MDL Method Detection Limit PQL Practical Quantitation Limit RDL. Reporting Detection Limit ND Not Detected indicates that the analyte was Not Detected at the RDL Cntr Analysis was performed using this container Regl.mt Regulatory Limit LCS Laboratory Control Sample MS Matrix Spike MSD Matrix Spike Duplicate DUP Sample Duplicate %Rec Percent Recovery RPD Relative Percent Difference LOD DoD Limit of Detection LOQ DoD Limit of Quantitation DL Dad Detection Limit ALS Environmental Laboratory Locations Across North America Canada Burlington Calgary Centre of Excellence Edmonton FortMcMurray FortSt John Grande Prairie London Mississauga Richmond HIIt Saskatoon Thunder Bay Vancouver Waterloo W rimpeg Yellowknife United States Cincinnati Everett FortCollins Holland Houston Middletown Salt Lake City Spring Gty York Mexlco. Monterrey Report ID 2125249 2/29/2016 Page 5 of 12 Page 2 of 9 AALSEnulronmental 34 Dogwood Lane ■ Middletown PA117057 a Phone 717 944 5541 ■ fax 717 944 1430 n www alsgiobal corn NE LAP Certificabons NJ PA010 NY 11759 PA 22 293 DoD E LAP A2LA 081901 State Certifications DE ID 11 MA PAO102 MD 128 VA460157 WV 343 ANALYTICAL RESULTS Workorder 2125249 011600813 Lab ID 2125249001 Date Collected 2/16/2016 08 00 Matrix Waste Water Sample ID 011600813 0001 Date Received 2/19/2016 08 43 Parameters Results Flag Units RDL Method Prepared By Analyzed By Cntr -71 WET CHEMISTRY Oil/Grease Hexane ND mg/L 22 EPA 1664E 2/28116 10 00 AT A Extractable Mr Brad W Kintzer Project Coordinator ALS Environmental Laboratory Locations Across North America Canada Burlington Calgary Centre of Excellence Edmonton Fort McMurray FortSt. John Grande Prairie London Mississauga Rkhmond Hlil Saskatoon Thunder Bay Vancouver Waterloo Winnipeg Yellowknife United States Gncinnatl Everett Fort Collins Holland Houston Middletown Salt Lake City Spring City York Mexico Monterrey Report ID 2125249 2/29/2016 Page 6 of 12 Page 3 of 9 Y I AL -S Enulronmental 34 Dogwood Lane ■ Middletown PA 17057 ■ Phone- 717 944 5541 ■ Fax 717 944 1430 ■ www alsglobal cam NE LAP Certifications NJ PAO10 NY 11759 PA 22 293 DoD E LAP A2LA 0818 01 State Certifications DE ID 11 MAPA0102 MD 128 VA4601S7 WV343 ANALYTICAL RESULTS Workorder 2125249 011600813 Lab ID 2125249002 Date Collected 2/16/2016 08 00 Matrix Waste Water Sample ID 011600813 0002 Date Received 2/19/2016 08 43 Parameters Results Flag Units RDL Method Prepared By Analyzed By Cntr WET CHEMISTRY Oil/Grease Hexane ND mglL 2 3 EPA 1664B Extractable 2128116 10 00 AT A Mr Brad W Kintzer Project Coordinator ALS Environmental Laboratory Locations Across North America Canada Burlington Calgary Centre of Excellence Edmonton FortMcMurray FartSt John Grande Prairie London Mississauga Richmond Hill Saskatoon Thunder Bay Vancouver waterloo Winnipeg Yellowknife United States Cincinnati Everett FortCollins Holland Houston Middletown Salt take City Spring City York Mexico. Monterrey Report I❑ 2125249 2/29/2016 Page 7 of 12 Page 4 of 9 3 AALSEnufronmental 34 Dogwood Lane ■ Middletown, PA`17057 ■ Phone 717 944 5541 ■ fax. 717 944 1430 a www alsglobal cam NE LAP Cernficatlons NJ PA010 NY 11759 PA 22 293 DoD E LAP A2LA 0818 01 Slate Ceraficatlons DE ID 11 MAPA0102 MD 128 VA460157 WV 343 ANALYTICAL RESULTS Workorder 2125249 011600813 Lab ID 2125249003 Date Collected 2/1612016 08 00 Matrix Waste Water Sample ID 011600813 0003 Date Received 2/19/2016 08 43 Parameters Results Flag Units RDL Method Prepared By Analyzed By Cntr WET CHEMISTRY Oil/Grease Hexane ND mglL 2 2 EPA 16646 2/28/16 10 00 AT A Extractable Mr Brad W Kintzer Project Coordinator ALS Environmental Laboratory Locations Across North America Canada Burlington Calgary Centre of Excellence Edmonton Fort McMurray fort St John Grande Prairie London Mississauga Richmond HIII Saskatoon Thunder Bay Vancouver Waterloo Winnipeg Yellowknife United States Cincinnati Everett Fort Collins Holland Houston Middletown Salt lake City Spring City York Mexico Monterrey Report ID 2125249 2/29/2016 Page 8 of 12 Page 5 of 9 A,ALS Enulronmental 34 Dogwood Lane a Middletown, PA'17057 o Phone 717 944 5541 a Fax 717 944 1430 it www alsglobal corn NE LAP Certifications NJ PAO10 NY 11759 PA22 293 DoD FLAP A2LA081801 State Certifications DE ID 11 MAPA0102 MD 128 VA460157 WV 343 ANALYTICAL RESULTS Workorder 2125249 011600813 Lab ID 2125249004 Date Collected 2/16/2016 08 00 Matrix Waste Water Sample ID 011600813 0004 Date Received 2/1912016 08 43 Parameters Results Flag Units RDL Method Prepared By Analyzed By Cnfr WET CHEMISTRY OillGrease Hexane ND mg1L 2 1 EPA 1664E Extractable 2/28116 10 00 AT A Mr Brad W Kintzer Project Coordinator ALS Environmental Laboratory Locations Across North America Canada Burlington Calgary Centre of Excellence Edmonton Fort McMurray Fort St John Crande Prairie London Mississauga Richmond Hill Saskatoon Thunder bay Vancouver waterloo Winnipeg Yellowknife United States Cincinnati Everett Fort Collins Holland Houston Middletown Salt Lake City Spring C1ty York Mexico, Monterrey Report ID 2125249 2/29/2016 Page 9 of 12 Page 6 of 9 AALSEnuironmental 34 Dogwood Lane in Middletown PA'17057 a Phone- 717 944 5541 ■ Fax 717 944 1430 a www aisgiobal tom r � r NE LAP Certifications NJ PA010 NY 11759 PA 22 293 DoD ELAP A21LA 0818 01 5tateCernficarions DE ID it MAPA0102 MD 128 VA460157 WV 343 QUALITY CONTROL DATA Workorder 2125249 011600813 QC Batch WETC1106600 Analysis Method EPA 1664B QC Batch Method EPA 1664E Associated Lab Samples 2125249001 2125249002 2125249003 2125249004 METHOD BLANK 2303221 Blank Reporting Parameter Result Units Limit Qualifiers OiilGrease Hexane ND mglL 2 0 Extractable LABORATORY CONTROL SAMPLE 2303222 Spike LCS LCS % % Rec Parameter Conc Units Result Rec Limit Qualifiers OillGrease Hexane 40 mglL 380 95 78 114 Extractable uiuLirease Hexane mg/L. 4U f 393 95 5 78 114 Extractable ALS Environmental Laboratory Locations Across North America Canada Burlington Calgary Centre of Excellence Edmonton FortMcMurray Fort5t. John Grande Prairie London Mississauga Richmond Hill Saskatoon Thunder Bay Vancouver waterloo Winnipeg Yellowknife United States Cincinnati Everett Fort Collins Holland Houston Middletown Salt Lake City Spring Ury York Mexico. Monterrey Report ID 2125249 2/29/2016 Page 10 of 12 Page 7 of 9 AALSEnulr©nmental 34 Dogwood Lane ■ Middletown, PA 17057 ■ Phone. 717 944 5541 ■ Fax 717 944 1430 ■ www alsglobal corn NE LAP Certifications NJ PA010 NY 11759 PA 22 293 DoD E LAP A2LA 0818 01 S tate Certificanons DE ID 11 MAPA0102 MD 128 VA460157 WV 343 QUALITY CONTROL DATA CROSS REFERENCE TABLE Workorder 2125249 011600813 Analysis Lab ID Sample ID Prep Method Prep Batch Analysts Method Batch 2125249001 011600813 0001 EPA1664B WETC1166600 2125249002 011600813 0002 EPA1664B WETC1166600 2125249003 011600813 0003 EPA 1664B WETCl166600 2125249004 011600813 0004 EPA1664B WETC1166600 ALS Environmental Laboratory Locations Across North America Canada. Burlington Calgary Centre of Excellence Edmonton Fort McMurray FortSt. John Grande Prairie London Mississauga Richmond Hill Saskatoon Thunder Bay Vancouver Waterloo Winnipeg Yellowknife United States Cincinnati Everett FortCollins Holland Houston Middletown Sail lake City Spring City York Mexico Monterrey Report ID 2125249 2/29/2016 Page 11 of 12 Page 8 of 9 D r m EMSL AnalyttcaL Inc. Environmental Chemistry Lab Service 2W Route 134 Korth, Cirin miason, NJ 08M TEL (856) M 4St14 FAX (8%) 786-5974 REPORT RESULTS TO Name Debbie Kreider PO# Chain of Custody / Analysis Request Form Pnnt ALL Information. -Incomplete chain of custody could result in the delay of analysis. SEND INVOICE TO: EMSL Proles Account Rep Indicate State v j * z 1 2 5 2 4 9 Company Company Turnaround Time - 10 Business Days EMSL Ana cal, Inc EMSL Anal cal, Inc. Address 200 Route 130 North Address 200 Route 130 North Analytical Laboratory Services City- Cinnaminson City Cinnaminson 34 Dogwood Lane Middletown, PA 17057 717-944-5541 State NJ Zip 08077 State NJ Zip 08077 PROJECT NAME Tel 556-858-4800 ext 2548 Fax 8564544M2 Tel 85&858-4800 Fax &%454-2362 Email' dkreider@etnsl cam Date of Sample Shipment 2/18/16 # of Samples in Shipment _4 (2 bottles per) Sampled by (Signature) Matrix I Preservative Sampling I Last Method and Test Needed Lab ' s r s x � O t7 � M '3 P� o ob �] b � a o ., Sample r`• � Q 05 *4 � kt � � � � � � 3 ri Number Client Sample Comp Crab ry 09.1 ii iiIl■■■■■■■■��■ .. .Temp ��7[r■■■■■■■��■ -Cooler. ..,CCCtLb1sCa Released By Date l4 Tmie Signature Reteased i1elrrery i►lethed Received By Signature Agency Date & Time Received 2/18/16 FedE]i ,QL Ig !v Correct containers? Sh! Garner Correct Samp Vol? Correct Preset aton? CdE UP` HeadspacelVolaWs? 0 Tracking#oXeW ere r.� O Please indicate reporting regairementa i Resatts Onty ®2 1umlrs and QC JJ3 Redacted Deliverables U4 Disk Dehverabte CIS Other Comments Energy Mineral and Land Resources ENVIRONMENTAL QUALITY 1 ebruary 02, 2016 Kent Hebert PALADIN Custom Works 230 Perry Road Kernersville, NC 27284 Subject Compliance Evaluation (hiotice of Deficiency) Permit No NCG 030638 Paladin Custom Works Forsyth County Dear Mr Hebert PA I MCCRORY Govemor DONALD R VAN DER VAART Secretary 1RACY DAVIS On January 26, 2016 Glen White of the North Carolina Department of Environmental Quality, Department of Energy, Minerals and Land Resources met with you at the subjc ct facility located at 230 Perry Road, Kernersville, NC to conduct a compliance inspection for the facilities Industrial Stormwater Permit This is the initial inspection for the facility Inspection consist of review of the Stormwater Pollution Prevention Plan, training and monitoring records and observation of the general condition of the site and outfall Your cooperation and assistance with the inspection were greatly appreciated Permit 1 his facility holds General Stormwater Permit NCG030638 to discharge stormwater from industrial activity associated with Metal Fabrication under the National Pollutant Discharge Elimination System (NPDES) Fhe permit became effective November 1, 2012 and expires on October 31, 2017 It was initially issued to this facility on September 27, 2013 A copy of the current permit is required to be maintained with the Stormwater Pollution Prevention Plan (SPPP) documents A copy of the current permit was available for review at the time of inspection Records/Reports This facility was required to develop and maintain a Stormwater Pollution Prevention Plan (SPPP) in accordance with Part 11, Section A of the permit the SPPP was well prepared, up to date and available for review at the time of inspection It included copies of blank forms to be filled out bi-annually for qualitative and analytical monitoring It included a signature sheet for annual training No documentation showing annual training or monitoring has been documented Facility Site Review 1 he facility assembles construction equipment attachments for Deere -Hitachi Machinery, the neighboring facility 1 he site itself was clean and appears to be well managed State of North Carolina I Environmental Quality I Fnergy Mmeral and Lind Resources 450 Hanes Mill Road — Suite 300 Winston Salem NC 27105 (336)776 9800 r Effluent Receiving Waters Stormwater from industrial activities at this fact]ity are discharged into receiving waters designated as Belows Creek, a class WS-IV, CA waters of the Roanoke River Basin via the one discharge point located at the fence line on the rear along the property line Self -Monitoring Program The facility is required to perform qualitative and analytical monitoring twice annually per requirements of the permit Inspection revealed that no monitoring has been performed to date Please begin conducting both qualitative and analytical monitoring at the next rainfall event and forward a copy of results of the analytical testing to this office via either US mail or by email at glen white c�r,nedenr gov so that results may be reviewed and included in your file Continue monitoring twice annually unless permit requirements change Failure to maintain your permit may result in a future Notice of Violation which may incude fines and fees up to $25,000 This report is being sent as a Notice of Deficiency which affords you the opportunity to become compliant before a future inspection is conducted to verify compliance Please include a copy of this report in your SPPP records Again, thank you for your time and assistance with inspection I£ you have questions or need additional information, please contact Glen White at (336) 776-9660 or at the above email Enclosures Inspection Report Sincerely, Matthew E Gantt, P E Regional Engineer Land Quality Section Winston-Salem Regional Office cc WSRO File Copy Division of Energy, Mineral and Land Resources (WSRO) Compliance Inspection Report Permit NCG030638 Effective 09/27/13 Expiration 10/31117 Owner Jrb Custom Works SOC Effective Expiration Facility JRB Custom Works dba Paladin Custom Works County Forsyth 230 Perry Rd Region Winston Salem Kemerswtle NC 27284 Contact Person Kent Hebert Title Phone 336 996 2796 Directions to Facility Bus 140 w from greensboro exit to nc hwy 66 n bear nw onto east min st for 2 mi then it on perry rd about 3 mi System Classifications Primary ORC Certification Phone Secondary ORC(s) On Site Representative(s) Related Permits Inspection Date 01/26/2016 Entry Time 10 15AM Primary Inspector Glen White Secondary Inspector(s) Exit Time 10 45AM Reason for Inspection Routine Inspection Type Permit Inspection Type Metal Fabrication Stormwater Discharge COC Facility Status ❑ Compliant Not Compliant Question Areas M Storm Water (See attachment summary) Phone 336 7769800 Compliance Evaluation Page 1 Permit NCG030638 Owner Facility JrbCustom Works Inspection Date 0112612016 Inspection Type Compliance Evaluation Reason for Visit Routine Inspection Summary (See Inspection Report) Page 2 Permit NCG030633 Owner Facility Jib Custom WorKs Inspection Date 01/2612016 Inspection Type Compliance Evaluation Reason for Vint Routine Stormwater Pollution Prevention Plan Yes Na NA NE Does the site have a Stormwater Pollution Prevention Plan? ❑ ❑ ❑ # Does the Plan include a General Location (USGS) map? r ❑ ❑ ❑ # Does the Plan include a Narrative Description of Practices ? r ❑ ❑ ❑ # Does the Plan include a detailed site map including outfall locations and drainage areas? r ❑ ❑ ❑ # Does the Plan include a list of significant spills occurring during the past 3 years? ❑ ❑ r ❑ # Has the facility evaluated feasible alternatives to current practices? r ❑ ❑ ❑ # Does the facility provide all necessary secondary containment? ❑ ❑ ❑ # Does the Plan include a 8MP summary? ❑ ❑ ❑ # Does the Plan include a Spill Prevention and Response Plan (SPRP)? ❑ ❑ ❑ # Does the Plan include a Preventative Maintenance and Good Housekeeping Plan? r ❑ ❑ ❑ # Does the facility provide and document Employee Training? ❑ N ❑ ❑ # Does the Plan include a list of Responsible Party($)? r ❑ ❑ ❑ # Is the Plan reviewed and updated annually? ❑ r ❑ ❑ # Does the Plan include a Stormwater FacII=ty Inspection Program? ❑ ❑ ❑ Has the Stormwater Pollution Prevention Plan been implemented? ❑ ❑ ❑ Comment " SPPP complete and well prepared Current with exception to documentation of annual trainin " Add a sheet to the SPPP for annual review sion off & documentino changes or no chance to werating_proced_ures_ Update needs to be done annually Just requires dowmenting whether or not there were changes and what was changed This can be accomplished in-house Qualitative Monitorincl Yes No NA NE Has the facility conducted its Qualitative Monitoring semi annually? ❑ r ❑ ❑ Comment Provide qualitative monitorii twice per yr as required for permit compliance The SPPP has several blank copies Kee all monitoring records with the SPPP for a minimum of 5 years Analytical _Monitorincf Yes No NA NE Has the facility conducted its Analytical monitoring? ❑ r ❑ ❑ # Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas? ❑ ❑ ❑ Comment Analytical mondonna must be provided twice tier vear for comoliance Required testin parameters is listed on Part II Section B of your General Permit Submit results to this office at Glen White's attention for review and file record _Results may be emalled to glen white(ancdenr gov or mailed to the address in the footer of the attached compliance letter Permit and Outfalls Yes No NA NE # Is a copy of the Permd and the Certificate of Coverage available at the site? M ❑ 1111 # Were all outfalls observed during the inspection? r ❑ 1111 # If the facility has representative oulfall status is it properly documented by the Division? ❑ ❑ 0 ❑ Page 3 permit NCG030638 Owner Facility Jrb Custom Works Inspection Date 01/26/2016 Inspection Type Compliance Evaluation Reason for Visit Routine # Has the facility evaluated all illicit (non stormwater) discharges? ❑ ❑ ■ ❑ Comment This facility has one outf_all located along the rear fenceline as indicated on the siteplan included with the SPPP Page 4 W 1nK0 rt>A IS4 66H f C7 ' A`i?A Elonaloffice PRe NCDENR North Carolina Department of Environment and Natural Resources Division of Energy, Mineral, and Land Resources Land Quality Section Tracy E Davis, PE, CPM Director September 27, 2013 Mr Kent Hebert JRB Custom Works 230 ferry Rd Kernersville, NC 27284 Pat McCrory, Governor John E Skvarla, III, Secretary Subject General Permit No NCG030000 JRB Custom Works dba Paladin Custom Works COC NCG030638 Forsyth County Dear Mr Hebert In accordance with your application for a discharge permit received on August 14, 2013, we are forwarding herewith the subject certificate of coverage to discharge under the subject state - NPDES general permit This permit is issued pursuant to the requirements of North Carolina General Statute 143-215 land the Memorandum of Agreement between North Carolina and the US Environmental Protection Agency dated October 15, 2007 (or as subsequently amended) Please take notice that this certificate of coverage is not transferable except after notice to the Division of Energy, Mineral, and Land Resources (DEMLR) If the facility changes ownership or is closed, the Division may require modification, revocation, or reissuance of the certificate of coverage This permit does not affect the legal requirements to obtain other permits which may be required by DEM LR, federal, state, or local governmental authorities 1612 Mail Service Center, Raleigh, North Carolina 27699-1612 • Telephone 919 707 9220 I FAX 919 733 2876 512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet http //portal ncdenr orglwebhr/land quality An Equal Opportunity l Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES GENERAL PERMIT NO NCG030000 CERTIFICATE OF COVERAGE No NCG03063 STORMWATER DISCHARGES NATIONAL POLL11TANT DISCHARGE ELIMINATION SYSTEM In compliance with the provision of North Carolina General Statute 143-215 1, other lawful standards and regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution Control Act, as amended, JRB Custom Works is hereby authorized to discharge stormwater from a facility located at JRB Custom Works dba Paladin Custom Works 230 Perry Road Kernersville Forsythe County to receiving waters designated as Belews Creek, a class WS-IV,CA water in the Roanoke River Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, [1,111, IV, V, and VI of General Permit No NCG030000 as attached This certificate of coverage shall become effective September 27, 2013 This Certificate of Coverage shall remain in effect for the duration of the General Permit Signed this day September 27, 2013 X�� P-"-, for Tracy E Davis, P E, Director Division of Energy, Mineral, and Land Resources By the Authority of the Environmental Management Commission NCDENR North Carolina Department of Environment and Natural Resources Division of Energy, Mineral, and Land Resources Land Quality Section Tracy E Davis, PE, CPM Director September 27, 2013 Mr Kent Hebert JRR Custom Works 230 Perry Rd Kernersville, NC 27284 Pat McCrory, Governor John E Skvarla, III, Secretary Subject General Permit No NCG030000 JRB Custom Works dba Paladin Custom Works COC NCG030638 Forsyth County Dear Mr Hebert In accordance with your application for a discharge permit received on August 14, 2013, we are forwarding herewith the subject certificate of coverage to discharge under the subject state - NPDES general permit This permit is issued pursuant to the requirements of North Carolina General Statute 143-215 1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection Agency dated October 15, 2007 (or as subsequently amended) Please take notice that this certificate of coverage is not transferable except after notice to the Division of Energy, Mineral, and Land Resources (DEMLR) If the facility changes ownership or is closed, the Division may require modification, revocation, or reissuance of the certificate of coverage This permit does not affect the legal requirements to obtain other permits which may be required by DEMLR, federal , state, or local governmental authorities 1612 Mail Service Center, Raleigh, North Carolina 276991612 • Telephone 919 707 92201 FAX 919 733 2876 512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet http llportal ncdenr orglweb/lr/land duality An Equal Opportunity l Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES GENERAL PERMIT NO NCG030000 CERTIFICATE OF COVERAGFNo NCG030638 STORMWATER DISCHARGES NATIONAL POLL[JTANT DISCHARGE ELIMINATION SYSTEM In compliance with the provision of North Carolina General Statute 143-215 1, other lawful standards and regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution Control Act, as amended, JRB Custom Works is hereby authorized to discharge stormwater from a facility located at JRB Custom Works dba Paladin Custom Works 230 Perry Road Kernersville Forsythe County to receiving waters designated as Belews Creek, a class WS-IV,CA water in the Roanoke River Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, 11, III, IV, V, and VI of General Permit No NCG030000 as attached This certificate of coverage shall become effective September 27, 2013 This Certificate of Coverage shall remain in effect for the duration of the General Permit Signed this day September 27, 2013 for Tracy E Davis, P E, Director Division of Energy, Mineral, and Land Resources By the Authority of the Environmental Management Commission Taylor -Smith, Aana From Taylor -Smith, Aana Sent Tuesday, September 10, 2013 7 06 AM To Wade, Larry Subject NCG030638 - JRB Custom Works Hi Larry, Just wanted to let you know I went to JRB Custom Works yesterday and the facility is as described in the NO1/map My recommendation is to issue the COC Thanks) Aana Taylor -Smith Land Quality Section Division of Energy, Mineral, and Land Resources NC DENR Winston-Salem Regional Office Phone (336) 771-5034 Fax (336) 771-4631 E-mail correspondence to and from this address may be subject to the North Carolina Public Records Low and may, be disclosed to third parties Wade, Larry k From Taylor -Smith, Aana Sent Tuesday September 10, 2013 7 06 AM To Wade, Larry Subject NCG030638 - JRB Custom Works Hi Larry, Just wanted to let you know I went to JRB Custom Works yesterday and the facility is as described in the NOI/map My recommendation is to issue the COC Thanks Aana Taylor -Smith Land Quality Section Division of Energy, Mineral, and Land Resources NC DENR Winston-Salem Regional Office Phone (336) 771-5034 Fax (336) 771-4631 E-mail correspondence to rind from this address may be subject to the North Carolina Public Records Caw and may be disclosed to third parties Taylor -Smith, Aana From Taylor -Smith, Aana Sent Monday, September 09 2013 9 26 AM To Wade, Larry Subject RE NCG030638 JRB Custom Works Hi Larry, I will go by 1RB this afternoon and let you know whether everything is as described Thanksi Aana Taylor Smith Land Quality Section Division of Energy, Mineral, and Land Resources NC DENR Winston-Salem Regional Office Phone (336) 771-5034 Fax (336) 771-4631 E mail correspondence to and from this address may be subject to the North Carolina Public Records Caw and may be disclosed to third parties From White, Sue Sent Monday, September 09, 2013 7 53 AM To Wade, Larry Cc Taylor -Smith, Aana Subject RE NCG030638 JRB Custom Works Hi Larry Aana Taylor Smith will be reviewing this NOI She reviews the NCG03's Since it's lust the two of us, feel free to send anything industrial storm water related to either of us and we'll get it to the right person Thanksi Sue Sue White Assistant Regional Engineer Land Quality Section Winston-Salem Regional Office Division of Energy, Mineral, and Land Resources Phone (336) 771-5033 Fax (336) 771-4631 1 E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties From Wade, Larry Sent Friday, September 06, 2013 11 35 AM To White, Sue Subject NCG0306381R6 Custom Works Sue, Please find attached the NOI for the subject project for your review Please let us know if the Regional Office has any concerns with issuing the COC for this NCG030000 permit Larry W Wade PE Telephone (919) 807-6375 Fax (919) 807-6494 Stormwater Permitting Program North Carolina Department of Environment & Natural Resources Division of Energy Mineral and Land Resources 1612 Mail Service Physical Address - 512 N Salisbury St Room 9425 Raleigh, NC 27699-1612 Raleigh, NC 27604 is a government E-mail *********E-mails sent and received from this address can be disclosed to third parties************ 2 Division of Water Quality 1 Surface Water Protection Section NCDENRNational Pollutant Discharge Elimination System Np G.Ra oexwwx�a FJ'RwmM MD NK R',C+ NCG030000 NOTICE OF INTENT FOR AGENCY USE ONLY Dale Roccw:d Year Manth 11 Da Ceru$eate of Coverx a Check N 1 Amount Ptmut Assn td to National Pollutant Discharge Elimination System application for coverage under General Permit NCG030000 STORMWATER DISCHARGES associated with activities classified as SIC (Standard Industrial Classification) 335 Rolling, Drawing, and Extrudin Nonferrous Metals SIC 3398 Metal Heat Treating {' SIC 34 Fabricated Metal Products SIC 35 Industrial and Commercial Machinery f SIC 36 Electronic and Other Electrical Equipment` SIC 37 Transportation Equipment SIC 38 Measuring, Analyzing, and Controlling Instruments d� ttr�hrF HLJ 1 _ SiC�frtvrae,�C31� *,J,F— For questions, please contact the DWO Regional Office for your area See page 4 (Please print or type) 1) Malling address of owner/operator (Address to which all permit correspondence will be mailed) Name JRB Custom Works Street Address 230 Perry Road City Kernersville State NC ZIP Code 27284 Telephone No 336-996-2796 Fax 336 996-6790 2) Location of facility producing discharge Facility Name JRB Custom Works dba Paladin Custom Works FaciHty Contact Kent Hebert Street Address 230 Perry Road City Kernersville State NC ZIP Code 27284 County Forsyth Telephone No 336-996-2796 Fax 336 996-6790 Email KHebert@PaiadinAttachments corn 3) Physical Location Information Please provide a narrative description of how to get to the facility (use street names, state road numbers, and distance and direction from a roadway intersection) Business I-40 West from Greensboro, exit to NC Hwy 66 north Bear northwest onto East Mountain Street for 2 miles, then right (north) on Perry Road about 0 3 miles —OR- Business 1-40 East from Winston-Salem, exit 10 onto Linville Street, then right (east) onto West Mountain Road Continue 4 5 miles, then (left) north on Perry Road about 0 3 miles (A copy of a county map or USGS quad sheet with the faculty clearly located must be submitted with this application } 4) Latitude 36 136 (36 deg OB min 17 sec) Longitude -80 09398 (-80 deg 05 min 36 sac) (deg, min, sec) Page 1 of 4 5WU 218 071408 Last revised 7114/08 NCG030000 N O 1 5) This NPDES Permit Application applies to which of the following ❑ New or Proposed Facility Date operation is to begin ® Existing 6) Standard Industrial Classification Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial activity at this facility SIC Code 3531 NAICS Code 33312 Construction Machinery Manufacturing 7) Provide a brief narrative description of the types of Industrial activities and products manufactured at this facility JRB Custom Works Installs components manufactured at other Paladin locations (couplers, buckets, thumbs, etc ) onto Deere/Hitachi-manufactured construction equipment such as excavators and other earth -moving machines Processes Include some welding, touch-up painting, and set-up of hydraulic controls 8) Discharge points / Receiving waters How many discharge points (ditches, pipes, channels, etc) convey stormwater from the property? 3 + 1 What Is the name of the body or bodies of water (creek, stream, river, lake, etc ) that the facility stormwater discharges and up in? Three inlets to the municipal storm sewer and one outfall to an unnamed Intermittent stream to Kernersville Lake (Belews Creek) Receiving water classification Kernersville Lake = WS IV, CA, Belews Creek WS IV, CA Is this a 303(d) listed stream? _Yes Has a TMDL been approved for this watershed? NIA If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm sewer system (e g City of Raleigh municipal storm sewer) Town of Kernersville 9) Does this facility have any other NPDES permits? ® No ❑ Yes If yes, list the permit numbers for all current NPDES permits for this facility 10) Does this facility have any Non -Discharge permits (ex recycle permit)? ® No ❑ Yes If yes, list the permit numbers for all current Non -Discharge permits for this facility 11) Does this facility employ any best management practices for stormwater control? ❑ No ® Yes (Show any structural BMPs on the site diagram ) It yes, please briefly describe Only non-structural BMPs are undertaken at this site 12) Does this facility have a Stormwater Pollution Prevention Plan? ❑ No ® Yes If yes, when was it implemented? 30 July 2013 13) Are vehicle maintenance activities occurring at this facility? ❑ No ® Yes 14) Hazardous Waste Page 2 of 4 SWU 218 071408 Last revised 7114/08 NCG030000 N O 1 a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ®No El Yes b) Is this facility a Small Quantity Generator (less than 1000 kg of hazardous waste generated per month) of hazardous waste? ❑ No ® Conditionally Exempt SQG Yes c) Is this facility a Large Quantity Generator (1000 kg or more of hazardous waste generated per month) of hazardous waste? ® No ❑ Yes d) Is hazardous waste stored In the 100 year flood plain9 ® No ❑ Yes it yes, include information to demonstrate protection from fioodmg e) If you answered yes to questions b or c , please provide the following Information Type(s) of waste Waste paint related material D001, F003, F005 How is material stored 55-gallon drums Where is material stored inside building, near paint booth How many disposal shipments per year 1-2 shipment per year Name o1 transport / disposal vendor Heritage —Crystal Clean Vendor address 2115 Dunavent Charlotte, NC 28203 15) Certlflcatlon North Carolina General Statute 143-215 6B (1) provides that Any person who knowingly makes any false statement representation, or ceriifloatlon In any applicatton, record report plan, or other document filed or required to be maintained under this Article or a ruls Implementing this Article or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Articla, or who falsifies, tampers with or knowingly renders Inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may Include a, fine not to exceed ten thousand dollars ($10 000) I hereby request coverage under the referenced General Permit I understand that coverage under this permit will constitute the permit requirements for the discharges) and is enforceable in the same manner as an individual permit I certify that I am familiar with the Information contained in this application and that to the best of my knowledge and belief such information is true, complete, and accurate Printed Name of Person Signing �eYt_ Pahelt Title _r�7- 9-- 2 a 13 (Signature of Applicant) (Date Signed) This Notice of Intent must be accompanied by a check or money order for $100 00, nrtade payable to NC©ENR Page 3 of 4 SWU 218 071408 Last revised 7/14108 NCG030000 N 0 1 Final Checklist This application will be returned as Incomplete unless all of the following Items have been Included ® Check for $100 made payable to NCDENR ® This completed application and all supporting documents ® A site diagram showing, at a minimum, (existing or proposed) (a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalis corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored, (f) Impervious areas, (g) site property lines ® Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map Mail the entire package to Stormwater Permitting Unit Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 kVo e The submission of this document does not guarantee coverage under the General Permit For questions, please contact the DWQ Regional Office for your area DWO Regional Office Contact Information Asheville Office (828) 296-4500 Fayetteville Office (910) 433-3300 Mooresville Office (704) 663-1699 Raleigh Office (919) 791-4200 Washington Office (252) 946-6481 Wilmington Office (910) 796-7215 Winston Salem (336) 771-5000 Central Office (919) 807 6300 Page 4 of 4 SWU 218 071408 Last revised 7/14108 Sanitary sewer pump statlon Site is paved with asphalt ♦ NORTH AN it Storm Water Outfaii No 1 Diesel tank Surfa a Run ff l,� Truck loadinglunloading ramp 0 ')a �< Storm Drain Inlet Equipm nt Wash area Parking`•,, � , i .IRB Custom \✓l 70 Works building Storm Drain JRB Custom Works Site Layout j, ,y Deere -Hitachi i parts & - equipment Figure 1 Slte Location and Topography JRB Custom Works Kerneravllle, NC (CENT L HEBERT AJ2 �JCJLJ �J 7565 4(33 FAIRVIEW RD {9t9J 34� BB IA/5�DNC APEX NC 27602 11 58151 i n', C -------- Is 106) A ' -joYle,--tom' - - �c n �I D I.i Bank of America ACH Rft 06300D1M PeejJ— eMS300Qi961: ❑00693306496n'?565 Division of Water Quality 1 Surface Water A e • Protection Section NCDENRNational Pollutant Discharge Elimination System too CwRouNA D�e- or EMVIRW.H[M �P NN RA RE50 iACE$ NCG030000 NOTICE OF INTENT FOR AGENCY USE ONLY Date Received Year Month Da Lcm&cafe orCovera NCGO Check # IAmount ermtt Ass; ed to National Pollutant Discharge Elimination System application for coverage under General Permit NCG030000 STORMWATER DISCHARGES associated with activities classified as SIC (Standard Industrial Classification) 335 Rolling, Drawing, and Extrudin " f Nonferrous Metals SIC 3398 Metal Heat Treating D �' t _ �3 SIC 34 Fabricated Metal Products- -4�f SIC 35 industrial and Commercial Machinery , SIC 36 Electronic and Other Electrical Equipment SIC 37 Transportation Equipment�� f SIC 38 Measuring, Analyzing, and Controlling Instruments t_i�t,and®® -5 W,h For question, please contact the DING Regional Office for your area See page 4 (Please print or type) 1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed) Name JRB Custom Works Street Address 230 Perry Road City Kernersville State NC ZIP Code 27284 Telephone No 336-996-2796 Fax 336-996 6790 2) Location of facility producing discharge Facility Name JRB Custom Works dba Paladin Custom Works Facility Contact Kent Hebert Street Address 230 Perry Road City Kernersville State NC ZIP Code 27284 County Forsyth Telephone No 336-996 2796 Fax 336-996-6790 Email KHebert®PaladinAttaehments com 3) Physical Location Information Please provide a narrattive description of how to get to the facility (use street names, state road numbers, and distance and direction from a roadway intersection) Business 1-40 West from Greensboro, exit to NC Hwy 66 north Bear northwest onto East Mountain Street for 2 miles, then right (north) on Perry Road about 0 3 miles -OR- Business 1-40 East from Winston-Salem, exit 10 onto Linville Street, then right (east) onto West Mountain Road Continue 4 5 miles, then (left) north on Perry Road about 0 3 miles (A copy of a county map or USGS quad sheet with the facility clearly located must be submitted with this application) 4) Latitude 36 138 (36 deg 08 min 17 sec) Longitude -80 09398 (-80 deg 05 min 38 sec) (deg, min, sec) Page 1 of 4 SWU 218 071408 Last revised 7/14/08 NCG030000 N O 1 5) This NPDES Permit Application applies to which of the following ❑ New or Proposed Facility Date operation is to begin ® Existing 6) Standard Industrial Classification Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial activity at this facility SIC Code 3531 NAILS Code 33312 Construction Machinery Manufacturing 7) Provide a brief narrative description of the types of industrial activities and products manufactured at this facility JRB Custom Works installs components manufactured at other Paladin locations (couplers, buckets, thumbs, etc ) onto Deere/Hitachi-manufactured construction equipment such as excavators and Other earth -moving machines Processes include some welding, touch-up painting, and set-up of hydraulic controls 8) Discharge points / Receiving waters How many discharge points (ditches, pipes, channels, etc) convey stormwater from the property? 3 + 1 What is the name of the body or bodies of water (creek, stream, river, lake, etc ) that the facility stormwater discharges end up in? Three inlets to the municipal storm sewer and one outfall to an unnamed intermittent stream to Kernersville Lake (Belews Creek) Receiving water classification Kernersville Lake = WS-IV, CA, Belews Creek WS-IV, CA Is this a 303(d) listed stream? _Yes Has a TMDL been approved for this watershed? NIA If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm sewer system (e g City of Raleigh municipal storm sewer) Town of Kernersville 9) Does this facility have any other NPDES permits? ® No ❑ Yes It yes, list the permit numbers for all current NPDES permits for this facility 10) Does this facility have any Non -Discharge permits (ex recycle permit)? ® No ❑ Yes If yes, list the permit numbers for all current Non -Discharge permits for this facility 11) Does this facility employ any best management practices for stormwater control? ❑ No ® Yes (Show any structural BMPs on the site diagram } If yes, please briefly describe Only non-structural BMPs are undertaken at this site 12) Does this facility have a Stormwater Pollution Prevention Plan? ❑ No ® Yes If yes, when was a implemented? 30 July 2013 13) Are vehicle maintenance activities occurring at this facility? ❑ No ® Yes 14) Hazardous Waste Page 2 of 4 SWU 218 071408 Last revised 7/14/08 NCG030000 N O 1 a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ® No ❑ Yes b) Is this facility a Small Quantity Generator (less than 1000 kg of hazardous waste generated per month) of hazardous waste ❑ No ® Conditionally Exempt SQG Yes c) Is this facility a Large Quantity Generator (1000 kg or more of hazardous waste generated per month) of hazardous waste? ® No ❑ Yes d) Is hazardous waste stored in the 100-year flood plain? ® No ❑ Yes If yes, include information to demonstrate protectlon from flooding e) If you answered yes to questions b or c , please provide the following information Tvpe(s) of waste Waste paint related material D001, F003, F005 How is material stored 55-gailon drums Where is material stored Inside building, near paint booth How many disposal shipments per year 1-2 shipment per year Name of transport / disposal vendor Heritage -- Crystal Clean Vendor address 2115 Dunavent Charlotte, NC 28203 15) Certification North Carolina General Statute 143-215 68 (1) provides that Any person who knowingly makes any false statement representatran or certification in any application record report plan, or other document fi ed or required to be maintained under this Article or a rule implementing this Article or who knowingly makes a false statement of a material fact in a rulemak#ng proceeding or contested case under this Article or who falsifies tampers with or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10 000) I hereby request coverage under the referenced General Permit I understand that coverage under this permit will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an Individual permlt I certify that I am familiar with the Information contained in this application and that to the best of my knowledge and belief such information is true, complete, and accurate Printed Name of Person Signing ein 1� Pchelt Title �11441-ze'��' �013 (Signature of Applicant) (Date Signed) This Notice of Intent must be accompanied by a check or money order for $100 00, made payable to NCDENR Page 3 of 4 5WU 218 071408 Last revised 7/14108 NCG030000 N O 1 Final Checklist This application will be returned as Incomplete unless all of the following items have been included ® Check for $100 made payable to NGDENR ® This completed application and all supporting documents ® A site diagram showing, at a minimum, (existing or proposed) (a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outtalls corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored, (0 impervious areas, (g) site property lines ® Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map Mail the entire package to Stormwater Permitting Unit Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Note The submission of this document does not guarantee coverage under the General Permit For questions, please contact the DWO Regional Office for your area DWQ Regional Office Contact Information Asheville Office (828) 296-4500 Fayetteville Office (910) 433-3300 Mooresville Office (704) 663-1699 Raleigh Office (919) 791-4200 Washington Office (252) 946-6481 Wilmington Office (910) 796 7215 Winston-Salem (336) 771-5000 Central Office (919) 807-6300 Page 4 of 4 SVVU 218 071408 East revised 7/14/08 KENT L HEBERT AA� (J(�Aj WJU 7565 403 FAIRVIEW Rd (919) 303-M62 6619/530 HC APEX NC 27W2 58457 so.. A16-0 E AZ 9 IL ie, �, 4 w " &.,t J- ro G.� F I IY A w 0 B. A BankofAmedca -*I,. ACHRlr053WDi98 D 1:0 5 3000 19 6i: 000 6 9 3 30P.4 9 6iI' 7 5 6 5 Figure 1 Site Location and Topography JRB Custom Works Kernersrnlle, NC NORTH 0ro , QQo� ` *Storm Water Outfall No 1 Diesel tank Buda bb Run fP \ \. Truck loading/unloading ramp Storm Drain Inlet o l Q- Eguipm nt \ _ Wash area Parking JRB Custom Works building p� ` h Sanitary sewer pump station - ,.� Deere -Hitachi Echols Road - parks & equipment Storm Drain Into s� Site is paved with asphalt JRB Custom Works Site Layout Kernersville NC