NCG060357_COMPLETE FILE - HISTORICAL_20160810

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. I /V CG c(.oc)3lD7
DOC TYPE 1 9 HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ aol (n bg r o
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review of the`facility fileslrecbrds aJkljAh.bn°siti JMili j% inspection r ��� 1 •'
�Tric�mspechori was perftirmeii by McKerizie!Smithana the followingdef ciencies/,observations'
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iIt is rec orrimended that:'Mother Murphey-S, aboI Vries take appropriate actions'to°carrectIthe + ,r r'a3
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noted deficiencieself you have any6questions conceming,this inspection, please contact,me at;
336` 373" 7665 or McKenaie Smith@greensboro ric'gov : , r f , , -` ° 'yam} x r `
Sincerely,
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Peter Schneider �Watcr Quality Supervisor
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nc
r.
i ArA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Donald R. van der Vaart
February 4, 2015
Mr. Brian Whitlock
Ecolab Inc.
8300 Capital Drive
Greensboro, North Carolina 27409
Subject: General Permit No. NCG060000
Ecolab Inc.
COC No. NCG060358
Guilford County
Dear Mr. Leavitt:
Secretary
In accordance with your application for a discharge permit received on October 27, 2014, we
are forwarding herewith the subject certificate of coverage (COC) 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).
If any parts, measurement frequencies, or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual
permit application. Unless such demand is made, this certificate of coverage shall be final and binding.
Per the requirements of the Randleman Lake Water Supply Watershed Buffer Rule, ail
stormwater drainage to stream buffers, from portions of this site that have been constructed after
April 1, 1999, must be discharged through a correctly designed level spreader or another device that
meets diffuse flow requirements per 15A NCAC 213.0250. Diffuse flow requirements are described in
Chapter 8 of the North Carolina Stormwater BMP Manual, available at:
http://portal.ncdenr.org/web/Ir/bmp-manual.
Please take notice that this certificate of coverage is not transferable except after notice to the
Division of Energy, Mineral and Land Resources (Division). The Division may require modification or
revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by the Division or permits required by
the Division of Water Resources, Coastal Area Management Act or any other federal, state or local
governmental permit that may be required.
Division of Energy, Mineral, and Land Resources
Energy Section - Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 - 919-707-92001 FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: hftp:l/portal.nodenr.orglwebllrl
An Equal Opportunity VAffirmative Action Employer - 50% Recycled 110% Post Consumer Paper

I
If you have any questions concerning this permit, please contact Richard Riddle, Stormwater Engineer
at telephone number [phone].
Sincerely,
i
.(aw os�
for Tracy��Lvis, P.E., CPM, Director
Division of Energy, Mineral and
Land Resources
cc: Raleigh Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060358
STORMWATER DISCHARGES
NATIONAL POLLUTANT 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,
Brian Whitlock
is hereby authorized to discharge'stormwater from a facility located at
Ecolab Inc.
8300 Capital Drive
Greensboro
Guilford County
to receiving waters designated as an unnamed tributary to East Fork Deep River, a Class WS-IV:* waterbody to
Cape Fear Basin; in accordance with the effluent limitations, monitoring requirements, and other conditions set forth
in Parts 1, II, III, IV, V and VI of General Permit No. NCG060000, as attached.
This Certificate of Coverage shall become effective February 4, 2015.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day February 4, 2015.
for Tracy E.�BAvis, P.E., CPM, birector
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission

V of l

Division of Water Quality I Surface Water
• •
Protection Section
NCDENRl'
National Pollutant Discharge Elimination System
Np C—OLY OErurtM EM OF
EN`IMOMMEMT N+P N�Uw aL RESOURCES
NCG060000
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under
NCG060000:
STORMWATER DISCHARGES associated with activities classified as:
FOR AGENCY USE ONLY
Daic Received
Year
Month
Da
2a/
l0
2-
Certificate orCovcr
NIC100 6
Check # ou
Yennit Asst ;ed to
13 ti tA 4 VLi 4
eral Permit
I OCT 2 7 2014 i
UENR - WAXER RE5ouKUtZr
SIC (Standard Industrial Classification) 20 Food and Kindred Products 401 &BUFFER FERMI ITTiNG
SIC 21 Tobacco Products
SIC 283 Drugs
SIC 284 Soaps, Detergents, & Cleaning Preparations; Perfumes, Cosmetics, & Other Toilet Preparations
SIC 422 Public Warehousing and Storage (except 4226)
For questions, please contact the DWQ Regional Office for your area. See page 4.
Do Not use this NOI for renewals.
(Please print or type)
1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed):
Name Ecolab Inc.
Street Address 8300 Capital Drive
City Greensboro State NC ZIP Code 27409
Telephone No. 336-931-2200 Fax: [phone]
2) Location of facility producing discharge:
Facility Name
Facility Contact
Facility Address
Facility City
Facility County
Telephone No.
Email
Ecolab Inc.
Brian Whitlock
8300 Capital Drive
Greensboro State NC ZIP Code 27409
Guilford
336-931-2112 Fax: [phone]
W illiam. W hitlock(a)ecolab.com
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). Take exit 208 on 1-40, take a right onto Sandy Ridge
Road. take the 1st right onto Triad Drive. take the 1st left onto Little Santee Road, take 1st right onto Capital
Drive, then EcoLab will be the 1 st left
(A copy of a county map or USGS quad sheet with the facility clearly located must be submitted with this application.)
4) Latitude 36°05'55" N Longitude 79059'16" W (deg, min, sec) /
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility
® Existing
Date operation is to begin 0 — ZZ• — H
S W U-221
Page 1 of 4
Last revised 11/15/12

NCG060000 N.O.I.
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: 2841
7) Activities
a) Provide a brief narrative description of the types of industrial activities and products manufactured
at this facility: facility manufactures soaps, detergents, and hand sanitizers/cleaners, activities include
material storage and handling areas
b) Check all activities occurring at this facility: NIA
❑ use or process meats ❑ use or process animal fats/byproducts
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? SDO-001
drains stormwater related to industrial activities; one outfall drains a non -industrial area on the North side of
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? East Fork Deep River-, C A V 6 S= tAL S S 0 3 — 06 — D JD ; -Sht, 1,44dx
Receiving water classification: WS-IV
Is this a 303(d) listed stream? Yes Has a TMDL been approved for this watershed? Yes, TMDL for
Turbidity and Fecal Coliform (Fecal Coliform sampling applicable only to facilities discharging to freshwaters
that process meats)
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). City of Greensboro municipal storm sewer
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.)
If yes, please briefly describe: Wet Detention Basin (see diagram), some material loading areas that are
bermed and sloped to wastewater treatment system and do not discharge to stormwater outfall. seconda
containment for bulk liquid chemical storage containers located indoors
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
IS Yes
If yes, when was it implemented? August 2014
13) Are vehicle maintenance activities occurring at this facility?
Page 2of4
5WU-221 Last revised 11/15/12

NCG060000 N.O.I.
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
►:4 ► . ■
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
® No ❑ 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 protection from flooding.
e) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: High PH chlorinated products,, ink waste lab solvent and manufacturing scrap
How is material stored: 1 to 5 gallon, 13 gallon, or 55 gallon containers
Where is material stored: Satellite accumulation areas in the QA Lab, Micro Lab, and different packaging
lines within the facility; flammable storage room
How many disposal shipments per year: 4-6 shipments per year
Name of transport 1 disposal vendor: Zebra Environmental & Industrial Services I ABED Environmental
Services
Vendor address: Zebra. 901 E Springfield Rd. High Point, NC 27261 ^
ADD: 1741 Calks Ferry Road Lexington. SC 29073
15) Certification:
North Carolina General Statute 143-215.613 (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report,
plan, or other document filed 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 rulemaking 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).
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 permit.
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 oLPerson Signing: Kendall Smith
Title:
(Signature of Applicant) (date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
Page 3 of 4
SWU-221 Last revised 11/15/12

NCG060000 N.O.I.
NCDENR. Do not send the check or money order separately.
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. Must be included with this application (not sent separately).
® 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 outfalls
corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
loaded, and unloaded, (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
Note
The submission of this document does not guarantee coverage under the General Permit.
For questions, please contact the DWQ Regional Office for your area.
DWQ Re ional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ... [phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 4 of 4
SWU-221 Last revised 11/15/12

r,
i
v
. M6,-
:ZRR -

Dew -I? — WsQ o
aOju�_, --F0o1Lv-=
ALl
NCDENR
North Carolina Department of Environment and Natural
Pat McCrory
Governor
Mr. Charles Trout
Mother Murphy's Laboratories, Inc.
2826 South Elm -Eugene Street
Greensboro, NC 27406
Dear Mr, Trout:
September 18, 2014
Resources
John E. Skvarla, ill
Secretary
RECEIVED
N.C. Dept. of ENR
SEP 2 5 2014
Winston-salem
Reglonal office
Subject: General Permit No. NCG060000
Mother Murphy's Laboratories, Inc.
COC No. NCG060357
Guilford County
In accordance with your application for a discharge permit received on September 8,
2014, we are forwarding herewith the subject certificate of coverage (COC) 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 upon
approval of the Division of Energy, Mineral, and Land Resources. The Division of Energy,
Mineral, and Land Resources may require modification or revocation and reissuance of the
certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be
required by the Division of Energy, Mineral, and Land Resources, the Coastal Area
Management Act, or any other federal or local government permit that may be required.
Per the requirements of the Jordan Lake Nutrient Strategy Buffer Rule, all stormwater
drainage to stream buffers, from portions of this site that have been constructed after August 1 I ,
2009, must be discharged through a correctly designed level spreader or another device that
meets diffuse flow requirements per 15A NCAC 213.0267. Diffuse flow requirements are
described in Chapter 8 of the North Carolina Stormwater BMP Manual, available at:
httpa/portal.ncdenr.org/web/Ir/bmv-manual.
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 / FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http://portal.ncdenr.orglweb/Irl
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

If you have any questions concerning this permit, please contact Julie Ventaloro at telephone
number [phone] or by email 'ulie.ventaloro a ncdenr. ov.
Sincerely,
ORIGINAL SIGNED M
KEN PICKLE
if,n:;:ioVi for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Winston-Salem Regional Office, Aana Taylor -Smith
Central Files
Stormwater Permitting Program Files

Ventaloro, Julie
From: Taylor -Smith, Aana
Sent: Thursday, September 18, 2014 7:03 AM
To: Ventaloro, Julie
Cc: Gantt, Matt; White, Sue
Subject: RE: Review Request NCG060357 Mother Murphy's Labs
Julie,
I have been to Mother Murphy's several times and have no concerns over this NO I. They are good to go!
Thanks!
Aana Taylor -Smith
Land Quality Section
Division of Energy, Mineral, and Land Resources
NC DENR Winston-Salem Regional Office
Phone: [phone]
Fax [phone]
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: Gantt, Matt
Sent: Wednesday, September 17, 2014 4:58 PM
To: Taylor -Smith, Aana; White, Sue
Subject: FW: Review Request NCG060357 Mother Murphy's Labs
Matthew E. Gantt, P.E.
NC DENR Winston-Salem Regional Office
Division of Energy, Mineral, and Land Resources
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
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: Ventaloro, Julie
Sent: Wednesday, September 17, 2014 1:04 PM
To: Gantt, Matt
Subject: Review Request NCG060357 Mother Murphy's Labs

Matt,
We've received an NO1 for an existing facility in your region:
NCG060357— Mother Murphy's Laboratories Inc in Guilford County. This site discharges stormwater at two points to
South Buffalo Creek (Class WS-V;NSW). The NOI is attached. The receiving water is listed as impaired for aquatic life
and benthos.
Please let me know if the Winston-Salem Regional Office has any concerns about issuing this COC. Please also let me
know of any potential impacts to wetlands. If we don't receive any objections, we'll issue the COC in 30 days.
Thanks,
Julie Ventaloro
Storniwatcr Permitting Program
NC Division of Cnergy, Mineral. and I -and Resources
1612 Mail Service Center. Raleigh, NC 27699-1612
Phone: [phone] , lax: (gig) 807-6,19.1
Website: httpllw to ersuRplywatershed.nc.gov
E-mail corresponderice to and f tom this address moy he subject to tire North Curolina Public Records L.uw and may he discloser! 1n third
parties.

Taylor -Smith, Aana
From: Gantt, Matt
Sent: Wednesday, September 17, 2014 4:58 PM
To: Taylor -Smith, Aana; White, Sue
Subject: FW: Review Request NCG060357 Mother Murphy's Labs
Attachments: NCG060357 Mother Murphy's Labs_NOl.pdf
Matthew E. Gantt, P.E.
NC DENR Winston-Salem Regional Office
Division of Energy, Mineral, and Land Resources
585 Waughtown Street
Winston-Salem, NC 27107
Voice: [phone]
FAX: [phone]
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: Ventaloro, Julie
Sent: Wednesday, September 17, 2014 1:04 PM
To: Gantt, Matt
Subject: Review Request NCG060357 Mother Murphy's Labs
Matt,
We've received an N01 for an existing facility in your region:
NCG060357— Mother Murphy's Laboratories Inc in Guilford County. This site discharges stormwater at two points to
South Buffalo Creek (Class WS-V;NSW). The NOI is attached. The receiving water is listed as impaired for aquatic life
and benthos.
Please let me know if the Winston-Salem Regional Office has any concerns about issuing this COC. Please also let me
know of any potential impacts to wetlands. If we don't receive any objections, we'll issue the COC in 30 days.
Thanks,
Julie Ventaloro
Stormwater Permitting Program
NC Division of Energy, Mineral, and land Resources
1612 Mail Service Center, Raleigh, NC 27699-1612
Phone: [phone]o Far: [phone]
Website: http://watersupplywatershed.nc.gov
E-mail correspondence to and from this address may be subject to the North Curolina Public Records Law and may be disclosed to third
parties.

k\1• "
NCDENRI.'rC.'
E_".el .gym NxrLm- REuwnc Es
NOTICE OF INTENT
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG060000
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
Certificate of Cove
Check ff Antamt
Permit Assi ed to
e n a err,
National Pollutant Discharge Elimination System application for coverage under General Permit
NCGO60000: RECEIVED
STORMWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) 20 Food and Kindred Products SEP _ 8 2014
SIC 21 Tobacco Products DENR-LAND QUALITY
SIC 283 Drugs STORMWATER PERMITTING
SIC 284 Soaps, Detergents, & Cleaning Preparations; Perfumes, Cosmetics, & Other Toilet Preparations
SIC 422 Public Warehousing and Storage (except 4226)
For questions, please contact the DEMLR Regional Office for your area. See page 4.
Do Not use this NOI for renewals.
(Please print or type)
1) Mailing address of owner/operator address to which all permit correspondence will be mailed):
Name
Street Address
City
Telephone No.
Mother Murphy's Laboratories,
2826 South Elm -Eugene Street
Greensboro
336-273-1737
2) Location of facility producing discharge:
State NC ZIP Code 27406
Fax: [phone]
Facility Name
Mother Murphy's Laboratories, Inc.
Facility Contact
Mr. Charles Trout
Facility Address
2826 South Elm -Eugene Street
Facility City
Greensboro State NC ZIP Code 27406
Facility County
Guilford
Telephone No.
336-273-1737 Fax: [phone]
Email
[e-mail]
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). Interstate 40 to Greensboro. Take Exit 37. Go north
one block. Turn left onto first road — West Carteret Street. Site is on the right
(A copy of a county map or USGS quad sheet with the facility clearly located must be submitted with this application.)
4) Latitude_36 deg, 2 min,14 sec North Longitude_79 deg, 47 min, 32 sec West _ (deg, min, sec)
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility
X Existing
Date operation is to begin
SWU-221
Page 1 of 4
Last revised 6/24114

,
NCG060000 N.O.I.
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: 2 0 8 7
7) Activities
a) Provide a brief narrative description of the types of industrial activities and products manufactured
at this facility: The facility manufactures various flavoring extracts and syrups. The facility uses oils and
other chemicals in the manufacturing process
b) Check all activities occurring at this facility:
❑ use or process meats ❑ use or process animal fats/byproducts
8) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? Two
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? South Buffalo Creek
Receiving water classification: g NSW
Is this a 303(d) listed stream? Yes Has a TMDL been approved for this watershed? No
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). NIA
9) Does this facility have any other NPDES permits?
X 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)?
X No
O 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
X Yes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe: ASTs outside the facili are located in a concrete containment area. All other
oils/chemicals are stored inside building
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
X Yes
If yes, when was it implemented? 2011 12012
13) Are vehicle maintenance activities occurring at this facility?
X No ❑ Yes
Page 2 of 4
SWU-221 Last revised 6124/14

r . ,
NCG060000 N.O.I.
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage; or Disposal Facility?
X No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
X No ❑ Yes if yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b. or c„ please provide the following information:
Type(s) of waste:
How is material stored. -
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal vendor: T
Vendor address:
15) Certification:
North Carolina General Statute 143-215.613 (i) provides that:
Any person who knowingly makes any false statement, representation, or Certification in any application, record, report,
plan, or other document filed 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 rulemaking 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 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 T,:%,
rson Sig
Title: r
(Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDENR_ Do not send the check or money order separately.
Page 3 of 4
SWU-221 Last revised 6124/14

NCG060000 N.O.I.
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. Must be included with this application (not sent separately).
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 outfalls
corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
loaded, and unloaded, (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 Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee coverage under the General Permit.
For questions, please contact the UEMLR Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office .....
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office
...[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 4 of 4
SWU-221 Last revised 6/24/14

L
_ h t
SITE11� t •
vtti �, �
14
J U300)
RECEIVED
DENR-LAND QUALITY
STORMWATER PERMITTING
Uwk d
�— Surface Water Flow Direction
1
Approx Scale: 1 inch = 900 feet4`�TM«�`r'!y
Topographic Map
Ref: Greensboro NC USGS Quadrangle Map 1951 dated Mother Murphy's Laboratories photorevised 1994 from Microsoft MSR Website 2826 South Elm -Eugene Street
Greensboro, North Carolina
Prepared by Blue Ridge Geological Services, Inc. Feb 201 1 Figure 1

iaU L- I
YA
.�EJIQdi�►VEW�iQ _ _.• � CuEAQ�rVYiEINRQ
-V-1
4 � I
r r �xai
AM,
rr
t � �
�. r
E
r` FJ
3g6S
Lwad;
V%.. Surface Water Flow Direction
Approx Scale: 1 inch = 300 feet Site Location Map
Mother Murphy's laboratories
2826 South Elm -Eugene Street
Ref: City of Greensboro NC G1S Greensboro, North Carolina
Sepl 2011 1 Figure 2

F FjfP7
Conaete
Lcgmd
l - Aboveground storage tanks (ASTs) in concrete containment - incl one 5,000-gal vegetable oil,
two 5,000-gal propylene glycol, one 5,000-gal corn syrup
2 - Air compressor
3 - Pad -mounted electrical transformer
d - Trash compactor
5 - Cardboard Recycling Dumpsters
6 - Compressed Air Cylinders
LD - Loading Dock
TT - Tank Truck Loading 1 Unloading l
/1111 Surface Water Flow Direction !
0 Stormwater Catch Basin/Inlet
OF-1 Stormwater Outfall
Ref Guilford County NC GIS 2008 Aerial Photograph
Prepared by Blue Ridge Geological Services
rn
Site Plan
Mother Murphy's Laboratories
2826 South Elm -Eugene Street
Greensboro, North Carolina
Sept 2011 Figure 3

5536
Blue. Ridge Geological Services, Inc. First Citizens JMEMW O, F.,
306 Eden Terrace w mm
Archdale, NC 27263 66-30-531
4,... ;.: [phone]
9/4/2014
A
PAY TO THE 2
ORDER;OF NCDENR **100.00 9
S
One Hundred and 00/100"*'*********************DOLLARS
NCDENR Blue Ridge Geological Services, irm. p
Land=Quality Section
Stormvirater Permitting Program
1612 Mail Service Center
MEMO Raleigh, NC 27699-1612 040
j +(/ �`-'�SJGNATURE
_ _Mather Murph s G eeiasbor.Q
11000 5 5 3 611' iM S 3 L00 3001'.00 40 L 2 3 6 6 2 9 20

w 44.
NCDENR
Division of Energy, Mineral, and Land Resources
Stormwater Permitting Unit Program
161 a Mail Service Center
Raleigh, North Carolina 27699-1612
Subject: Notice of Intent
Application for Coverage Under NPDES General Stormwater Permit NCG060000
Mother Murphy's Laboratories, Inc.
2826 South Elm -Eugene Street
Greensboro, Guilford County, North Carolina
Dear Gentlemen:
On behalf of Mother Murphy's Laboratories, Inc., Blue Ridge Geological Services, Inc. (Blue Ridge)
prepared the attached application for coverage under NPDES General Permit #NCG060000 to discharge
storm water associated with industrial activities at the subject site (Figures I through 3). A check for
$100 for the new application fee is attached. Please contact the undersigned at 336-431-5454 if you have
any questions concerning this application or you need additional information.
Sincerely,
Je rey L. Gerlock, L.G.
NC Licensed Geologist # 1 141
Cc: Mr. Charles Trout, Mother Murphy's
Attachments — Application, Figures, Check
RECEIVED
SEP 8 2014
OENR-LAND QUALITY
STORMWATER PERMITTING
306 Eden Terrace, Suite C, Archdale, NC 27263 * Phone/Fax: [phone]

0 r
Arz-am
�p
®.&M."A.
NCDENR
[IMAry.MIM .wn NpLYIw rZr�04>A'iCJ
NOTICE OF INTENT
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG 060000
FOR AGENCY USE ONLY
Date Received
Year Monlh Day
Certificare o£Covcra ge
Chcck #
Amounl
Pcnnit ASsi ed to
en 44LIOCO
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG060000: RECEIVED
STORMWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) 20 Food and Kindred Products S�P mil.
SIC 21 Tobacco Products DENR-LAND QUALITY
SIC 283 Drugs STORMS VATER PERMITTING
SIC 284 Soaps. Detergents, & Cieaning Preparations; Perfumes, Cosmetics, & Other Toilet Preparations
SIC 422 Public Warehousing and Storage (except 4226)
For questions, please contact the DEMLR Regional Office for your area. See page 4.
Do Not use this NOl for renewals.
(Please print or type)
1) Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name Mother Murphy's Laboratories, Inc.
Street Address 2826 South Elm -Eugene Street
City Greensboro State NC ZIP Code 27406
Telephone No, 336-273-1737 Fax: [phone]
2) Location of facility producing discharge:
Facility Name
Mother Murphy's Laboratories, Inc.
Facility Contact
Mr. Charles Trout
Facility Address
2826 South Elm -Eugene Street
Facility City
Greensboro State NC ZIP Code 27406
Facility County
Guilford
Telephone No.
336-273-1737 Fax: [phone]
Email
[e-mail]
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). Interstate 40 to Greensboro. Take Exit 37. Go north
one block. Turn left onto first road — West Carteret Street. Site is on the right
(A copy of a county map or USGS quad sheet with the facility clearly located must be submstted with this application.)
4) Latitude-36 deg, 2 min, 14 sec North Longitude_79 deg, 47 min, 32 sec West _ (deg, min, sec)
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility
X Existing
Date operation is to begin
SW U-221
Page 1 of 4
Last revised 6/24114

40 q
NCG060000 N.O.I.
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: 2 0 8 7
7) Activities
a) Provide a brief narrative description of the types of industrial activities and products manufactured
at this facility: The facility manufactures various flavoring extracts and syrul3s. The facility uses oils and
other chemicals in the manufacturing process
b) Check all activities occurring at this facility:
❑ use or process meats ❑ use or process animal fats/byproducts
8) Discharge points I Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? Two
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? South Buffalo Creek
Receiving water classification: C
Is this a 303(d) listed stream? Yes Has a TMDL been approved for this watershed? No
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). NIA
9) Does this facility have any other NPDES permits?
X 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)?
X 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
X Yes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe: ASTs outside theacility are located in a concrete containment area. All „crther
oilslchemicals are stored inside building
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
X Yes
If yes, when was it implemented? 2011 12012
13) Are vehicle maintenance activities occurring at this facility?
X No ❑ Yes
S W U-221
Page 2 of 4
Last revised 6124114

A
NCG060000 N.O.I.
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
XNo El Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
X No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal vendor: _
Vendor address:
16) Certification:
North Carolina General Statute 143-215.6B (i) provides that;
Any person who knowingly makes any false statement, representation, or certification in any application, record, report,
plan, or other document filed 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 rulemaking proceeding or contested case under this Article; or
who falsities, 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 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
Title:
(Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDENR. Do not send the check or money order separately.
Page 3 of 4
5WU-221 Last revised 6124114

M
NCGO60000 N.O.I.
Final Checklist
This applicatlon will be returned as Incomplete unless all of the following items have been included:
Check for $100 made payable to NCDENR. Must be included with this application (not sent separately).
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 outfalls
corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
loaded, and unloaded, (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 Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1512
Note
The submission of this document does not guarantee coverage under the General Permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office
... [phone]
Mooresville Office
... [phone]
Raleigh Office ........
[phone]
Washington Office
...[phone]
Wilmington Office
... [phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 4 of 4
SWO-221 Last revised 6124l14

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STORMWATER PERMI fTING
E" Surface Water Flow Direction
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Topographic Map
Ref: Greensboro NC USGS Quadrangle Map dated 1951 Mother Murphy's Laboratories
photorevised 1994 from Microsoft MSR Website 2826 South Elm -Eugene Street
Greensboro, North Carolina
Prepared by Blue Ridge Geological Services, Inc. Feb2otl 1 Fipuro 1

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Approx Scale: 1 inch = 300 feet
Site Location Map
Mother Murphy's laboratories
2826 South Elm -Eugene Street
Ref: City of Greensboro NC GIS Greensboro, North Carolina
Sept 2011 I Figure 2

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1, Room
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l - Aboveground storage tanks (ASTs) in concrete containment - Ind one $,000-gal vegetable oil,
two 5,000-gal propylene glycol, one 5,000-gal corn syrup
2 - Air compressor
3 - Pad -mounted electrical transformer
4 - Trash compactor
S - Cardboard Recycling Dumpsters
6 - Compressed Air Cylinders
LD - Loading Dock
TT - Tank Truck Loading / Unloading
Surface Water Flow Direction
Stormwater Catch Basin/inlet
OF-1 Stormwater Outfall
Ref Guilford County W GlS 2008 Aerial Photograph Guilford County W GlS 2008 Aerial Photograph
Prepared * Blue Ridge Gcobgrcal Services
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Site Plan
Mother Murphy's Laboratories
2826 South Elm -Eugene Street
Greensboro, North Carolina