NCG210440_COMPLETE FILE - HISTORICAL_20180317

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /V Ca c2 101/
DOC TYPE CX HISTORICAL FILE
MONITORING REPORTS
DOC DATE n a [91 (6) D3 7
YYYYMM DD

1 L
Morman, Alaina
From: Riddle, Rick L
Sent: Thursday, May 17, 2018 3:27 PM
To: Morman, Alaina
Subject: FW:Wellons ncg210440
Attachments: Map.pdf; 05262016.pdf; Water sample report.pdf
Richard (Rick) L. Riddle, Jr.
Stormwater Engineer
919 807-6375 office
NCDEQ
.- Nothing Compares
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Lambe, Brian
Sent: Monday, February 12, 2018 3:47 PM
To:Allen,Trent<[e-mail]>
Cc: Riddle, Rick L<[e-mail]>
Subject: FW: Wellons ncg210440
Trent,
I am a DEMLR specialist in the Wilmington Office. We need your input on a site that does not quite fit into any NPDES
permitting. Here's the story...
A year ago I received a complaint regarding a site on HC Powers Road in Wallace, Duplin County. The site receives
turkey poult litter composed of wood mulch. The mulch is sent through a sorter to separate the turkey waste from the
mulch, guess about 15:1 ratio. The mulch is sent to boilers for fuel and the turkey waste is used for fertilizer. The site
receives a significant amount of trucks every day.
The site is located in the floodplain for Rockfish Creek(C, Sw) and the site does flood frequently.
Wellons, the company, did test downstream in Rockfish Creek, report attached, 910 fecal colonies reported (well
downstream). The water discharging from the site has a much more septic look.
I consulted with DWR, CAFO people and Jim Gregson. They did not think it met their rules, 14 (?) days uncovered, in
that the waste is constantly turned over. I argued that there is always a quantity of waste on site.
I know there is one other site in NC like this in Kinston (maybe). But we do not know how to really handle this. Any
input would be invaluable. Thank you.
i

J R`
Brian Lambe
Environmental Specialist
910-796-7314
state of Nonh Carolina I Environmental Quality I Energy,Mineral and Land Resources
127 Cardinal Drive Extension I Wilmington,NC 28405
910 796 7213 T 910 350 2004 F I burl:iioortal�rcdenr.nre'x•eb:lri
•
From: Riddle, Rick L
Sent: Monday, February 12, 2018 11:21 AM
To: Lambe, Brian<[e-mail]>
Subject: RE: Wellons ncg210440
13rian.
No sure if he still is, but he used to be in the Animal Feed Industry part of Waste Water permitting. This sites activity and
especially their outfall numbers indicate that they would not be covered under an NCG2 I which is more for lumber&
wood products. Trent would know what permit would he more applicable to them. If not,Jon Risgaard could assist in
which direction the site should go.
Thanks
Rick
Richard L. Riddle, Jr.
Stormwater Engineer
Compares_-
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties_
From: Lambe, Brian
Sent: Monday, February 12, 2018 11:08 AM
To: Riddle, Rick L<[e-mail]>
Subject: RE: Wellons ncg210440
Forgive me, why do I need to talk to Trent Allen?
Brian Lambe
Environmental Specialist
910-796-7314
State of North Carolina I Environmental Quality I Energy,Mineral and Land Resources
127 Cardinal Drive Extension I Wilmington,NC 28405
910 796 7215 'r I 910 350 2004 F I Lttn:llnortaLncdenr.orte n chid
From: Riddle, Rick L
Sent: Friday, February 09, 2018 2:48 PM
To: Lambe, Brian <[e-mail]>
Subject: RE: Wellons ncg210440
2

Brian,
I remember having a discussion about this application last year. Were you able to discuss with Trent Allen in DWR about
this project and what you observed onsite? I remember discussing this with Bradley Bennett at the time that the numbers
from the testing sent to us were way outside of our benchmark limits meaning that the company falls outside of the
NCG21 permit. A proper SIC code from them is also necessary.
I should have followed up on this discussion earlier but I didn't.
From the pictures, it looks like they have done little to clean up the operations.
Rick
Richard L. Riddle, Jr.
Stormwater Engineer
t
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
From: Lambe, Brian
Sent: Friday, February 09, 2018 1:30 PM
To: Riddle, Rick L<[e-mail]>
Subject: Wellons ncg210440
What is the status of this permit application? I am in a pickle in that I cannot ask for their SWPPP or even see any
testing of their discharge.
Brian Lambe
Environmental Specialist
910-796-7314
State of North Carolina 1 Environmental Quality 1 Energy Mineral and Land Resources
127 Cardinal Drive Extension Wilmington,NC 28405
910 796 7215 T 1 910 350 2004 1, 1 lath i(poriaLncdem Qt o eb/lr
3

Riddle, Rick L
From: Bennett, Bradley
Sent: Tuesday, February 21, 2017 10:33 AM
To: Riddle, Rick L
Subject: FW: DWR Contact to Discuss Wellons
Rick,
Here is the email i sent to Brian back in November.
•
BB
Bradley Bennett
Stormwater Permitting Program I Phone: [phone]
NC Division of Energy, Mineral and Land Resources I Fax: [phone]
1612 Mail Service Center I Email: bradley bennett(a)ncdenr.gov
Raleigh, NC 27699-1612 Web: http:llportal.ncdenr.orgtwebflrlstormwater
Email correspondence to and from this address may be subject to public records laws •
From: Bennett, Bradley
Sent:Tuesday, November 01, 2016 1:40 PM
To: Lambe, Brian <[e-mail]>
Cc: Riddle, Rick L<[e-mail]>
Subject: DWR Contact to Discuss Wellons
Brian,
I left you a voicemail on this yesterday after I met with Jon Risgaard and Trent Allen with DWR to talk about this project. I
think it would be helpful if you could talk with Trent about the project and go through all the things you saw on
site. Trent's actually in the FRO but is working with the non-discharge group in Raleigh some right now. Trent's contact
information is:
Phone: [phone]
Email: [e-mail]
Maybe we can have a conference call to go through some things on this one.
BB
Bradley Bennett
Stormwater Permitting Program I Phone: [phone]
NC Division of Energy, Mineral and Land Resources I Fax: [phone]
1612 Mail Service Center I Email: bradley.bennetta.ncdenr.00v
Raleigh, NC 27699-1612 I Web: http:llportal.ncdenr.orglwebllrlstormwater
Email correspondence to and from this address maybe subject to public records laws
1

Riddle, Rick L
From: Lambe, Brian
Sent: Wednesday, August 10, 2016 2:28 PM
To: Bennett, Bradley
Cc: Riddle, Rick L; Georgoulias, Bethany
Subject: FW: Wellons Wallace Site
Attachments: docoument for ncdeq.pdf
Follow Up Flag: . Follow up
Flag Status: Flagged
Brian Lambe
Environmental Specialist
910-796-7314
State of North Carolina I Environmental Quality Energy,Mineral and Land Resources
127 Cardinal Drive Extension I Wilmington,NC 25405
910 796 7215 T 1 910 350 2004 F hnealportal.ncdenr.orglwebild
From: Marie Peedin [mailto:[e-mail]]
Sent: Friday,July 22, 2016 9:40 AM
To: Lambe, Brian <[e-mail]>; Garald Cottrell <[e-mail]>
Subject: Wellons Wallace Site
Brian
Here is the report for the samples taken as requested. I have also attached a map showing the approximate
locations of the test.
Please let me know how the state want to resolve this NOV issue and which permit to submit so the owners can
get this issue behind them and be in compliance.
If you have questions let me know.
Marie U. Peedin, PE
252-945-2983
I' e
,ENGINEERING
ii
202 Camilla Road
Washington, NC 27889
t

r l
Riddle, Rick L
From: Lambe, Brian
Sent: Tuesday, May 31, 2016 8:38 AM
To: Riddle, Rick L
Subject: FW: Wellons Energy Site - Wallace
Attachments: Map.pdf
Follow Up Flag: Follow up
Flag Status: Flagged
Brian Lambe
Environmental Specialist
910-796-7314
State of North Carolina I Environmental Quality I Energy,Mineral and Land Resources
127 Cardinal Drive Extension I Wilmington,NC 28405
910 796 7215 T I 910 350 2004 F I httn:l/portal.ncdenr.org/web/lr/
From: Lambe, Brian
Sent: Tuesday, May 31, 2016 8:35 AM
To: 'Marie Peedin' <[e-mail]>
Subject: FW: Wellons Energy Site - Wallace
Attached is a map where I think you should be sampling. If you would like I can meet you on site to discuss. Outfall 1
and 2 are obvious. Outfall 3 is the outletof the pond. Outfall 4 is combined from multiple outfalls leading into the
ditch. The samples should be collected very soon. There is still rain in the forecast this week, but only one of the
sampling locations is really rain dependent.
Also, I am about to start drafting a NOV for sediment and erosion control. I will send this to you as well.
•
Brian Lambe
Environmental Specialist
910-796-7314
State of North Carolina I Environmental Quality I Energy,Mineral and Land Resources
127 Cardinal Drive Extension I Wilmington,NC 28405
910 796 7215 T 1 910 350 2004 F I httn:llportal.ncdenr.orglweb/lri
From: Lambe, Brian
Sent: Tuesday, April 12, 2016 11:15 AM
To: Marie Peedin <[e-mail]>
Subject: RE: Wellons Energy Site - Wallace
I disagree with the sampling location. I think we should meet on site to discuss. Please suggest a date and time. I did
send it to Bradley
Brian Lambe
Environmental Specialist
Land Quality Section
NC Division of Energy, Mineral, and Land Resources
I
[phone] •i

t 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: Marie Peedin [mailto:mupeedin cr,ibx.engineering.com]
Sent: Tuesday, April 12, 2016 10:03 AM
To: Lambe, Brian <brian.lambe(a7ncdenr.gov>
Subject: Wellons Energy Site - Wallace
Brian
Here is the test result from the creek at the location shown on the map included with the report. Just let me
know how we need to proceed.
Thanks
Marie U. Peedin, PE
252-945-2983
202 Camilla Road
Washington, NC 27889
2

Division of Energy, Mineral and Land Resources FOR AGENCY USE ONLY
AvraIt,
Stormwater Permitting Program Ycar Month Day
Date Reccrved
National Pollutant Discharge Elimination System Cenificatoof Cowr e
wolrtH Gnwx.Dc�,w1NLNT or N
&
CK�ROimLWT 0
WO Nn y,ReaOUV CCS ` ' � O
crtnil Assiµncd to
ldolle
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG210000:
For STORMWATER DISCHARGES associated with activities classified as:
SIC 24 Timber Products(except as specified below),including Wood Chip Mills;
And, Like activities deemed by DEMLR to be similar in the process and/or the exposure of raw
materials, products, by-products, or waste materials.
i r-r)
The following activities are specifically excluded from coverage under this General Permit: '--
• Wood Kitchen Cabinets(SIC 2434) FEB 05 2016
• Wood Preserving (SIC 2491)
• Logging (SIC 2411) ' `' Y
•Standard Industrial Classification Code
STO;i:�WAi ER F A:ric ! :G
(Please print or type)
1) Mailing address of owner/operator(address to which official permit correspondence will be mailed):
Name Wellons Engergr Solutions
Owner Contact(a person) Garaid Cottrell
Street Address 312 S. Front Street, Suite 6
City New Bern State NC ZIP Code 28560-2134 _
Telephone No.' 336-339-9055 Fax:
E-mail Address [e-mail]
2) Location of facility producing discharge: Poxl
Facility Name Wellanis Energy Solutions P uQ It'Materia Screening Yard 1494 Co
Facility Contact(a person) Oarald C ttrell �517 C f1B it7 f
Street Address
City State NC ZIP Coded ,1
County •Duplin. \.
Telephone No. 3367339-9055 Fax:
.r
3) Permit Contact
Permit Contact(a person)Marie Peedin, PE, inner Banks Engineering, PC
Contact E-mail mupeedin@ibxengineering,com -
Contact phone number252-945-2983
4) 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). Site is located along H C Powers Road approximately
1.73 miles west from the intersection of NC 41 and HC powers Road
(A copy of a county map or USGS quad sheet with Facility dearly located on the map is required to be submitted with this application)
Page 1 of 4
SIM-236.080113 Last revised 7/2114

NCc29ONO N.O.(.
5) Latitude 34 43'39"}
[ Longitude 78 02'47"
(degrees, minutes,
seconds) 11 , 175 1 ' 5'014 381
6) This NPDES Permit Application applies to which of the following :
O New or Proposed Facility Date operation is to begin
X Existing
7) Standard Industrial Classification (SIC):
Provide the 4 digit Standard Industrial Classification Code(SIC Code)that describes the primary industrial
activity at this facility
SIC Code:_0_024,
8) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility:Turkey poult bedding material has been approved by EPA as a viable solid fuel for boiler
operations. Prior to use as a fuel source the material is screened and the wood chips then are hauled off to
be used for fuel. The screenings are stock piled in a separate area and sold as fertilizer material. The
operation shows a recovery rate of 93% of Poult Bedding Material is being used as fuel with only 7%
remaining onsite for disposal.
9) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property?2
10) Receiving waters:
What is the name of the body or bodies of water(creek, stream, river, lake, etc.)that the facility stormwater
discharges end up in? Doctors Creek
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).
11) Does this facility have any other water quality permits?
X No
❑ Yes
If yes, list the permit numbers for all current water quality permits for this facility:
12) Does this facility have any Non.Discharge permits (ex: recycle permits)?
X No
O Yes
if yes, list the permit numbers far all current Non-Discharge permits for this facility:
13) Does this facility employ any best management practices for stormwater control?
X No
❑ Yes
If yes, please briefly describe: _
14) Does this facility have a Stormwater Pollution Prevention Plan?
X No
Page 2 of 4
SWU-236-080113 Last revised 7/2/14

NCG2I0000 N.O.I.
❑ Yes
if yes, when was it implemented?
15) Does this facility have exposed accumulations of sawdust, bark, mulch,wood chips, or similar size
woody material on-site for longer than seven (7) days? (Exposed directly to rainfall or to run-on from
other areas of the facility.)
❑ No X Yes
16) Are vehicle maintenance activities occurring at this facility?
X No ❑ Yes
17) 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) 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 I disposal vendor:
Vendor address:
18) Certification:
North Carolina General Statute 143-215.6 b(I)provides that:
Any person who knowingly makes any false statement,representation,or certification in any application,record,report,plan,or other
document Pled 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
[Environmental Management)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.
Page 3 of 4
SWU-236.080113 Last revised 712114

NCG210000 N.O.I.
Printed Name of Person _Gerald Cottrell
Title: Presi nt
(Si o Applicant) ------- (Date Signed)
Notice of Intent must be accompanied by a check or money order for$100.00 made payable to:
NCOENR
Final Checklist
This.application will be returned as incomplete unless all of the following Items have been included:
Check for$100 made payable to NC DENR
0/ This completed application and ail supporting documents
D Copy of county map or USGS quad sheet with location of facility clearly marked on map
Mail the entire package to:
Stormwater Permitting 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 the issuance of an NPOES permit.
For questions,please contact the DEMLR Central Office or Regional Office for your area.
To visit our website,go to http:l/portal.ncdenr.orq/webllr/stormwafer
DEMLR Regional Office Contact Information:
+,Wirt!on taw ,� ��"
Asheville Office [phone]r
• 04.ve ow, a_W iatra°-
Fayetteville Office [phone] e itit,,401 e74210 I
Mooresville Office [phone] M � �'Teo Raleigh Office [phone] 4 hiji, 17 oor4sr to a „Washington Office ...[phone] � �� ,
fp s
Wilmington Office .. [phone] yi
Winston-Salem [phone] .ren'11,[ �' --
Central Office [phone]
A©tOFI
Page 4 of 4
SWU-236-080113 Last revised 712/14

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i Environmental Chemists, Inc.
envirochem 6602 Windmill Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
710 Bowsertown Road,Manteo,NC 27954 • 252.473.5702 Lab/Fax
•uti 255-A Wilmington Highway,Jacksonville,NC 28540 • 930.347.5843 Lab/Fax
ANALYTICAL&CONSULTING CHEMISTS [e-mail]
Inner Banks Engineering Date of Report: Jun 23, 2016
202 Camilla Road Customer PO#:
Washington NC 27889 Customer ID: 16030008
Attention: Report#: 2016-07805
Project ID: Welions Energy-Wallace
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
16-18685 Site: SW-1 6/13/2016 1:50 PM Water jay baker/envirochem
Test Method Results Date Analyzed
Residue Suspended(TSS) $ SM 2540 D 50.0 mg/L •L 06/14/2016
Temperature SM 2550 a 23.5 C 06/13/2016
pH SM 4500 H B 6.94 units 06/13/2016
Total Phosphorus SM 4500 P F 3.23 mg/L 06/19/2016
BOD SM 5210 B 7 mg/L 06/15/2016
COD SM 5220D 136 mg/L 06/16/2016
Fecal Coliform SW9222DMF 2900 Colonies/100mL 06/13/2016 P)CGot.
Total Nitrogen (Caic)
Total Kjeldahl Nitrogen (TKN) EPA 351 2 9.6 mgfL 06/19/2016
Nitrate+Nitrite-Nitrogen EPA353.2 0.06mg/L 06/15/2016
Total Nitrogen Tome Nitrogen 9.7 mg/L 06/23/2016
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
16-18686 Slte:SW-2 6/13/2016 1:10 PM Water jay baker/envirochern
Test Method Results Date Analyzed
Residue Suspended (TSS) SM 2540 D 20.5 mg/L Iic 06/14/2016
Temperature SM 2550 B 31.9 C 06/13/2016
pH SM 4500 H B 6.60 units 06/13/2016
Total Phosphorus SM 4500 P F 3.96 mg/L 06/19/2016
BOB SM 5210 B 26 mg/L 06/15/2016
COD SM 5220D 389 mg/L * 06/16/2016
Fecal Coliform SM 9222D MF �60000 Colonies/1©0rat. 06/13/2016
Total Nitrogen (Galt)
Total Kjeldahl Nitrogen (TKN) EPA 351.2 21.2 mg/L 06/19/2016
Nitrate+Nitrite-Nitrogen EPA353.2 0.02 mg/L 06/15/2016
Total Nitrogen Total Nitrogen 21.2 mg/L 06/23/2016
Report*:: 201B•07e05 Page 1 of 3

Environmental Chemists, Inc. j?Ill
envirochem 6602 Windmill Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
710 Bowsertown Road,Manteo,NC 27954 • 252.473.5702 1.4ib/Fax
255-A Wilmington Highway,Jacksonville,NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL&CONSULTING CHEMISTS [e-mail]
Inner Banks Engineering Date of Report: Jun 23, 2016
202 Camilla Road Customer PO#:
Washington NC 27889 Customer ID: 16030008
Attention: Report#: 2016-07805
Project ID: Welions Energy-Wallace
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
16-18687 Site: S+-3 6/13/2016 1:20 PM Water jay baker/envirochem
Test Method Results LL Date Analyzed
Residue Suspended (TSS)% SM 2540 D 32.5 mg/L 4 06/14/2016
Temperature SM 2550 B 33.1 C 06/13/2016
pH SM 4500 H a 8.96 units 06/13/2016
Total Phosphorus SM 4500 P F 4.52 mg/L 06/19/2016
BOO SM 5210 a 34 mg/L 06/15/2016
COD SM 5220D 417 mg/L il: 06/16/2016
Fecal Coliform SM 92220 MF lit352 Colonies/100mL 06/13/2016
Total Nitrogen (Calc)
Total Kjeldahl Nitrogen (TKN) EPA 3512 23.9 mg/L 06/19/2016
Nitrate+Nitrite-Nitrogen EPA 353.2 0.03 mg/L 06/15/2016
Total Nitrogen Total Nitrogen 23.9 mg/L 06/23/2016
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
16-18688 Site: SW-4 6/13/2016 1:35 PM Water jay baker/envirochem
Test Method Results Date Analyzed
Residue Suspended (TSS) SM 2540 D 152 rng/L 06/14/2016
Temperature SM 2550 a 22.8 C 06/13/2016
pH SM 4500 H s 7.71 units 06/13/2016
Total Phosphorus SM 4500 P F 10.4 mg/L 06/19/2016
BOO SM 5210 a 15 mg/L 06/15/2016
COD SM 5220D 324 mg/L 4 06/16/2016
Fecal Coliform SM 9222D MF 11nies/100m 06/13/2016
Total Nitrogen (Calc)
Total Kjeldahl Nitrogen (TKN) EPA 351.2 37.9 mg/L 06/19/2016
Nitrate+Nitrite-Nitrogen EPA 353.2 0.10 mg/L 06/15/2016
Total Nitrogen Total Nitrogen 38.0 mg/L 06/23/2016
Report if:. 2016.07505 Page 2 of 3

•
Environmental Chemists, Inc.
envirochein 6602 Windmill Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
710 Bowsertown Road,Manton,NC 27954 • 252.473.5702 Lab/Fax
255-A Wilmington Highway,Jacksonville,NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL&CONSULTING CHEMISTS infoglenvironmentalchemists.com
Inner Banks Engineering Date of Report: Jun 23, 2016
202 Camilla Road Customer PO#:
Washington NC 27889 Customer ID: 16030008
Attention: Report#: 2016-07805
Project ID: Welions Energy-Wallace
Comment: n
Reviewed by: {�k' ,LOk1 V )
Report#:: 201 6-07B05 Page 3 of 3

W
ngton
Way Wilm ,NC 28405
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F CE: 910 I392-0223 FAX [phone]
NCDENR: DWQ CERTIFICATION#94 NCDHHS: DLS CERTIFICATION#37729 Infocenvironmentalchernista.com
Analytical&Consulting Chemists
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Permit: NCG210440 Owner-Facility:Wellons Energy Solutions
Inspection Date: 05/26/2016 Inspection Type:Compliance Evaluation Reason for Visit: Routine
Analytical Monitoring Yes No NA NE
Has the facility conducted its Analytical monitoring? ❑ • ❑ ❑
#Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas? ❑ 0 0
Comment: Application under review.
Permit and Outfalls Yes No NA NE
#Is a copy of the Permit and the Certificate of Coverage available at the site? ❑ • ❑ ❑
#Were all outfalls observed during the inspection? ❑ • 0 0
#If the facility has representative outfall status,is it properly documented by the Division? ❑ • ❑ ❑
#Has the facility evaluated all illicit(non stormwater)discharges? ❑ • ❑ ❑
Comment: Application under review.
Qualitative Monitoring Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? ❑ • 0 0
Comment: Application under review.
Stormwater Pollution Prevention Plan Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan? 0 11 0 ❑
#Does the Plan include a General Location(USGS)map? ❑ • El ❑
#Does the Plan include a'Narrative Description of Practices"? ❑ ❑ ❑
#Does the Plan include a detailed site map including outfall locations and drainage areas? 01100
#Does the Plan include a list of significant spills occurring during the past 3 years? 0 • El ❑
#Has the facility evaluated feasible alternatives to current practices? 0 • 0 0
#Does the facility provide all necessary secondary containment? ❑ • 0 ❑
#Does the Plan include a BMP summary? ❑ • 0 El
#Does the Plan include a Spill Prevention and Response Plan(SPRP)? ❑ • El ❑
#Does the Plan include a Preventative Maintenance and Good Housekeeping Plan? 011E10
#Does the facility provide and document Employee Training? ❑ • 0 ❑
#Does the Plan include a list of Responsible Party(s)? [] 111 ❑ ❑
#Is the Plan reviewed and updated annually? El • El El
#Does the Plan include a Stormwater Facility Inspection Program? 0 • ❑ ❑
Has the Stormwater Pollution Prevention Plan been implemented? ❑ • 0 ❑
Comment: Application under review.
Page: 3

Storm Water Permitting Unit
' NC DEMLR
1612 Mail Service Center
N A' 1 Raleigh,NC 27699-612
ENGINEERINGaG 252.945.2983 REC..P I D
E
202 CAMILLA RD. FEB 0 5 2016
„.„1., WASHINGTON,NC 27889 r S M:. DENR-LAND Q;IAL.ITY
STORM4firP.TER PERIviflTING
Attention : Stormwater Permitting
Date: 2/2/16 Project No. 15040
Re: NOV—Wellons Site
WE ARE SENDING YOU ® Attached ❑ Under separate cover via
the following items:
❑ Shop drawings ❑ Prints ® Plans ❑ Samples ❑ Specifications
❑ Copy of letter ❑ Change order ❑
CO PIES DATE No DESCRIPTION
] NPDES Discharge Permit Application
USGS Map
I Check for S 100.00
THESE ARE TRANSMITTED as checked below:
® For approval ❑ Approved as submitted ❑ Resubmit copies for approval
❑ For your use El Approved as noted ❑Submit copies for distribution
❑ As requested ❑ Returned for corrections El Return corrected prints
❑ For review and comment ❑
El FOR BIDS DUE 20 0 PRINTS RETURNED AFTER LOAN TO US
REMARKS:
Sorry for the delay in getting this information to you. The check is included and the permit was previously sent
under separate cover. The additional information will also be sent under separate cover once a final decision can be
made regarding the type of NPDES permit. Please call me if you have questions.
Marie U. Peedin, PE.

•
Division of Energy,Mineral and Land Resources FOR AGENCY USE ONLY
Stormwater PermittingProgram Date Received
Arridi
gYc sr Month Pay
o•••. National Pollutant Discharge Elimination System Certificate of Coma
Ntf
eLi `NCDENR
NOrtH C.ha..HulnlNta NCG210000 .003
GNNIGM,[M AND r Rcswnec,
c�ddCIt A$$le5ncd CO
�
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG210000:
For STORMWATER DISCHARGES associated with activities classified as:
SIC 24 Timber Products (except as specified below), including Wood Chip Mills;
And, Like activities deemed by DEMLR to be similar in the process and/or the exposure of raw
materials, products, by-products, or waste materials.
The following activities are specifically excluded from coverage under this General Permit: -1;:... .s t F
• Wood Kitchen Cabinets(SIC 2434) FEB 0 5 2016
• Wood Preserving (SIC 2491)
• Logging (SIC 2411) DEE.;N'R LAND QUA.Ii'f
•Standard industrial Classification Code LTG' :'lVr^i ER F)=i;iVl,f 1 NO
(Please print or type)
1) Mailing address of owner/operator(address to which official permit correspondence will be mailed):
Name Wellons Engerg Solutions •
Owner Contact(a person)Garald Cottrell
Street Address 312 S. Front Street, Suite 6
City New Bern State NC ZIP Code 28560-2134
Telephone No: 336-339-9055 Fax:
E-mail Address garald.cottreli©wellons.com
2) Location of facility producing discharge: 11;-r
Facility Name Wellons Energy Solutions Po�Material Screening Yard Duplin Co
Facility Contact(a person)Garald Cottrell ,/
Street Address 312-S..F tr 5/7 A_ �d
City .le�rBeri t U),. �e. State NC ZIP Code..28554.1-1-34- 2B a
County Duplin
Telephone No. 336-339-9055 Fax:
3) Permit Contact
Permit Contact(a person)Marie Peedin, PE, Inner Banks Engineering, PC
Contact E-mail [e-mail]
Contact phone number252-945-2983 -
4) 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). Site is located along H C Powers Road approximately
1.73 miles west from the intersection of NC 41 and HC Powers Road
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted with this application)
Page 1 of 4
SWU-236-080113 Last revised 7/2/14

P r
NCG210000 N.Q.I.
5) Latitude 34 43'39" Longitude 78 02'447" (degrees, minutes,
seconds) 6N 05 - ! r fi VJ f 33
1
6) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin
X Existing
7) Standard Industrial Classification (SIC):
Provide the 4 digit Standard Industrial Classification Code(SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 0_024__
8) Provide a brief narrative description of the types of Industrial activities and products manufactured at
this facility:Turkey poult bedding material has been approved by EPA as a viable solid fuel for boiler
operations. Prior to use as a fuel source the material is screened and the wood chips then are hauled off to
be used for fuel. The screenings are stock piled in a separate area and sold as fertilizer material. The
operation shows a recovery rate of 93% of Poult Bedding Material is being used as fuel with only 7%
remaining onsite for disposal.
9) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property?2
10) Receiving waters:
What is the name of the body or bodies of water(creek, stream, river, lake, etc.)that the facility stormwater
discharges end up in? Doctors Creek
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).
11) Does this facility have any other water quality permits?
X No
❑ Yes • •
If yes, list the permit numbers for all current water quality permits for this facility:
12) Does this facility have any Non-Discharge permits (ex: recycle permits)?
X No
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
13) Does this facility employ any best management practices for stormwater control?
X No
❑ Yes
If yes, please briefly describe:
14) Does this facility have a Stormwater Pollution Prevention Plan?
X No
Page 2 of 4
SWU-236-080113 Last revised 7/2/14

NCG210000 N.O.I.
❑ Yes
If yes,when was it implemented?
15) Does this facility have exposed accumulations of sawdust, bark, mulch,wood chips, or similar size
woody material on-site for longer than seven (7) days? (Exposed directly to rainfall or to run-on from
other areas of the facility.)
❑ No X Yes
16) Are vehicle maintenance activities occurring at this facility?
X No ❑ Yes
17) 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) 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/disposal vendor:
Vendor address:
18) Certification:
North Carolina General Statute 143-215.6 b (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
[Environmental Management]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 E 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.
Page 3of4
5WU-236-080113 Last revised 7/2/14

NCG2I0000 N.O.I.
Printed Name of Persongg: Gerald Cottrell
Title: Presi nt_
JzTz-1//5
(Signett ppficant) (Date Signed)
Notice of intent must be accompanied by a check or money order for$100.00 made payable to:
NCOENR
Final Checklist
T�ishis.applicatlon will be returned as incomplete unless all of the following Items have been included:
€2 Check for$100 made payable to NC DENR
❑/ This completed application and all supporting documents
fY Copy of county map or USGS quad sheet with location of facility clearly marked on map
Mail the entire package to:
Stormwater Permitting 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 the issuance of an NPDES permit.
For questions,please contact the DEMLR Central Office or Regional Office for your area.
To visit our website,go to http:llportal.ncdenr.orulwebltr/stormwater
DpMLR Regional Office Contact Information;
Asheville Office [phone] ,4Z6 Sofa, x< , /_ .7!
•
Fayetteville Office [phone] • `Va. ) ,44- ,.
Mooresville Office [phone]
.�-. • ��� ,� = �� 'F:- 4,,,,i1VArt. .7.ktd;
Raleigh Office [phone] >< .o�.Washington Office ...[phone] .W'r� ` � � r t 4� tri,v;Wilmington Office [phone] ., �
Winston-Salem 335 771-5000 • eft "or ,
Central Office [phone]
V/Mig, neton
Page 4 of 4
SWU-236 080113 Lest revised 712/14

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•
002320
•/.TAE L LON S EM bank. Ail of apserving you- -24-22/1230
Energy Solutions
2525 W. FIRESTONE LN VANCOUVER,WA 98660 CHECK DATE CONTROL NO- AMOUNT
[phone]
12/14/2015 002320 $**""*****100.00 N
ro
PAY One Hundred and 00/100 Dollars
NC DENR
TO THE AND LAND RESOURCES
ORDER 1612 MAIL SERVICE CENTER
OF RALEIGH, NC 27699-1612
United States e
0002320i1` 2 3000 2 201: L53695249D75fi'
•
•
•
•

North Carolina Secretary of State Page 1 of 1
North Carolina
At;Q DEPARTMENT OF THE
ElFO. aine F. Marshall
. Secretary SECRETARY OF STATE
. PO Box 29822 Raleigh,NC 27826-0622 [phone]
Account Login Register
Date: 3/24/2014
Click here to:
View Document Filings I File an Annual Report
1 Print a Pre-populated Annual Report Fillable PDF Form I Amend A Previous Annual Report l
Corporation Names
Name Name Type
NC W. E. PARTNERS V, LLC LEGAL
Limited Liability Company Information
SOSI D: 1322894
Status: Current-Active
Effective Date: 6/12/2013
Citizenship: DOMESTIC
Duration: PERPETUAL
Annual Report Status: CURRENT
Registered Agent
Agent Name: COTTRELL, GARALD
Office Address: 104 MELLEN ROAD
NEW BERN NC 28562
Mailing Address: 104 MELLEN ROAD
NEW BERN NC 28562
Principal Office
Office Address: NO ADDRESS
Mailing Address: NO ADDRESS
Officers/Company Officials
This website is provided to the public as a part of the Secretary of State Knowledge Base(SOSKB)system. Version:
2648
http:l/www.secretary.state.nc.us/corporations/Corp.aspx?Pitemld=10272191 3/24/2014

AipiAt
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM Pat McCrory, Governor
Director John E. Skvarla, Ill, Secretary
March 20, 2014
CERTIFIED MAIL 7013 2630 0002 0760 5253
RETURN RECEIPT REQUESTED
W.E. Partners V, LLC
Gerald Cottrell
104 Mellen Road
New Bern, NC 28562
Dear Mr. Cottrell:
A review of our records show that your facility known as W.E. Partners House of Raeford
Rose Hill on N. NC Hwy 117, Rose Hill, North Carolina is operating without a National
Pollutant Discharge Elimination System permit. Coverage for steam electric power as
defined by 40 CFR 122.26(b)(14)(vii) will require an individual permit. More information can be
found on the Division's website at: httt ://portal.ncdenr.orq/web/lr/npdes-stormwater,
You will need to contact NC Division of Water Resources to inquire about the boiler blowdown
being separately discharged that will need a NCG50 wastewater permit.
1 have enclosed application forms for your convenience. Please note these forms should
be submitted to the North Carolina NPDES program central office attention to Bradley Bennett.
Should you have any questions concerning the application form, please do not hesitate to
contact me at 910-796-7314 or [e-mail]. You are required to apply for this
permit within 30 days of receiving this correspondence. I thank you for your cooperation with
this matter.
Sincerely,
Brian Lambe
Land Quality Section
Wilmington Regional Office
End: NOI, inspection
cc:
Wilmington Regional Office
127 Cardinal Drive Extension,Wilmington, North Carolina 28405 Phone:[phone] Fax[phone]

Ai,A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM Pat McCrory, Governor
Director John E. Skvaria, III, Secretary
March 20, 2014
CERTIFIED MAIL 7013 2630 0002 0760 5253
RETURN RECEIPT REQUESTED
W.E. Partners V, LLC
Gerald Cottrell
104 Mellen Road
New Bern, NC 28562
Dear Mr. Cottrell:
A review of our records show that your facility known as W.E. Partners House of Raeford
Rose Hill on N. NC Hwy 117, Rose Hill, North Carolina is operating without a National
Pollutant Discharge Elimination System permit. Coverage for steam electric power as
defined by 40 CFR 122.26(b)(14)(vii) will require an individual permit. More information can be
found on the Division's website at: http:// ortal.ncdenr.orq/webllrinpdes-stormwater.
You will need to contact NC Division of Water Resources to inquire about the boiler blowdown
being separately discharged that will need a NCG50 wastewater permit.
I have enclosed application forms for your convenience. Please note these forms should
be submitted to the North Carolina NPDES program central office attention to Bradley Bennett.
Should you have any questions concerning the application form, please do not hesitate to
contact me at 910-796-7314 or [e-mail]. You are required to apply for this
permit within 30 days of receiving this correspondence. I thank you for your cooperation with
this matter.
Sincerely,
Brian Lambe
Land Quality Section
Wilmington Regional Office
End: NOI, inspection
cc:
Wilmington Regional Office
127 Cardinal Drive Extension,Wilmington, North Carolina 28405 Phone:[phone]/Fax[phone]

North Carolina Secretary of State Page 1 of 1
North Carolina
" Elaine F. Marshall DEPARTMENT OF THE
Secretary SECRETARY OF STATE
' PO BoK 29822 Raleigh,NC 27828-0622 [phone]
Account Login Register
Date: 3/24/2014
Click here to:
View Document Filings I File an Annual Report
JPrint a Pre-populated Annual Report Fillable PDF Form I Amend A Previous Annual Report I
Corporation Names
Name Name Type
NC W. E. PARTNERS IV, LLC LEGAL
Limited Liability Company Information
SOSID: 1203982
Status: Admin. Dissolved
Effective Date: 5/16/2011
Citizenship: DOMESTIC
State of Inc.: NC
Duration: PERPETUAL
Registered Agent
Agent Name: COTTRELL, GARALD B
Office Address: 1836 EASTCHESTER DR., SUITE 108
HIGH POINT NC 27265 •
Mailing Address: 1836 EASTCHESTER DR., SUITE 108
HIGH POINT NC 27265
Principal Office
Office Address: 1836 EASTCHESTER DR-, SUITE 108
HIGH POINT NC 27265
Mailing Address: 1836 EASTCHESTER DR., SUITE 108
HIGH POINT NC 27265
Officers/Company Officials
Title: MANAGER
Name: GARALD B. COTTRELL
Business Address: 1836 EASTCHESTER DR., SUITE 108
HIGH POINT NC 27265
This website is provided to the public as a part of the Secretary of State Knowledge Base(SOSKB) system. Version:
2648
http://www.secretary.state.nc.us/corporations/Corp.aspx?Pitemld=9753350 3/24/2014

Environmental Chemists, Inc.
envirochem 6602 Windmill Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
{ q''D' 710 Bowsertown Road,Manteo,NC 27954 • 252.473.5702 Lab/Fax
255-A Wilmington Highway,Jacksonville,NC 28590• 910.347.5893 Lab/Fax
ANALYTICAL&CONSULTING CHEMISTS [e-mail]
Inner Banks Engineering Date of Report: Jun 23, 2016
202 Camilla Road Customer PO#:
Washington NC 27889 Customer ID: 16030008
Attention: Report#: 2016-07805
Project ID: Wellons Energy-Wallace
•
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
16-18685 Site:.SW-1 6/13/2016 1:50 PM Water jay baker/envirochem
Test Method Results Date Analyzed
Residue Suspended(TSS) SM 2540 D 50.0 mg/L 06/14/2016
Temperature SM 2550 B 23.5 C 06/13/2016
pH SM 4500 H B 6.94 units 06/13/2016
Total Phosphorus SM 4500 P F 3.23 mg/L 06/19/2016
BOD SM 5210 B 7 mg/L 06/15/2016
COD SM5220D 136 mg/L 06/16/2016
Fecal Coliform sM9222DMF 2900 Colonies/100mL 06/13/2016
Total Nitrogen (Calc)
Total Kjeldahl Nitrogen (TKN) EPA 351.2 9.6 mg/L 06/19/2016
Nitrate+Nitrite-Nitrogen EPA 353.2 0.06 mg/L 06/15/2016
Total Nitrogen Total Nitrogen • 9.7 mg/L 06/23/2016
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
16-18686 Site:SW-2 6/13/2016 1:10 PM Water jay baker/envirochem
Test Method Results Date Analyzed
Residue Suspended (TSS) SM 2540 D 20.5 mg/L 06/14/2016
Temperature SM 2550 a 31.9 C 06/13/2016
pH SM 4500 H B 8.80 units 06/13/2016
Total Phosphorus SM 4500 P F 3.96 mg/L 06/19/2016
BOD SM 5210 B 26 mg/L 06/15/2016
COD SM 5220D 389 mg/L 06/16/2016
Fecal Coliform SM 9222D MF >60000 Colonies/100mL 06/13/2016
Total Nitrogen (Caic)
Total Kjeldahl Nitrogen (TKN) EPA 351.2 21.2 mg/L 06/19/2016
Nitrate+Nitrite-Nitrogen EPA 353.2 0.02 mg/L 06/15/2016
Total Nitrogen Total Nitrogen 21.2 mg/L 06/23/2016
Report 11:: 2015-07805 Page 1 of 3

Environmental Chemists, Inc.
envirochem 6602 Windrs tit i Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
1 1 I 710 Bowsct-town Road,Manteo,NC 27954 • 252.473.5702 Lab/Fax
255-A Wilmington I-lighway,Jacksonville,NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL&CONSULTING CHEMISTS info rr environmenialclremisls.eosn
Inner Banks Engineering Date of Report: Jun 23, 2016
202 Camilla Road Customer PO#:
Washington NC 27889 Customer ID: 16030008
Attention: Report#: 2016-07805
Project ID: Wetlons Energy-Wallace
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
16-18687 Site: SW-3 6/13/2016 1:20 PM Water jay baker/envirochem
Test Method Results Date Analyzed
Residue Suspended (TSS) SM 2540 0 32.5 mg/L 06/14/2016
Temperature SM 2550 B 33.1 C 06/13/2016
pH SM 4500 H B 8.96 units 06/13/2016
Total Phosphorus SM 4500 P F 4.52 mglL 06/19/2016
BOD SM 5210 B 34 mg/L 06/15/2016
COD SM 52200 417 mglL 06/16/2016
Fecal Coliform SM 92220 MF 352 Colonies/100mL 06/13/2016
Total Nitrogen(Cale)
Tota Kjeldahl Nitrogen (TKN) EPA 351.2 23.9 mg/L 06/19/2016
Nitrate+Nitrite-Nitrogen EPA 353,2 • 0.03 mg/L 06/15/2016
Total Nitrogen Tctal Nitrogen 239 mg/L 06/23/2016
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
16-18688 Site: SW-4 6/13/2016 1:35 PM Water jay baker/envirochem
Test Method Results Date Analyzed
Residue Suspended (TSS) SM25400 152 mg/L 06/14/2016
Temperature SM 2550 B 22.8 C 06/13/2016
pH SM 450D H B 7.71 units 06/13/2016
Total Phosphorus SM 4500 P F 10.4 mg/L 06/19/2016
BCD sM 5210 B 15 mg/L 06/15/2016
COD sM 5220D 324 mg/ 06/16/2016
Fecal Coliform SM 92220 MF 1180 Colonies/100mL 06/13/2016
Total Nitrogen (Cate)
Total Kjeldahl Nitrogen (TKN) EPA 351.2 37.9 mglL 06/19/2016
Nitrate+Nitrite-Nitrogen EPA 353.2 0.10 mg/L 06/15/2016
Total Nitrogen Total Nitrogen 38.0 mg/L 06/23/2016
Report#:: 2016-07805 Page 2 of 3

•
Environmental Chemists, Inc.
a Ii
envirochern 6602 Windmill Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
I 710 Bowsertown Road,Mantco,NC 27954 • 252.473.5702 i ab/Fax
255-A Wilmington Highway,Jacksonville,NC 28540• 910.347.5843 Lab/Fax
ANALYTICAL 8 CONSULTING CHEMISTS info ri nvironmenialehemists.conu
Inner Banks Engineering Date of Report: Jun 23, 2016
202 Camilla Road Customer PO#:
Washington NC 27889 Customer ID: 16030008
Attention: Report#: 2016-07805
Project ID: Wellons Energy-Wallace
Comment: }
Reviewed by: 1'uJJ t:02. 1 Ofi J
Report#: 2018-07805 Page 3 of 3

envirochem Way Wilmington,
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ENVIRONMENTAL CHEMISTS, I N C Windmill 32484OFFIE:91039-0223 FAX 910. - 4244
NCOENR:DWQ CERTIFICATION#94 NCfHHS:DLS CERTIFICATION#37729 [e-mail]
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PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Energy,Mineral Secretary
and Land Resources
ENVIRONMENTAL QUALITY
TRACY DAVIS
I)irccIor
May 31, 2016
NOTICE OF VIOLATIONS OF THE
SEDIMENTATION POLLUTION CONTROL ACT
AND
GENERAL PERMIT - NCG 010000
TO DISCHARGE STORMWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
FOR CONSTRUCTION ACTIVITIES
CERTIFIED MAIL #7013 2630 0002 0760 6618
RETURN RECEIPT REQUESTED
Wellons Energy Solutions, LLC
Robert Moore,Chief Financial Officer
312 South Front Street, Suite 6
New Bern,NC 28560-2134
CERTIFIED MAIL #7013 2630 0002 0760 6632
RETURN RECEIPT REQUESTED
Wellons Energy Solutions, LLC
2525 Firestone Lane
Vancouver WA 98660
RE: Project Name: Wellons Energy Solutions Mulch Processing Facility
Project ID: Duplin-2016-025
County: Duplin •
Compliance Deadlines: 10 days from receipt for SPCA violations
10 days from receipt by certified mail for
Construction Stormwater Permit NCG 010000
violations
Dear Sir or Madam:
On May 26,2016,personnel of this office inspected a project located on H C Powers Road,Wallace
in Duplin County,North Carolina. This inspection was performed to determine compliance with the
North Carolina Sedimentation Pollution Control Act (SPCA) of 1973 and General Permit - NCG
010000 to Discharge Stormwater Under The National Pollutant Discharge Elimination System for
Construction Activities(Construction Stormwater Permit NCG 010000). The inspection revealed a
land-disturbing activity of approximately 5.0 acres being conducted.
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
127 Cardinal Dr Extension Wilmington, NC 28405• Phone: [phone] • FAX: [phone]
Internet:http:Ilportal.ncdenr.orglwebllrl
An Equal Opportunity 1 Affirmative Action Employer—50% Recycled 110%Post Consumer Paper

Notice of Violations
Wellons Energy Solutions
May 31, 2016
Page 2 of 4
It is our understanding that you and/or your firm are responsible for this land-disturbing activity. The
purpose of this letter is to inform you that this activity was found to be in violation of the SPCA,
G.S. 113A-50 to 66, Title 15A, North Carolina Administrative Code (NCAC), Chapter 4 and
Construction Stormwater Permit NCG 010000. If you feel that you are not responsible for the
following violations, please notify this office immediately.
The violations of the SPCA that were found are:
1. Failure to file an erosion and sedimentation control plan with this office 30 or more days
prior to initiating any land-disturbing activity that will disturb more than one acre on a tract,
failure to secure this office's prior approval of the plan for any land-disturbing activity prior •
to beginning the land-disturbing activity. G.S. 1 I3A-54(d)(4), G.S. 113A-57(4) and 15A
NCAC 4B.0107(c). An erosion control plan has not been filed.
2. Failure to take all reasonable measures to protect all public and private property from damage
by such land-disturbing activities. 15A NCAC 4B .0105. No measures have been installed
to prevent offsite sedimentation.
The violations of the Construction Stormwater Permit NCG 010000 that were
found are:
I. Discharge of stormwater without a permit. Because the land-disturbing activity does not
have an approved erosion and sedimentation control plan it does not have coverage under the
Construction Stormwater Permit NCG 010000 and you are not permitted to discharge
stormwater. G.S. 143-215.1(a) and 15A N.C.A.C. 02H .0126 NCG 010000 has not been
issued for the site.
2. Failure to install and maintain BMPs and control measures,.NCG 010000 Section III. 4)
The permittee must select, install, implement and maintain best management practices
(BMPs) and control measures that minimize pollutants in the discharge to meet the
requirements of this permit. Measures have not been installed to minimize pollutants.
To correct these violations, you must:
1. Submit three (3) copies of an approvable sedimentation and erosion control plan and the
appropriate plan review fee to this office. Until the required plan has been approved, no land-
disturbing activity may be conducted, except that which is necessary to bring the site into
compliance. Until an erosion and sedimentation plan has been approved, any land-disturbing
activity, except that which is necessary to bring the site into compliance, will constitute
additional violations of the SPCA and G.S. 143-215.1(a) and 15A N.C.A.C. 02H .0126 .
Following our review of the plan within 30 days of receipt, this office will notify you that the

Notice of Violations
Wellons Energy Solutions
May 31, 2016
Page 3 of 4
plan has been approved,approved with modifications or disapproved. Following approval of the
plan, all land-disturbing activity on the site must be conducted in accordance with the terms of
the approved plan, the SPCA and the implementing rules and Construction Stormwater Permit
NCG 010000.
2. Install measures under the direction of an engineer to minimize pollution on the site. Measures
installed should be approvable by this office and included in the permit application.
SPCA Violations
The violations of the SPCA cited herein may be referred to the Director of the Division of Energy,
Mineral and Land Resources(Director)for appropriate enforcement action, including civil penalty
assessments for an initial one-day violation and/or a continuing violation. The penalty for an initial
one-day violation of the SPCA may be assessed in an amount not to exceed$5,000.00. The Division
of Energy, Mineral and Land Resources is not required to provide a time period for compliance
before assessing an initial penalty for the violations of the SPCA cited herein. Please be advised that
a civil penalty may be assessed for the initial day of violations of the SPCA regardless of whether the
violations are corrected within the time period set out below.
In addition, if the violations of the SPCA cited herein are not corrected within 10 calendar days of
receipt of this Notice,this office may request that the Director take appropriate legal action against
you for continuing violations pursuant to NCGS 1 13A-61.1 and 113A-64. A penalty may be
assessed from the date of the violation of the SPCA,pursuant to NCGS 113 A-64(a)(1),and for each
day of a continuing violation of the SPCA in an amount not to exceed $5,000.00 per day.
Construction Stormwater Permit NCG 010000 Violations
The violations of the Construction Stormwater Permit NCG 010000 cited herein may be referred to
the Director of the Division of Energy, Mineral and Land Resources (Director) for appropriate
enforcement action, including civil penalty assessments for a continuing violation, This Notice
serves as a letter of proposed civil penalty assessment. You have 10 calendar days from receipt of
this Notice by certified mail to cease the violations listed above, and to submit in writing reasons
why the civil penalty should not be assessed.
Accordingly,you are directed to respond to this letter in writing within 10 calendar days of receipt of
this Notice by certified mail_ Your response should be sent to this regional office at the letterhead
address and include the following:
1. The date by which the corrective actions listed above have been or will be completed.
2. Rainfall data and self-inspection or self-monitoring records from (date) to (date)

Notice of Violations
Wellons Energy Solutions
May 31, 2016
Page 4 of 4
3. A plan of action to prevent future violations.
4. A plan for restoration of sedimentation damage.
5. Reasons why a civil penalty should not be assessed.
Pursuant to G.S. 1 43-215.6A, these violations and any future violations are subject to a civil penalty
assessment of up to a maximum of$25,000.00 per day for each violation. Your above-mentioned
response to this correspondence, the degree and extent of harm to the environment and the duration
and gravity of the violation(s) will be considered in any civil penalty assessment process that may
occur.
Please be advised that any new land-disturbing activity associated with this project should not begin
until the area presently disturbed is brought into compliance with the SPCA and Construction
Stormwater Permit NCG 010000. When corrective actions are complete, you should notify this
office so that work can be inspected. You should not assume that the project is in compliance with
the SPCA and Construction Stormwater Permit NCG 010000 until we have notified you. After
installation,all erosion control measures must be maintained in proper working order until the site is
completely stabilized.
We solicit your cooperation,and would like to avoid taking further enforcement action. At the same
time, it is your responsibility to understand and comply with the requirements of the SPCA and
Construction Stormwater Permit NCG 010000. Copies of the relevant statute and administrative
rules may be examined at this office or will be sent to you upon request. Should you have questions
concerning this notice or the requirements of the SPCA and Construction Stormwater Permit NCG
010000 please contact either Brian Lambe or me at your earliest convenience.
Sincerely, •
Daniel Sams, PE
Regional Engineer
Land Quality Section
Enclosures: Sedimentation Inspection Report
Construction Stormwater Permit NCG 010000
Financial Responsibility Form
Erosion Control Plan Checklist
cc: State Sedimentation Specialist
Regional Water Quality Supervisor

r
: : PAT MCCRORY
a
;r' . Governor
��l;l� „ -�� DONALD R. VAN DER VAART
Energy,Mineral sccrelo
and Land Resources ry
ENVIRONMENTAL QUALITY
TRACY DAVIS
Drrecror
May 31, 2016
NOTICE OF VIOLATIONS OF THE
SEDIMENTATION POLLUTION CONTROL ACT
AND
GENERAL PERMIT - NCG 010000
TO DISCHARGE STORMWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
FOR CONSTRUCTION ACTIVITIES
CERTIFIED MAIL #7013 2630 0002 0760 6618
RETURN RECEIPT REQUESTED
Wellons Energy Solutions,LLC
Robert Moore,Chief Financial Officer
312 South Front Street, Suite 6
New Bern,NC 28560-2134
CERTIFIED MAIL#7013 2630 0002 0760 6632
RETURN RECEIPT REQUESTED
Wellons Energy Solutions, LLC
2525 Firestone Lane
Vancouver WA 98660
RE: Project Name: Wellons Energy Solutions Mulch Processing Facility
Project ID: Duplin-2016-025
County: Duplin
Compliance Deadlines: 10 days from receipt for SPCA violations
10 days from receipt by certified mail for
Construction Stormwater Permit NCG 010000
violations
Dear Sir or Madam:
On May 26,2016,personnel of this office inspected a project located on H C Powers Road,Wallace
in Duplin County,North Carolina. This inspection was performed to determine compliance with the
North Carolina Sedimentation Pollution Control Act (SPCA) of 1973 and General Permit -NCG
010000 to Discharge Stormwater Under The National Pollutant Discharge Elimination System for
Construction Activities(Construction Stormwater Permit NCG 010000).The inspection revealed a
land-disturbing activity of approximately 5.0 acres being conducted.
Division of Energy, Mineral, and Land Resources
Energy Section•Geological Survey Section• Land Quality Section
127 Cardinal Dr Extension Wilmington, NC 28405• Phone: [phone]• FAX: [phone]
Internet: http:llportal.ncdenr.orglwebllrl
An Equal Opportunity 1 Affirmative Action Employer—50%Recycled 110%Post Consumer Paper

Notice of Violations
Wellons Energy Solutions
May 31, 2016
Page 2 of 4
•
It is our understanding that you and/or your firm are responsible for this land-disturbing activity. The
purpose of this letter is to inform you that this activity was found to be in violation of the SPCA,
G.S. 113A-50 to 66, Title 15A, North Carolina Administrative Code (NCAC), Chapter 4 and
Construction Stormwater Permit NCG 010000. If you feel that you are not responsible for the
following violations, please notify this office immediately.
The violations of the SPCA that were found are:
1. Failure to file an erosion and sedimentation control plan with this office 30 or more days
prior to initiating any land-disturbing activity that will disturb more than one acre on a tract,
failure to secure this office's prior approval of the plan for any land-disturbing activity prior
to beginning the land-disturbing activity. G.S. 113A-54(d)(4), G.S. 113A-57(4) and 15A
NCAC 4B.0107(c). An erosion control plan has not been filed.
2. Failure to take all reasonable measures to protect all public and private property from damage
by such land-disturbing activities. 15A NCAC 4B .0105. No measures have been installed
to prevent offsite sedimentation.
The violations of the Construction Stormwater Permit NCG 010000 that were
found are:
I. Discharge of stormwater without a permit. Because the land-disturbing activity does not
have an approved erosion and sedimentation control plan it does not have coverage under the
Construction Stormwater Permit NCG 010000 and you are not permitted to discharge
stormwater. G.S. 143-215.1(a) and 15A N.C.A.C. 02H .0126 NCG 010000 has not been
issued for the site.
2. Failure to install and maintain BMPs and control measures, NCG 010000 Section III. 4)
The permittee must select, install, implement and maintain best management practices
(BMPs) and control measures that minimize pollutants in the discharge to meet the
requirements of this permit. Measures have not been installed to minimize pollutants.
To correct these violations, you must:
1. Submit three (3) copies of an approvable sedimentation and erosion control plan and the
appropriate plan review fee to this office. Until the required plan has been approved,no land-
disturbing activity may be conducted, except that which is necessary to bring the site into
compliance. Until an erosion and sedimentation plan has been approved, any land-disturbing
activity, except that which is necessary to bring the site into compliance, will constitute
additional violations of the SPCA and G.S. 143-215.1(a) and 15A N.C.A.C. 02H .0126 .
Following our review of the plan within 30 days of receipt, this office will notify you that the

Notice of Violations
Wellons Energy Solutions
May 31, 2016
Page 3 of 4
plan has been approved,approved with modifications or disapproved. Following approval of the
plan, all land-disturbing activity on the site must be conducted in accordance with the terms of
the approved plan, the SPCA and the implementing rules and Construction Stormwater Permit
NCG 010000.
2. Install measures under the direction of an engineer to minimize pollution on the site. Measures
installed should be approvable by this office and included in the permit application.
SPCA Violations
The violations of the SPCA cited herein may be referred to the Director of the Division of Energy,
Mineral and Land Resources (Director)for appropriate enforcement action,including civil penalty
assessments for an initial one-day violation and/or a continuing violation. The penalty for an initial
one-day violation of the SPCA may be assessed in an amount not to exceed$5,000.00. The Division
of Energy, Mineral and Land Resources is not required to provide a time period for compliance
before assessing an initial penalty for the violations of the SPCA cited herein. Please be advised that
a civil penalty may be assessed for the initial day of violations of the SPCA regardless of whether the
violations are corrected within the time period set out below.
In addition, if the violations of the SPCA cited herein are not corrected within l 0 calendar days of
receipt of this Notice,this office may request that the Director take appropriate legal action against
you for continuing violations pursuant to NCGS 113A-61.1 and 113A-64. A penalty may be
assessed from the date of the violation of the SPCA,pursuant to NCGS 113A-64(a)(1),and for each
day of a continuing violation of the SPCA in an amount not to exceed $5,000.00 per day.
Construction Stormwater Permit NCG 010000 Violations
The violations of the Construction Stormwater Permit NCG 010000 cited herein may be referred to
the Director of the Division of Energy, Mineral and Land Resources (Director) for appropriate
enforcement action, including civil penalty assessments for a continuing violation. This Notice
serves as a letter of proposed civil penalty assessment. You have 10 calendar days from receipt of
this Notice by certified mail to cease the violations listed above, and to submit in writing reasons
why the civil penalty should not be assessed.
Accordingly,you are directed to respond to this letter in writing within 10 calendar days of receipt of
this Notice by certified mail. Your response should be sent to this regional office at the letterhead
address and include the following:
1. The date by which the corrective actions listed above have been or will be completed.
2. Rainfall data and self-inspection or self-monitoring records from (date) to (date)

Notice of Violations
Wellons Energy Solutions
May 31, 2016
Page 4 of 4
3. A plan of action to prevent future violations.
4. A plan for restoration of sedimentation damage.
5. Reasons why a civil penalty should not be assessed.
Pursuant to G.S. 143-215.6A,these violations and any future violations are subject to a civil penalty
assessment of up to a maximum of$25,000.00 per day for each violation. Your above-mentioned
response to this correspondence,the degree and extent of harm to the environment and the duration
and gravity of the violation(s) will be considered in any civil penalty assessment process that may
occur.
Please be advised that any new land-disturbing activity associated with this project should not begin
until the area presently disturbed is brought into compliance with the SPCA and Construction
Stormwater Permit NCG 010000. When corrective actions are complete, you should notify this
office so that work can be inspected. You should not assume that the project is in compliance with
the SPCA and Construction Stormwater Permit NCG 010000 until we have notified you. After
installation,all erosion control measures must be maintained in proper working order until the site is
completely stabilized.
We solicit your cooperation,and would like to avoid taking further enforcement action. At the same
• time, it is your responsibility to understand and comply with the requirements of the SPCA and
Construction Stormwater Permit NCG 010000. Copies of the relevant statute and administrative
rules may be examined at this office or will be sent to you upon request. Should you have questions
concerning this notice or the requirements of the SPCA and Construction Stormwater Permit NCG
010000 please contact either Brian Lambe or me at your earliest convenience.
Sincerely,
Daniel Sams, PE
Regional Engineer
Land Quality Section
Enclosures: Sedimentation Inspection Report
Construction Stormwater Permit NCG 010000
Financial Responsibility Form
Erosion Control Plan Checklist
cc: State Sedimentation Specialist
Regional Water Quality Supervisor

.,x'10:T45g I„MEi 43.19N7 q.05TR Q110N SaT4RM,WATER I., SPE�TIQN _REPO:F7T_ ; �,�x.
North Carolina Department of Environmental Quality --
Land Quality Section: 127 Cardinal Dr Extension Wilmington, NC 28405, Phone: [phone]
COUNTY: Duplin PROJECT: WELLONS ENERGY SOLUTIONS MULCH PRORIVER BASIN: WHITE OAK
PERSON FINANCIALLY RESPONSIBLE: Mr. Robert Moore,Wellons Energy Solutions, PROJECT# DUPLI-2016-025
ADDRESS: 312 SOUTH FRONT ST NEWLRN NC 28560-2134 CASE#
1. PROJECT LOCATION: H C Powers Rd. Wallace NC
Pictures: YES Video: Digital: X
2. Weather and Soil Conditions: SOS CLEAR DRY First Inspection:NO
3. Is site currently under Notice of Violation? NO
4, Is the site in compliance with S.P.C.A. and rules? NO
5. Violations:
a. No Approved Plans-G.S. 113A-57 (4)and 15A N.C.A.0 413.0107 (c)and Discharge of stormwater without a permit,
G.S. 143-215.1(a) and 15A N.C.A.C. 02H .0126
f. Failure to take all reasonable measures- 15A N.C.A.C. 4B.0105
6. Is the site in compliance with NPDES Permit NCG 010000?: NO
r. Failure to have approved plan and NPDES Permit on site NCG 010000 Sec.III, 3(d) _
s. Failure to install and maintain BMPs and control measures NCG 010000 Section III. (4)
7. Has Sedimentation Damage occurred since last inpections? YES
Lake/natural watercourse on the tract: YES Lake/natural watercourse off the tract: YES Other Property: YES
Description:TWO DITCHES LEADING OFF SITE.
Degree of Damage: 1)SLIGHT
Stormwater Discharge Outfall with high turbidity or sedimentation loss:
8. Contact Made with (name): BILL GATES Title: SITE SUPER
Inspection Reports SENT TO PERSON FINANCIALLY RESPONSIBLE Date GivenlSent: MAY 31, 2016
9. Corrective Actions Needed:
Submit an adequate sedimentation and erosion control plan for approval, covering all areas disturbed or to be disturbed.
Take all reasonable measures to prevent sedimentation damage to adjacent property such as the following: install
measures to prevent offsite sedimentation, obtain approval for NPDES NCG21000 permit.
Submit an adequate sedimentation and erosion control plan for approval, covering all areas disturbed or to be disturbed.
Install erosion and sediment control devices sufficient to retain sediment on the tract.
10. COMMENTS: Submit an erosion control plan to this office. Refer to Notice of Violation. Please contact me if you have any
questions or to set up a compliance meeting.
brian.lambtAncdenr.gov.
•
Report By: Brian Lambe Others Present
Date of Inspection: MAY 26, 2016 Time Arriving on Site: 11:00 Time Leaving Site: 12:00
cc;
Revision Date 10/16/2015 Page 1 of 1 '

SEDIMENTATION/CONSTRUCTION STORMWATER INSPECTION REPORT
North Carolina Department of Environmental Quality
Land Quality Section: 127 Cardinal Dr Extension Wilmington, NC 28405, Phone: [phone]
COUNTY: Duplin PROJECT: WELLONS ENERGY SOLUTIONS MULCH PROIRIVER BASIN: WHITE OAK
PERSON FINANCIALLY RESPONSIBLE: �Mrr. Robert Moore,Wellons Energy Solutions, PROJECT# DUPLI-2016-025
ADDRESS: 312 SOUTH FRONT ST NEW-KRN NC 28560-2134 CASE#
1. PROJECT LOCATION: H C Powers Rd. Wallace NC
Pictures: YES Video: Digital: X
2. Weather and Soil Conditions: SOS CLEAR DRY First Inspection:NO
• 3. Is site currently under Notice of Violation? NO
4. Is the site in compliance with S.P.C.A. and rules? NO
5. Violations:
a. No Approved Plans - G.S. 113A-57 (4) and 15A N.C.A.0 4B.0107 ( c ) and Discharge of stormwater without a permit,
G.S. 143-215.1(a) and 15A N.C.A.C. 02H .0126
f. Failure to take all reasonable measures- 15A N.C.A.C. 4B.0105
6. Is the site in compliance with NPDES Permit NCG 010000?: NO
r. Failure to have approved plan and NPDES Permit on site NCG 010000 Sec.11l, 3(d)
s. Failure to install and maintain BMPs and control measures NCG 010000 Section III. (4)
7. Has Sedimentation Damage occurred since last inpections? YES
Lakelnatural watercourse on the tract: YES Lake/natural watercourse off the tract: YES Other Property: YES
Description:TWO DITCHES LEADING OFF SITE.
Degree of Damage: 1) SLIGHT
Stormwater Discharge Outfall with high turbidity or sedimentation loss:
8. Contact Made with (name): BILL GATES Title: SITE SUPER
Inspection Report: SENT TO PERSON FINANCIALLY RESPONSIBLE Date Given/Sent: MAY 31, 2016
9. Corrective Actions Needed:
Submit an adequate sedimentation and erosion control plan for approval, covering all areas disturbed or to be disturbed.
Take all reasonable measures to prevent sedimentation damage to adjacent property such as the following: install
measures to prevent offsite sedimentation, obtain approval for NPDES NCG21000 permit.
Submit an adequate sedimentation and erosion control plan for approval, covering all areas disturbed or to be disturbed.
Install erosion and sediment control devices sufficient to retain sediment on the tract.
10. COMMENTS: Submit an erosion control plan to this office. Refer to Notice of Violation. Please contact me if you have any
questions or to set up a compliance meeting.
[e-mail].
Report By: Brian Lambe Others Present:
Date of Inspection: MAY 26, 2016 Time Arriving on Site: 11:00 Time Leaving Site: 12:00
cc;
Revision Date 10/16/2015 Page 1 of 1

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Environmental Chemists, Inc.
•
envirochem 6602 Windmill Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax .
710 Bowsertown Load,Manteo,NC 27954 - 252.473,5702 Lab/Fax
® 255-A Wilmington Highway,Jacksonville,NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL&.CONSULTING CHEMISTS [e-mail]
Inner Banks Engineering Date of Report: Mar 21, 2016
202 Camilla Road Customer PO#:
Washington NC 27889 Customer ID: 1603000E
Attention: Report#: 2016-02980
Project ID: Wellons Energy-Wallace
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
16-07015 Site: Creek ig Rockfish 3/7/2016 1:40 PM Water jay baker/envirochem
Test Method Results Date Analyzed
Residue Suspended (TSS) SM 2540 D 3.7 mg/L 03/08/2016
Total Phosphorus SM 4500 P r 0.12 mg/L 03/17/2016
BOD SM 5210 E3 <2 mg/L 03/09/2016
COD SM5220D 37 mg/L 03/11/2016
Fecal Coliform SM 9222D MF 910 Colonies/100mL 03/07/2016
Total Nitrogen(Caic)
Total Kjeldahl Nitrogen (TKN) EPA351.2 1.1 mg/L 03/17/2016
Nitrate+Nitrite-Nitrogen EPA 353.2 <0.02 mg/L 03/09/2016
Total Nitrogen Total Nitrogen 1.1 mg/L 03/21/2016
Comment: to
Reviewed by: tall v� C41
Report f:: 2016.02080 Page 1 of 1

mington,N
28405
envrochem ENVIRONM=NTA . CH.:MISTS, INC OFFICE:9 01 1392-0223FAX910-3 2 24
Analytical&Consulting Chemists
NCDENR:DWQ CERTIFICATION#94 NCDHHS:DLS CERTIFICATION#37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY
CLIENT: �,,,R 1 Le fits .. PROJECT NAME: ta.6.1s 1"y-&hf!•.... REPORT NO: / -- 15Y0
ADDRESS: CONTACT NAME: PO NO:
REPORT TO: PHONE/FAX:
J COPY TO: email:
Sampled By: rJ.e&-- SAMPLE TYPE: I=Influent, E=_Effluent,W=Well, ST=Stream, SO Soil,SL=Sludge, Other:
Collection o PRESERVATION
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Sample Identification R a. �. n -14 c Q`.. 1 m4 to r� �1 "+ o o w ANALYSIS REQUESTED
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Delivered By: Received By: i 0 /C Af eD Date: ?. /G Time: . L 'r
Comments: TU N ROUND:

North Carolina Department of Environmental Quality
Pat McCrory Donald van der Vaart
Governor Secretary
October 22, 2015
CERTIFIED MAIL#7013 2630 0002 0760 5604
RETURN RECEIPT REQUESTED
Wellons Energy Solutions, LLC
Robert Moore, Chief Financial Officer
312 South Front Street, Suite 6.
New Bern, NC 28560-2134
CERTIIHEIID MAIL#7013 2630 0002 0760 6311
RETURN RECEIPT REQUESTED
Wellons Energy Solutions, LLC
2525 Firestone Lane
Vancouver WA 98660
Subject: Notice of Intent
NPDES Stormwater Permit Required
Wello;i s Energy Solutions Waste Area Duplin Conlity
Duplin County
Dear Mr. Moore:
It has come to the attention of the Division of Energy,Mineral, and Land Resources (DEMLR)
that the Wellons Energry Solutions business located on H C Powers Road in Duplin County does
not have the required NPDES Stormwater General Permit. General Permit NCG210000 is
applicable to all owners or operators of stormwater point source discharges associated with
establishments primarily engaged in timber products [standard industrial classification(sic)24]
and activities deemed by DEMLR to be similar in the process and/or the exposure of raw
materials,products, by-products, or waste materials. However, you may need an individual
permit if the material on site includes animal waste products.
Process for applying for a General Stormwater Permit:
You are required to apply for the.NPDES Permit by filling out and mailing a Notice of Intent
(NOI)form to the Stormwater Permitting Unit, Division of Energy,Mineral, and Land Resources
at 1617 Mail Service Center,Raleigh,NC 27699-1617. The general permit text is located on the
Division's website at http://portal.ncdenr.org/web/lr/npdes-stormwater. There is a$100.00 fee
required to make application for this permit.
You are directed to apply for the NPDES General.Stormwater Permit NCG210000 within 30
calendar days of receipt of this correspondence. Should you need assistance completing the
Division of Energy, Mineral, and Land Resources
Land Quality Section—Wilmington Regional Office
127 Cardinal Drive Extension, Wilmington, North Carolina 28405 e [phone] I Fax: [phone]
An Equal Opportunity\Affirmative Action Employer• 30% Post Consumer Paper o Internet:
httrriinnrtal nrrlanr nrn/wphllr1

October 22, 2015
Page 2 of 2 '
,
application, call Brian Lambe at 910-796-7314 or contact him at email address Brian.l..arnbe
@,ncdenr.gov. Attached are the notice of intent and a technical bulletin which provides
shouldu take de
information concerning the NPDES General.Permit NCG210000. Additionally,y
immediate steps to temporarily prevent untreated stormwater from leaving the site. Best
manangement practices should be installed under direction of an engineer.
Failure to apply for coverage under this NPDES Permit will constitute a violation of North •
Carolina General Statute 143-215.1(a), which states, no person shall make any outlets into the
waters of the State without receiving a permit from the Commission and has complied with all
conditions set forth in the permit. Thank you for your attention to this matter. ti
Sincerely,
P
11-3-1-
Daniel Sams, PE
Wilmington Regional Supervisor
Encl: NOI,Technical Bulletin
cc: DEMLR WiRO
DEMLR Central Files
r
U.S. Postal Service,~, 1 U.S. Postal Service,.
CERTIFIED MAIL. RECEIPT CERTIFIED MAIL. RECEIPT
(Domestic Mall Only;No insurance Coverage Provided) r i (Domestic Mail Only;No insurance Coverage Provided)
0 For delivery Information visa our webslte at www,usps.Com®
J] For delivery Iniormallon visit our webslte at vrww.uaps.come
`lcl • FFOCIIAL USE USE
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(Endorsement Required) Hero Q Restricted Delivery Fee
Delivery Foe L (Endorsement Required)
(Endorsemdorsemen!Required) rn - -
- Total Postage&Foe4
• th Total Postage&Fees Wellons Energy Solutions, LLC.
Wellons Energy Solutions, LLC. Sent To 2525 Firestone Lane
;'Sent To
r Streer•Apt.No.; Robert Moore © o" et Apt Vancouver, WA 98660
312 South Front St.. Suite 6 1
•
or PO Box No. City Sfats ZPP+a
f a`City,State,ZIP.. New Bern, NC 28560-2134 i
PS Form 3800,A
PS Form 3800, •
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SENDER COMPLETE THISFSECTION ` ' + COMPLETE[[� HISu'SECTION ON■DELIVERY tr•
")...•t� <.+. .4..7!i�; k...,Y W. - 'i.•..e '� f.�...r.__..n il..,.iti. Fr . � Y.Y: nr'rr�l1 .4 t.r.�=.3ku1./..�_i.)1:,? ...I 4/•• 5..'k
tN Complete items 1,2,and 3.Also complete A. i9'• ��
item 4 if Restricted Delivery Is desired. // I��,(�❑Agent
m Print your name and address on the reverse X had
I. At / / &L '�3"Addressee
so that we can return the card to you. '--lye. by(Printed fame) C. Date of Delivery
M Attach this card to the back of the mailpiece, •. 1 •
or on the front If space permits. �. �� £•
D. is delivery address different from Item 1? 0 Yes
1. Article Addressed to: If YES,enter delivery address below: 0 No
Wellons Energy Solutions, LLC.
Robert Moore
312 South Front St., Suite 6 •
"Jew Bern, NC 28560-2134 3. Service Type
0 Certified Mail° 0 Priority Mail Express"
❑Registered 0 Return Receipt for Merchandise
❑Insured Mail 0 Collect on Delivery
4. Restricted Delivery?(Extra Fee) 0 Yes
2. Article Number --
(Punster from service label) 7E 13 2630 0002 0760 5604
PS Form 3811,July 2013 Domestic Return Receipt

UNITED STATES eRzt,4pt1 C -' First-Class Mail
Postage&Fees Paid
•047: � USF'S
Permit No.G-10
• Sender: PIe Se print your name, address, and ZlP+4®in this box*
NCDEQ/WiRO --
Land Quality Section •
127 Cardinal Drive Extension •
Wilmington, NC 28405-3845
•
_ I
OSS4062 f pill,II jl"rl111ii1•Iti#l3ll„Iii"lipuiiulltiuhttilhII'1'
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SENDER 'COMPLETE THIS SECTION c L COMPLETE THIS SECTION ON DELIVERY i `
:a+ �s,V 4 i ,c �.,a ° .x 1. i f•,¢� ..t L .>.,..A... c4t`$_rn i
Complete items 1,2,and 3.Also complete A. S nature 1p
.item 4 if Restricted Delivery is desired. X UAgent
D Print your name and address on the reverse • U 0 Addressee
so that we can return the card to you. B. Received I4y(Pr! ma C. Dat•of p=five
U Attach this card to the back of the ,mail lece l
•or on the front if space permits. p ■ \�1 � "��
D. Is delivery address different from item O v s
1. Article Addressed to: If YES,enter delivery address below: ❑ No
Wellons Energy Solutions. LLC.
2525 Firestone Lane
Vancouver, WA 98660
3. Service Type
' ❑Certified Mar ❑ Priority Mall Express-
: ❑Registered 0 Return Receipt for Merchandise
❑ Insured Mail 0 Collect on Delivery
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7013 263fl fl0fl2 fl760 6311
(Transfer from service label)
PS Form 3811,July 2013 Domestic Return Receipt

•
UNITED STATES POSTAL SERVICE
First-Class Mail
Postage 8,Fees Paid
uSPS •
Permit No.G-10 j
• Sender: Please print your name, address, and ZIP+4®in this box*
NCDEQ/WiRO
Land Quality Section
127 Cardinal Drive Extension
Wilmington, NC 28405-3845

North Carolina Department of Environmental Quality
Pat McCrory Donald van der Vaart
Governor Secretary
October 22, 2015
CERTIFIED MAIL #7013 2630 0002 0760 5604
RETURN RECEIPT REQUESTED
Wellons Energy Solutions, LLC
Robert Moore, Chief Financial Officer
312 South Front Street, Suite 6.
New Bern, NC 28560-2134
CERTIFIED MAIL #7013 2630 0002 0760 6311
RETURN RECEIPT REQUESTED
Wellons Energy Solutions, LLC
2525 Firestone Lane
Vancouver WA 98660
Subject: Notice of Intent
NPDES Stormwater Permit Required
Wellons Energy Solutions Waste Area Duplin County
Duplin County
Dear Mr. Moore:
It has come to the attention of the Division of Energy, Mineral, and Land Resources (DEMLR)
that the Wellons Energry Solutions business located on H C Powers Road in Duplin County does
not have the required NPDES Stormwater General Permit. General Permit NCG210000 is
applicable to all owners or operators of stormwater point source discharges associated with
establishments primarily engaged in timber products [standard industrial classification (sic) 24]
and activities deemed by DEMLR to be similar in the process and/or the exposure of raw
materials, products, by-products, or waste materials. However, you may need an individual
permit if the material on site includes animal waste products.
Process for applying for a General Stormwater Permit:
You are required to apply for the NPDES Permit by filling out and mailing a Notice of Intent
(NOI) form to the Stormwater Permitting Unit, Division of Energy, Mineral, and Land Resources
at 1617 Mail Service Center, Raleigh,NC 27699-1617. The general permit text is located on the
Division's website at http://portal.ncdenr.org/web/lr/npdes-stonmwater. There is a $100.00 fee
required to make application for this permit.
You are directed to apply for the NPDES General Stormwater Permit NCG210000 within 30
calendar days of receipt of this correspondence. Should you need assistance completing the
Division of Energy, Mineral, and Land Resources
Land Quality Section —Wilmington Regional Office
127 Cardinal Drive Extension, Wilmington, North Carolina 28405 • (910) 796-72151 Fax: [phone]
An Equal Opportunity\Affirmative Action Employer• 30% Post Consumer Paper• Internet:
httn•//nrnhal nrricnr nrnlwahllrl

Wellons Energy Solutions
October 22, 2015
Page 2 of 2
application, call Brian Lambe at 910-796-7314 or contact him at email address Brian.Lambe
ncdenr.gov. Attached are the notice of intent and a technical bulletin which provides
information concerning the NPDES General Permit NCG210000. Additionally, you should take
immediate steps to temporarily prevent untreated stormwater from leaving the site. Best
manangement practices should be installed under direction of an engineer.
Failure to apply for coverage under this NPDES Permit will constitute a violation of North
Carolina General Statute 143-215.1(a), which states, no person shall make any outlets into the
waters of the State without receiving a permit from the Commission and has complied with all
conditions set forth in the permit. Thank you for your attention to this matter.
Sincerely,
Daniel Sams, PE
Wilmington Regional Supervisor
Encl: NOI, Technical Bulletin
cc: DEMLR WiRO
DEMLR Central Files

Division of Energy,Mineral and Land Resources FOR AGENCY USE ONLY
Stormwater PermittingProgram Date R "`d
Age
� � � Year Month Oav
� National Pollutant Discharge Elimination System Certificate o1Covera eNICIG[2 11 I [ I [
NCDENR _ Check Amount
tiOnTh(:Nnpuxw DONATKNT OF NCG210000
HxNRpxmCier N+p Ng1.F.R[sw!Cr!
Permit Assigned to
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG210000:
For STORMWATER DISCHARGES associated with activities classified as:
SIC 24 Timber Products(except as specified below), including Wood Chip Mills;
And, Like activities deemed by DEMLR to be similar in the process and/or the exposure of raw
materials, products, by-products, or waste materials.
The following activities are specifically excluded from coverage under this General Permit:
• Wood Kitchen Cabinets(SIC 2434) •
• Wood Preserving (SIC 2491)
• Logging (SIC 2411)
'Standard industrial Classification Coda
(Please print or type)
1) Mailing address of owner/operator(address to which official permit correspondence will be mailed):
Name Wellons Engergy Solutions
Owner Contact(a person)Gerald Cottrell
Street Address 312 S. Front Street, Suite 6
City New Bern State NC ZIP Code 28560-2134
Telephone No. 336-339-9055 Fax:
E-mail Address [e-mail]
2) Location of facility producing discharge:
Facility Name Wellons Energy Solutions Poult Material Screening Yard Duplin Co
Facility Contact (a person)Gerald Cottrell
Street Address 312 S. Front Street, Suite 6
City New Bern State NC ZIP Code 28560-2134 •
County Duplin
Telephone No. 336-339-9055 Fax:
3) Permit Contact
Permit Contact(a person)Marie Peedin, PE, Inner Banks Engineering, PC
Contact E-mail [e-mail]
Contact phone number252-945-2983
4) 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). Site is located along H C Powers Road approximately
1.73 miles west from the intersection of NC 41 and HC Powers Road
(A copy of a county map or USGS quad sheet with facility clearly located on the map Is required 10 be submitted with this application)
Page 1 of 4
SVW-236-060113 Last revised 712114

•
NCG21 0000 N.O.I.
5) Latitude 34 43'39" Longitude 78 02'47" (degrees, minutes,
seconds)
6) This NPDES Permit Application applies to which of the following :
0 New or Proposed Facility Date operation is to begin
X Existing
7) Standard Industrial Classification (SIC):
Provide the 4 digit Standard Industrial Classification Code (SIC Code)that describes the primary industrial
activity at this facility
SIC Code: 0 024
8) Provide a brief narrative description of the types of Industrial activities and products manufactured at
this facility:Turkey poult bedding material has been approved by EPA as a viable solid fuel for boiler
operations. Prior to use as a fuel source the material is screened and the wood chips then are hauled off to
be used for fuel_ The screenings are stock piled in a separate area and sold as fertilizer material. The
operation shows a recovery rate of 93%of Poult Bedding Material is being used as fuel with only 7%
remaining onsite for disposal.
9) Discharge points/Receiving waters:
How many discharge points(ditches, pipes, channels, etc.)convey stormwater from the property?2
10) Receiving waters:
What is the name of the body or bodies of water(creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Doctors Creek
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).
11) Does this facility have any other water quality permits?
X No
0 Yes
If yes, list the permit numbers for all current water quality permits for this facility:
12) Does this facility have any Non-Discharge permits(ex: recycle permits)?
X No
❑ Yes
If yes, list the permit numbers for ail current Non-Discharge permits for this facility:
13) Does this facility employ any best management practices for stormwater control?
X No
0 Yes
if yes, please briefly describe:
14) Does this facility have a Stormwater Pollution Prevention Plan?
X No
Page 2 of 4
SWJ-236.080113 Last revised 712114

NCG210000 N.O.I.
❑ Yes
If yes,when was it implemented?
.15) Does this facility have exposed accumulations of sawdust, bark,mulch,wood chips,or similar size
woody material on-site for longer than seven (7)days? (Exposed directly to rainfall or to run-on from
other areas of the facility.)
❑ No X Yes
16) Are vehicle maintenance activities occurring at this facility?
X No ❑ Yes
17) 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) 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/disposal vendor:
Vendor address:
18) Certification:
North Carolina General Statute 143-215.6 b(I) provides that:
Any person who knowingly makes any false statement,representation,or certification in arty 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
'Environmental Management'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 l 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.
Page 3 of 4
SWU-236-000113 Last revised 7/2114

NCG210000 N.O.I. •
Printed Name of Person g: Gerald Cottrell
Title: Presi t
J z/z Z//
(Si Applicant) (Date Signed)
Notice of Intent must be accompanied by a check or money order for$100.00 made payable to:
NCDENR
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for$100 made payable to NC DENR
❑ This completed application and all supporting documents
❑ Copy of county map or USGS quad sheet with location of facility clearly marked on map
Mail the entire package to:
Stormwater Permitting 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 the issuance of an NPDES permit.
For questions,please contact the DEMLR Central Office or Regional Office for your area.
To visit our website, go to http://portal.ncdenr.org/web/ir/stormwater
DEMLR Regional Office Contact Information: t r
Asheville Office [phone] � i °I�1 ' ,
Fayetteville Office [phone] 4k
Mooresville Office [phone] ,g• ,r� `
Raleigh Office [phone] til' -to } of°; n•-
Washington Office ...(252) 946-64$1 44 oor• N2 �
Wilmington Office .., [phone] rs --� �✓
Winston-Salem [phone] • en, Ire .- -d
Central Office ... [phone]
neton
Page 4 of 4
SWU-236.080113 last revised 7r2114

4
AlCidlifA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM Pat McCrory, Governor
Director John E. Skvaria, Ill, Secretary
March 20, 2014
CERTIFIED MAIL 7013 2630 0002 0760 5253
RETURN RECEIPT REQUESTED
W.E. Partners V, LLC
Gerald Cottrell
104 Mellen Road
New Bern, NC 28562
Dear Mr. Cottrell:
A review of our records show that your facility known as W.E. Partners House of Raeford
Rose Hill on N. NC Hwy 117, Rose Hill, North Carolina is operating without a National
Pollutant Discharge Elimination System permit. Coverage for steam electric power as
defined by 40 CFR 122.26(b)(14)(vii) will require an individual permit. More information can be
found on the Division's website at: http://portal.ncdenr.orq/web/Ir/npdes-stormwater.
You will need to contact NC Division of Water Resources to inquire about the boiler blowdown
being separately discharged that may need a NCG500000 wastewater permit.
I have enclosed application forms for your convenience. Please note these forms should
be submitted to the North Carolina NPDES program central office attention to Bradley Bennett.
Should you have any questions concerning the application form, please do not hesitate to
contact me at 910-796-7314 or brian.lambe©ncdenr.gov. You are required to apply for this
permit within 30 days of receiving this correspondence. I thank you for your cooperation with
this matter.
Sincerely,
ri Lambe
Land Quality Section
Wilmington Regional Office
End: NOI, inspection
cc:
Wilmington Regional Office
127 Cardinal Drive Extension,Wilmington,North Carolina 28405 Phone:[phone]/Fax[phone]

•
or
Site Inspection Report
Site Number: WT001818
Site Name: W.E. Partners House of Raeford Rose Hill
Site Address: 104 Mellen Rd
County: Duplin Region: Wilmington
Directions:
Latitude: Longitude:
Site Owner Name: Cottrell, Garald
Inspection Date: 03/20/14
Reason for Inspection: Complaint
. Inspection Type: Site Inspection (non-DOT)
Inspection Contact Person: Phone:
On-Site Representative(s):
Primary Inspector: Brian P Lambe/..- t
/ Phone:
Secondary Inspector{s): f'
Facility compliance Status: n Compliant II Not Compliant
Program Area: NPDES SW- Industrial
Question Areas:
® Failure to Secure NPDES SW Permit
Inspection Summary:
Met with site operator. Asked him if he had a NPDES permit for the site,which he did not know. Site is a wood chip boiler, steam
generator, House of Raeford leases property to W.E. Partners IV, LLC and purchases power back. W.E. Partners IV, LLC is
dissolved, W.E. Partners LLC and W.E. Partners V, LLC are active entities.
Wood chip mulch is delivered to the site,often with animal litter mixed in and henceforth separated. Wood chips are burnt to heat
boiler. Stormwater discharges come from mulch stockpiles. Boiler is in a building. A pipe discharging from the boiler house into the
ditch was found.
Failure to Secure NPDES SW Permit Yes No NA NE
Does the site have a NPDES Industrial Stormwater Permit? OMOD
Comment: No permit for site.
Page: 1

Site Inspection Report
Site Number: WT001818
Site Name: W.E. Partners House of Raeford Rose Hill
Site Address: 104 Mellen Rd
County: Duplin Region: Wilmington
Directions:
Latitude: Longitude:
Site Owner Name: Cottrell, Gerald
Inspection Date: 03/20/14
Reason for Inspection: Complaint
Inspection Type: Site Inspection (non-DOT)
Inspection Contact Person: Phone:
On-Site Representative(s):
Primary Inspector: Brian P Lamb- Phone:
Secondary Inspector(s):
Facility compliance Status: n Compliant 111 Not Compliant
Program Area: NPDES SW- Industrial
Question Areas:
Failure to Secure NPDES SW Permit
Inspection Summary:
Met with site operator. Asked him if he had a NPDES permit for the site,which he did not know. Site is a wood chip boiler,steam
generator. House of Raeford leases property to W.E. Partners IV, LLC and purchases power back, W.E. Partners IV, LLC is
dissolved. W.E. Partners LLC and W.E. Partners V, LLC are active entities.
Wood chip mulch is delivered to the site,often with animal litter mixed in and henceforth separated. Wood chips are burnt to heat
boiler. Stormwater discharges come from mulch stockpiles. Boiler is in a building. A pipe discharging from the boiler house into the
ditch was found.
Failure to Secure NPDES SW Permit Yes No NA NE
Does the site have a NPDES Industrial Stormwater Permit? Q • Q ❑
Comment: No permit for site.
Page: 1

VVeUona Energy Solutions PoubYerd
S1onnvvater Monitoring Site Map
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Environmental Chemists, Inc.
envirochem 6602 Windmill Way,Wilmington,NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
{ 710 Bowsertown Road,Manteo,NC 27954 • 252.473.5702 Lab/Fax
255-A Wilmington Highway,Jacksonville,NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL&CONSULTING CHEMISTS [e-mail]
Inner Banks Engineering Date of Report: Mar21, 2016
202 Camilla Road Customer PO#:
Washington NC 27889 Customer ID: 16030008
Attention: Report#: 2016-02980
Project ID: Wellons Energy-Wallace
Lab ID Sample ID: Collect Date!Time Matrix Sampled by
16-07015 Site: Creek Rockfish 3/7/2016 1:40 PM Water jay baker/envirochem
Test Method Results Date Analyzed
Residue Suspended (TSS) 5M 2540 D 3.7 mg/L 03/08/2016
Total Phosphorus SM 4500 P F 0.12 mglL 03/17/2016
BOO SM 5210 S <2 mg/L 03/09/2016
COD SM5220D 37rng/L 03/11/2016
Fecal Coliform sM 9222D MF 910 Colonies/100mL 03/07/2016
Total Nitrogen(Calc)
Total Kjeldahl Nitrogen (TKN) EPA351.2 1.1 mg/L 03/17/2016
Nitrate+Nitrite-Nitrogen EPA 353.2 < 0.02 mg/L 03/09/2016
Total Nitrogen Total Nitrogen 1.1 mg/L 03/21/2016
Comment: -- _
Reviewed by:
•
Report#:: 2016.02980 Page 1 of 1

•
6602 Windmill Way Wilmington,NC 28405
envirochern ENVIRONMENTAL CHEMISTS, INC OFRCE:910'39 2-0223 FAX [phone]
Analytical&Consulting ChemistsNCDENR:DWQ CERTIFICATION#94 NCDHHS:DLS CERTIFICATION#37729 [e-mail]
COLLECTION AND CHAIN OF CUSTODY
CLIENT: ,,, ,,,,,,U 1Lh IA/5.. PROJECT NAME: a t s Z....13r.4.kftt., REPORT NO: /G ► 2-V a
ADDRESS: CONTACT NAME: PO NO:
REPORT TO: PHONE/FAX:
COPY TO: email:
J
Sampled By: ..4 — SAMPLE TYPE_: I=Influent, E=Effluent,W=Well,ST=Stream, SO=Soil,SL=Sludge, Other:
Collection 1 yr� W PRESERVATION
Sample Identification E F a `n ca o o o f ram , y "� z o ANALYSIS REQUESTED
m�a a Time Temp _ " Q u =z 'z z O
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Transfer Relinquished By: Date/Time Received By: Date/Time
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Delivered By: Received By: �, , 1 Al �i_A . ! Date: �. le Time: L
Comments: TU N ROUND:

Permit No. NCG210000
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG210000
TO DISCHARGE STORMWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
For establishments primarily engaged in manufacturing:
Lumber and Wood Products
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,this permit is hereby issued to all owners or
operators,hereinafter permittees,which are covered by this permit as evidenced by receipt of a Certificate
of Coverage by the Environmental Management Commission to allow the discharge of stormwater to the
surface waters of North Carolina or to a separate storm sewer system conveying discharges to surface
waters in accordance with the terms and conditions set forth herein.
•
Coverage under this General Permit is applicable to:
• All owners or operators of stormwater point source discharges associated with establishments
primarily engaged in activities classified as Lumber and Wood Products, Except Furniture [Standard
• Industrial Classification (SIC) 24], including Wood Chip Mills;
• Stormwater point source discharges from like industrial activities deemed by The Division of Water
Quality(DWQ) to be similar to these operations in the process,or the discharges,or the exposure of
raw materials, intermediate products,by-products,products,or waste products.
Except upon DWQ determination of similarity as provided immediately above,the following
activities and associated discharges are excluded from coverage under this General Permit:
• Establishments primarily engaged in: Logging [SIC 2411]; or manufacturing Wood Kitchen Cabinets
[SIC 2434]; or Wood Preserving [SIC 2491].
The General Permit shall become effective on August 1, 2013.
The General Permit shall expire at midnight on July 31, 2018.
Signed this day July 31, 2013.
Original signed by Matt Matthews
for Thomas A. Reeder, Acting Director
Division of Water Quality
By the Authority of the Environmental Management Commission

Permit No. NCG210000
Table 2 Monitoring Schedule
Monitoring Sample Start End
Year 1 - Period 1 1 August 1, 2013 December 31, 2013
Year 1- Period 2 2 January 1, 2014 June 30, 2014
Year 2 - Period 1 3 July 1, 2014 December 31, 2014
Year 2- Period 2 4 January 1, 2015 June 30, 2015
Year 3 - Period 1 5 July 1, 2015 December 31, 2015
Year 3 - Period 2 6 January 1, 2016 June 30, 2016
Year 4 - Period 1 7 July 1, 2016 December 31, 2016
Year 4 - Period 2 8 January 1, 2017 June 30, 2017
Year 5 -Period 1 9 July 1, 2017 December 31, 2017
Year 5 - Period 2 10 January 1, 2018 July 31, 2018
Footnotes:
1 Maintain semi-annual monitoring and reporting during permit renewal process unless other
provisions of this permit prompt monthly sampling.
2 If no discharge occurs during the sampling period,the permittee must submit a monitoring report
indicating"No Flow"or"No Discharge"within 30 days of the end of the sampling period.
The permittee must report the results from each sample taken within the monitoring period (See Part
III E). However, for purposes of benchmark comparison and Tiered response actions,the permittee
shall use the analytical results from the first sample with valid results within the monitoring period..
The permittee shall compare monitoring results to the benchmark values in Table 3. The benchmark
values in Table 3 are not permit limits,but should be used as guidelines for implementation of the
permittee's SPPP. Exceedances of benchmark values require the permittee to increase monitoring and
reporting,increase management actions, increase record keeping, and/or install stormwater Best
Management Practices (BMPs) in a tiered program. See descriptions of Tier One,Tier Two,and Tier
Three response actions below. In the event that the Division releases the permittee from continued
monthly monitoring and reporting under Tier Two or Tier Three,DWQ's release letter may remain in
effect through subsequent reissuance of this permit, unless the release letter provides for other
conditions or duration.
Table 3 Benchmark Values for Analytical Monitoring Requirements
Discharge Characteristics Benchmark Value
Chemical Oxygen Demand 120 mg/L
Total Suspended Solids 100 mg/L
Total Suspended Solids (HQW, ORW,Trout(Tr), and PNA waters) 50 mg/L
Part II Page 6of10

Permit No. NCG210000
Qualitative Monitoring Response,below. A written record of the permittee's investigation,evaluation,
and response actions shall be kept in the SPPP.
Qualitative Monitoring Response
Qualitative monitoring is for the purposes of evaluating SPPP effectiveness,assessing new sources of
stormwater pollution,and prompting the permittee's response to pollution. If the permittee
repeatedly fails to respond effectively to correct problems identified by qualitative monitoring,or if
the discharge causes or contributes to a water quality standard violation,DWQ may but is not
limited to:
• require that the permittee revise, increase,or decrease monitoring frequency for some or
all parameters (analytical or qualitative);
• require the permittee to install structural stormwater controls;
• require the permittee to implement other stormwater control measures;
• require the permittee to perform upstream and downstream monitoring to characterize
impacts on receiving waters; or
• require the permittee implement site modifications to qualify for a No Exposure Exclusion.
SECTION D: ON-SITE VEHICLE MAINTENANCE MONITORING REQUIREMENTS
Facilities that have any vehicle maintenance activity occurring on-site which uses more than 55
gallons of new motor oil and hydraulic oil per month,combined,when averaged over the
calendar year shall perform analytical monitoring as specified below in Table 5. All analytical
monitoring shall be performed during a measureable storm event at all stormwater discharge
outfalls (SDOs) that discharge storm water runoff from vehicle maintenance areas.
Table 5 Analytical Monitoring Requirements for On-Site Vehicle Maintenance
Discharge Characteristics Units Measurement Sample Sample
Frequency) Type2 Location3
Non-Polar Oil & Grease by
mg/L semi-annual Grab SDO
EPA Method 1664 (SGT-HEM)
Total Suspended Solids (TSS) mg/L semi-annual Grab SDO
Total Rainfall4 inches semi-annual Rain gauge New Motor Oil Usage gallons/month semi-annual Estimate -
Footnotes:
1 Measurement Frequency: Twice per year(unless other provisions of this permit prompt monthly
sampling) during a measureable storm event,until either another permit is issued for this,facility or
until this permit is revoked or rescinded. If the facility is monitoring monthly because of Tier Two or
Three response actions under the previous General Permit,the facility should continue a monthly
monitoring and reporting schedule.
2 Grab samples shall be collected within the first 30 minutes of discharge.
Part II Page 9 of 10

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, Please print Or type in-the unshaded areas only
ttill—if?areas are spaced for elite type, i.e.. 12characrers/inchl. Form Approved. OMB No. 20 0 0086.
FORM U.S. ENVIRONMENTAL PROTECTION AGENCY : ' 1. EPA I.D.NUMBER
1 ��.EPA GENERALINFORMATION „A
Consolidated Permits Program F D;
GENERAL (Read the"General Instructions"before darting.} I r • - .. I3 1 IA ,s
LAB L IYalS 1\ N �y , GENERAL INSTRUCT10 N$ • ..•`
EFA !,O NUMB• ER\ \ \\\\\\\ 1! a preprinted,label-has been provided, affix'
I.`\\ \ \ \ \ it in the designated space. Review the inform
ti anon carefully; if any of it is incorrect, cross'
•
\1N. FACILITY NAME ` through it and enter the correct data in the: •
\ \ \\\ \ �\ appropriate fill-in aria'below, Also, if any of•
\ \-: • .the preprinted data is absent (the area to the
FA\LITY left of the label space lists The information
' V' MAILING ADDRESS I \\ ." PLEASE PLACE•LABEL IN THIS SPACE i! t % !
-8.which;
\� I ♦ must be completed.regardless). Complete. ail i
'VI. FACILITY .` items if no label has,been provided. Refer to;
• LOCATION the instructions..•for•detailed :item. descrip--
' :tions and for-the legal,authorizations,under
•
.. -which this data Is collected
II.POLLUTANT CHARACTERISTICS' °
INSTRUCTIONS: Complete A through J to determine.whether-you need to submit any permit application forms to the EPA:If you answer"yes"to any „'-
questions, you must submit this form and the supplemental form listed in the parenthesis following the question:Mark"Xr'in the box in the third column
if the supplemental form is attached, If you answer "no":to each_question,you need not submit any of these corms.Youimay answer"no"if your activity , ".
is excluded from permit requirements;see Section C of the instructions.See also,Section 0 of the instructions for definitions`of bold-faced terms.•
SPECIFIC QUESTIONS A.Ft,K earn MAR,i so'Rr
• TLf Na. ATTA=..co1 • • ...;SPECIFIC QUESTIONS •'.y',.;,:: Yrs No -
• ATTICM6p
A. 'Is this facility a publicly owned treatment.works B. Does or.will this facility (either existing or proposed!
which results in a discharge to waters of the U.S.? .'include:,''concentrated animal feeding operationRor'.
;FORM 2A1 • .;aquatic aniline( production facility which results in`e '
• . - ,. a ^discharge to waters of the U.S.?(FORM 28) ,` . „ 3. I ,I
C. Is this a facility which currently results in.discharges D. Is this a proposed facility (other than those described
to waters of the U.S. other than those described in in A or B-above( which will result in''a.discharge to
A or B above? (FORM 2C1 rr :, r• waters of the U.S.?(FORM 2D) . ..� .. ,.'"
E. Does or mil this facility treat, store, or dispose of F. Do you of will.you inject at this facility industrial o
r.
municipal effluent below the lowermost stratum''con-
hazardous wastes? (FORM 31 •• taining, within One quarter mile of the well bore,'
• .. :. •". . ,e underground,sources of drinking water?(FORM 41
G. Do you or will you inject at tFis facility any produced
water or other fluids which are brought to the surface H. Do you or-Will.you inject at this facility'fluids forspe
in connection with conventional oil or'natural gas pro,' 'cial processes such es•mining of sulfur by•:the'Frasch
duction, inject fluids used for enhanced recovery of. process'solution•miniing`of minerafs,•?in_srtu cor bus '1
tian`of fossil fuel or recovery of geothermal energy?..
oil or natural gas;or inject fluids for'storage a!ligwd, ''(FORM 4}✓ ' .1 ch ', `.; Iti t,', i u,.
hydrocarbons. (FORM 41 sa 3, • 31 :. .:1: v r. .,, 3• 311: r..
I. Is this facility a proposed stationary.source which,is' • J. Is this-facility°a proposed stationary source;which is1'
-`one of the 28 industrial categories/listed in.the'ryn• NOT,tona of the.28 industrial categories listed in then
structions and which:.will potentially,emit?100 tons instructions and which-wtll;potentially.emit 250itons't.
' iper .year-ofy.any .air,' pollutant 'regulated underrthe t per,year of,anyafr,pollutant',regulatedunder-the',Cliinl
Clean''Air-Act and 'rria affect Or be located n an y .;,rK ti ,s `Air;`Rct and;inay affect or be,Iocated I�;anattammertt•
"attainment area?,(FORM 51,.. Cie�al`f.. ems+�rtriv'f:lE .,,,,a •..4. z3i.at. . tr:erea71(FORl1Ai51:V..�:, .,'... .ii: ..,h:j.°Is.;, 3c ,A 7i.3•• :.., -...._rz-.
1111 NAME OF FACILITY " •
-,,. i..-r. 10, , , , ' ::..,-.1 ,..
. IV. FACILITY CONTACT • I I
' A. NAME h TITLE(test -frr$l;r It fine(.' s.'?;;k ^",9.;PHONE(ari.•aCodr-,,no I I i tti.t-
. . e l?
as as as n• ,I' „ -•la e+ •.
V. FACILITY MAILING ADDRESS I l
A. STREET OR P.O. BOX- ., .'r.
I i I I I I I I I I 1 I I I I I I I I I I I .I f I I I I I -
3 6
B. CITY OR TOWN C.STATE O. ZIP CODE ,,::..
cI I 1 I + i I I I T I I I I I I I I I I I I I I I - f I I 1 I
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1 a 11 - . as. 7r-t•sr- a. I -
VI. FACILITY LOCATION 11
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A.STREET, ROUTE NO.OR OTHER SPECIFIC IDENTIFIER ,
= 1 I T r 1 1 I 1 S I I i l I I I I I I r I I I I I I I 1 r ..
51 . — .
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C.CITY OR TOWN s i•;- -� 3 O,ST ATE •E 'ZIP CODE! F•COUNTY CODE ✓, '.-
111 .111I11111. 1111111111111- .. • . ., I I I .•I I it krlu'rn • ..t1 S4
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EPA Form 3510-1 (8-90) CONTINUE ON REVERSE

ONTINUED FROM THE FRONT
VII.SiC CODES(4-digir.in order of priority! -
A. FIRST Y:.:!...B.SECOND n'ii,'. ";' ,.1. - ^ C'"1:
91 1 I I (specify) :� 1 1 I (specify)
C THIRD - O-'FOIJRTM
q i 1 I I (speeifr) C i I I I (specifi.l
7 7
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V111.OPERATOR INFORMATION
- - A. NAME, • •- •- - B. Ii the name Iiscad-Isi -
c I F I 1 ! I I f I I F 7 . I ] I 1 I I I l i 1 i I I I 1 I I ! I I I I 1 L I Item VIII-A also,ttid
owner?..-. --07:°`''i.Y,
8 CD YES DN0-
,s i. • - f� 66 r::•;wf:a.
C.STATUS OF OPERATOR (Enter the appropriate II:ter Oilo the answer box;if':(1rhi'r", specify.). D. PHONE (arcs rode& Itn,J
F = FEDERAL M t.PUBLIC(other than federal ornate) (specify) I I1 I I 1 �;
S=STATE 0 .OTHER (specify) A ti
P o PRIVATE is If IS - 11.4 'IS • II l 12'• • In ,
•' . E. STREET OR P.O. DOTE ' .. l . .. .. r. • I r"
• . r
I I T I • i i I I I i I i I I I I I I I I I -1 I I I I I -I 1 4 ,r7 i 1k •
. F. CITY OR TOWN ' - . ' G.STATE, H. ziP.coos IX.•INOIAN'LAND
I I I I I I I I .1 1 1 ..‘ I I I I I I I .1 I I I I i , I I I Is the facility located orrindianllands?.;
i]-YES'`'a: EJ NO. ^:,_,fig r`.
i . I , . , , I I [ . i I •• I • • I I , 3�.::',52 11 x. -.. y.;•
- - - - . -ii '-at ♦■ • U, - »►i :4;i•'Frr: tdk't:i4'•' - -_.y.A rorman
X.EXISTING ENVIRONMENTAL PERMITS
A. NPOE5(Discharges 1OSurface Water) .EA:P50(AirEnussions from Proposed Sources)' -;� � I,, i::•, •"';'i,.,-;•,L.' - g-s
e r i ! I I I ! l I I I i I 1 -c s t I r I I I: I I II I I ,I I s 1 -� +': _A .W3'3241
•
`� , • l 1 , , [ t l , ,]0 1 I1 •,,I i , 1 , L l . , , l 110 ....., r.,•". _ - - . «
IS IS 17 '
. ' B. usC(Underground injection of Fluids) I-oTHER (specify) K - =7..'H•.. •I • d iva
II 1 •1 I I I I I I I I I I C T ., 1 I I I I I F IIII (specify)
9I5 .a UU I.] II L 1 30 IS SO
C. RCRA(Ha:ardoI Wastes) E.OTH ER (Sprcifl'J f •`"'`:le j`0
c r , I I I 1 1 I 1 1 I I 1 i c r_�,. 1 1 '1 1 l I I I 1 ! I 1 (specify)
9 R 9
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XI.MAP
,.., y , .. r t.-: r -a1 r w• .;.' .... . ...y. ae L'�-^+r- - ' 'sue
Attach to';this`•application.a;topographic map of-the area extending to;.at least one mile beyond.property bounderies,,The map,:musi Show + il
the outline of,the facility,•the-location•of-eachof Its•existing and proposed:intake and discharge strut tares,each of.its hazardoustwasire ',
treatment storage for-disposai-facilities and-each.wel I where.it infects fluids-underground iincluJeill wrings'•rivers and othersurfacei"",
-water bodies in the map area:See instructions for precise requirements ':��. -rVir . x.:. ' - I " z ' ' t.-
• . L . ..... •r . _ .:.,_:•� :: .. .rn -•t.,,-4, kF:+.a .,.,.ti,1.4.W!>'v...••!':_ir--=- �•,..-.. -i�i."r_'a•'t'.k'-s-1 k; A.V. iu-•_
XH.:NATURE OF.BUSIN£SS(provide.a brief description
•
•
•
•
•
•
•
•
XHll'C"TIHCAll's"instructi"AIIIIIIIEIIIIIIIIIIIIIIIIMIIIIIIIIIIIMIIIIIMIIIIMI-
-
I certify under penalty.of law-that 1 have personally examined and am familiarwith the'informationsubmitted in'thisapplication and all54-t: -
'attachments and that;•based on my inquiry of those persons immediately responsibl_e-for-obtairiirrg.the information`contained in ihe:: • •
application, I believe that the information is true, accurate and complete.-i am aware that there are significant penalties-for submitting
false information,including the possibility of fine and imprisonment. . . . '
A. NAME &OFFICIAL TITLE(type or print) . B.SIGNATURE - C. DATE SIGNED
COMMENTS FOR.OFFICLAL USE ONLY.
• i,I Y 5_ - w '",,i - `Fr$i,. '.li k .•.4 �i 4Z4I1P. r i:- ,r7'f 'rgg -. 4,'.�It .�, .J w a ;- i.. t {•` �]
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'. s r:; L�. �.h, 4i.i : I r x 43,.s o-•...I ,.. x w1 `' n , Z, �,1a< 0.a r,•11 ; xet EPA Form 3510.1 (8.90) •

•
United States Office of EPA Form 3510-1
Environmental Protection Enforcement
Agency Washington,DC 20460 Revised August 1990
Permits Division
•
EPA Application Form 1 - General
Information
• •
• Consolidated Permits Program
•
This form must be completed by all persons applying for
a permit under EPA's Consolidated Permits Program. See
the general instructions to Form 1 to determine which
other application forms you will need.

DESCRIPTION OF CONSOLIDATED FORM 1 PACKAGE
PERMIT APPLICATION FORMS TABLE OF CONTENTS
The Consolidated Permit Application Forms are: Section A.General Instructions
Form 1 --General Information (Included in this part); • Section B.Instructions for Form 1
Form 2.-Discharges to Surface Water(NPDES Permits): Section C,Activities Which Do Not Require Permits
2A. Publicly Owned Treatment Works (Reserved - not included in Section D.Glossary
this package),
Form 1 (two copies) •
213. Concentrated Animal Feeding Operations end Aquatic Animal
Production Facilities(not included in this package),
2C. Existing Manufacturing, Commercial, Mining, and Silvicultural
Operations(not included in this package),and •
•
21). New Manufacturing, Commercial, Mining, and Silviculture!
Operations(Reserved-nor included in this package);
Form 3 - Hazardous Waste Application Form (RCRA Permits --
not included in this package);
Form 4 - Underground Injection of Fluids (WC Permits - Re-
served-not included in this package);end
Form 5 - Air Emissions in Attainment Areas IPSD Permits - Re-
served-not included in this package).
•
SECTION A—GENERAL INSTRUCTIONS
•
Who Must Apply NOTE: Certain activities not listed above also are subject to EPA
administered environmental permit requirements. These include per-
With the exceptions described in Section C of these instructions, Fed- mits for ocean dumping, dredged or fill material discharging, and
oral laws prohibit you from conducting•any of the following activities certain types of air emissions. Contact your EPA Regional office for
without a permit. further information.
NPDES (National Pollutant Discharge Elimination System Under the
Clean Water Act, 33 U.S.C. 1251). Discharge of pollutants into the Table 1. Addresses of EPA Regional Contacts and States Within the
waters of the United States. •
Regional Office Jurisdictions
RCRA (Resource Conservation and Recovery Act 42.U.SC 690f). REGION I
Treatment,storage,or disposal of hazardous wastes.
Permit Contact, Environmental and Economic Impact Office, U.S.
UIC (Underground Injection Control Under the Safe Drinking Water Environmenta! Protection Agency, John F. Kennedy Building, Bos•
Act, 42 U.S.0 300f). Injection of fluids underground by gravity flow ton,Massachusetts 02203, [phone],FTS 223-4635.
or pumping. Connecticut, Maine,Massachusetts, New Hampshire, Rhode Island,
•
and Vermont.
PED (Prevention of Significant Deterioration Under the Clean Air
Acr, 72 U.S.0 7401). Emission of an sir pollutant by a new or mail- REGION Il
Pied facility in or near an area which has attained the National Ambient
Air Quality Standards for that pollutant. Permit Contact, Permits Administration Branch, Room 432, U.S.
EnviEach of the above permit programs is operated in any particular State New rYp k 1t0007al r(212)2�A9880,FTS 2 26 64--9880deral 1aza, New York,
by either the United States Environmental Protection Agency (EPA) New Jersey,New York,Virgin Islands,and Puerto Rico.
or by an approved State agency,You must use this application form to
apply for a permit for those programs administered by EPA. For those REGION III
programs administered by approved States,contact the State environ- •
mental agency for the proper forms. Permit Contact (3 EN 23), U.S. Environmental Protection Agency, •
6th & Walnut Streets, Philadelphia, Pennsylvania. 19106, (2151
If you have arty questions about whether you need a permit under any 597--8816,FTS 597-8816,
of the above programs, or if you need information as to whether a Delaware, District of Columbia, Maryland, Pennsylvania, Virginia,
particular program is administered by EPA or a State agency,or if you . and West Virginia.
need to obtain application forms, contact your EPA Regional'office.
(listed in Table 1). REGION IV
Uoon your request, and based upon information supplied by you, Permit Contact, Permits Section, U.S. Environmental Protection
EPA will determine whether you are required to obtain a permit for Agency, 345 Court{and Street, N,E., Atlanta, Georgia 30365, (4041
a particular facility, Be sure to.contact EPA if you have a question, 881-2017,FTS 257-2017.
because Federal laws provide that you may be heavily penalized If Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, •
you do not apply for a permit when a permit is required. South Carolina,and Tennessee.
Form 1 of the EPA consolidated application forms collects general REGION V
information applying to all programs. You must fill out Form 1 regard-
less of which permit you are applying for. in addition,you mutt fill • Permit Contact (SEP), U.S. Environmental Protection Agency, 230
Out One of the supplementary forms (Forms 2 - 5) for each permit South Dearborn Street, Chicage, Illinois 60604, (3121 353-2105,
needed under each of the above programs. Item II of Form 1 will FTS 353-2106
guide you to the appropriate supplementary forms. Illinois,Indiana,Michigan,Minnesota,Ohio,end Wisconsin.
You should note that there are certain exclusions to the permit require-
ments listed above. The exclusions are described In detail In Section C
of these instructions. If your activities are excluded from permit re •
•
-
quirements then you do•not need to complete and return any forms.
1-1

•
•
SECTION A—GENERAL INSTRUCTIONS(continued)
Table 1 (continued) Table 2(continued)
REGION VI 4(1.i/C) A reasonable time prior to construction
for new wells; as directed by the Director
Permit Contact (6AEP), U.S. Environmental Protection Agency, for existing wells.
First International Building, 1201 Elm Street, Dallas,Texas 75270, 5(PSD) Prior to commencement of construction.
{2141 767-2765,FTS 729-2765.
Arkansas, Louisiana,New Mexico,Oklahoma,and Texas. *Please note that some of these forms are not yet available for use
and are listed as "Reserved" at the beginning of these instructions.
REGION VII Contact your EPA Regional office for information on current appli-
cation requirements and forms,
Permit Contact. Permits Branch, U.S. Environmental Protection
Agency, 324 East 11th Street, Kansas City, Missouri 64106, 18161 1 If your present permit expires on or before November 30,1980,the
758-5955,FTS 758-5955. filing date is the date on which your permit expires. If your permit
Iowa,Kansas,Missouri,and Nebraska. expires during the period December 1, 1980—May 31, 1981,the fil-
. ing date is 90 days before your permit expires.
REGION VIII
Federal regulations provide that you may not begin to construct a
Permit Contact (8E—WE),Suite 103,U.S. Environmental Protection new source in the NPDES program,a new hazardous waste management
Agency, 1860 Lincoln Street,Denver,Colorado 80295, (303)837— facility, a new injection well, or a facility covered by the PSD program
4901,FTS 327--4901. before the issuance of a permit under the applicable program, Please
Colorado, Montana, North Dakota, South Dakota, Utah, and note that if you are required to obtain a permit before beginning con-
Wyoming. ttruction, as described above, you may need to submit your permit
application well in•advance of an applicable deadline listed in Table 2,
REGION IX
Permit Contact,Permits Branch 1E-41, U.S.Environmental Protection Fees
Agency, 215 Fremont Street,.San Francisco, California 94105,
(4151 556-3450, FTS 556-3450. The U.S. EPA does not require a fee for applying for any permit under
Arizona, California, Hawaii, Nevada, Guam, American Samoa, and the consolidated permit programs. (However, some States which ad-
Trust Territories. minister one or more of these programs require fees for the permits
which they issue.)
REGION X
Permit Contact (M!5 521), U.S. Environmental Protection Agency. Availability of Information to Public
1200 6th Avenue, Seattle, Washington 98101, [phone],
FTS 399-7176. Information contained in these application forms will, upon request,
Alaska,Idaho.Oregon,and Washington. be made available to the public for inspection and copying. However,
you may request confidential treatment for certain information which
you submit on certain supplementary forms. The specific Instructions
Where to File for each supplementary form state what information on the form,if
any, may be claimed as Confidential and what procedures govern the
The application forms should be rna'.Ied to the EPA Regional office claim. No information on Forms 1 end 2A through 2D may be claimed
whose Region includes the State in which the facility is located (see es confidential.
Table 1).
if the State in which the facility is located administers a Federal permit Completion of Forms
program under which you need a permit,you should contact the appro-
priate State agency for the correct forms. Your EPA Regional office Unless otherwise specified in instructions to the forms, each item in
(Table 1) can tell you to whom to apply and can provide the appro- each form must be answered. To indicate that each item has been con-
prate address and phone number. sidered, enter "NA," for not applicable, if a particular item does not
fit the circumstances or characteristics of your facility or activity.
When to File If you have previously submitted Information to EPA or to an approved
State agency which answers a question,you may either repeat the in-
Because of statutory requirements, the deadlines for filing applications formation in the space provided or attach a copy of the previous sub-
vary according to the type of facility you operate end the type of per- mission. Some items in the form require narrative explanation.If more
mit you need.These deadlines are as follows:' space is necessary to answer a question,attach a separate sheet entitled
"Additional Information,"
Table 2.Filing Dates for Permits
FORM(permit) WHEN TO FILE - Financial Assistance for Pollution Control
•
2A(NPDES) 180 days before your present NPDES per- There are a number of.direct loans,loan guarantees,and grants available
mit expires, to firms and communities for pollution control expenditures.These are
28(NPDES) 180 days before your present NPDES per. provided by the Small Business Administration, the Economic Develi
mit expires', or 180 days prior to start- opment Administration, the Farmers Home Administration, and the
• up if you are a new facility, Department of Housing and Urban Development. Each EPA Regional
2C(NPDES) 180 days before your present NPDES per- office (Table 1) has an economic assistance coordinator who can pro-
mit expires'. vide you with additional information.
2D(NPDESI 180 days prior to startup.
3(Hazardous Waste). . . Existing facility: Six months following EPA's construction grants program under Title II of the Clean Water
publication of regulations listing hazard- Act is an additional source of assistance to publicly owned treatment
ous wastes. works.Contact your EPA Regional office for details.
New facility: 180 days before commencing
physical construction.
•
•
1-2

SECTION B — FORM 1 LINE—BY—LINE INSTRUCTIONS
This form must be completed by all applicants. Table 3(continued)
•
Petroleum storage end transfer units with a total norage capacity
Completing This Form exceeding 300,000 barrels;
Taconite ore processing plants;
Please type or print in the unshaded areas only.Some items have small Glass fiber processing plants;and
graduation marks in the fill—in spaces. These marks indicate the num- Charcoal production plants.
ber of characters that may be entered into our data system.The marks
are spaced at 1(6" intervals which accommodate elite type(12charec•
Mrs per inch). If you use another type you may ignore the marks. If Item 111
you print, place each character between the marks.Abbreviate if neces-
sary to stay within the number of characters allowed for each item. Enter the facility's official or legal name. Do not use a colloquial
Use one space for breaks between words, but not for punctuation name.
marks unless they are needed to clarify your response. •
Item IV
Item I •
Give the name, title, and work telephone number of a person who is
Space Is provided at the upper right hand corner of Form 1 for loser- thoroughly familiar with the operation of the facility and with the facts
tion of your EPA Identification Number. If you have an existing tacit• reported in this application and who can be contacted by reviewing
ity, enter your Identification Number, If you don't know your EPA offices if necessary.
Identification Number,please contact your EPA Regional office(Table
1), which will provide you with your number. If your facility is new
(not yet constructed),leave this item blank. Item V
•
Give the complete mailing address of the office where correspondence
Item II should be sent. This often is not the address used to designate the lo•
cation of the facility or activity.
Answer each question to determine which supplementary forms you
need to fill out, Be sure to check the glossary in Section D of these
instructions for the legal definitions of the bold faced words. Check Item VI
Section C of these instructions to determine whether your activity
• is excluded from permit requirements. Give the address or location of the facility identified in Item III of this.
form- If the facility lacks a street name or route number,give the most
If you answer "no" to every question, then you do not need a permit, accurate alternative geographic information (e.g., section number or
and you do not need to complete and return any of these forms, quarter section number from county records or at intersection of Rts.
425 end 221.
If you answer "yes" so any question, then you must complete and file
the supplementary form by the deadline listed in Table 2 along with
this form. (The applicable form number follows each question and is Item VII
enclosed in parentheses.)You need not submit a supplementary form if
you already have a permit under the appropriate Federal program, List, in descending order of significance, the four 4—digit standard
unless your permit is due to expire and you wish to renew your permit, industrial classification (SIC) codes which best describe your facility
in terms of the principal products or services you produce or provide.
Questions Cli and (JI of Item 11 refer to major new or Modified sources Also, specify each classification in words.These classifications may dif-
subject to Prevention of Significant Deterioration (P5D1 requirements fer from the SIC codes describing the operation.generating the dis-
under the Clean Air Act. For the purpose of the PSD program, major charge,air emissions,or hazardous wastes.
sources are defined as: (A)Sources listed in Table 3 which have the po-
tential to emit 100 tons or more per year emissions:and (B)All other SIC code numbers are descriptions which may be found in the "Stan-
sources with the potential to emit 250 tons or more per year. See dare! Industrial Classification Manual" prepared by the Executive Of-
Section C of these instructions for discussion of exclusions of Certain f ice of the President, Office of Management and Budget, which is
modified sources. available from the Government Printing Office, Washington, D.C.
Use the current edition of the manual. If you have any questions con-
Table 3. 28 Industrial Categories Listed in Section 169(1)of the Clean earning the appropriate SIC code for your facility,contact your EPA
Air Act of 1877 Regional office(see Table 1).
•
Fossil fuel-fired steam generators of more than 250 million BTU per
hour heat Input; Item Vlll—A
Coal cleaning plants(with thermal dryers);
Kraft pulp mills; ' Give the name, as it is legally referred to, of the person, firm, public
Portland Cement plants; organization,or any other entity which operates the facility described
Primary zinc smelters; in this application. This may or may not be the same name as the fa•
Iron and steel mill plants; tility. The operator of the facility is the legal entity which controls
Primary aluminum ore reduction plants; the facility's operation rather than the plant or site manager. Do not
Primary copper smelters; use a colloquial name.
Municipal incinerators capable of charging more than 250 tons of re-
fuse per day;
Hydrofluoric acid plants; Item VIiI—B
Nitric acid plants;
Sulfuric acid plants; Indicate whether the entity which operates the facility also owns it
Petroleum refineries; by marking the appropriate box,
Lime plants;
Phosphate rock processing plants;
Coke oven batteries; Item VIII—C
Sulfur recovery plants;
Carbon black plants(furnace process); Enter the appropriate letter to indicate the legal status of the operator
Primary lead smelters; of the facility. indicate "public" for a facility solely owned by local
Fuel conversion plants; governments)such as a city,town,county,parish,etc.
Sintering plants;
Secondary metal production plants;
Chemical process plants; • Items VII I—D—I•1
Fossil fuel boilers (or combination thereof) totaling more than 250
million BTU per hour heat input: • Enter the telephone number and address of the operator identified in
Item ViII—A.
•
1-3

•
SECTION B-FORM 1 LINE-BY-LINE INSTRUCTIONS(continued) •
Item IX Item XI(continued)
indicate whether toe facility is located on Indian Lands. Mid Continent Mapping Canter Ark., lit., Iowa, Kane., La.,
National Cartographic Information Mich., Minn., Miss., Mo.,
Center N. Oak., Nebr.,Okla.,5.Oak„
Item X U.S.G.S. and Wis.
1400 Independence Road
Give the number of each presently effective permit issued to the fa- Rolla,Mc,65403
ditty for each program or, if you have previously filed an application Phone No. 1314) 341-0851
but have not yes received a permit,give the number of the application,
if any. Fill in the unshaded area only. If you have more than one cur- Rocky Mountain Mapping Center Alaska, Colo., Mont.,N.Mex.,
rently effective permit for your facility under a particular permit pro National Cartographic Infomation Tex.,Utah.and Wyo.
gram, you may list additional permit numbers on a separate sheet of i Center
paper. List any relevant environmental Federal (e.g.,permits under the U.S.G.S.
Ocean Dumping Act,Section 404 of the Clean Water Act or the Surface Stop 504,Box 25046 Federal Center
Mining Centro! and Reclamation Act), State (e.g., State permits for Denver,Co.80225
new air emission sources in nonattainment areas under Pert A of the Phone Na. [phone]
Clean Air Act or Stare permits under Section 404 of the Clean Water
Act),or local permits or applications under"other." Western Mapping Center Ariz., Calif., Hawaii, Idaho,
National Cartographic Information Nev., Dreg., Wash., American
Canter • Samoa, Guam, and Trust
Item XI U.S.G.S. • Territories
345 Middlefield Road
Provide a topographic map or maps of the area extending at least to Menlo Park,Ca.94025
one mile beyond the property boundaries of the facility which clearly Phone No.[phone]
show the following.
The legal boundaries of the facility; item XII
The location end serial number of each of your existing and proposed Briefly describe the nature of your business (e.g., products produced
intake and discharge structures; or services provided).
All hazardous waste management facilities;
Item X111
Each well where you inject fluids underground;and Federal statues provide for severe penalties for submitting false inform•
All springs and surface water bodies in the area, plus all drinking etion on this application form. •
water wells within 1i4 mile of the facility which are identified in the
public record or otherwise known to you. 18 U.S.C.Section 1001 provides that "Whoever, in any matter within
the jurisdiction of any department or agency of the United States
If an intake or discharge structure, hazardous waste disposal site, or knowingly and willfully falsifies, conceals or covers up by any trick,
injection well associated with the facility is located more than one mile scheme, or device a material fact, or makes or uses any false writing
from the plant, include it on the map, if possible. If not, attach addi- or document knowing same to contain any false,fictitious or fraudu-
tionel sheets describing the location of the structure,disposal site,.or lent statement or entry, shall be fined not more than $10,000 or im-
well, and identify the U.S. Geological Survey (or other) map corres- prisoned not more than five years,or both."
ponding to the location.
Section 3091c)(2) of the Clean Water Act and Section 113(c)(2)of the
On each map, include the map scale,a meridian arrow showing north, Clean Air Act each provide that "Any person who knowingly makes
end latitude and longitude et the nearest whole second.On ail maps of i any false statement, representation, or certification in any applica•
rivers, show the direction of the current, and in tidal waters,show the lion, , shall upon conviction, be punished by a fine of no more then
directions of the ebb and flow tides, Use a 7-1/2 minute series map $10,000 or by imprisonment for not more than six months, or both.''
published by the U.S. Geological Survey, which may be obtained through the U.S. Geological Survey Offices listed below. If 7-1/2 In addition,Section 3006[d}(3) of the Resource Conservation and Re
-
minute minute series map has not been published for your facility site, then covery Act provides for a fine up to $25,000 per day or Imprisonment
you may use a 15 minute series map from the U.S.Geological Survey, up to one year,or both, for a first conviction for making a false state-
If neither a 7-1/2 nor 15 minute series map has been published for your meat in any application under the Act,and for double these penalties
facility site, use a plat map or other appropriate map,including all the upon subsequent convictions.
requested information; in this case, briefly describe land uses in the
map area(e.g.,residential,commercial). FEDERAL REGULATIONS REQUIRE THIS APPLICATION TO BE
SIGNED AS FOLLOWS:
You may trace your map from a geological survey chart,or other map •
meeting the above specifications. If you do, your map should bear a A. For a corporation,by a principal executive officer of at least the
note showing the number or title of the map or chart it was traced level of vice president. However, if the only activity in Item II which
from. Include the names of nearby towns, water bodies, and other is marked "yes" is Question G, the officer may authorize a person
prominent points. An example of an acceptable location map is shown having responsibility for the overall operations of the well or wall
in Figure 1-1 of these instructions.(NOTE:Figure 1-1 is provided for field to sign the certification. In that case, the authorization must be •
purposes of illustration only, and does not represent any actual fa- written and submitted to the permitting authority.
dlify.) B. For partnership or sole proprietorship, by a general partner or the
U.S.G.S.OFFICES AREA SERVED proprietor,respectively;or
Eastern Maoping Center Ala., Conn., Del., D.C., Fla., C. For a municipality, State, Federal, or other public facility, by
National Cartographic Information Ga., Ind., Ky., Maine, Md., either a principal executive officer or ranking elected official,
Center Mass., N,H., N.J., N.Y„ N.C.,
U.S.G.S. S.C., Ohio, Pa., Puerto Rico,
536 National Center R.J., Tern., Vt., Va., W. Va.,
Reston, Va.22092 and Virgin Islands.
Phone No. (703) B60-6336
•
1-4

SECTION C—ACTIVITIES WHICH DO NOT REQUIRE PERMITS
1. National Pollutant Discharge Elimination System Permits Under II. Hazardous Waste Permits Under the Resource Conservation and
the Clean Water Act. You are not required to obtain en NPDES permit Recovery Act. You may be excluded from the requirement to obtain
if your discharge is in one of the following categories,as provided by a permit under this program if you fall into one of the following
the Clean Water Act (CWA)and by the NPDES regulations (40 CFR categories:
Parts 122-1251. However, under Section 510 of CWA a discharge ex-
. emoted from the federal NPDES requirements may still be regulated Generators who accumulate their own hazardous waste on—site for
by a State authority; contact your State environmental agency to de- less than 90 days as provided in 40 CFR 262,34;
termine whether you need a State permit.
Farmers wha dispose of hazardous waste pesticide from their own use
A. DISCHARGES FROM VESSELS. Discharges of sewage from ves- as provided,in 40 CFR 262.51;
eels, effluent from property functioning marine engines, laundry,
shower, and galley sink wastes, and any•other discharge incidental to Certain persons treating, storing, or disposing of small quantities of
she normal operation of a vessel do not require NPDES permits. hazardous waste as provided in 40 CFR 261.4 or 261,5:and
However, discharges of rubbish, trash, garbage, or other such meter •
-
iale discharged overboard require permits, and so do other discharges Owners and operators of totally enclosed treatment facilities as de-
when the'vessel is operating in a capacity other than as a means of fined in 40 CFR 260.10,
transportation, such as when the vessel is being used as an energy or
mining facility,a storage facility,.or a seafood processing facility, or Check with your Regional office for details. Please note that even if
is secured to the bed of the ocean, contiguous zone,or waters of the you are excluded from permit requirements, you may be required by
United States for the purpose of mineral or oil exploration or de- Federal regulations to handle your waste in a particular manner.
vetopment.
B. DREDGED OR FILL MATERIAL. Discharges of dredged or fill Ill, Underground Injection Control Permits Under the Safe Drinking
material into waters ofthe United States do not need NPDES permits Water Act. You are not required to obtain a permit under this program
if the dredging or filling is authorized bye permit issued by the U.S. if you;
Army Corps of Engineers or an EPA approved State under Suction
404 of CWA. Inject into existing wells used to enhance recovery of oil and gas or
to store hydrocarbons (note, however, that these underground injec•
C. DISCHARGES INTO PUBLICLY OWNED TREATMENT WORKS Lions are regulated by Federal rules);or
(POI-WI. The introduction of sewage, industrial wastes, or other poi-.
lutants into a POTW idoes not need an NPDES permit. You must . Inject into or above a stratum which contains,within 1)4 mile of the
comply with all. applicable pretreatment standards promulgated well bore, en underground source of drinking water (unless rout-in'
under Section 307(b) of CWA, which may be included'in the permit 'action is the.type identified in Item II-H, for which you do'need a
issued to the POTW. If you have a plan or an agreement to switch permit). However,you must notify EPA of your injection and submit
to a f OTW in the future, this does not relieve you of the obligation certain required information on forms supplied by the Agency,and
to apply for and receive en NPDES permit until you have slopped your operation may be phased out if you are a generator of hazardous
discharging pollutants into waters of.the United States. wastes or a hazardous waste management facility which uses wells
or septic tanks to dispose of hazardous waste,
(NOTE: Dischargers into.privately owned treatment works do nor
have to apply for or obtain NPDES permits except as otherwise re-
quired by the EPA,Regional Administrator. The owner or operator IV. Prevention of Significant Deterioration Permits Under the Clean
of the treatment works itself, however, must apply for a permit and Air Act. The PSD program applies to newly constructed or modified
identify all users in its application. Users so identified will receive facilities (both of which ere referred to as 'new sources') which in-
public notice of actions taken on the permit for the treatment works.) crease air emissions, The Clean Air Act Amendments of 1977 exclude '
small new sources of air emissions from the P50 review program.Any
D. DISCHARGES FROM AGRICULTURAL AND S1LVICULTUR- new source in an industrial category listed in Table 3 of these instruc-
AL ACTIVITIES. Most discharges from agricultural and silvicultural tions whose potential to emit is less than 100 tons per year is not re-
activities to waters of the United States do not require NPDES per- • quired to get a P80 permit. In addition,any new source in an industrial
mite. These include runoff from orchards,cultivated crops, pastures, category not listed in Table 3 whose potential to emit is less than 250
range lands, and forest lands. However, the discharges listed below tons per year is exempted from the PSD requirements.
do require NPDES permits. Definitions of the terms listed below are
contained in the Glossary section of these instructions. Modified sources which increase their net emissions (the difference
between the total emission increase: and total emission decreases et..
1. Discharges from Concentrated Animal Feeding Operations, the source)less than the significant amount set forth in EPA regulations
(See Glossary for definitions of "animal feeding operations"and are also exempt from PSO requirements. Contact your EPA Regional
"concentrated animal feeding operations." Only the latter require office(Table f)for further information.permits.)
2. Discharges from Concentrated Aquatic Animal Production
Facilities. (See Glossary for size cutoffs.)
3. Discharges associated with approved Aquaculture Project:.
4. Discharges from Silvicultural Point Sources. (See Glossary for
the definition of "silviculture point source.") Nonpoint source
silvicultural activities are excluded from NPDES permit require-
ments. However, some of these activities, such as stream crossings
for roads, may involve point source discharges of dredged or fill - .
material which may require a Section 404 permit, See 33 CFR
209.120.
E. DISCHARGES IN COMPLIANCE.WITH AN ON—SCENE CO-
ORDINATOR'S INSTRUCTIONS.
1-5

SECTION B—FORM 1 LINE—BY—LINE INSTRUCTIONS(continued)
•
Item IX Item XI (continued)
Indicate whether the fac,[ity is located on Indian Lands- Mid Continent Mapping Center Ark., III„ lows, Kans., La.,
National Cartographic Information Mich., Minn„ Miss., Mo.,
Center N. Oak., Nebr.,Okla.,5.Dak.,
Item X U.S.G.S. and Ws.
1400 Independence Road
Give the number of each presently effective permit issued to the fa• Rolla, Mc.65401
Cility for each program or, if you have previously filed an application Phone No.131+1) 341-0851
but have not yet received a permit,give the number of the application,
if any. Fill in the unshaded area only. If you have more then one cur- Rocky Mountain Mapping Center Alaska, Colo., Mont.,N.Mex.,
rently effective permit for your facility under a particular permit pro National Cartographic Infomation Tex.,Utah,end Wyo,
gram, you may list additional permit numbers on a separate sheet of •
Center
paper. List any relevant environmental Federal (e.g.,permits under the U.S.G.S.
Ocean Dumping Act,Section 404 of the Clean Water Act or the Surface Stop 504,Box 25046 Federal Center
• 'Mining Control and Reclamation Act), State (e.g„ State permits for Denver,Co.80225
new air emission sources in nonartainment areas under Part D of the Phone Na.1303)234-2326
Clean Air Act or State permits under Section 404 of the Clean Water
Act),or local permits or applications under"other." Western Mapping Center Ariz., Calif., Hawaii, Idaho,
National Cartographic Information Nev., Oreg., Wash., American
Center Samoa, Guam, and Trust
Item XI U.S.G.S. Territories
345 Middlefield Road
Provide a topographic map or maps of the area extending at least to Menlo Park,Ca.94025
one mile beyond the property boundaries of the facility which clearly Phone No. €415i 323-8111
show the following:
The legal boundaries of the facility; Item XII
The location and serial number of each of your existing and proposed Briefly describe the nature of your business (e.g„products produced
intake and discharge structures; or services provided).
All hazardous waste management facilities;
Item XIII
Each well where you inject fluids underground;and •
Federal statues provide for severe penalties for submitting false inform•
•
All springs and surface water bodies in the area, plus all drinking etian on this application form.
water wells within 1/4 mile of the facility which are identified in the
public record or otherwise known to you. 18 U.S.C. Section 1001 provides that "Whoever, in any matter within
the jurisdiction of any department or agency of the United States
If an intake or discharge structure, hazardous waste disposal site, or, knowingly and willfully falsifies, conceals or covers up by any trick,
injection well associated with the facility is located more than one mile scheme, or device a material fact, or makes or uses any false writing
from the plant, include it on the map, if possible. If not, attach addi- or document knowing same to contain any false, fictitious or fraudu-
tional sheets describing the.location of the structure,disposal site, or lent statement or entry, shall be fined not more than $10,000 or im•
well, and identify the U.S. Geological Survey (or other) map corres- prisoned not more than live years,or both."
ponding to the location.
Section 3091e112) of the Clean Water Act and Section 1131c)(21 of the
On each map, include the map scale, a meridian arrow showing north, Clean Air Act each provide that "Any person who knowingly makes
and latitude and longitude at the nearest whole second.On all maps of . any false statement, representation, or certification in any app[ica•
rivers, show the direction of the current, and in tidal waters,show the tion, . . . shall upon conviction, be punished by a fine of no more than
directions of the ebb and flow tides. Use a 7-1/2 minute series map $10,000 or by Imprisonment for not more than six months, or both,"
published by the U.S. Geological Survey, which may be obtained In addition,Section 3008€d)13) of the Resource Conservation and Re
through the U.S. Geological Survey Offices listed below. If a 7-1/2
minute series map has not been published for your facility site, then covery Act provides for a fine up to $25,000 per day or imprisonment
you may use a 15 minute series map from the U.S. Geological Survey. up to one year, or both, for a first conviction for making a false state.
If neither a 7-1/2 nor 15 minute series map has been published for your merit in any application under the Act,and for double these penalties
facility site, use a plat map or other appropriate map,including all the upon subsequent convictions.
requested information: in this case, briefly describe land uses in the
map area le.g.,residential,commercial), FEDERAL REGULATIONS REQUIRE THIS APPLICATION TO BE
SIGNED AS FOLLOWS:
You may trace your map from a geological survey chart,or other map
meeting the above specifications. If you do, your map should bear a A. For a corporation,by a principal executive officer of at least the
note showing the number or title of the map or chart it was traced level of vice president. However, if the only activity in Item II which
from. Include the names of nearby towns, water bodies, and other is marked "yes" is Question G, the officer may authorize a person
prominent points. An example of an acceptable location map Is shown having responsibility for the overall operations of the well or well
in Figure 1-1 of these instructions.(NOTE:Figure 1-1 is provided for field to sign the certification. In that case, the authorization must be
purposes of illustration only, and does not represent any actual fa written and submitted to the permitting authority.
cility.) B. For partnership or sole proprietorship, by a general partner or the
U.S.G.S.OFFICES AREA SERVED proprietor,respectively;or
Eastern Mapping Center Ala., Conn., Del., D.C., Fla., C. Far a municipality, State, Federal, or other public facility, by
National Cartographic Information Ga., Ind., Ky., Maine, Md.,
either a principal executive officer or ranking elected official.
•
Center Mass., N.H., N.J., N.Y„ N.C.,
U.S.G S. S.C., Ohio, Pa., Puerto Rico,
536 National Center R,I„ Tenn., Vt., Va„ W. Va.,
Reston,Vs,22992 and Virgin Islands.
Phone No, [phone]
•
•
1-4

SECTION C—ACTIVITIES WHICH DO NOT REQUIRE PERMITS
•
I. National Pollutant Discharge Elimination System Permits Under II. Hazardous Waste Permits Under the Resource Conservation end
the Clean Water Act, You are not required to obtain an NPDES permit Recovery Act. You may be excluded from the requirement to obtain
if your discharge is in one of the following categories,as provided by a•permit under this program if you fell into one of the following
the Clean Water Act (CWA)and by the NPDES regulations (40 CFR categories:
Parts f22—725). However, under Section 510 of CWA a discharge ex-
empted from the federal NPOES requirements may still be regulated Generators who accumulate their own hazardous waste or—site for
by a State authority; contact your State environmental agency to de- less than 90 days as provided in 40 CFR 262.34;
termine whether you need a State permit.
farmers who dispose of hazardous waste pesticide from their own use
A. DISCHARGES FROM VESSELS. Discharges of sewage from yes- as provided in40 CFR 262.51;
sell, effluent from properly functioning marine engines, laundry,
shower, and galley sink wastes, end any other discharge incidental to Certain persons treating, storing, or disposing of small quantities of
the normal operation of a vessel do not require NPDES permits. hazardous waste et provided irn40 CFR 261,4 or 261.5:and
However, discharges of rubbish, trash, garbage, or other such mater-
ials discharged overboard require permits,and so do other discharges Owners and operators of totally enclosed treatment facilities as de,
when the'vessel is operating in a capacity other than as a means of fined in 40 CFR 260.10.
transportation,such as when the vessel is being used as an energy or .
mining facility,a storage facility, or a seafood processing facility,or Check with.your Regional office for details. Please note that even if
is secured to the bed of the ocean, contiguous zone,or waters of the you are excluded from permit requirements,you may be required by
United States for the purpose of mineral or oil exploration or de- Federal regulations to handle your waste in a particular manner,
velopment.
B. DREDGED OR FILL MATERIAL. Discharges of dredged or fill III. Underground Injection Control Permits Under the Safe Drinking
material into waters of the United States do not need NPDES permits Water Act. you are not required to obtain a permit under this program
if the dredging or filling is authorized by•e permit issued by the U.S. if you:
Army Corps of Engineers or an EPA approved State under Section
404 of CWA. Inject into existing wells used to enhance recovery of oil and gas or
to store hydrocarbons (note, however, that these underground infec.
C. DISCHARGES INTO PUBLICLY OWNED TREATMENT WORKS dons ere regulated by Federal rules):or
(POTW). The introduction of sewage, industrial wastes, or other pol-
lutants into a POTW does riot need an NPDES permit. You must Inject into or above a stratum which contains,within 1/4 mile of the
comply with all applicable pretreatment standards promulgated well bore,•en underground source of drinking water (unless your in-
under Section 307(b) of CWA,which may Be included in the permit /action is the.type identified in Item 11-H, for which you do need a
issued to the POTW. If you have a plan or an agreement to switch permit). However,you.must notify EPA of your injection and submit
to a POTW in the future, this does not relieve you of the obligation certain required information on forms supplied by the Agency,and
to apply for and receive an NPDES permit until you have stopped• your operation may be phased out if you are a generator of hazardous
discharging poliutants into waters of the United States. wastes or a hazardous waste management facility which uses wells
or septic tanks to dispose of hazardous waste. •
(NOTE: Dischargers into,privately owned treatment works do not
have to apply for or obtain NPDES permits except es otherwise re-
quired by the EPA Regional Administrator. The owner or operator IV. Prevention of Significant Deterioration Permits Under the Clean
of'the treatment works itself, however, must apply fora permit and Air Act. The PSD program applies to newly constructed or modified
identify all users in its application. Users so identified will receive facilities (both of which are referred to as 'new sources") which in-
public notice of actions taken on the permit for the treatment works.) crease air emissions, The Clean Air Act Amendments of 1977 exclude
small new sources of air emissions from the PSD review program.Any
O. DISCHARGES FROM AGRICULTURAL AND S1LVICULTUR- new source in art industrial category listed in Table 3 of these instruc-
AL ACTIVITIES. Most discharges from agricultural and silviculture) tions whose potential to emit is less than 100 tons per year is not re-
activities to waters of the United States do not require NPDES per- • quired to get a PSD permit, In addition,any new source in en industrial
mits. These include runoff from orchards, cultivated crops,pastures, category not listed in Table 3 whose potential to emit is less than 250
range lands, and forest lands. However, the discharges listed below tons per year is exempted from the PSD requirements.
do require NPDES permits, Definitions of the terms listed below are
contained in the Glossary section of these instructions. Modified sources which increase their net emissions (the difference
between the total emission increaser end total emission decreases at.
1. Discharges from Concentrated Animal Feeding Operations. the source)less than the significant amount set forth in EPA regulations
(See Glossary for definitions of "animal feeding operations"and are also exempt from PSD requirements. Contact your EPA Regional
'concentrated animal feeding operations." Only the latter require office(Table t)for further information.
permits.)
2. Discharges from Concentrated Aquatic Animal Production
Facilities. (See Glossary for size cutoffs.)
3. Discharges associated with approved Aquaculture Projects, •
4. Discharges from Silviculture! Point Sources. (See Glossary for
the definition of "silvicultural point source.") Nonpoint source
silvicultural activities are excluded from NPDES permit require-
ments. However, some of these activities, such as stream crossings
for roads; may involve point source discharges of dredged or fill
material which may require a Section 404 permit. See 33 CFR
209,120,
E. DISCHARGES IN COMPLIANCE.WITH AN ON—SCENE CO-
ORDINATOR'S INSTRUCTIONS.
•
1-5

•
SECTION D —GLOSSARY
NOTE: This Glossary includes terms used in the instructions and in Forms 1, 2B,2C,and 3. Additional terms wilt be included in the
future when other forms are developed to reflect the requirements of other parts of the Consolidated Permits Program. If you have
any questions concerning the meaning of any of these terms, please contact your EPA Regional office(Table 11
ALIQUOT means a sample of specified volume used to make up a total AREA PERMIT means a UIC permit applicable to all or certain wells
composite sample. within a geographic area, rather than to a specified well,under 40 CFR
Section 122.37,
ANIMAL FEEDING OPERATION means a Tot or facility (other than
an aquatic animal production facility) where the following conditions ATTAINMENT AREA means, for any air pollutant,an area which has
are met: • been designated under Section 107 of the Clean Air Act as having
ambient air quality levels better than any national primary or secondary
A. Animals (other than aquatic animals) have been, erl, or will be ambient air quality standard for that pollutant.Standards have been set
stabled or confined and fed or maintained for a total of 45 days or for sulfur oxides, particulate matter, nitrogen dioxide,carbon rnonox-
more in any 12 month period;and ide, ozone, lead, and hydrocarbons. For purposes of the Glossary,
"attainment area" also refers to "unclassifiable area," which means,
B. Crops,vegetation,forage growth,or post--harvest residues are not for any pollutants, an area designated under Section 107 as unclassi-
sustained in the normal growing season over any portion of the lot fiable with respect to that pollutant due to insufficient Information,
or facility.
Two or more animal feeding operations under common ownership • BEST MANAGEMENT PRACTICES (BMP) means schedules of activi-
are a single animal feeding operation if they adjoin each other or if ties,prohibitions of practices,maintenance procedures,and other man-
they use a common area or system for the disposal of wastes. agement practices to prevent or reduce the pollution of waters of the •
United States. BMP's include treatment requirements,operation proce-
dures, end practices to control plant site runoff, spillage or leaks,
ANIMAL UNIT means a unit of measurement for any animal feeding sludge or waste disposal,or drainage from raw material storage.
operation calculated by adding the following numbers: The number of
slaughter and feeder cattle multiplied by 1.0; Plus the number of ma-
ture dairy cattle multiplied by 1.4;Plus the number of swine weighing BIOLOGICAL MONITORING TEST means any test which includes
over 25 kilograms (approximately 55 pounds) multiplied by 0.4; Plus the use of aquatic algal, invertebrate,or vertebrate species to measure
the number of sheep multiplied by 0.1; Pius the number of horses acute or chronic toxicity, and any biological or chemical measure of
multiplied by 2.0. bioaccumulation,
APPLICATION means the EPA standard national forms for applying BYPASS means the intentional diversion of wastes from any any por-
for a permit, including any additions,revisions,or modifications to the don of a treatment facility.
forms;or forms approved by EPA for use in approved States,including
any approved modifications or revisions. For RCRA, "application"
also means"Application,Part B." • CONCENTRATED ANIMAL FEEDING OPERATION means an animal
• feeding operation which meets the criteria sat forth in either(A}or(B)
below or which the Director designates es such on a case—by—case
APPLICATION, PART A means that part of the Consolidated Permit basis:
Application forms which a RCRA permit applicant must complete to
qualify for interim status under Section 3005(e) of RCRA and for con- A. More than the numbers of animals specified in any of the follow-
sideration for a permit. Pert A consists of Form 1 (General informa- ing categories are confined;
Lion)and Form 3(Hazardous Waste Application Form).
1. 1,000 slaughter or feeder cattle,
APPLICATION, PART 6 means that part of the application which a 2.700 mature dairy cattle(whether milked or dry cows),
FiCRA permit applicant must complete to be issued a permit.(NOTE:
EPA is not developing a specific form for Part B of the permit moll- 3. 2,509 swine each weighing over 25 kilograms (approximately
cation, but an instruction booklet explaining what information must be 55 pounds),
supplied is available from the EPA Regional office.)
4.500 horses,
APPROVED PROGRAM or APPROVED STATE means a State pro- 5, 10,000 sheep or lambs,
gram which has been approved or authorized by EPA under 40 CFR
Part 123. 6.55,000 turkeys,
7. 100,000 laying hens or broilers Of she facility has a continuous
AQUACULTURE PROJECT means a defined managed water area overflow watering),
which uses discharges of pollutants into that designated area for the
maintenance or production of harvestable freshwater, estuarine, or 8. 30,000 laying hens or broilers (IF the facility has a liquid manure
marine plants or animals. "Designated area" means the portions of the handling system),-
waters of the United States within which the applicant plans to con-
fine the cultivated species,using a method of plan or operation (includ- 9.5,000 ducks,or
ing, but not limited to, physical confinement) which, on the basis of
reliable scientific evidence, is expected to ensure the specific individual 10.1,000 animal units;or
organisms comprising an equai:ulture crop will enjoy increased growth
attributable to the discharge of pollutants and be harvested within a B. More than the following numbers and types of animals are con-
defined geographic area. fined:
1.300 slaughter or feeder cattle,
AQUIFER means a geological formation,group of formations,or part
of a formation that is capable of yielding a significant amount of water 2.200 mature dairy cattle(whethermilked or dry cows),
to a well or spring,
3. 750 swine each weighing over 25 kilograms (approximately 55
pounds),
AREA OF REVIEW means the area surrounding an Injection well
which is described according to the criteria set forth in 40 CFR Section 4. 150 horses,
146.06.
1-6

SECTION 13—GLOSSARY (continued)
•
CONCENTRATED ANIMAL FEEDING OPERATION (continued) DIRECTOR means the EPA Regional Administrator or the State Di-
5.3,000 sheep or lambs, rector as the context requires.
6. 16,500 turkeys, DISCHARGE(OF A POLLUTANT)means:
7, 30,000 laying hens or broilers (if the facility has continuous A. Any addition of any pollutant or combination of pollutants to •
overflow watering), waters of the United States from any point source;or
B. 9,000 laying hens or.broilers (if the facility has a liquid manure• B. Any addition of any pollutant or combination of pollutants to the
handling system), waters of the contiguous zone or the ocean from any point source
9. 1,500 ducks,or other than a vessel or other floating craft which is being used as a
means of transportation.
10.300 animal units;AND This definition includes discharges into wafers of the United States
Either one of the following conditions are met: Pollutants are di from: Surface runoff which is collected or channelled by man; Dis-
charged into waters of the United States through a manmade ditch; charges through pipes,sewers,or other Conveyances owned by a State,
municipality, or otherrperson which do not leadn to POTW's:and Dis-
flushing system or other similar manmade device (''nanmade" charges through pipes, sewers, or other conveyances, leading into
means constructed by man and used for the purpose of transporting privately owned treatment works. This term does not include an ad-
wastes); or Pollutants are discharged directly into waters of the dition of pollutants by any indirect discharger.
Unites States which originate outside of and pass over, across, or •
through the facility or otherwise come into direct contact with the •
animals confined in the operation. DISPOSAL fin the RCRA program) means the discharge,deposit, in-
•Provided, however, that no.animal feeding operation is a carmen- jection, dumping,.spilling, leaking, or placing of any hazardous waste
into or on any land or.water so that the hazardous waste or any constit-
trated animal feeding operation as defined above if such animal . uent of it may enter the environment or be emitted into the air or
feeding operation discharges only in the event of a 25 year,24 hour discharged into any waters,including ground water.
storm event.
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY DISPOSAL FACILITY means a facility or part of a facility at which
hazardous waste is intentionally placed into or on land or water,and •
means a hatchery, fish farm,or other facility which contains,'grows or at which hazardous waste will remain after closure.
holds aquatic animals in either of the following categories,or which the
Director designates as such on a case—by—case basis: ,
EFFLUENT LIMITATION means any restriction imposed by the
A. Cold water fish species or other cold water aquatic animals includ- • Director on quantities, discharge rates, and concentrations of poIlu-
ing, but not limited to, the Salmonidae family of fishC(e.g., trout and tants which are discharged from point sources into waters of the
salmon) in ponds, raceways or other similar structures which dip United States, the waters of the continguous zone, or the ocean.
charge at least 30 days per year but does not include:
1. Facilities which produce less than 9,090 harvest weight kilograms' 'EFFLUENT LIMITATION GUIDELINE means a regulation published .
(approximately 20,000 pounds) of aquatic animals per year; and by.the Administrator under Section 304(b) of the Clean Water Act to
• adopt or revise effluent limitations.
2. Facilities which feed less than 2,272 kilograms (approximately
5,000. pounds) of food during the calendar month of maximum
feeding. ENVIRONMENTAL PROTECTION AGENCY (EPA) means the
•
B. Warm water fish species or other warm water aquatic animals United States Environmental Protection Agency.
including, but not limited to, the Ameiuridae, Cetrarchidae, end
Cyprinidae families of fish (e.g.,'respectively, catfish, sunfish, and EPA IDENTIFICATION NUMBER means the number assigned by EPA .
minnows) in ponds,-raceways, or other similar structures which dis- to each generator,transporter,and facility.
charge at least 30 days per year,but does not include; •
-
1. Closed ponds which discharge only during periods of excess run- •
EXEMPTED AQUIFER means an aquifer or its portion that meets the
off;or
criteria in the definition of USDW, but which has been exempted ac-
2. Facilities which produce less than 45,454 harvest weight kilo- cording to the procedures in 40 CFR Section 122.351b).
grams (approximately 100,000 pounds]of aquatic animals per year.
EXISTING HWM FACILITY means a Hazardous Waste Management
COOLING WATER means water used to reduce tempera- facility which was in operation, or tOr which construction had corn-
CONTACT • menced, on or before October 21, 1976.Construction had commenced
lure which comes into contact with a raw material, intermediate pro- if (A) the owner or operator had obtained all necessary Federal,State,
duct,waste product other than heat,or finished product. and local preconstruction approvals or permits, end either (B1) a con-
tinuous on—site, physical construction program had begun, or (B2)
means any device in which a material is stored, the owner or operator had entered Into contractual obligations, which. .
CONTAINERa treated, any portable of,or otherwise handled. could not be cancelled or modified without substantial loss,for con-
struction of the facility to be completed•within a reasonable time,
•
CONTIGUOUS ZONE means the entire zone established by the United (NOTE: This definition reflects the literal language of the statute.However, EPA believes that amendments to RCRA now in conference
States under article 24 of the convention of the Territorial Sea and the will shortly be enacted and will change the date for determining when
Contiguous Zone.
a facility is an "existing facility"ro one no earlier than May of 1980,-
indications are the conferees are considering October 30, 1980. •
CWA means the Clean Water Act (formerly referred to the Federal Accordingly, EPA encourages every owner or operator of a facility
which was built or under construction as of the promulgation date of
Water Pollution Control Act) Pub. L. 92-500, as amended by Pub, sitehe
L.95-217 and Pub. L.95-576,33 U.S.C.1251 et seq. t RCRA program regulations to file Part A of its permit application •
so that it can be quickly processed for interim status when the change
• in the law takes effect. When those amendments are enacted, EPA will
DIKE means any embankment or ridge of either natural or manmade amend this definition.)
•
materials used to prevent the movement of liquids,sludges, solids,or
other materials. EXISTING SOURCE or EXISTING DISCHARGER (in the NPOES
• program) means any source which is not a new source or a new dis-
charger.DIRECT DISCHARGE means the.discharge of a pollutant as defined .
below.
•
1-7

SECTION D GLOSSARY (continued)
•
EXISTING INJECTION WELL means an injection well other than a NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
new injection well. (NPDES) means the national program for issuing modifying,revoking
and reissuing, terminating, monitoring, and enforcing permits end
imposing and enforcing pretreatment requirements, under Sections
FACILITY means any HWM facility, UIC underground injection well, 307, 318, 402, and 405 of CWA. The term includes an approved
NPDES point source. PSO stationary source, or any other facility or program. -
activity (including land or appurtenances thereto) that is subject to
regulation under the RCRA,U1C,NPDES,or PSD programs.
NEW DISCHARGER means any building, structure,facility,or instal-
lation; (A) From which there is or may be a new or additional discharge
FLUID means material or substance which flows or moves whether in of pollutants at a site at which on October 18, 1972, it had never dis-
a semisolid,liquid,sludge,gas,or any other form or state. charged pollutants; (81 Which has never received a finally effective
NPDES permit for discharges at that site;and (C) Which is not a"new
source." This definition includes an indirect discharger which corn-
GENERATOR means any person by site,whose act or process produces mences discharging into waters of the United States. It also includes
hazardous waste identified or listed in 40 CFR Part 261. any existing mobile point source, such as en offshore oil drilling rig,
seafood processing vessel, or aggregate plant that begins discharging
at a location for which it does not have an existing permit.
GROUNDWATER means water below the land surface in a zone of
saturation. •
NEW HWM FACILITY means a Hazardous Waste Management facility
which began operation or for.which construction commenced after
HAZARDOUS SUBSTANCE means any of the substances designated ' October 21,1976.
under 40 CFR Part 116 pursuant to Section 311 of CWA. (NOTE:
These substances are listed in Table 2c-4 of the instructions to Farm •
2C) NEW INJECTION WELL means a well which begins injection after a
UIC program for the State in which the well is located is approved,
HAZARDOUS WASTE means a hazardous waste es defined in 40 CFR
Section 261.3 published May 19,1980. NEW SOURCE (in the NPDES program)means any building,structure,
facility, or installation from which there is or may be a discharge of
pollutants,the construction of which commenced:
HAZARDOUS WASTE MANAGEMENT FACILITY (HWM facility)
means 'all contiguous land, structures, appurtenances, and improve- A. After promulgation of standards of performance under Section
meats on the land, used for treating,storing,or disposing of hazardous 306 of CWA which are applicable to such source;or
wastes. A facility may consist of several treatment,storage,or disposal
operational units (for example, one or more landfills,surface impound. B. After proposal of standards of performance in accordance with
meets,or combinations of them). Section 306 of CWA which are applicable to such source,but only if
the standards are promulgated in accordance with Section 306 within
120 clays of their proposal.
IN OPERATION means a facility which is treating,storing,or disposing
of hazardous waste.
NON—CONTACT COOLING WATER means water used to reduce
temperature which does not come into direct contact with any raw
INCINERATOR (in the RCRA program) means an enclosed device material, intermediate product, waste product (other than heat), or
using controlled flame combustion, the primary purpose of which is to finished product.
thermally break down hazardous waste. Examples of incinerators are
rotary kiln,fluidized bed,and liquid injection incinerators.
OFF—SITE means any site which is not"on—site,"
INDIRECT DISCHARGER means a nondomestic discharger introduc-
ing pollutants to a publicly owned treatment works. ON—SITE means on the same or geographically contiguous property
which maybe divided by public or private right(s)—of—way,provided
the entrance and exit between she properties is at a cross—roads inter-
INJECTION WELL means a well into which fluids are being injected. section, and access Is by crossing as opposed to going along, the
. right(s)—of—way. Non—contiguous properties owned by the same per-
son,but connected by a right—of—way which the person controls and
INTERIM AUTHORIZATION means approval by EPA of a State to which the public does not have access, is also considered on—site
hazardous waste program which has met the requirements of Section property.
3006(c) of RCRA and applicable requirements of 40 CFR Part 123,
Subparts A,8,and F.
OPEN BURNING means the combustion of any material without the
following characteristics:
LANDFILL means a disposal facility or part of a facility where hazard-
ous waste is placed in or on land and which is not a land treatment A. Control of combustion air to maintain adequate temperature for
facility,a surface impoundment,or an injection well. efficient combustion;
B. Containment of the combustion—reaction in an enclosed device
LAND•TREATMENT FACILITY (in the RCRA program) means a to provide sufficient residence time and mixing for complete corn-
facility or pert of a facility at which hazardous waste is applied onto or bustion;and
incorporated into the soil surface; such facilities are disposal facilities
if the waste will remain after closure. C.Control of emission of the gaseous combustion products.
• (See also"incinerator"and"thermal treatment"). •
LISTED STATE• means a State listed by the Administrator under
Section 1422 of SOWA as needing a State UIC program.
OPERATOR means the person responsible for the overall operation
of a facility.
MGD means millions of gallons per day.
OUTFALL means a point source,
MUNICIPALITY means a city, village,town,borough,county, parish,
• district, association, or other public body created by or under State
law and having jurisdiction over disposal of sewage,industrial wastes, OWNER means the person who owns a facility or part of a facility.
or other wastes, or an Indian tribe or an authorized Indian tribal organ-
ization, or a designated and approved management agency under
Section 208 of CWA.
f-8
!'

SECTION O—GLOSSARY(continued) •
•
PERMIT means en authorization, license, or equivalent control docu- ROCK CRUSHING AND GRAVEL WASHING FACILITIES are facil-
ment issued by EPA or an approved State to implement the require- ities which process crushed and broken stone, gravel, and riprap (see
ments of 40 CFR Parts 122. 123,end 124. 40 CFR Parr 435, Subpart 8, and the effluent limitations guidelines
for these facilities).
PHYSICAL CONSTRUCTION (in the RCRA program) means excava-
tion, movement of earth, erection of forms or structures, or similar SDWA means the Safe Drinking Water Act (Pub. L 95-523,as amend•
activity to prepare a HWM facility to accept hazardous waste. ad by Pub. L. 95-1900,42 U.S.C. Section 300(f) Cr seq.)
PILE means any noncontainerized accumulation of solid. nonflowing SECONDARY INDUSTRY CATEGORY means any industry category
hazardous waste that is used for treatment or storage. which is not a primary industry category. •
POINT SOURCE means any discernible,confined,and discrete Convey- SEWAGE FROM VESSELS means human body wastes and the wastes
ante, including but not limited to any pipe, ditch, channel, tunnel, from tiolets and other receptacles intended to receive or retain body
conduit, well, discrete fissure, container, rolling stock, concentrated wastes that are discharged from vessels and regulated under Section 312
animal feeding operation,vessel or other floating craft horn which poi- of CWA, except that with respect to commercial vessels on the Great
lutants are or may be discharged. This term does riot include return Lakes this term includes graywater. For the purposes of this definition,
flows from irrigated agriculture, ' "graywater"means galley,bath,and shower water,
POLLUTANT means dredged spoil, solid waste, incinerator residue, SEWAGE SLUDGE means the solids,•residues,and precipitate separat-
' filter backwash, sewage, garbage, sewage sludge, munitions, chemical ed from or created in sewage by the unit processes of a POTW. "Sew-
waste,biological materials,radioactive materials(except those regulated age" as used in this definition means any wastes,including wastes from
under the Atomic Energy Act of 1954,as amended(42 U.S.C. Section humans, households, commercial establishments, industries, and storm
2011 et seq.. ), heat, wrecked or discarded equipment; rocks, sand, water runoff, that are discharged to or otherwise enter a publicly
cellar dirt and industrial, municipal, and agriculture waste discharged Owned treatment works.
into water. It does not mean:
A, Sewage from vessels;or• SILVICULTURAL POINT SOURCE means any discernable, confined,
and discrete conveyance related to rock crushing, gravel washing, log
8, Water,gas, or other material which is injected into a well to facili- sorting, or log storage facilities which are operated in connection with
sate production of oil or gas, or water derived in association with oil silvicultural activities and from which pollutants are discharged into
and gas production and disposed of•in a well, if the well used either waters of the United States. This term does not include nonpoint
to facilitate production or for disposal purposes is approved by source silvicultural activities such as nursery operations, site prepare-
authority of the State in which the well is located, end if the State tion, reforestation and subsequent cultural treatment, thinning, pre-
determines that the injection or disposal will not result in the degrade- scribed burning, pest and fire control, harvesting operations, surface •
tion of ground or surface water resources, drainage,•or road construction and maintenance from which there is
natural runoff. However, some of these activities(such as stream cross-
(NOTE: Radioactive materials covered by the Atomic'Energy Act are ing for roads)may involve point source discharges of dredged or fill
those encompassed in ire definition of source, byproduct, or special material which may require a CWA Section 404 permit. "Log sorting
nuclear materials. Examples of materials not covered include radium and log storage facilities" are facilities whose discharges result from the
and accelerator produced isotopes. See Train v. Colorado Public holding of unprocessed wood, e.g., logs or roundwood with bark or
Interest Research Group, Inc.,426 U.S. 1 (19761.) after removal of bark in self—contained bodies of water(mill ponds or
. log ponds) or stored on land where water is applied intentionally on
the logs (wet decking). (See 40 CFR Part 429,Subpart,and the efflu-
PREVENTION OF SIGNIFICANT DETERIORATION (PSD) means enr limitations guidelines for these facilities.) •
the national permitting program under 40 CFR 52.21 to prevent emis-
sions of certain pollutants regulated under the Clean Air Act horn signi-
ficantly deteriorating air quality In artair.ment areas. STATE means any of the 50 States, the District of Columbia, Guam,
the Commonwealth of Puerto Rico, the Virgin Islands, American
Samoa, the Trust Territory of the Pacific Islands(except in the case of
PRIMARY INDUSTRY CATEGORY means any industry category list- RCRA), and the Commonwealth of the Northern Mariana Islands
ad in the NR DC Settlement Agreement (Natural Resources.Defense (except in the case of CNJA).
Council v. Train, 8 ERC 2120 (D.D.C. 19761, modified 12 ERC 1833 •
(D.O,C 19791).
STATIONARY SOURCE (in the PSD program) means any building,
structure,facility, or installation which emits or may emit any air.pol•
PRIVATELY OWNED TREATMENT WORKS means any device or lutant regulated under the Clean Air Act."Building,structure,facility, •
system which is: (Al Used to treat wastes from any facility whose or installation" means any grouping of pollutant—emitting activities
operator is not the operator of the treatment works; and (RI Not a which are located on one or more contiguous or adjacent properties
POTW. and which are owned or operated by the same person (or by persons •
under common control).
PROCESS WASTEWATER means any water which,during manufectur.
ing or processing, comes into direct contact with or results from the STORAGE (in the RCRA program) means the holding of hazardous
production or use of any raw materiel,intermediate product, finished waste for a temporary period at the end of which the hazardous waste
product,byproduct,or waste product, is treated,disposed,or stored elsewhere.
PUBLICLY OWNED TREATMENT WORKS or POTW means any de- STORM WATER RUNOFF means water discharged as a result of rain,
• vice or system used in the treatment (including recycling and reclarna- snow,or other precipitation,
tion) of municipal sewage or industrial wastes of a liquid nature which
is owned by a State or municipality, This definition includes any sew-
ers, pipes, or other conveyances only if they convey wastewater to a SURFACE IMPOUNDMENT or IMPOUNDMENT means a facility or •
POTW providing treatment, part of a facility which is a natural topographic depress on, manmade
excavation, or diked area formed primarily of earthen materials (a/-
though it may be lined with manmade materials), which is designed to
RENT means use of another's property in return for regular payment. hold an accumulation of liquid wastes or wastes containing free liquids,
end which is not en injection well. Examples of surface impoundments
are holding, storage, settling, and aeration pits, ponds, end lagoons.
RCRA means the Solid Waste Disposal Act as amended by the Resource
Conservation and Recovery Act of 1976 (Pub. L 94-580,as amended
by Pub. L'95-609,42 U.S.0 Section 6901 et seq.). TANK (in the RCRA program) means a stationary device,designed to
contain an accumulation of hazardous waste which is constructed pre-
madly of non—earthen materials (e.g-, wood, concrete, steel, plastic)
which provide structural support.
1-9 •
+.

SECTION D—GLOSSARY(continued) •
THERMAL TREATMENT (in the RCRA program) means the treat- WATERS OF THE UNITED STATES means:
ment of hazardous waste in a device which uses elevated temperature as
the primary means to change the chemical,physical,or biological char- • A. All waters which are currently used,were used in the past,or may •
acter or composition of the hazardous waste. Examples of thermal be susceptible to use in interstate or foreign commerce, including
treatment processes are incineration,molten salt,pyrolysis,calcination, all waters which are subject to the ebb and flow of the tide;
wet air oxidation,and microwave discharge.(See also"incinerator"and
"open burning"), B.All interstate waters,including interstate wetlands;
C. All other waters such as intrastate lakes, rivers, streams(including
TOTALLY ENCLOSED TREATMENT FACILITY (in the RCRA pro- intermittent streams), mudflats, sanditats, wetlands, sloughs, prairie
gram) means a facility for the treatment of hazardous waste which is di- potholes, wet meadows, playa lakes, and natural ponds, the use,
rectly connected to an.industrial production process and which is con- degradation,or destruction of which would or could affect interstate
strutted and operated in a manner which prevents the release of any or foreign commerce including any such waters:
hazardous waste or any constituent thereof into the environment dur-
ing treatment.An example is a pipe in which waste acid is neutralized. 1. Which are or could be used by interstate or foreign travelers for
recreational or other purposes,
TOXIC POLLUTANT means any pollutant listed as toxic under Section 2. From which fish or shellfish are or could be taken and sold in
307(a)(I)of CWA. interstate or foreign commerce,
3. Which are used or could be used for industrial purposes by in-
TRANSPORTER (in the RCRA program) means a person engaged in dustries in interstate commerce;
the of f- site transportation of hazardous waste by air,rail,highway,or
water. D. All impoundments of waters otherwise defined as waters of the
United States under this definition;
TREATMENT (in the RCRA program) means any method, technique, E. Tributaries of waters identified in paragraphs (A) — (D) above;
or process, including neutralization, designed to change the physical,
chemical, or biological character or composition of any hazardous F.The territorial sea;and
waste so as to neutralize such waste, or so as to recover energy or ma-
terial resources from the waste,or so as to render such waste non—haz- • G. Wetlands adjacent to waters(other than waters that are themselves
ardous, or less hazardous; safer to transport, store, or dispose of; or wetlands)identified in paragraphs(A).— (F)of this definition.
amenable for recovery, amenable for storage, or reduced in volume. •
Waste treatment systems, including treatment.ponds or lagoons design-
ed to meet requirement of CWA (other than cooling ponds as defined •
UNDERGROUND INJECTION means.well injection. in 40 CFR Section 423.77(m) which also meet the criteria'of this
definition) are not waters of the United States, This exclusion applies
only to manmade bodies of water which neither were originally created
UNDERGROUND SOURCE OF DRINKING WATER or USDW means • in waters of the United States (such as a disposal area in wetlands)nor
an aquifer or its portion which is not an exempted aquifer and: resulted from the impoundments of waters of the United States. •
A.Which supplies drinking water for human consumption;or
WELL INJECTION or UNDERGROUND INJECTION means the sub-
B. In which the ground water contains fewer than 10,000 mg/I total- surface emplacement of fluids through a bored, drilled,or driven well;
dissolved solids. - or through a dug well,where the depth of the dug welt is greater than
the largest surface dimension.
UPSET means an exceptional incident in which there is unintentional
and temporary noncompliance with technology—based permit effluent WETLANDS means those areas that are inundated or saturated by
limitations because of factors beyond the reasonable control of the surface or groundwater at a frequency and duration sufficient to sup-
• permittee. An upset does not include noncompliance to the extent port,and that under normal circumstances do support,a prevalence of
caused by operational error, improperly designed treatment facilities, vegetation typically adapted for life in saturated soil conditions.Wet- •
inadequate treatment facilities,lack of preventive maintenance,or care- lands generally include swamps, marshes, bogs, end similar areas.
less or improper operation.
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T 4
instructions - Form 2F
Application for Permit to Discharge Storm Water
Associated with Industrial Activity
Who Must File Form 2F
Form 2F must be completed by operators of facilities which discharge storm water associated with industrial
activity or by operators of storm water discharges that EPA is evaluating for designation as a significant
contributor of pollutants to waters of the United States, or as contributing to a violation of a water quality
standard.
Operators of discharges which are composed entirely of storm water must complete Form 2F (EPA Form
3510-2F) in conjunction with Form 1 (EPA Form 3510.1).
Operators of discharges of storm water which are combined with process wastewater (process wastewater
is water that comes into direct contact with or results from the production or use of any raw material, interme-
diate product. finished product, byproduct,waste product, or wastewater) must complete and submit Form
2F, Form 1, and Form 2C (EPA Form 3510-2C).
Operators of discharges of storm water which are combined with nonprocess wastewater (nonprocess
wastewater includes noncontact cooling water and sanitary wastes which are not regulated by effluent guide-
lines or a new source performance standard, except discharges by educational, medical, or commercial
chemical laboratories) must complete Form 1, Form 2F, and Form 2E (EPA Form 3510-2E).
Operators of new sources or new discharges of storm water associated with industrial activity which will be
combined with other nonstormwater new sources or new discharges must submit Form 1, Form 2F, and
Form 2D (EPA Form 3510-2D),
Where to File Applications
The application forms should be sent to the EPA Regional Office which covers the State in which the facility
is located. Form 2F must be used only when applying for permits in States where the NPDES permits
program is administered by EPA. For facilities located in States which are approved to administer the NPDES
permits program. the State environmental agency should be contacted for proper permit application forms
and instructions.
Information on whether a particular program is administered by EPA or by a State agency can be obtained
from your EPA Regional Office. Form 1, Table 1 of the "General Instructions' lists the addresses of EPA
Regional Offices and the States within the jurisdiction of each Office.
Completeness
Your application will not be considered complete unless you answer every question on this form and on Form
1. if an item does not apply to you,enter"NA"(for not applicable)to show that you considered the question.
Public.Availability of Submitted Information
You may not claim as confidential any information required by this form or Form 1,whether the information
is reported on the forms or in an attachment. Section 402(j) of the Clean Water Act requires that all permit
applications will be available to the public. This information will be made available to the public upon request.
Any information you submit to EPA which goes beyond that required by this form, Form 1, or Form 2C you
may claim as confidential, but claims for information which are effluent data will be denied.
If you do not assert a claim of confidentiality at the time of submitting the information. EPA may make the
information public without further notice to you. Claims of confidentiality will be handled in accordance with
EPA's business confidentiality regulations at 40 CFR Part 2.
. Definitions
All significant terms used in these Instructions and in the form are defined in the glossary found in the General
Instructions which accompany Form 1
EPA ID Number •
Fill in your EPA Identification Number at the top of each odd-numbered page of Form 2F. You may copy this
number directly from item 1 of Form 1.
EPA Form 35t0.2F (11 40) I - 1

• Item 1
You may use the map you provided for item XI of Form 1 to determine the latitude and longitude of each of
your outfalls and the name of the receiving water.
item II-A
If you check"yes"to this question,complete all parts of the chart,or attach a copy of any previous submission
you have made to EPA containing the same information.
Item II-B
You are not required to submit a description of future pollution control projects if you do not wish to or if none
is planned.
Item III
Attach a site map showing topography (or indicating the outline of drainage areas served by the outfall(s)
covered in the application if a topographic map is unavailable) depicting the facility including:
•
each of its drainage and discharge structures;
the drainage area of each storm water outfall;
paved areas and building within the drainage area of each storm water outfall, each known past or
present areas used for outdoor storage or disposal of significant materials,each existing structural con-
trol measure to reduce pollutants in storm water runoff,materials loading and access areas,areas where
pesticides, herbicides, soil conditioners and fertilizers are applied;
each of its hazardous waste treatment. storage or disposal facilities (including each area not required to
have a RCRA permit which is used for accumulating hazardous waste for less than 90 days under 40 CFR
262.34);
each well where fluids from the facility are injected underground; and
springs. and other surface water bodies which receive storm water discharges from the facility,
Item IV-A
For each outfall, provide an estimate of the area drained by the outfall which is covered by impervious
surfaces. For the purpose of this application, impervious surfaces are surfaces where storm water runs off at
rates that are significantly higher than background rates (e.g., predevelopment levels) and include paved
areas. building roofs, parking lots, and roadways. Include an estimate of the total area (including ail impervi-
ous and pervious areas)drained by each outfall. The site map required under item Ill can be used to estimate
the total area drained by each outfall.
Item IV-B
Provide a narrative description of significant materials that are currently or in the past three years have been
treated, stored, or disposed in a manner to allow exposure to storm water: method of treatment, storage or
disposal of these materials; past and present materials management practices employed, in the last three
years, to minimize contact by these materials with storm water runoff; materials loading and access areas:
and the location, manner,and frequency in which pesticides, herbicides,soil conditioners,and fertilizers are
applied. Significant materials should be identified by chemical name, form (e.g., powder, liquid, etc.), and
type of container or treatment unit. Indicate any materials treated, stored, or disposed of together. "Signifi•
cant materials"includes,but Is not limited to: raw materials;fuels;materials such as solvents,detergents,and
plastic pellets;finished materials such as metallic products;raw materials used in food processing or produc-
tion; hazardous substances designated under'Section 101(14).of CERCLA; any chemical the facility is re-
' quired to report pursuant to Section 313 of Title III of SARA;fertilizers; pesticides; and waste products such _
as ashes. slag and sludge that have the potential to be released with storm water discharges.
item IV-C
For each outfaft, structural controls Include structures which enclose material handling or storage areas,
covering materials, berms, dikes, or diversion ditches around manufacturing, production, storage or treat-
ment units. retention ponds, etc. Nonstructural controls include practices such as spill prevention plans,
employee training,visual inspections, preventive maintenance,and housekeeping measures that are used to
prevent or minimize the potential for releases of pollutants.
EPA Form 3510-2F (11-90) ! -2

item V
Provide a certification that all outfalls that should contain storm water discharges associated with industrial
activity have been tested or evaluated for the presence of non-storm water discharges which are not covered
by an NPDES permit. Tests for such non-storm water discharges may include smoke tests, fluorometric dye
tests. analysis of accurate schematics, as well as other appropriate tests. Part B must include a description
of the method used,the date of any testing,and the onsite drainage points that were directly observed during
a test. All non-storm water discharges must be identified in a Form 2C or Form 2E which must accompany
this application (see beginning of instructions under section titled Who Must File Form 2F"for a description
of when Form 2C and Form 2E must be submitted).
Item VI
Provide a description of existing information regarding the history of significant leaks or spills of toxic or
hazardous pollutants at the facility in the last three years
Item VII-A, B, and C
These items require you to collect and report data on the pollutants discharged for each of your outfalls. Each
part of this item addresses a different set of pollutants and must be completed in accordance with the specific
instructions for that part. The following general instructions apply to the entire item.
General Instructions
Part A requires you to report at least one analysis for each pollutant listed. Parts 3 and C require you to report
analytical data in two ways. For some pollutants addressed in Parts B and C, if you know or have reason to
know that the pollutant is present in your discharge.you may be required to list the pollutant and test (sample
and analyze) and report the levels of the pollutants in your discharge. For all other pollutants addressed in
Parts B and C, you must list the pollutant if you know or have reason to know that the pollutant is present in
the discharge.and either report quantitative data for the pollutant or briefly describe the reasons the pollutant
is expected to be discharged. (See specific instructions on the form and below for Parts A through C.) Base
your determination that a pollutant is present in or absent from your discharge on your knowledge of your
raw materials. material management practices, maintenance chemicals, history of spills and releases, inter.
mediate and final products and byproducts, and any previous analyses known to you of your effluent or
similar effluent.
A. Sampling: The collection of the samples for the reported analyses should be supervised by a person
experienced in performing sampling of industrial wastewater or storm water discharges. You may con-
tact EPA or your State permitting authority for detailed guidance on sampling techniques and for answers
to specific questions. Any specific requirements contained in the applicable analytical methods should
be followed for sample containers, sample preservation, holding times, the collection of duplicate sam-
ples. etc. The time when you sample should be representative, to the extent feasible, of your treatment
system operating properly with no system upsets. Samples should be collected from the center of the
flow channel, where turbulence is at a maximum,at a site specified in your present permit, or at any site
adequate for the collection of a representative sample.
For pH, temperature, cyanide, total phenols, residual chlorine, oil and grease, and fecal coliform, grab
samples taken during the first 30 minutes(or as soon thereafter as practicable) of the discharge must be
used (you are not required to analyze a flow-weighted composite for these parameters). For all other
pollutants both a grab sample collected during the first 3o minutes(or as soon thereafter as practicable)
of the discharge and a flow-weighted composite sample must be analyzed. However,a minimum of one
grab sample may be taken for effluents from holding ponds or other impoundments with a retention
period of greater than 24 hours.
Alt samples shall be collected from the discharge resulting from a storm event that is greater than G.1
inches and at least 72 hours from the previously measurable(greater than 0.1 inch rainfall) storm event
Where feasible, the variance in the duration of the event and the total rainfall of the event should not
exceed 50 percent from the average or median rainfall event in that area.
A grab sample shall be taken during the first thirty minutes of the discharge (or as soon thereafter as
practicable), and a flow-weighted composite shall be taken for the entire event or for the first three hours
of the event.
Grab and composite samples are defined as follows:
EPA Form 3510.2F (11.90) I -3

Grab sample: An individual sample of at least 100 milliliters collected during the first thirty minutes
(or as soon thereafter as practicable) of the discharge.This sample is to be analyzed separately from
the composite sample.
Flow-Weighted Composite sample:A flow-weighted composite sample may be taken with a con-
tinuous sampler that proportions the amount of sample collected with the flow rate or as a combina-
tion of a minimum of three sample aliquots taken in each hour of discharge for the entire event or for
the first three hours of the event, with each aliquot being at least 100 milliliters and collected with a
minimum period of fifteen minutes between aliquot collections. The composite must be flow propor-
tional; either the time interval between each aliquot or the volume of each aliquot must be propor-
tional to either the stream flow at the time of sampling or the total stream flow since the collection of
the previous aliquot. Aliquots may be collected manually or automatically. Where GC/MS Volatile
Organic Analysis (VOA) is required,aliquots must be combined in the laboratory immediately before
analysis. Only one analysis for the composite sample is required.
Data from samples taken in the past may be used. provided that:
All data requirements are met;
Sampling was done no more than three years before submission: and
All data are representative of the present discharge.
Among the factors which would cause the data to be unrepresentative are significant changes in produc-
tion level, changes in raw materials, processes,or final products, and changes in storm water treatment.
When the Agency promulgates new analytical methods in 40 CFR Part 136, EPA will provide information
as to when you should use the new methods to generate data on.your discharges. Of course, the
Director may request additional information, including current quantitative data, if they determine it to be
necessary to assess your discharges. The Director may allow or establish appropriate site-specific sam-
pling procedures or requirements, including sampling locations,the season in which the sampling takes
place. the minimum duration between the previous measurable storm event and the storm event sam-
pled, the minimum or maximum level of precipitation required for an appropriate storm event, the form.
of precipitation sampled (snow melt or rainfall), protocols for collecting samples under 40 CFR Part 136,
and additional time for submitting data on a case-by-case basis.
B. Reporting: All levels must be reported as concentration and as total mass. You may report some or all
of the required data by attaching separate sheets of paper instead of filling out pages VII-t and VII-2 if the
separate sheets contain all the required information in a format which is consistent with pages VII-1 and
Vli-2 in spacing and in identification of pollutants and columns. Use the following abbreviations in the
columns headed"Units."
Concentration Mass
ppm parts per million lbs pounds
mg/I milligrams per liter ton tons (English tons)
ppb parts per billion mg milligrams
ugh . micrograms per liter g grams
kg kilograms T tonnes (metric tons)
•
All reporting of values for metals must be in terms of"total recoverable metal,"unless:
(1) An applicable, promulgated effluent limitation or standard specifies the limitation for the metal in
dissolved, valent, or total form; or
(2) Ali approved analytical methods for the metal inherently measure only its dissolved form (e.g.,
hexavalent chromium); or
(3)The permitting authority has determined that in establishing case-by-case limitations it is neces-
sary to express the limitations on the metal in dissolved,valent, or total form to carry out the provi-
sions of the CWA. If you measure only one grab sample and one flow-weighted composite sample
for a given outfall, complete only the'Maximum Values'columns and insert "1" into the "Number of
Storm Events Sampled" column. The permitting authority may require you to conduct additional
analyses to further characterize your discharges.
EPA Form 3510-2F (11.90) I -4

it you measure more than one value for a grab sample or a flow-weighted composite sample for a given
outfall and those values are representative of your discharge, you must report them. You must describe
your method of testing and data analysis. You also must determine the average of all values within the
last year and report the concentration mass under the 'Average Values" columns, and the total number
of storm events sampled under the"Number of Storm Events Sampled"columns,
C. Analysis: You must use test methods promulgated in 40 CFR Part 136; however, if none has been
promulgated for a particular pollutant, you may use any suitable method for measuring the level of the
pollutant in your discharge provided that you submit a description of the method or a reference to a
published method. Your description should include the sample holding time, preservation techniques,
and the quality control measures which you used. If you have two or more substantially identical outfalls,
you may request permission from your permitting authority to sample and analyze only one outfall and
submit the results of the analysis for other substantially identical outfalls. If your request is granted by the
permitting authority, on a separate sheet attached to the application form, identify which outfall you did
test, and describe why the outfalls which you did not test are substantially identical to the outfall which
you did test.
Part VII-A
Part VII-A must be completed by all applicants for all outfalls who must complete Form 2F.
Analyze a grab sample collected during the first thirty minutes (or as soon thereafter as practicable) of the
discharge and flow-weighted composite samples for all pollutants in this Part, and report the results except
use only grab samples for pH and oil and grease. See discussion in General Instructions to Item VII for
definitions of grab sample collected during the first thirty minutes of discharge and flow-weighted composite
sample. The "Average Values"column is not compulsory but should be filled out if data are available.
Part Vlt-B
List all pollutants that are limited in an effluent guideline which the facility is subject to (see 40 CFR Subchap-
ter N to determine which pollutants are limited in effluent guidelines) or any pollutant listed in the facility's
NPDES permit for its process wastewater (if the facility is operating under an existing NPDES permit;. Com-
plete one table for each outfall. See discussion in General instructions to item VII for definitions of grab
sample collected during the first thirty minutes (or as soon thereafter as practicable) of discharge and flow-
weighted composite sample The "Average Values" column is not compulsory but should be filled out if data
are available.
Analyze a grab sample collected during the first thirty minutes of the discharge and flow-weighted composite
samples for all pollutants in this Part, and report the results, except as provided in the General Instructions.
Part VII-C
Part Vll-C must be completed by all applicants for all outfalls which discharge storm water associated with
industrial activity, or that EPA is evaluating for designation as a significant contributor of pollutants to waters
of the United States, or as contributing to a violation of a water quality standard. Use both a grab sample and
a composite sample for aft pollutants you analyze for in this part except use grab samples for residual chlorine
and fecal coliform. The 'Average Values" column is not compulsory but should be filled out if data are
available. Part C requires you to address the pollutants in Table 2F-2, 2F-3, and 2F-4 for each outfalf. Pollu-
tants in each of these Tables are addressed differently.
Table 2F-2: For each outfall, list all pollutants in Table 2F-2 that you know or have reason to believe are
discharged (except pollutants previously listed in Part VII-B). If a pollutant is limited in an effluent guideline
limitation which the facility.is subject to (e.g use of TSS as an indicator to control the discharge of iron and
aluminum), the pollutant should be listed in Part VII-B. If a pollutant in table 2F-2 is indirectly limited by an
effluent guideline limitation through an indicator, you must analyze for it and report data in Part VII-C. For
Other pollutants listed in Table 2F-2 (those not limited directly or indirectly by an effluent limitation guideline).
that you know or have reason to believe are discharges, you must either report quantitative data or briefly
describe the reasons the pollutant Is expected to be discharged.
Table 2F-3: For each outfall, list all pollutants in Table 2F-3 that you know or have reason to believe are
discharged. For every pollutant in Table 2F-3 expected to be discharged in concentrations of 10 ppb or
greater, you must submit quantitative data. For acrolein, acrylonitrile, 2.4 dinitrophenol, and 2-methyl-4,6
dinitrophenof, you must submit quantitative data if any of these tour pollutants is expected to be discharged
EPA Form 3510-2F (11.90) I - 5

in concentrations of 100 ppb or greater. For every pollutant expected to be discharged in concentrations less
than 10 ppb (or 100 ppb for the four pollutants listed above), then you must either submit quantitative data
or briefly describe the reasons the pollutant is expected to be discharged.
Small Business Exemption-If you are a'small business.'you are exempt from the reporting requirements
for the organic toxic pollutants listed in Table 2F-3. There are two ways In which you can qualify as a "small
business". If your facility is a coal mine,and if your probable total annual production is less than 100,000 tons
per year, you may submit past production data or estimated future production (such as a schedule of esti-
mated total production under 30 CFR 795.14(c)) instead of conducting analyses for the organic toxic pollu-
tants. If your facility is not a coal mine, and if your gross total annual sales for the most recent three years
average less than 5100,000 per year (in second quarter 1980 dollars), you may submit sales data for those
years instead of conducting analyses for the organic toxic pollutants. The production or sales data must be
for the facility which is the source of the discharge. The data should not be limited to production or sales for
the process or processes which contribute to the discharge, unless those are the only processes at your
facility. For sales data, in situations involving intracorporate transfer of goods and services,the transfer price
per unit should approximate market prices for those goods and services as closely as possible. Sales figures
for years after 1980 should be indexed to the second quarter of 1980 by using the gross national product
price deflator (second quarter of 1980.100). This index is available in National Income and Product Ac-
counts of the United Stales (Department of Commerce, Bureau of Economic Analysis).
Table 2F-4: For each outfall, list any pollutant in Table 2F-4 that you know or believe to be present in the
discharge and explain why you believe it to be present. No analysis is required, but if you have analytical
data. you must report them. Note: Under 40 CFR 117.12(a)(2), certain discharges of hazardous substances
(listed at 40 CFR 177.21 or 40 CFR 302.4) may be exempted from the requirements of section 311 of CWA,
which establishes reporting requirements, civil penalties, and liability for cleanup costs for spills of oil and
hazardous substances. A discharge of a particular substance may be exempted if the origin, source, and
amount of the discharged substances are identified in the NPDES permit application or in the permit. if the
permit contains a requirement for treatment of the discharge, and if the treatment is in place. To apply for an
exclusion of the discharge of any hazardous substance from the requirements of section 311, attach addi-
tional sheets of paper to your form, setting forth the following information:
1 The substance and the amount of each substance which may be discharged.
2. The origin and source of the discharge of the substance.
3. The treatment which is to be provided for the discharge by:
a. An onsite treatment system separate from any treatment system treating your normal dis-
charge:
b. A treatment system designed to treat your normal discharge and which is additionally capable
of treating the amount of the substance identified under paragraph 1 above: or
c Any combination of the above.
See 40 CFR 117.12(a)(2) and (c), published on August 29, 1979, in 44 FR 50766, or contact your Regional
Office (Table 1 on Form 1, Instructions),for further information on exclusions from section 311.
Part VII-D
If sampling is conducted during more than one storm event, you only need to report the information re-
quested in Part VII-D for the storm event(s)which resulted in any maximum pollutant concentration reported
in Part Vlf-A, V1I-B, Or VII-C.
Provide flow measurements or estimates of the flow rate, and the total amount of discharge for the storm
'event(s) sampled,the method of flow measurement,or estimation. Provide the data and duration of the storm
event(s) sampled, rainfall measurements,or estimates of the storm event which generated the sampled runoff
and the duration between the storm event sampled and the end of the previous measurable(greater than 0.1
inch rainfall) storm event.
Part VlI-E
List any toxic pollutant listed in Tables 2F-2, 2F-3, or 2F-4 which you currently use or manufacture as an
intermediate or final product or byproduct. In addition, ff you know or have reason to believe that 2.3,7.8-te-
trachlorodibenzo-p-dioxin (TCDD) is discharged or it you use or manufacture 2,4.5-trichlorophenoxy acetic
EPA Form 3510-2F (11.90) I -6

acid(2.4,5,-T);2-(2,4,5-trichlorophenoxy)propanoic acid(Silvex,2,4,5,-TP);2-(2,4,5-trichlorophenoxy)ethyl.
2,2-dichloropropfonate (Erbon); 0,0-dimethyl 0-(2,4,5-trichlorphenyl) phosphorothioate (Ronnel); 2,4,5-
trichlorophenol (TCP); or hexachlorophene (HCP); then list TCDD. The Director may waive or modify the
requirement if you demonstrate that it would be unduly burdensome to identity each toxic pollutant and the
Director has adequate information to issue your permit. You may not claim this information as confidential;
however, you do not have to distinguish between use or production of the pollutants or list the amounts.
Item VIII
Self explanatory. The permitting authority may ask you to provide additional details after your application is
received.
Item X
The Clean Water Act provides for severe penalties for submitting false information on this application form.
Section 309(c)(4) of the Clean Water Act provides that'Any person who knowingly makes any false material
statement, representation, or certification in any application, . . .shall upon conviction, be punished by a fine
of not more than $10,000 or by imprisonment for not more than 2 years. or by both. If a conviction of such
person is for a violation committed after a first conviction of such person under this paragraph, punishment
shall be by a fine of not more than 520,000 per day of violation, or by imprisonment of not more than 4 years,
or by both."40 CFR Part 122.22 requires the certification to be signed as follows:
(A) For a corporation: by a responsible corporate official. For purposes of this section, a responsible
corporate official means (i) a president. secretary, treasurer, or vice-president of the corporation in
charge of a principal business function, or any other person who performs similar policy- or decision-
making functions for the corporation, or (ii) the manager of one or more manufacturing. production, or
operating facilities employing more than 250 persons or having gross annual sales or expenditures
exceeding 525,000.000 (in second-quarter 1980 dollars), if authority to sign documents has been as-
signed or delegated to the manager in accordance with corporate procedures.
Note: EPA does not require specific assignments or delegation of authority to responsible corporate
officers identified in 122.22(a)(1)(i). The Agency will presume that these responsible corporate officers
have the requisite authority to sign permit applications unless the corporation has notified the Director to
the contrary. Corporate procedures governing authority to sign permit applications may provide for
assignment or delegation to applicable corporate position under 122.22(a)(1)(ii) rather than to specific
individuals.
(B) For a partnership or sole proprietorship: by a general partner or the proprietor, respectively; or
(C) For a municipality, State, Federal, or other public agency: by either a principal executive officer
or ranking elected official. For purposes of this section,a principal executive officer of a Federal agency
includes (i)the chief executive officer of the agency,or(ii)a senior executive officer having responsibility
for the overall operations of a principal geographic unit of the agency (e.g., Regional Administrators of
EPA).
EPA Form 3510-2F (11-90) I -

Table 2F-1
Codes for Treatment Units
Physical Treatment Processes
t-A Ammonia Stripping 1-M Grit Removal
1-B Dialysis 1-N Microstraining
1-C Diatomaceous Earth Filtration 1-0 Mixing
1-D Distillation 1-P Moving Bed Filters
' 1•E Electrodialysis 1-0 Multimedia Filtration
1-F Evaporation 1-R Rapid Sand Filtration
1-G Flocculation 1-S Reverse Osmosis (Hyperfiltration)
I-H Flotation 1-T Screening
1-I Foam Fractionation 1-U Sedimentation (Setting)
1•J Freezing 1-V Slow Sand Filtration
1-K Gas-Phase Separation 1-W Solvent Extraction
1-L Grinding(Comminutors) 1-X Sorption .
Chemical Treatment Processes .
2-A Carbon Adsorption 2-G Disinfection (Ozone)
2.B Chemical Oxidation 2-H Disinfection (Other)
2•C Chemical Precipitation 2-I Electrochemical Treatmeit
2-D Coagulation 2-J Ion Exchange
2•E Dechlorination 2-K . Neutralization
2-F Disinfection (Chlorine) • 2-L Reduction
Biological Treatment Processes
3-A Activated Sludge 3-E Pre-Aeraticrt
3-5 Aerated Lagoons 3-F Spray Irrigation/Land Application
3-C Anaerobic Treatment 3-G• Stabilization Ponds
3-0 Niuification.Denitrification 3-H Trickling Filtration
Other Processes
Z.:. Discharge to Surface Water 4-C Reuse/Recycle of Treated Effluent
4-8 Ocean Discharge Through Outfall 4-D Underground Injection
Sludge Treatment and Disposal Processes
5-A Aerobic Digestion 5-M Heat Drying
5-13 Anaerobic Digestion 5-N Heat Treatment
5-C Belt Filtration 5-0 Incineration
5-0 Centrifugation 5-P Land Application
5-E Chemical Conditioning 5-0 Landfill
5-F Chlorine Treatment 5-R Pressure Filtration
5-G Composting s-S Pyrolysis
5-H Drying Beds 5-T Sludge Lagoons
.5-I Elutriation 5-U Vacuum Filtration
5-J Flotation Thickening 5-V Vibration
5-K • . Freezing 5-W Wet Oxidation
5-L Gravity Thickening
EPA Form 3510-2F (11-90) I -8

Table 2F-2
Conventional and Nonconventional Pollutants Required To Be Tested by Existing Discharger it
Expected To Be Present
Bromide
Chlorine,Total Riniduat
Color •
Feca!Colitorm
Fluoride
Nitrate•NiKite
Nitrogen.Total Kjedatll
Oil and Grease
Phosphorus.Total Radioactive',/
Sulfate
Sulfide
Sulfite
Surfactants
Aluminum.Total
Barium,Total
Boron,Total
Cobalt.Total
Iron,Total
Magnesium,Total
Molybdenum,Total
Magnesium,Total
Tin.Total
7itan.t.:m,TC:a:
EPA Form 3510-2F (11.90) I -9

Table 2F-3
Toxic po)lutarlts required to be
identified by applicant If expected to be present
Toxic Pollutants and Total Phenol
Antimony,Total Copper,Total Silver,Total
Arsenic,Total Lead.Total Thallium.Total
Beryllium,Total Mercury.Total Zinc,Total
Cadmium,Total Nickel,Total Cyanide,Total
Chromium.Total Selenium,Total Phenols.Total
GC/MS Fraddon Volatllss Compounds
Acrolein Dichlorobromomethane 1,1,2,2.•Tetrachloroethane
Acrylonitrile 1,1-Dichloroethane Tetrachloroethylene
Benzene 1,2-Dichloroethane Toluene
Bromoform 1,1-Dichloroethylene 1,2•Trans-Dichloroethylene
Carbon Tetrachloride 1.2-Dichloropropane • 1,1,1•Trichloroethane
Chlorobenzene 1,3-Dichloropropylene 1,1,2-Trichioroethene
Chlorodibromomethane Ethytbenzene Trichloroethylene
Chloroethana Methyl Bromide Y,nyl.C1 loride
2•Chloroethylvinyi Ether Methyl Chloride
Chloroform Methylene Chloride
Acld Compounds
2-Chlorophe".ol 2.4-Diniirophenol Pentacnlcropnenol
2,4•DichlorOphenel 2•Nitrophenol Phenol
2.4-Dimetnylphenol 4-Nitrophenol 2,4,6-Trichlorophenot
4 6-Dinitro•O-Cresol p-Chloro•M-Cresol
Base/Neutral
Acenaphthene 2-Chloronaphthalene Fluroranthene
Acenapnthylene 4-Chlorophenyl Phenyl Ether Fluorene
Anthracene Chrysene Hexachlorobenzene
Benzidine Dibenzo(a.h)anthracene Hexachlorobutadiene
Benzola)anthrecene 1,2-Dichlorobenzene Hexachloroethane
Benzo(a)pyrens 1.3-Dichtorobenzene lndsno1 1.2,3-cd)PYrene
3,4•Benzofluoranthene 1,4-Dichlorobenzene Isophorone
Benzo(pni)perylene 3,3'•Dichlorobenzidine Napthalene
Benzoiklflu0ranthehe Diethyl Phthalate Nitrobenzene
Bis(2-chtoroethoxylmethane Dimethyf Phthalate N•Nitrosodimethylamine
Bis(2-chloroethyllether Di-N-Butyl Phthalate N-Nilrosodi-N-Propytamine
Bisl2-chloroisopropyltether 2.4-Dinitrotolusne N-Nitrosodiphenyiamine
Bis(2-etnylyhsxyl)phlhalate 2,6-Dinitrotoluens Phenanthrene
4-Bromophenyl Phenyl Ether Di-N-Oclylphthalate Pyrene
Butylt»nryl Phthalate 1,2-Diphenylhydraline(as Azoben- 1,2,4-Trichlorobenzene
zone)
Pssdcldes
Aldrin Dieldrin PCB•1254
Alpha-BHC Alpha-Endo utfan PCB-1221
Beta•BHC Beta-Endosutfen PCB-1232
Gamma-BHC Endosutfan Sulfate PCB-1248
Delta-BHC Endrin PCB-1260
Chlordane Endrin Aldehyde PCB-1016
4,4'-DDT Heptachlor Toxaphene
4,4'-DOE Heptachlor Epoxide
4,4'.DIhD PCB-1242
EPA Form 3510-2F (11.90) I - 10

Table 2F-4
Hazardous substances required to be
identified by applicant if expected to be present
Toxic Pollutant
Asbestos
Hazardous Substances
Acetaldehyde Dinitrobenzene Napthenic acid
Atlyl alcohol Diquat Nitrotoluene
Attyl chloride Ditiutloton Parathion
Amyl acetate Diuron Phenolsulfonate
Aniline Epichtorohydrin Phosgene
Benzonitrile Ethion Propargite
Benzyt chloride Ethylene diamine Propylene oxide
Butyl acetate Ethylene dibromide Pyrethrins
Butylamine formaldehyde Ouinoline
Carbaryl Furtural Resorcinol
Carboturan Guthion Stronthium
Carbon disul`:ce Isoprene Strychnine
Chiorpyrifos lsopropanolamine Styrene
Coumaphos Kelthane 2,4.5-T 12.4,5.Trichlorophenoxyacetic
acid)
Cresol Kepone TOE )1etrachlorodionenytethane)
CrctonaloehyZe Malathion 2.4.5•TP 12-f2.4.5-Trichiorophencxyl
propanoic acid]
Cyc fohe x e ne Me roaptodimethur Ts ichloroten
2.4-D(2.4-Dichlcroahenoxyacetic Methoxychlor Triethylamine
acid)
Diazincn Methyl mercaptan Trimethylamine
^camba Methyl methacrylate Uranium
Oichlobe^.I Methyl parathion Vanadium
Dichlcne Mevinphos Vinyl acetate
2.2-Dichleropropicnic acid Mexacarbate Xylene
Dithlcrvos Monoethyl amine Xylenol
Diethyl amine Monomethyi amine Zrconium
Dimethyl amine Naled
EPA Form 3510-2F {11.90) I - 11

EPA ID Number (copy from item r of Form 7) • '`,a Form Approved.
Please print ortype in the unshaded areas OnlyOMB Na expire 8-3.
Approval expires 8-33.38.
Form United States Environmental Protection Agency 1
A Washington,DC 20460
2F i,,,,,,EpA Application for Permit To Discharge Stormwater I
NPCES Discharges Associated with Industrial Activity
Paperwork Reduction Act Notice
Public reponing burden for this application is estimated to average 28.6 hours per application, including time for reviewing instructions,
searching existing data sources.gathering and maintaining the data needed,and completing and reviewing the collection of information.Send
comments regarding the burden estimate, any other aspect of this collection of information.or suggestions for improving this form.including i
suggestions which may increase or reduce this burden to: Chief. Information Policy Branch, PM-223, U.S. Environmental Protection Agency,
401 M St., SW, Washington, DC 20450. or Director. Office of Information and Regulatory Affairs, Office of Management and Budget.
Washington. DC 20503.
I. Otitian Location 11111.111111111111.111111111111111.1111111111.11.11111111.11111111111111111111
For each euttali list the latitude and lonQituoe of its location to the nearest 15 seconds fnci the name r f�her receivino water.
A. Curtail Number D.Receiving Water
(list) B. Latitude C.longitude (name,!
f ,
. , 1
T •1
I). Irti 0rovements 1
A. Are you now required by any Federal, State, or local authority to meet any implementation schedule for the construction, upgrading or
operation ci wastewater treatment equipment or practices or any other environmental programs which may affect the discharges
described in this application? This includes. but is not limited to. permit conditions. administrative or enforcement orders. enforcement
ccmp.iance Schedule letters.StrpulationS.court orders.and grant or loan conditions.
4.Final
I. Identification of Conditions. 2.Affected Curtails _ Compliance Date
Agreements, Etc. number source of discharge 3-Brief Description of Project a.req. b.proj.
r
. ,
-- 7
A_
B. You may attach additional sheets describing any additional water pollution (Or other environmental projects which may affect your
discharges) you now have under way or which you plan. Indicate whether each program is now under way or planned,and indicate your
actual or planned schedules for construction.
ill. Site Drains.e Ma
Attach a site map showing topography (or indicating the outline'ot drainage areas served by the ouitall{s) covered in the application if a
topographic map is unavailable) depicting the facility including: each of its intake and discharge structures; the drainage area of each storm
water outtall: paved areas and buildings within the drainage area of each storm water outfall, each known past or present areas used for
outdoor storage or disposal of significant materials, each existing structural control measure to reduce pollutants in storm water runoff,
materials loading and access areas, areas where pesticides, herbcides, soil conditioners and fertilizers are applied: each of its hazardous
waste treatment. storage or disposal units (including each area not required to have a RCRA permit which is used for accumulating hazardous
waste under 40 CFR 262,344,each well where fluids from the facility are injected underground; springs, and other surface water bodies which .
receive storm water discharges from the facility.
EPA Form 3510.2F 01.90) Page 1 of 3 Continue on Page 2

• • EPA ID Number (Copy from Item r of Form 1) 1z Form APPr veil.
OMB Na 2040-0086.
Please print or type in the unshaded areas only Approval expires8-31-98.
-
Form United states Environmental Protection Agency
eh Washington,DC 20460
2FEPA Application for Permit To Discharge Stormwater
"�DES oF Discharges Associated with Industrial Activity
Paperwork Aeduction Act Notice
Public reporting burden for this application is estimated to average 28.6 hours per application, including time for reviewing instructions. '
searching existing data sources.gathering and maintaining the data needed.and completing and reviewing the collection of information.Send
comments regarding the burden estimate,any other aspect of this collection of information,or suggestion,for improving this form,including
suggestions which may increase or reduce this burden to: Chief, Information Policy Branch, PM-223, U.S. Environmental Protection Agency,
401 M St.. SW, Washington, DC 20460, or Director, Office of Information and Regulatory Affairs, Office Of Management and Budget,
Washington. DC 20503.
I. Outlall Location
_ For each outfall list the latitude and longitude of its location tO the nearest 15 seconds and the name of the rsceivfna water.
A.Outfall Number D.Receiving Water
(1'is!) B.Latitude C.Longitude (name)
•
-1
i
H. Im.rovements I
A, Are you now required by any Federal. State, or local authority to meet any implementation schedule for the construction, upgrading or
operation of wastewater treatment equipment or practices or any other environmental programs which may affect the discharges
' described in this application? This includes, but is not limited to, permit conditions. administrative or enforcement orders, enforcement
compliance schedule letters,stipulations.court orders.and grant or loan conditions.
4,Final
1. Identification of Conditions. 2. Affected Outfalls Compliance Date,
Agreements. Etc. number source of discharge 3.Brief Description of Project a.req. b.proj.
I
•
—1
B. You may attach additional sheets describing any additional water pollution (or other environmental projects which may affect your
discharges)you now have under way or which you plan. Indicate whether each program is now under way Or planned,and indicate your
actual or planned schedules for construction.
HI. its Praina•e Ma. I .
Attach a site map showing topography (or Indicating the outline of drainage areas served by the outfall(s) covered in the application if a
topographic map is unavailable)depicting the facility including: each of its intake and discharge structures; the drainage area of each storm
water outfall; paved areas and buildings within the drainage area of each storm water outfit!, each known past or present areas used for
outdoor storage or disposal of significant materials, each existing structural control measure to reduce pollutants in storm water runoff,
materials loading and access areas, areas when pesticides, herbicides, soil conditioners and fertilizers are applied; each of its hazardous
waste treatment, storage or disposal units (including each area not required to have a RCRA permit which is used for accumulating hazardous
waste under 40 CFR 262,34);each well where fluids from the facility are injected underground; springs, and other surface water bodies which
receive storm water discharges from the facility.
EPA Form 3510.2F (11-90) Page 1 of 3 Continue on Pape2

•
•
Continued from the Front •
► . r • t e - . • + • I I •
A. For each outlet,provide an estimate of the area (include units)of impervious surfaces (including paved areas and building roots)drained
to the outtail.and an estimate of the total surface area drained by the outfall.
Outfall Area of impervious Surface Total Area Drained Outfall Area Of Impervious Surface Total Area Drained
„Nrrnoer (orovidtualtsl (omvide units) Jar+ (nldvidaiipitsl (provide units)
B. Provide a narrative description of significant materials that are currently or in the past three years have been treited,stored or disposed in
a manner to allow exposure to storm water; method of treatment,storage,or disposal: past and present materials management practices
employed. in the last three years.to minimize contact by these materiels with storm water runoff: materials loading and access areas;and
the location, manner.and frequency in which pesticides.herbicides,soil conditioners,and fertilizers are applied.
•
•
C For each our ail pr=vice me locaticn and a description of existing structural and nonstructural contra' measures to reduce pollutants in
storm water runoff:and a'description of the treatment the storm water receives,including the schedule and type of maintenance for control
any treatment rne,asures and the ult met...0snosaf Of any solid or fluid wastes other titan by diseharoe
Outfall List Codes from
•
Number Treatment Table 2F•I
•
V. Nonstormwater Diacharf es
• A. I certify unoer penalty of law mat the outfall(s) covered by this application have been tested or evaluated for the presence of
nonstormwater discharges. and that all nonstormwater discharges from these'duffel.(;)are identified in either an accompanying Form 2C
or Form PE aoo6cation for the outtag
Name and Official Title woe or print) Signature Date Signed
B. Provide a description of the method used,the date of any testing,and the onsite drainage points that were directly observed during a test.
•
VI. Sir nificant k or .111
Provide existing information regarding the history of significant leaks or spills of toxic or hazardous pollutants at the facility in the last three
years.including the approximate date and location of the spill or leak.and the type and amount of material released.
•
•
•
EPA Form 3510.2F (11.90) Page 2 of 3 Continue on Page 3
a •

EPA lD Number (copy from Rem 1 of Form 1)
Continued from P 2
A.e.C,&D: Sea instructions before prooeliding,Complete one set of tables for each outfall.Annotate the outfafl number in the space provided.
Tables Vl1.A,Vli-B,and VII-C are included on separate shuts numbered V11.1 and V11.2.
E. Potential discharges not covered by analysis• Is any pollutant listed in Table 2F-2 a substance or a component of a substance which you
currently use or manufacture as an Intermediate or final product or byproduct?
{ I Yes r?sr all such pollutants below) r No (go to Section VN1)
•
•
• ••' • F . r • a .
1 I Yes (::sr res-'ts belt..) I I No (go to Section IX)
•
•
•
. • t 1 l - t • it : • 1
•
DYes D No (go to Section X)
A Name B.Address D.Area Code.&Phone No. ! 0 Pollutants Analyzed
•
■ r
A.Name&Official Title (i)1pe or print) B.Area Code and Phone No
C. Signature 0.Date Signer
EPA Form 3510-2F (11.90) • Page 3 of 3

or
EPA ID Number (copy from Item r of Form tt . — F B Na2dW+D088,
if Approve!expires 8.31-08.
'VII. Discharge Information (Continued from page 3 of Form 2F)
Part A• You must provide the results of at least one analysis tar every pollutant in this table. Complete one table for each outtall. See
instructions for additional details.
Maximum Values Average Values Number
Pollutant (include units) (include units) of
and Grab Sample Grab Sample Storm
Ct.5 Nurrber Taken Dining Flow.weighted Taken During mow-weighted Events
First 30 First 30
lif availabrer Minutes Composite Minutes Composite Sample Sources of Pollutants
.
Oil and Grease
a.oiogical Ctygen
Demand #2OD5r i
Cnemical Oxygen
Demand 1CMDt 1 _
Total Suspended
Solids 1TSS! _
Total Kieldahl
Nitrogen -
Nitrate plus
,Nitrite Nitrogen
•
"bra.
•
4-• +: ^-ur Max.'^.um kiirimum Maximum
Part B• eacri pollutant:rat is ,.mrtec +n an effluent guideline which me facility is SubleCt to or any Oallutant its:ed in the facility s NOES
per nit for is process wastewa er lit the facility is operating under an existing NPDES permits. Complete one table for each curtail.
See tht instrucions for ad2itiona'details.aho re_aulternents
Maximum Values Average Values Number
Po+;::-a.,t firclude units; (include units) of
a-C Grab Sample Grab Sample Storm
Taker During Flow-weighted Taken During Flow-weighted Events ,
Firs: First 30
a:a er kr:notes. Composite Minutes Composite Sampled Sources of Pclru:ants
• •
.
,
•
•
1 i l
t ! f
r `
•
I � !
•
i I
EPA Form 3510.2F (11-90) Page vim Continue on Aeverser

Continued from this Front
Part C- List each pollutant shown in Tables 2F-2.2F•3,and 2F4 that you know or have reason to believe is present. See the instructions for
additional details and requirements.Complete one table for each motel!.
—
Maximum Values Average Values Number
Pollutant (Include units) (include units) of
• and Grab Sample Grab Sample Storm
• CAS Number Taken
Wiring • Flow-weighted Taken rt During F1ow-weighted Events
/if available) Minutes Composite Minutes Composite Sampled. Sources of Pollutants
i i
1 i ! I
1
r
i
•
I
i I i i
f
•
r
i _
•
I i _
Part 0• Provide data for the storm event()which resulted in the maximum values for the flow weighted composite sample
1. 2, 3. 4. 5. O. 7. 8.
Date of Duration Total rainfall Number of hours between Maximum floe rate Total flow from Season Form of
beginning of storm mess- during rain event rain event Precipitation
Storm of Storm during storm event wed and and of previous (gallons/minute or (gallons or sample was (rainfall,
Event (in minutes) (in inches) measurable rain event , specify units_ specify units) taken snowmen)
•
i - - - _
9. Provide a description of the method of flow measurement or estimate.
•
EPA Form 3510-2F (11.90) Page VI1.2
•
I