NCG050247_COMPLETE FILE - HISTORICAL_20140508

STORMWATER DIVISION CODING SHEET
RESCISSIONS
PERMIT NO.
DOC TYPE
❑COMPLETE FILE -HISTORICAL
DATE OF
RESCISSION
ri ol Om D� D
YYYYMMDD

1
ATA
NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
John E. Skvarla, III
Secretary
April 17, 2014 RECEIVED
Ms. Cynthia Wyatt
MAY 0.8: 2014
MCC -Norwood, LLC
CENTRAL PILES
1006 Norwalk St
DWQI@OG
Greensboro, NC 27407
Subject: NPDES General Permit NCG050000
MCC -Norwood, LLC
Formerly Bluegrass Labels Company
Certificate of Coverage NCG050247
Guilford County
Dear Ms. Wyatt:
Division personnel received your request to revise your stormwater permit Certificate of
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained
in the General Permit remain unchanged and in full effect. This revised Certificate of Coverage
is issued under the requirements of North Carolina General Statutes 143-215.1 and the
Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency.
If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sincerely,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Winston-Salem Regional Office, M. Gantt
Deborah Reese, DEMLR Budget Office — please update billing info
Stormwater Permitting Program Files
Central Files
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-92001 FAX: [phone]
512 !North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http://portal.ncdenr.org/web/lrl
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG050000
CERTIFICATE OF COVERAGE No. NCG050247
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
MCC -Norwood, LLC
is hereby authorized to discharge stormwater from a facility located at
MCC -Norwood, LLC
1006 Norwalk St
Greensboro
Guilford County,
to receiving waters designated as unnamed tributary to unnamed tributary to South Buffalo
Creek, a class WS-V;NSW water in the Cape Fear River Basin, in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, II, III, and IV of
General Permit No. NCG050000 as attached.
This certificate of coverage shall become effective April 17, 2014
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 17, 2014
ORIGINAL SIGNED M
LXKI
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

AF j�" Division of Energy, Mineral & Land Resources
i Land Quality Section/Storm-water Perm1,9
National Pollutant Discharge Elimination S
NCDENR
PERMIT NAME/OWNERSHIP CHANGE FORWR 1
ENY{RO.,MEIR FMO N4URwL RE50URCC!
FOR AGENCY USE ONLY
Dat- eceived
W05 hWth
I Day
2014
OENR. WAT'LR QUALITY
I. Please enter the permit number for which the change is requested." WETLANDS AND STOR!"TERBRANCd
NPDES Permit
(or) Certificate of Coverage
ill C S 4 5 4 0 0 0
N. G G 0 5 0 2 4 7
H. Permit status prior to requested change.
a. Permit issued to (company name):
Bluegrass Labels Company, LLC
b. Person legally responsible for permit:
Cynthia S Wyatt
First M1 Last
Operations Manager
Title
1006 Norwalk Street
Permit Holder Mailing Address
Greensboro NC 27407
City State Zip
"[phone] [phone]
Phone Fax
c. Facility name (discharge):
Bluegrass Labels Company, LLC
d. Facility address:
1006 Norwalk Street "
Address
Greensboro NC 27407
City State Zip
e. Facility contact person:
William D Smithers [phone]
First I MI I Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of:
❑ Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to (company name): -
MCC -Norwood, LLC
c. Person legally responsible for permit:
Cynthia S Wyatt
First MI Last
Operations Manager
Title
1006 Norwalk Street
Permit Holder Mailing Address
L`
Greensboro NC 27407
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
City State Zip
[phone]. c nthia. att mcclabel.com
Phone E-mail Address
MCC -Norwood, LLC
1006 Norwalk Street _
Address
Greensboro NC 27407
City . State Zip
William D Smithers
First M1 Last
[phone] wiIiiam.smithers(amcclabel.corn
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan. 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: William D'Smithers
First Mt Last
HSE Coordinator
Title
1006 Norwalk Street
Mailing Address
Greensboro NC 27407
City State Zip
[phone] [e-mail]
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
Vt. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1, Cynthia S. Wygtt-, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
/ �✓ March 31, 2014
d Signa Date
APPLICANT CERTIFICATION
1, Cynthia S. Wyatt, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
"J March 31.2014
Sign e Date
....................................
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014