NCG080755_COMPLETE FILE - HISTORICAL_20130426

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
1v Cc, 0 d / SS
DOC TYPE
tP-HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ 01-
YYYYMMDD

`o�oF WAr�Rpr, / Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
`? r
] North Carolina Department of Environment and Natural Resources
� Y
Coleen H. Sullins, Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N I C 1 S 10 1 1 1 1 1 1 1 N I C I G I 0_1 8 1 0 7 1 5 1 5
II
III
Permit status prior to requested change.
a. Permit issued to (company name): Rollin
b. Person legally responsible for permit: Jim
c. Facility name (discharge):
d. Facility address:
Frito-Lay Sales, LP
Schmitt.
First MI Last
Fleet Man
Title
2700 Nevada Blvd
Permit Holder Mailing Address
Charlotte NC 28273
City State Zip
[phone] [phone]
Phone Fax
FOREST CITY BIN
168 MEADOWBROOK
Address
FOREST CITY NC 28043
City State Zip
e, Facility contact person: Jim Schmitt [phone]
First / MI / Last Phone
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: Change of person legally responsible for permit/ Contact Person
b. Permit issued to (company name): Rolling Frito-Lay Sales, LP
c. Person legally responsible for permit: Rob Sapienza
First MI Last
Fleet Manaaer
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
Title
2700 Nevada Blvd
Permit Holder Mailing Address
Charlotte NC 28273
City State Zip
[phone] [e-mail]
Phone E-mail Address
FOREST CITY BIN
168 MEADOWBROOK
Address
FOREST CITY
NC 28043
City
State Zip
Rob
Sapienza
First
MI Last
[phone]
[e-mail]
Phone
E-mail Address
Revised 812008

PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
N. Permit contact information (if different from the person legally responsible for the permit)
Permit contact:
First MI Last
Title
Mailing Address
City State Zip
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)
VI 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):
I, , 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.
Signature
APPLICANT CERTIFICATION
Date
I, Rob Sapienza, 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 incompl
Signature
Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 7008

Michael F. Easley
ECEI VED Governor
William G. Ross Jr., Secretary
�rrJ4 Carolling �gp rtme of Environment and Natural Resources
Y [[��((jj Alan W. Klimek, P.E., Director
Division of Water Quality
WATER OUALITY SECTION. x...._
I. CURRENT PERMIT INFORMATION:
Permit Number: N/C/ I I I I I 1 1 or
Certificate of Coverage Number: NI C/G/11 /k1 T /_6 J /J
1. Permit holder's
r
f ;Y 23 20J
2. Permit's signing official's name and title: ✓ 1 i �� 1R� S�Y%
(Person legally responsible for permit)
Igo.t M(&atio�� -
y (Title)
lr. Mailing address: 15� F`fkb D. City:yM0, RiUL..'
State: CIA Zip Code: 5P I W Phone: now- _Lis-u "
H. NEW OWNER/NAME INFORMATION:
L This request for change is a result of:
❑ Change in ownership of company ❑ Name change for company
❑ Change in ownership of property/facility ❑ Name change for property/facility
DO Other (please explain): C�angr_ 1'" cbInj11r 1 pe-shn
2. Owner/Operator Information
Company or Owner or Operator Name: W % UYI A Ir Irl tD - L
(name to be put on permi / certificate of coveraj
Owner`s/operatorl; or signing official's name: -Ti J(,omi tt
Title:
Owner Contact: Mon CLVim; � � Title: Ejtt t wdYipiQlc k-
Mailing address: �R11 Ne�uO�ala. Glyd. City: l0 �
State: Zip Code:Phone:
E-mail address: Wyl . SGV%Yv%;
we
3. Facility Information
Facility Name: �omk UN 161
Facility Contact: Title:
Facility Mailing address: MB �� �}} Awb►fn0 Y.. City:
State: �i (� Zip Code: oL4"b Phone: (8O3)
E-mail address: \A . SGwhtt CA'M
5 W U-239-080102

S
PERMIT NAME / OWNERSHIP CHANGE FORM
4. Permit Contact Information (if different from facility contact)
Permit Contact: 70yn sonm mt _ Title: �Jzt ,
Mailing address: 2gil NQ,YGAcu 161vd - City: CVA&r o
State: W (_ Zip Code:u W46 __ Phone: (r�04 ) 563 - 1S'D
E-mail address: 1\ft . S GY1 t''Yi 1
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF WATER QUALITY UNLESS
ALL OF THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBIIHTTAL.
REQUIRED ITEMS:
1. This completed application
2. Legal documentation of the transfer of ownership (such as a contract, deed, articles of incorporation)
Certification must be completed and signed by both the current permit holder and the new applicant in the case of change of
ownership. For name change only, complete and sign the application certification.
Current Permittee'9 Certification:
I, im �r ynsU�1 _, attest that this application for name/ownership change has
been reviewed and is accurate and complete to the best of nay knowledge. I understand that if all required parts of this application
are not completed and that if all re uired porting information and attachments are not included, this application package will be
returned as incor e.
Signature: u Date: y
4/_
Applicant s Certtifica,�
I, 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 and attachments are not included, this application
package will b4reed as incomplete. .
f
Signature: Date: O r"
r
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION & MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
Point Source Branch
Attn: Valery Stephens
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
S WU-239-O8o t o2

O�0 WAr�9QG
Crj �
October 8, 2004
Mr. Jim Johnston
Rolling Frito-Lay Sales, LP
157 Fleet Drive
Villa Rica, GA 30180
Michael F. Easley. Governor
William G. Ross Jr.. Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Subject: General Permit No. NCG080000
Forest City Bin
COC NCG080755
Rutherford County
Dear Mr. Johnston:
In accordance with your application for a discharge permit received on September 7,
2004 we are forwarding herewith the subject certificate of coverage to discharge under the
subject state — NPDES general permit. This permit is issued pursuant to the requirements of
North Carolina General Statute 143-215 .1 and the Memorandum of Agreement between North
Carolina and the US Environmental Protection Agency dated May 9, 1994 (or as subsequently
amended).
Please take notice that this certificate of coverage is not transferable except after notice to
the Division of Water Quality. The Division of Water Quality may require modification or
revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be
required by the Division of Water Quality or permits required by the Division of Land
Resources, Coastal Area Management Act or any other Federal or Local governmental permit
that may be required.
If you have any questions concerning this permit, please contact Jonathan Diggs at
telephone number [phone] ext. 537.
Sincerely,
ORIGINAL SIGNED 13Y
BRADLEY BENNETT
Alan W. Klimek, P.E.
cc: Asheville Regional Office
Central Files
Stormwater and General Permits Unit Files
NonfiCaroiina
Naturally
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: h2o.enr.state.nc.us 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]
An Equal Opportunity/Aflirmalive Action Employer — 50% Recycled/10% Post Consumer Paper

t
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG080000
CERTIFICATE OF COVERAGE NO. NCG080755
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,
Rolling Frito-Lay Sales, LP
is hereby authorized to discharge stormwater from a facility located at
Forest City Bin
168 Meadowbrook
Forest City
Rutherford County
to receiving waters designated as Bracketts Creek, a class C water in the Broad River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, 1I, III,
IV, V, and VI of General Permit No. NCGO80000 as attached.
This certificate of coverage shall become effective October 8, 2004.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 8, 2004.
ORIGINAL SIGNED BY
BRADLEY BENNETT
Alan W. Klimek, Director
Division of Water Quality
By Authority of the Environmental Management Commission

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Markers
Name: Rolling Frito-Lay NCGO80755
Short Name: RIngF
Coordinates: 0350 20' 37.86" N, 0810 53' 20.80" W
Comment: Rolling Frito-Lay NCGO80755 subbasin (03-08-02), Broad River Basin, Rutherford
County, Bracketts Creek, Class C, USGS quad F11 SW