NCG180041_COMPLETE FILE - HISTORICAL_20060627

STORMWATER DIVISION CODING SHEET
RESCISSI0N5
PERMIT NO.
DOC TYPE
❑COMPLETE FILE -HISTORICAL
DATE OF
RESCISSION
❑
YYYYMMDD

Michael F. Easley, Govemmor
William G. Ross Jr., Sometary
North Carolina Delartment of Enviro went and Nahnal Resources
Plan W. Klimek, P.E. J)hcctm
Division of Water Quality
SURFACE WATER PROTECTION SECTION
PERMIT NAME/OWNERSHIP CHANGE'FORM
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) . Certificate of Coverage
N I C N I C I C. a D
11. Permit status prior to status change.
a. Permit issued to (company name): t e,f,1n n
b. Person legally responsible for permit: a
First / Mi 1 I Last
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c. Facility name (discharge):'
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e. Facility contact person:
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Hi. Please provide the following for the requested change (revised permit).
a. Request for change is a result of
❑ Change in ownership of the facility
❑ T4ame change of the facility 0� owner
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PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information: (if different from the person legally responsible for the permit)
Permit contact:
First / Ml / last
Title
t Mailing Address
City State Zip
phone Ismail Addtrs,+
V. Will the permitted facility continue to conduct the same industrial activities conducted prior to
this ownership or name change?
r jii� Yes ,
❑ No (please explain)
VL 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 1ew11 for -an ownership change request. Articles of incorporation are not sufficient for
an ownership change.
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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, ` ` . -
PERMI'TTEE.CERTIFICA ION (Permit holder prior to ownership change):
>i _ t �� appname/ownership
N Yi ,attest that this Itca4ion for a
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 pac a will be ed as incomplete.
S'I Dale
APPLICANT CERTIFICATION:
attest that this application for a natne%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 acid that if all required supporting information is not included, this
application package will be returned_" incomplete:
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 7/2005

State of North Carolina
` Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
Kerr T. Stevens, Director
August 27, 1999
BOB WOOD
LEXINGTON FURNITURE INDUSTRIES PLT 4/5
P.O. BOX 1008
LEXINGTON. NC 27293
Dear Permittee:
1 � •
_0
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Reissue - NPDES Stormwater Permit
Lexington Furniture industries Ph 4/5
COC Number NCG 180041
Davidson County
In response to your renewal application for continued coverage under general permit NCG180", the Division of
Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This permit is reissued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between the state of North Carolina and the U.S. Environmental Protection Agency, dated December 6, 1983.
The following information is included with your permit package:
* A copy of general stormwater permit NCG180000
* A Stormwater Pollution Prevention Plan (SPPP) Certification Form. Completion of this form is required to
certify that you have developed and implemented the SPPP as per the conditions of the permit. This form
must be completed and returned to the Division within 30 days of receipt of this letter.
DO NOT SEND the SPPP with the signed form.
* Five copies of the Analytical Monitoring form and five copies of the Qualitative Monitoring form
* A copy of a Technical Bulletin on the Stormwater program which outlines program components and
addresses frequently asked questions
* A corrected Certificate of Coverage if you indicated a name change on the Renewal Application
Your coverage under this general permit is not transferable except after notice to DWQ. The Division may require
modification or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law rule, standard, ordinance, order, judgment, or
decree.
If you have any questions regarding this permit package please contact Bill Mills of the Central Office Stormwater
and General Permits Unit at [phone], ext. 548
Sincerely,
164
for Kerr T. Stevens
Director, Division of Water Quality
cc: Central Files
Winston-Salem Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG180000
CERTIFICATE OF COVERAGE No. NCG180041
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,
LEXINGTON FURNITURE INDUSTRIES
is hereby authorized to discharge stormwater from a facility located at
LEXINGTON FURNITURE INDUSTRIES
1893 BROWN STREET EXT
LEXINGTON
DAVIDSON COUNTY
to receiving waters designated as Rat Spring Branch in the Yadkin - Pee Dee River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, II, III,
IV, V, and VI of General Permit No. NCGI80000 as attached.
This certificate of coverage shall become effective August 27, 1999.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 27, 1999.
for Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
May 26, 1995
Bob Wood
Lexington Furniture Indust-4,5
P.O. Box 1008
Lexington, NC 27293
Subject: General Permit No. NCG 180000
Lexington Furniture Indust-4,5
COC NCG 180041
Davidson County
Dear Bob Wood
In accordance with your application for discharge permit received on February 17, 1995, 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
December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division
of Environmental Management. The Division of Environmental Management 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 Environmental Management 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 question concerning this permit, please contact MR. BILL MILLS at telephone number
919/733-5083.
Sincerely, 0Figr1al Signed By
Coleen H. Sul".;Ins
A. Preston Howard, Jr. P.E.
cc: Winston-Salem Regional Office
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO. _NCG180000
CERTIFICATE OF COVERAGE NO. NCG180041
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,
Lexington Furniture Industries
is hereby authorized to discharge stormwater from a facility located at
Plants #4 and #5
1893 Brown Street Extension
Lexington
Davidson County
to receiving waters designated as Rat Spring Branch in the Yadkin - Pee Dee Diver Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I,1I, I11
and IV of General Permit No. NCG180000 as attached.
This Certificate of Coverage shalt become effective May 26, 1995.
This Certificate of Coverage shall remain in effect for the duration of the General' Permit.
Signed this day May 26, 1995.
calee n 'ri. �-uiliilns
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission

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NPDES �J CG I go0i(/
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EXPIRATI'ON DATE
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