NCG210430_COMPLETE FILE - HISTORICAL_20130827

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IVUc,al0yjl�
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM
Director
August 27, 2013
Susan Harrison
Carolina Mat Inc.
193 Hwy 149 N
PO Box 339
Plymouth, NC 27962
Pat McCrory, Governor
John E. Skvaria, III, Secretary
Subject: General Permit No. NCG210000
Carolina Mat, Inc
COC NCG210430
Washington County
Dear Ms. Harrison:
In accordance with your application for a stormwater discharge permit, we are
forwarding herewith the subject certificate of coverage to discharge under the subject
state - Stormwater NPDES general permit. This permit is'issued pursuant to the
requirements of North Carolina General Statute 143-215.1 and the Memorandum of
Agreement between North Carolina and the US Environmental Protection Agency dated
October 15, 2007 (or as subsequently, amended).
Please take notice that this certificate of coverage is not transferable except after
notice to the Division of Energy, Mineral and Land Resources. The Division may require
modification or revocation and reissuance of the certificate of coverage. Also note that
this permit takes the place of a previous permit issued to your facility that expired. The
early permit became inactive in our system and due to federal requirements we are unable
to reissue coverage under the previous permit number. Permit number NCG210312 is
inactive and your coverage is replace by this permit (NCG210430).
This permit does not affect the legal requirements to obtain other permits which
may be required by the Division of Energy, Mineral and Land Resources or permits
required by the Division of Water Resources, Coastal Area Management Act or any other
federal, state or local governmental permit that may be required.
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 - Telephone [phone] FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http:Ilportal,ncdenr.orglwebArlland-Aualiit
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

Ms. Susan Harrison
August 27, 2013
Page 2 of 2
If you have any questions concerning this permit, please contact Bradley Bennett at
telephone number [phone]
Sincerely,
gt xv-vt
for Tracy E. Davis, P.E., CPM
cc: Washington Regional Office, Pat McClain
Central Files
Stormwater Permitting Unit Files

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE No. NCG210430
STORMWATER DISCHARGES
NATIONAL_P_O1.ILUTANT 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,
Carolina Mat, Inc
is hereby authorized to discharge stormwater from a facility located at
Carolina Mat, Inc.
193 Highway 149 N
Plymouth
Washington County
to receiving waters designated as UT to Welch Creek, a class C, SW water in the Roanoke
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. NCG210000 as
attached.
This certificate of coverage shall become effective August 27, 2013.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 27, 2013.
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

LOCATION MAP:
USGS Map: Plymouth - West
Latitude: 35°50'13" N NCG210430 Facility
Longitude: 76°46'03" W_
Carolina Mat, Inc Location ~ County: Washington
Stream Class: C, SW
Receiving Stream: UT to Welch Creep L
Sub -basin: 03-03-09 (Roanoke River Basin) [OWL Not to Scale

NCDENR
Nb C+4OU U6i�A NM OF
Ewv .� e--o N� - Rena m
Division of Water Quality / Water Quality Section
National Pollutant Discharge Elimination System
NCG210000
FOR AGENCY USF ONLY
Date Received
Year
Month
Da
Cenificate of Coverage
Check 9 1 Amount
Permit Ass' ed to
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG210000:
STORMWATER DISCHARGES associated with activities classified as:
SIC* 24 Timber Products (except as specified below), including Wood Chip Mills (as of April 2011)
SIC* N/A Like activities deemed by DWQ 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 Ge``rmit: 1
I�
• Wood Kitchen Cabinets (SIC• 2434) �
• Wood Preserving (SIC+ 2491)
• Logging (SIC* 241) 'T ' U61
' Standard Industrial Classification Code
p .:_R QUALITY
(Please print or type) wetse. ___�k�swaier Branch
1) Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name S a0 CC Y•0 � iV(% e- YwC'J - el, C__
Owner Contact
Street Address I 1`1 - • 0• I O 3
City vim n LA'h State IJC ZIP Code 2 �? C( (p Z
Telephone No. cl 5,a' q 93 - Y 14 S' Fax: a r Q 3- S 1? 7
E-mail Address
2) Location of facility producing discharge:
Facility Name �C� it 0 1 n'C' lYi t
Facility Contact
Contact E-mail
Street Address
City
County
Telephone No. a sX q3 -_ 0 S'
3) Physical Location Information:
Please provide a narrative description of now to get to
distance and direction from a roadway intersection).
nC.
State /l% C ZIP Code a �?a is
Fax: d 5., _ '1 Y3 -
facility (use street names, state road numbers, a
JA
(A ! YJ Ic1 'Dt .� u r A 11 rim ±LL ct 4 t=y �, F 5-oc,'
(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)
4) Latitude 35 50 /511 Longitude 76W 07" (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin
ZV Existing -
MCCG, 21 U3! Z — p��mif e PlrecQ c� /r1c><c7/r'vt=
Page 1 of 4
ir�•�d;ec�'
►ar\
SWU-236-031811

NCG210000 N.O.I.
6) 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-,'?, .z. y
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: _ M ay,, tiJ� +.,,r P MrkA-S
8) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property?
9) 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? {A'r +o U JP_ 151, �'r 2e�r C l u-ss C 5 Q
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).
', _t
10) Does this facility have any other NPDES permits?
IN No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
No
❑ Yes
If yes, list the permit numbers for afl current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
O Yes
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
><Yes
If yes, when was it implemented?
lq1?1-!�
14) Does this facility store exposed piles of sawdust, bark, mulch, wood chips, or similar material on -site
for longer than seven (7) days? (Exposed directly to rainfall or to run-on from other areas of the
facility.)
h No ❑ Yes
15) Are vehicle maintenance activities occurring at this facility?
*No ❑ Yes
Page 2 of 4
SWU-236-031811

" • --NGG210000 N.O.I.
16) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
;YNo ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
KNo ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
A 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:
17) Certification:
North Carolina General Statute 143-215.6 b (1) 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 I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed I, me of Person Signing: S t.t-5.C4,nn
Title: t' _
of Applicant)
/1- -1 'Z_
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Page 3 of 4
S W U-236-031811

NCG210000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
Check for $100 made payable to 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 Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DWQ Central Office or Regional Office for your area.
To visit our webslfe, go to htt :// ortal.ncdenr.or /webAv /Ws/su
DWQ Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 4 of 4
SWU-236-031811

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F W A rF Michael F. Easley, Governor
9 William G. Ross Jr., Secretary
�O� QG North Carolina Department of Environment and Natural Resources
r!j 7 Alan W. Klimek, P.E. Director
j Division of Water Quality
0 Y
April 28, 2003
Ronald Harrison
Plymouth Pallett Co -Washington
PO Box 712
Plymouth, NC 27962
Subject: NPDES Stormwater Permit Renewal
Plymouth Pallett Co -Washington
COC Number NCG210312
Washington County
Dear Permittee:
In response to your renewal application for continued coverage under general permit NCG210000, 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 new Certificate of Coverage
• A copy of General Stormwater Permit NCG210000
• A copy of the Analytical Monitoring Form (DMR)
• A copy of the Qualitativel Monitoring Form
• A copy of a Technical Bulletin for the general permit
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 the Department of
Environment and Natural Resources, 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,
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Stormwater & General Permits Unit Files
Washington Regional Office
NiD�NR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1 800 623-7748

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE No. NCG210312
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,
Plymouth Pallett Co Inc
is hereby authorized to discharge stormwater from a facility located at
Plymouth Pallett Co -Washington
Ken Trowbridge Rd
Plymouth
Washington County
to receiving waters designated as a UT to Welch Creek, a class C Sw stream, in the Roanoke
River Basin in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, III, IV, V, and VI of General Permit No. NCG210000 as
attached.
This certificate of coverage shall become effective May 1, 2003.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 28, 2003.
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

W a
7
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
4 -r
TOM HARRISON
PLYMOUTH PALL,E-1I' CO-WASHING'I.ON
P O BOX 712
Pi,l'MOUTH, NC 27962
Dear Permitter:
Alan W. Klimek, P.E., Director
Division of Water Quality
September 4. 2002
Suh_jcet: iWDES Stormwater Permit Coverage Renewal
Plymouth Pollen Co-washington
COC NttnthCr nc,210312
Washin"ton County
Y0Ur facili(y is currently covered for stormwater discharge under General Pcrmit NCG210000, This perinit expires
on March 31. 2003. The Division staff is currently in the process of rewriting this perinit and is scheduled to have
the pcnnit reissued by early spring of 2003. Once the permit is reissued, your Facility would he eligible for
continued coverage under the reissued permit.
In order (o assure your continue] Coverage under the general permit, you must apply to the Division ol' Watcr
01.1ality (DWQ) for renewal ol' your permit coverage. To make (his renewal process easier. we are informing you in
advance that your permit aiycra,le will he expiring. Enclosed you will Find a Permit Coverage Renewal
Application Form. The application must he completed and returned by October 2. 2002 in order to assure
continued coverage under the general pcnnit. Due to staff and hudgct constraints, letters confirming, Our receipt of,
the completed application %Vill not be sent.
Failure to request renewal within the time period specified. may resull in a civil assessntcni of at least $250.00.
Lar-cr penalties may be assessed dcpcndink, on thu delinquency ot'the request. Discharac ol'stormwaler from your
facility without covera Ie under a valid storrnwater NPDES permit would constitute a violation ol' NCGS 143-215. l
and could resul( in assessments of civil penalties of tip to $10.(}00 per day_
]'lease note that recent iedcral Ic�aislalion has extended the " tto exposure exclusion" to all operators of industrial
lhcilities in any of the 1 1 ctttcoories of "storm water discharges associated with industrial activity-" (except
construction activities). 11' you feel yore' facility C,tn certify a condition ol- "no expostirc". i.e. the facility industrial
materials and operations are not cxposcd to stornrnater. you can apply for the no exposure exclusion. Frn- additional
information contact the Cenral Office Stornwater Staff member listed below or check the Sutrmwater & General
Permits Unit Wch Site at ht[palh2o.cnr.state.nc:uslsulsu�rnnvatcr.huul
11' the subject stor inwater discharge to waters of the state has been terminated, please complete the enclOscd
Rescission Request Form. tNlailing instructions are listed on the hottom of the form. You will be notified when the
rescission process has been completed.
IE'you have my questions regarding the perinit renewal procedures please contact Robert "Tankard of the
Washin ,ton Regional Office at 2-52-946-6481 or Bill klills of the Central Office Stornlwawr Unit at (919)
733-50R3. e.xt. 54S
Sincerely.
Bradley Bennett. Supervisor
Storniwater and General Permits Unit
cr: Central Files
Storni%vater and General Permits Unit Files
Washington Rc�_,ional Office
ern
NC©ENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1-800-623-7748

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
May 1, 1998
TOM HARRISON
PLYMOUTH PALLETT CO-WASHINGTON
KEN TROWBRIDGE RD
PLYMOUTH, NC 27962
Subject: Reissued Stormwater General Permit for
Certificate of Coverage No. NCG210312
Washington County
Dear Permittee:
4 4
[D E N F1
In response to your renewal application for continued coverage under the General Permit
NCG040000, the Division of Water Quality (DWQ) is forwarding herewith the General Permit
NCG210000 which is a new General Permit to cover most of the Timber Products Industry. You
have now been given coverage under NCG210000 and your coverage under NCGO40000 is hereby
terminated. 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.
The following information is included with your permit package:
■ A copy of the stormwater general permit NCG210000.
■ A new Certificate of Coverage under general permit NCG210000.
■ A Stormwater Pollution Prevention Plan Certification Form. This form certifies that you have
developed and implemented the Stormwater Pollution Prevention Plan (SPPP) required in your
permit (both NCG040000 and NCG210000). 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 Analytical Monitoring forms.
■ Five copies of Qualitative Monitoring forms.
m A copy of a Technical Bulletin on the stormwater program which outlines program components
and addresses frequently asked questions.
Your certificate of coverage is not transferable except after notice to DWQ. 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
DWQ or permits required by the Division of Land Resources, Division of Air Quality, Coastal Area
Management Act or any other Federal or Local governmental permits that may be required.
If you have any questions concerning this permit or other attached documents, please contact the
Stormwater and General Permits Unit at telephone number [phone].
Sincerely,
. &1�1�nv—
for A Preston Howard, Jr., P. E.
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 AND NATURAL RESOURCES
DIVISION OF WATER QUALITY - -
GENERAL PERMIT NO. NCG210000
CERTIFICATE OF COVERAGE NO. NCG210312
STORMWATER DISCHARGES
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,
PLYMOUTH PALLETT CO-WASHINGTON
is herby authorized to discharge stormwater from a facility located at:
KEN TROWBRIDGE RD
PLYMOUTH, NC
WASHINGTON COUNTY
to receiving waters designated as Ut Welch Creek in the Roanoke River Basin
in accordance with the effluent limitations, monitoring requirements and other conditions set forth in Parts I,
11, lII and IV of General Permit No. NCG210000 as attached.
This Certificate of Coverage shall become effective May 1, 1998.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day May 1,1998
for A. Preston Howard, Jr., P.E., Director
Division of Water Quality
By Authorization of the Environmental Management Commission

State of North Carolina
Department of Environment,
Health and Natural Resources &14 •
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary ID EF4
A. Preston Howard, Jr., P.E., Director
March 8, 1996
Mr. Tom Harrison
Plymouth Pallett Co. -Washington
Ken Trowbridge Rd.
Plymouth, NC 27962
Subject: General Permit No. NCGO40000
Plymouth Pallet Co. -Washington
COC NCGO40312
Washington County
Dear Mr. Harrison:
In accordance with your application for discharge permit received on January 23, 1996, 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 questions concerning this permit, please contact Tony Evans at telephone number 919/733-
5083.
Sincerely, ORRGINA SIGNED BY
BRADLEY BEMETT
A. Preston Howard, Jr., P. E.
cc: Washington 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. NCG040000
CERTIFICATE OF COVERAGE No. NCGO40312
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,
Plymouth Pallet Company
is hereby authorized to discharge stormwater from a facility located at
Plymouth Pallet Company
Ken Trowbridge Road
Plymouth, NC
Washington County
to receiving waters designated as unnamed tributary to Welch Creek, Class C Sw, in the Roanoke River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, 11, Ill
and IV of General Permit No. NCG040000 as attached.
This certificate of coverage shall become effective March 8, 1996.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day March 8, 1996.
Gp2G1N .-j. sj2NED 5Y
6!�ADL =Y BE3�h
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission
_—A

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FACILITY:
COUNTY: W a S{ 1) n c�ko n
NPDES: N C G v C4 v 3 t
MAP#: D 3 I S 6
DSN FLOW-.
NIA
LATITUDE: 50 3 �•
LONGITUDE: '7 0 '1 d a 3 /,
RECEIVING STREAM: �A T UJ .Q LC� Qr-ePJQ
STREAM CLASS: C. S C j
DISCHARGE CLASS:
STORMWATER
EXPIRATION DATE: S /3 j q q

CUSTOM PALLET & CRATING, INC.
NCDENR— 5tormwater & General.
Item to be. Paid - Description
t LZ'CEi1SE5 & Fees
Check Number: 76521
Check Date: Jun 30, 2011
Duplicate
Check Amount: $10 0 . 0 0
Discount Taken Amount Paid
100.00
76521