NCG050424_COMPLETE FILE - HISTORICAL_20151005 (2)

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
HISTORICAL FILE
0 MONITORING REPORTS
DOC DATE
❑ a 1715 it) or
YYYYMMDD

North Carolina Department of Environmental Quality
Pat McCrory
Governor
Mr. Taizo Uchiyama
Uchiyama MFG America, LLC
494 Arrington Bridge Road
Goldsboro, NC 27530
Dear Mr. Uchiyama:
October 5, 2015
Donald R. van der Vaart
Secretary
RECEIVED
OCT u 8
CENTRAL FILES
DWR SECTION
Subject: NPDES General Permit NCG050424
Uchiyama MFG America, LLC
Formerly Uchiyama America, Inc.
Certificate of Coverage NCGO50424
Wayne County
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].
Arely,
U
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Washington Regional Office
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/Ir/
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. NCGO50000
CERTIFICATE OF COVERAGE No. NCG050424
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,
Uchiyama MFG America, LLC
is hereby authorized to discharge sto-nwater from a facility located at:
Uchiyama MFG America, LLC
494 Arrington Bridge Road
Goldsboro
Wayne County
to receiving waters designated as the Neuse River, a class C; waterbody to Neuse River Basin;
in accordance with the effluent limitations, monitoring requirements, and other conditions set
forth in Parts I, 1I, III, and IV of General Permit No. NCG050000 as attached.
This certificate of coverage shall become effective October 5, 2015.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 5, 2015.
for Tracy E. Davis, P.E., Director T
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

Division of Energy, Mineral & Land Resources
! Land QualitySection/Stormwater Permitting
ALI
National Pollutant Discharge Elimination System
NC®ENR
"wcw
CxNnOn Nurt wo N,atw..i ROW11Cn PERMIT NAMEIOWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
NPDES Permit
(or) Certificate of Coverage
N
C
Islol
I
I
IN ICIG10151014
2 4
H.
Permit status prior to requested change.
a. Permit issued to (company name):
Uchiyama America Inc.
b. Person legally responsible for permit:
Taizo Uchiyama
First Ml Last
Ceo
Title
RECEIVED
494 Arrington Bridge Road
0 5 2015
Permit Holder Mailing Address
Goldsboro NC 27530
DEhfR-LAND QUALITY
City State Zip
STQRMWATER PERMITTING
[phone] [phone]
Phone Fax
c. Facility name (discharge):
Uchiyama America Inc.
d. Facility address:
494 Arrington Bridge Road
Address
Goldsboro NC 27530
City State Zip
e. Facility contact person:
Teddy J. Chrisman 919 273-4917
First / MI / 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):
Uchiyama MFG America LLC
c. Person legally responsible for permit:
Taizo Uchiyama
First MI Last
Ceo
Title
494 Arrington Bridge Road
Permit Holder Mailing Address
Goldsboro NC 27530
City State Zip
919 731-2364
Phone E-mail Address
d. Facility name (discharge):
Uchiyama MFG America LLC
e. Facility address:
494 Arrington Bridge Road
Address
Goldsboro NC 27530
City State Zip
f. Facility contact person:
Teddy .1 Chrisman
First M1 Last
[phone] [e-mail]
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: Teddy J Chrisman
First Ml Last
Projects , Environment & Safety Manager
Title ^
494 Arrington Bridge Road
Mailing Address
Goldsboro NC 27530
City State Zip
[phone] tchrisman@umc .uma.com
Phone E-mail Address
V Will the permitter/ 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 naive change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, Taizo Uchiyama, 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.
September 11, 2015
ignature . Date
APPLICANT CERTIFICATION
1, Taizo Uchiyama, 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.
September 11, 2015
Slinature 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. 201A

Central Files: APS _ SWP _
10/10/2014
Permit Number NCGO50424✓ Permit Tracking Slip
Program Category Status Project Type
NPDES SW In review New Project
Perm it Type Version Permit Classification
Apparel/Printing/Paper/Leather/Rubber Stormwater Discharge COC COC
Primary Reviewer � �� � IV
��Permit Contact Affiliation
bilLdiuguid ' tj)
Coastal SWRUIe O C T 13 2014
Permitted Flow CENTRAL FILES
DWR SECTION
Facility
Facility Name
Uchiyama America Inc.
Location Address
494 Arrington Bridge Rd
Major/Minor Region
Minor Washington
County
Wayne
Facility Contact Affiliation
Goldsboro ` NC 27530 Teddy Chrisman
494 Arrington Bridge Rd
Owner Goldsboro NC 27530
Owner Name Owner Type
Uchiyama America Inc Non -Government
Owner Affiliation
Teddy Chrisman
494 Arrington Bridge Rd
Dates/Events Goldsboro NC 27530
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Issue
Effective
Expiration
71212014
fb1Iol111'
10/0o/1�
Regulated Activities
Requested /Received Events
Miscellaneous manufacturing
RO staff report received
8/12114
RO staff report requested
7114l14
Outtall 1
Waterbody Name Streamindex Number Current Class Subbasin
NEUSE RIVER 27-(56) C;NSW 03-04-12

ALTA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
October 10, 2014
Mr. Teddy J. Chrisman
Uchiyama America Inc.
494 Arrington Bridge Road
Goldsboro, North Carolina 27530
Subject: General Permit No. NCG050000
Uchiyama America Inc.
COC No. NCGO50424
Wayne County
Dear Mr. Chrisman:
John E. Skvarla, Ill
Secretary
In accordance with your application for a discharge permit received on July 2, 2014, we are
forwarding herewith the subject certificate of coverage (COC) 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 October 15, 2007 (or as subsequently amended).
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 Energy, Mineral and Land Resources (Division). 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 Division 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.
If you have any questions concerning this permit, please contact Bill Diuguid, Stormwater
Program Planner at telephone number [phone].
Sincerely,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and
Land Resources
cc: Washington Regional Office
Central Files
Stormwater Permitting Unit Files
Attachments
1612 Mail Service Center, Raleigh, North Carolina 27699-1612
Phone: [phone] Internet: www ncdenr.gov
An Equal Opportunity 1 AlfrmaVve Action Employer — Made in pars by recycled 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. NCG050424
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,
Uchiyama America Inc.
is hereby authorized to discharge stormwater from a facility located at
Uchiyama America Inc.
494 Arrington Bridge Road
Goldsboro
Wayne County
to receiving waters designated as the Neuse River, a Class C; NSW waterbody to Neuse River Basin; in accordance
with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, I1, III, IV, V and VI
of General Permit No. NCG050000, as attached.
This Certificate of Coverage shall become effective October 10, 2014.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 10, 2014.
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
By Authority of the Environmental Management Commission

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Division of Water Quality / Water Quality Section
NCDENR National Pollutant Discharge Elimination System
N� CrRO DJ�w O
EHVI mmew AND N, m"n Rnougccs
NCG050000
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year
Monih i
Da
CettiGcateofCovera e
Check R
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National Pollutant Discharge Elimination System application for coverage under General Permit
NCGO50000:
STORMWATER DISCHARGES associated with activities classified as:
SIC' 23 Apparel and Other Finished Products Made from Fabrics and Similar Materials
SIC' 265 Paperboard Containers and Boxes
SIC' 267 Converted Paper and Paperboard Products
SIC" 27 Printing, Publishing and Allied Industries
SIC' 30 Rubber and Miscellaneous Products (except as specified below)
SIC' 31 Leather and Leather Products (except as specified below)
SIC' 39 Miscellaneous Manufacturing Industries
SIC" NIA 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 followingactivities are specifically excluded from coverage under this General 0'�
P Y �� � !J 1J
SIC' 301 Tires and Inner Tubes
SIC' 311 Leather Tanning and Finishing J U L (; 24 70111
' standard Industrial Classification CodeD)TNRRF--7VATEPUALi77
(Please print or type) W .A& aom. � a°a►tcr,
1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed)
Name Uchiyama America Inc
Street Address 494 Arrington Bridge Road
City Goldsboro State NC ZIP Code 27530
Telephone No. 919-731-2364 Fax: [phone]
E-mail Address [e-mail]
2) Location of facility producing discharge:
Facility Name
Facility Contact
Contact E-mail
Street Address
City
County
Telephone No.
Uchiyama America Inc.
Teddy J. Chrisman
[e-mail]
494 Arrington Bridge Road
Goldsboro State NC ZIP Code 27530
Wayne
919-731-2364 x 222 Fax: [phone]
3) 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). From Goldsboro, take US-117S toward Wilmington
Approx. 3.5 miles. Turn left onto Arrington Bridge Rd./NC 581 for 1.1 miles. Facility is on the right.
Page 1 of 4
SWU-220-071408 Last Revised 7/14/2008

NCG050000 N.O.I.
(A copy of a counyyap or USGS quad sheet with facility clearly located on the map is required with this application)
4) Latitude y.20 30 N Longitude 78.0 15 W (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
X Existing
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 3 0 5 3
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: Manufacture of Automotive gaskets and seals
8) Discharge points:
How many discharge points (ditches, pipes, channels, etc.) convey storm water from the property? 2
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? Neuse River C- NSW _ 09 -o q- ) Z. 2'7 - 6G
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). Not Applicable
10) Does this facility have any other NPDES permits?
X 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)?
X No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
X Yes
If yes, please briefly describe: Roof -top run-off management, Grasses conveyances, Bulk Storage tank
Containment, graded pavement and curbing
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
X Yes
If yes, when was it implemented? 2007
14) Are vehicle maintenance activities occurring at this facility?
X No ❑ Yes
Page 2 of 4
SWU-220-071408 Last Revised 7/14/2008

NCGO50000 N.O.I.
15) 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?
❑ No X 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: Methyl Ethyl Ketone Mixture
How is material stored:55-gallon Drums
Where is material stored: Mix room (Indoors)
How many disposal shipments per year: 12
Name of transport / disposal vendor: Eastern Environmental Management
Vendor address:518 South Pearl Street, PO Box 4030, Rocky Mount, NC 27803
16) 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 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 Name of Person Signing: lembf N!/"
Title. v oA`, �iN e,--0
(SignatuA 9f Applicant) (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
SWU-220-071408 Last Revised 7/14/2008