NCG210028_COMPLETE FILE - HISTORICAL_20180530

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
I
DOC TYPE
r!�r'HISTORICALFILE
❑ MONITORING REPORTS
DOC DATE
❑ Do)� O
YYYYMMDD

Barer
May 23, 2018
NCDEQ Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, NC 27699-1636
RE: Certificate of Coverage No. NCG210028
Year 6 — Period 1
Stormwater Discharge Outfall Monitoring Report
Baxter Healthcare Corporation
Enclosed is the semiannual SDO monitoring report as required by the General Stormwater Permit
NCG210028, Part I1, Section B. Sample values are within benchmark limits. We will continue to
monitor the outfalls as required.
If you have any questions regarding this report, please contact Corey Carpentier at 828-756-6636.
I certify, under penalty of law, that this document and all attachments were prepared under my direction
or supervision in accordance with a system designed to assure that qualified personnel properly gather
and evaluate the information submitted. Based on my inquiry of the person or persons who manage the
system, or the persons directly responsible for gathering the information, the information submitted is, to
the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false information including the possibility of fines and imprisonment for
knowing violations.
Sincerely,
Corey Carpentier
EHS
Enclosures: Semiannual DMR (Original + Copy)
Cc: Rick Styles
Baxter Healthcare Corporation
PO Box 1390, Marion, NC 28752
1 828.756.4151

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Parent [document: It-PMROL64iroul 1r1AkiA V&nt A F11S 1"U0,W10Y-2V4b1U orl: ULI UJ/LU'I b
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
ror' guidance onfrlling out thiv.forrrr, please visit: http:l/h2o.enr.state.nc.us/su/rorms_Documents.htrOrniscforms
Permit No
NICI6�1olLplolololol
Facility Name:
County:
Inspector: 17
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches):
or Certificate of Coverage No.: NICIGI-D I (o l 0l 01,?IO 1
Was this a Representative Storm Event? (See information below) ZYes ❑ No
Please check your permit to verify rf Qualitative Monitoring !oust he performed during a representative
slorrn event (requirements vary).
A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
f)W-l:J RIa U-�Af
(Signature of Permittee or Designee)
1. Outfall Description: 1
Outfall No. i Structure (pipe, ditch, etc.) L1�Do� �0�1eT' � �� C�>r)ll I
Receiving Stream:
Describe the industrial activities that occur within the Outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ OU1 d'J L�G%"jL'
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): QIle-
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Parent Document: ENVIRO-04 Attachment #I Issue Date: 09-29-15
4. . Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
I (D 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
51 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
D, 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe 1-3C)
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
9
123 of 123

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Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
National Pollutant Discharce Elimination Svstem
FOR AGENCY USE ONLY
Date Received
Year
Month I Day
�V
PERMIT NAMEIOWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested. L4 ���� Q
NPDES Permit (or) Certificate of Coverage
N C S fl 2 13 4 4 2 N G 1G1 2 1 I 0 0 0 0
11. Permit status gEjaE to requested change.
a. Permit issued to (company name): _ Moncure Plywood
b. Person legally responsible for permit: Brian Cullen
First M1 Last
c. Facility name (discharge):
d. Facility address:
East Region Manager
Title
PO Box 1 1 i 0
Permit Holder Mailing Address
Chester SC 29706
City State Zip
[phone] ( )
Phone Fax
Moncure Plywood
306 Corinth Road
Address
Moncure NC 27559
City State Zip
e. Facility contact person: Brian Van Gelder (803) 385
First / MI / Last Phone
111. 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):
c. Person legally responsible for permit
Boise Cascade Wood Products, LLC
Brian Cullen
1, irsi M I Last
East Region Manager
r Title
1—%LU1fl \/Fr Po Box l 110
MAR 1 S 2018 Permit Holder Mailing Address '
Chester 5C 29706
FILE j City State Zip
UVJR SEC JO ' [phone] briancuflen a bc.corn a�
Phone _ F-mail Address
d. Facility name (discharge): Boise Cascade Wood Products, LLC
e. Facility address: 306 Corinth Road
Address
Moncure NC 27559
City State Zip
f. Facility contact person: Brian W Van Gelder
First Ml Last
(803) 3854957 brianvan Tefder(r�,bc.com
Phone L-mail Address
IV. Permit contact information (if different from the person legally responsible for the pert -nit)
Revised Jan. 27, 2014

rL
,! 64PDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: Brian W Van Gelder
First M 1 Last
East Region Environmental Manager
"Fide
306 Corinth Rd
Mailing Address
Moncure NC 27559
City State 'Gip
(803) 3854957 brianvangelder a bc.com
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 RE 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, Brian Cullen, 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 i replete.
1ZLZI /ZcI f
Signature Date
APPLICANT CERTIFICATION
I, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best ofmy knowledge. 1 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
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