HomeMy WebLinkAboutNCG140433_COMPLETE FILE - HISTORICAL_20170221STORMWATER DIVISION CODING SHEET
RESCISSIONS
PERMIT NO.�L/o
�L33
DOC TYPE
❑COMPLETE FILE -HISTORICAL
DATE OF
RESCISSION
❑
YYYYMMDD
Deborah Reese
From:
Bennett, Bradley
Sent:
Tuesday, February 21, 2017 3:08 PM
To:
Deborah Reese
Cc:
Alexander, Laura
Subject:
NCG140433
Deborah,
I got a call today about the invoice for this facility. They indicated that they have never constructed to plant and are
going to request rescission. I forwarded the form to them to handle that.
::
Bradley Bennett
Stormwater Permitting Program
NC Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, NC 27699-1612
Phone: (919) 807-6378
Fax: (919) 807-6494
Email: brad ley.bennett .ncdenr.gov
Web: http:llportal.nodenr.org/web/Ir/stormwater
Email correspondence to and from this address may be subject to public records laws
A
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
March 17, 2014
Mr. John Young, VP
Zachry Construction Corporation
1203 Free Nancy Ave.
Statesville, NC 28677
Pat McCrory, Governor
John E. Skvarla, Ili, Secretary
Subject: General Permit No. NCG140000
Zachry Const. Corp. - Portable Central Mix
Concrete Batch Plant 518-502
COC No. NCG140433
Iredell County
Bear Mr. Young:
In accordance with your application for a discharge permit received on February 3, 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).
Please note that NCG140000 contains effluent limitations for process wastewater discharges
(see Part IV, Section D). Wastewater discharges must meet the requirements of these effluent
limitations. An exceedence of any of these limitations is a violation of permit conditions.
Please note that permit requirements in Part 11, Section A, numbers 1-5, and Part 11, Section B,
number 1 are no longer valid per NC Session Law 2011-394. however, note that Part I1, Section A,
number b, and Part 11, Section B, numbers 2-10 are unaffected by this Session Law. Those sections will
remain in effect for the duration of this permit term. Please be reminded that your facility must notify the
appropriate DWQ Regional Office at least 72 hours in advance of operation of your wastewater treatment
facility.
This certificate of coverage is not transferable except upon approval of the Division of Energy,
Mineral, and Land Resources (DEMLR). if the facility changes ownership or is closed,DEMLR 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 DEM LR, or permits required by
other federal state or local authorities.
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 • Telephone 919-707-92201 FAX: 919-733-2876
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http://portal.ncdeg.org/webllr/lafid-guaii[y
An Equal Opportunity 1 Affirmative Action Employer -- 50% Recycled 110% Post Consumer Paper
If you have any questions concerning this permit, please contact harry Wade PE at telephone number
(919) 807-6375 or email at larry.wade@ncdenr.gov.
Sincerely,
1�
far Tracy E. Davis, P.E., CPM
cc; Mooresville Regional Office
Central Files
Stormwater Permitting Unit Files
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 - Telephone 919-707-92201 FAX: 919.733-2876
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http:I/portal.ncdenr.or.qlweblirlland ualit ,
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. NCG140000
CERTIFICAsTE OF COVERAGE No. NCG140433
STORMWATER AND PROCESS WASTEWATER 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,
Zachry Construction Corporation
is hereby authorized to discharge stormwater and process wastewater from a facility
located at
Zachry Construction Corp. - Portable Central Mix Concrete Batch Plant 518-S02
300 Victory Lane
Statesville
Iredell County
to receiving waters designated as UT to Fourth Creek, a class C water in the Yadkin / Pee
Dee 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. NCG140000 as
attached.
This certificate of coverage shall become effective March 17, 2014.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day March 17, 2014.
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission
YJ zAc14A,r
January 30, 2014
NCDE'NR
Storm Water Permitting Unit
Attn: Division of Energy, Mineral and Land Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Application for General Permit NCG 140000
Division of Water {duality:
Zachry Construction Corporation (ZCC) is contracted with the North Carolina
Department of Transportation (NCDOT) to retrofit the interchange of 1-77 and 1-40 in
Statesville, NC. This project requires the operation of a portable batch plant to service
concrete pavment construction. The concrete batch plant will be located in the existing
NCDOT Right -of -Way for the duration of the project.
The project will require intermittent use of the plant from May 2014 thru 2016. The total
amount of concrete the temporary plant is expected to produce will be approximately
45,000 Cubic Yards. if you have further questions regarding the operation of the
concrete batch plant or the attached application for permitting please call me at (336)
710-3678.
Regards,
Zachry (
K. Adams, PE
Engineer
Corporation
Zachry Construction Corporation
PO Box 7228
Statesville, North Carolina, 28687
T-e WA
0 Division of Water Quality / Surface Water Protection
Ewa
NCDENRNational Pollutant Discharge Elimination System r„/
NQR CA ouL DuM .Ew or l I' -�/
ENVIRONMENT AND NRLR+.L nEeou RCEr ��� 400�0 \
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
a a
a
Certificate ofCovera e
Check N
I Amourt
b
ivo
Permit Assi ncd to
Q
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG140000:
STORMWATER AND PROCESS WASTEWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) Code: 3273 and like activities - Ready Mixed Concrete
This NOI may be an application to discharge process wastewater. NCG140000 contains effluent limitations for
process wastewater discharges. Wastewater discharges must meet the requirements of these effluent
limitations. An exceedence of any of these limitations will result in a violation of the permit conditions.
For questions, please contact the DWQ Central Office or Regional Office in your area. (Seepage 6)
(Please print or type)
1) Mailing address of owner/operator (official addres2 to which all neCIpjj ggrrespond ellcg wfl.he
Ll]aiigd : (Please print or type all entries in this application form.)
Legal Owner Name Zachry Construction Corporation
(Please attach the most recent Annual Report to the NC Secretary of State showing the current legal name. Alternatively this
permit can be given to an individual.)
Signee's Name (as signed for in question 29 below) John Young_, VP
Street Address 1203 Free Nancy Ave. _
City Statesville State NC ZIP Code 28677
Telephone No. 7( 04) _ 818-5580 Email J_ordan.adams{a.zachrucorp.com
Alternate Contact Name Jordan Adams Email (if different)
Alternate Contact Telephone (if different) (336) 710-3678
2) Location of facility producing discharge:
Facility Name Zachry Construction Corp. -_Portable Central _Mix Concrete Batch Plant 518-502
Facility Contact Jordan Adams
Street Address 300 Victory Lane _...,_
City Statesville State NC ZIP Code 28625
County Iredell
Telephone No. 3( 36) 710-3678 Fax: NIA
3) Physical location information:
Please provide narrative directions to the facility (use street names, state road numbers, and distance and
direction from a roadway intersection). When traveling on 1-40_exit onto Old Mocksville Rd. (Exit 154). Turn
North onto Old Mocksville Rd. Travel approx. 1110'h of a mile and turn left onto Wilson Park Road. After 1/2 Mi.
Wilcnn Park Rd hprnmps Virtnry I anp The farilitii_islacated_Y._Mi_nn Right nntn Virtnry I anp T
(A copy of a county map or USGS quad sheet with facility clearly located on the map is a required part of this application.) •-�_,� -
4) Latitude 35°48' 42.63169" Longitude 80° 51' 07.380480" (deg, min, sec)
5) This NPDES Permit Application applies to the following (check all that apply):
X New or Proposed Facility
O Existing Facility Permit #
Date operation is to begi
FEB - 3 20+4
Page 1 of 7
SW U-229.1103201 1
NCG140000 N.O.l.
6) Consultant's application information:
Consultant:
Consulting Firm:
Mailing Address:
City:
State: Zip Code:
Phone:( )
Email:
Fax: ( )
(Optional)
Staple Business Card Here:
7) Provide the 4 digit Standard industrial Classification Code (SIC Code) that describes the primary
industrial activity at this facility:
SIC Code: 3273
8) Provide a brief description of the types of industrial activities and products produced at this facility:
(Attach a site diagram showing the process areas present at this facility.)
Portable Central Mix Concrete Batch Plant
9) Discharge points / Receiving waters:
Number of discharge points (ditches, pipes, channels, etc.) that convey stormwater and/or wastewater from
the property:
stormwater-only.' Wastewater -only.,_ Wastewater Commingled with Storm water. 2
For new facilities: Expected date of commencement of discharge: May 1. 2014
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
and/or wastewater discharges end up in? Tributary 3 to 41h Creek_
Receiving water class ification(s), if known: C_—
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). N/A
Will this facility discharge wastewaterto SA (Shellfishing) waters? O Yes X No
Note: Discharge of process wastewater to receiving waters classified as WS-11 to WS-V or SA must
be approved by the N.C. Division of Water Resources, Public Water Supply Section. If DWR
does not approve, coverage under NCG140000 cannot be granted. None discharges of
process wastewater are permitted in receiving waters classified as WS-1 or freshwater ORW.
10) Each applicant shall provide the following information (attach additional sheets as necessary):
Two (2) site plans depicting the facility or site with numbered outfalls which indicate stormwater and
wastewater outfalls. The plans shall legibly show. at a minimum, (existing or proposed):
o Outline of drainage areas with topographical lines and features
o S tormwate r/wastewa ter treatment structures
o Location of numbered stormwaterlwastewater outfalls (corresponding to which drainage areas)
a Runoff conveyance structures
o Areas and acreage where materials are stored
o Impervious area acreages
o Location(s) of streams and/or wetlands the site is draining to, and any applicable buffers
o Site property lines, North Arrow, and bar scale
Page 2 of 7
SW U-229-07122011
NCG140000 N.Oa.
o If applicable, the 100-year floodplain line
o Acreage of each stormwater and wastewater topographical area
o Each of the facilities' wastewater or stormwater source and discharge structures and each of its
hazardous waste treatment, storage, or disposal facilities
o Site location (insert)
Site plans shall be 24" x 3 6 " ja size.
• Line drawing and description, Aline drawing of the water flow through the facility, A pictorial
description of the nature and amount of any sources of water and any collection and treatment measures.
A narrative description and identification of each type of process, operation, or production area which
contributes wastewater to the effluent for each outfall, and a description of the treatment the wastewater
receives (or will receive), including the ultimate disposal of any solid or fluid wastes other than by
discharge. Processes, operations, or production areas may be described in general terms (e.g. "ash silo").
11) Does the applicant have any unresolved Notice of Violations (NOVs)?
X No O Yes
12) What types of wastewater does your facility generate or discharge?
Type of Authorized Wastewater,
Generate
Discharge
S., h to WW
Treatment
System
Vehicle and equipment cleaning (VE)
X
X
O
Wetting of raw material stockpiles RM
X
X
O
Mixing drum cleaning MD
X
X
O
Further explanation, if necessary:
13) Will your facility spray -down or actively wet aggregate piles?
O No X Yes
14) Does the facility use any of the following on site?
O Phosphorus -containing Detergents
O Brighteners X Other Cleaning Agents
X Non -phosphorus -containing Detergents
O Other:
15) Are wastewater treatment facilities planned in the 100-year flood plain?
X No O Yes
16) Does your facility use or plan to use a recycle system, or recycle components in your treatment system?
O Yes X No
If yes, what size storm event is the system designed to hold before overflowing? (for example, 90-yr, 24-hr)
NIA year, 24-hr rainfall event
Page 3 of 7
SWU-229-07122011
NCG140000 N.O.I.
17) Will your facility build a closed -loop recycle system that meets design requirements in 15A NCAC 02T
1000 and hold your facilities' working volume'?
�s
X Yes 0 No
Will your facility discharge wBsie.Water to surface waters?
X Yes O No
If the facility's treatment system meets the design requirements of 15A NCACO2T .1000 (including
holding the 25-year, 24-hour storm plus one foot of freeboard), holds the working volume of your site,
and does L24S discharge wastewater to surface waters, you may not be required to obtain an NPDES
permit for wastewater discharges. If you believe this is the case, please contact DWQ's Aquifer Protection
Section Land Application Unit Central Office Supervisor or staff (1636 Mail Service Center, Raleigh, NC
27699-1636) for more information on obtaining the necessary permits or approvals. If you will discharge
wastewater or stormwater to surface waters, please continue to apply for a permit to discharge associated
with ready -mixed concrete or like operations under NCG140000. For further questions, please contact
DWQ's Stormwater Permitting Unit Staff.
18) A wastewater treatment alternatives review is required by 15A NCAC 2».0105 (c)(2) for any new or
expanding water pollution control facility's discharge in North Carolina. You may attach additional sheets.
a) What wastewaters were considered for this alternatives review? X VE X RM X MD
b) Connection to a Municipal or Regional Sewer Collection System:
i) Are there existing sewer lines within a one -mile radius? ..................................... X Yes 0 No
(1) If Yes, will the wastewater treatment plant (WWTP) accept the wastewater? .... O Yes 0 No
(a) If No, please attach a letter documenting that the WWTP will not accept the wastewater.
(b) If Yes, is it feasible to connect to the WWTP? Why or why not?*
This alternate is not feasible because of the cost and the short duration this portable plant will be
operanonai.
c) Closed -loop Recycle System (must meet design requirements of 15A NCAC 2T .1000):
Are you already proposing a closed -loop recycle system (CLRS)? O Yes X No
(1) If Yes, contact DWQ's Aquifer Protection Section's Land Application Unit
(2) If No, is this option technologically feasible (possible)? Why or why not?'
This alternate is not feasible because of the cost and the short duration this portable plant will be
operational.
3) If No, is it feasible to build, a CLRS on your site? Why or why not?*
This alternate is not feasible because of the cost and the short duration this portable plant will be
operational,
(4) What is the feasibility of building a CLRS compared to direct surface water discharge?'
This alternate is not feasible because of the cost and the short duration this portable plant will be
operational.
d) Surface or Subsurface Disposal System (e.g., spray irrigation):
i) Is a surface or subsurface disposal technologically feasible (possible)? ....................0 Yes X No
See DWQ's Aquifer Protection Section Land Application Unit's Water Balance Calculation Policy for more information, on DWQ LAU's
website hii :1! ortal.ncdenr.or Iweblw cies for mrtp�eXoag 7
SW U-229-07122011
NCG140000 N.O.I.
Why or Why not? _
This alternate is not feasible because of the cost and the short duration this portable plant will be
operational.
ii) Is a surface or subsurface disposal system feasible to implement?* ........... . .............. 0 Yes X No
Why or Why not?
This alternate is not feasible because of the cost and the short duration this portable plant will be
operational.
iii) What is the feasibility of employing a subsurface or surface discharge as compared to a direct
discharge to surface waters?{
This alternate is not feasible because of the cost and the short duration this ortable p1wt will be
operational,
e) Direct Discharge to Surface Waters: Is discharge to surface waters the most environmentally sound
alternative of all reasonably cost-effective options of the wastewaters being considered?*... X Yes 0 No
ij If No, contact DWQ's Land Application Unit to determine permitting requirements.
f) If this review included all wastewater discharge types, would excluding some types (e.g. raw
stockpile wetting) make any of the above non -discharge options feasible?..............0 Yes X No
'You maybe asked to provide further information to support your answers to these questions after the initial review.
Feasibility should take into account initial and recurring costs.
19) Does this facility employ any best management practices for 5tormwatercontrol? 0 No XYes
If yes, please briefly describe: Permanent vegetation established in ditches wf rock checks and wattles. The
sediment basins catching the stormwater also have skimmers and weirs installed.
20) Does this facility have a Stormwater Pollution Prevention Plan? X No 0 Yes
If yes, when was it implemented?
21) Are vehicle maintenance activities (VMA) occurring or planned at this facility? 0 No XYes
If yes, does your VMA area discharge into your wastewater treatment device? 0 No X Yes
22) Does this facility have a Division of Land Resources Erosion & Sedimentation Control (E&SC) Permit?
0 No X Yes
If yes, list the permit numbers for all current E&SC permits for this facility: Under NCDOT Ownership No.3909
23) Is your facility subject to Phase If Post -Construction Area? 0 Yes
If yes, who is the permitting authority?
X No
24) Is your facility located in one of the 20 Coastal Counties? 0 Yes X No
Is your facility adding more than 10,000 ftz of built -upon area or CAMA Major Permit? 0 Yes 0 No
Page 5 of 7
SVdu-229-07122011
NCG140000 N.O.I.
25) Is your facility discharging wastewater (treated or untreated) such as water from wetting of aggregate piles,
drum rinse -out, or vehicle and equipment cleaning to a stormwaterBMP? O No X Yes
If yes, please attach your approval from the permitting authority to do so.
26) Does this facility have any other NPDES permits? X No O Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
27) Does this facility have any Non -Discharge permits (ex: recycle permits)? XNo O Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
28) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
X No O Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
X No 0 Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No O Yes
d) Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal vendor;
Vendor address:
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
O Check for $100 made payable to NCDENR.
' O This completed application and all supporting documentation. See Question 10,
r O If an Erosion & Sedimentation Control (E&SC) Plan is required from Division of Land Resources (DLR)
or local designee: documentation verifying applicant has developed and submitted that Plan to the
governing agency (required per 15A NCAC 02H .0138).
' I O Two (2) site plans depicting the site plan with numbered outfalls which indicate stormwater and wastewater
outfalls. See Question 10.
O A county map or USGS quad sheet with location of facility clearly marked.
29) Signatory Requirements (per 40 CFR 122.22)
All applications, reports, or information submitted to the Director shall be signed and certified.
a. All notices of intent to be covered under this General Permit shall be signed as follows:
(1) For a corporation: by a responsible corporate officer. For the purpose of this permit, a responsible corporate officer means: (a) a president,
secretary, treasurer or vice president of the corporation in charge of a principal business function, or any other person who performs similar
policy or decision making functions for the corporation, or (b) the manager of one or more manufacturing production or operating facilities
employing more than 250 persons or having gross annual sales or expenditures exceeding 25 million (in second quarter 1980 dollars), if
authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures.
(2) For a partnership or sole proprietorship: by a general partner or the proprietor, respectively; or
(3) For a municipality, state, federal, or other public agency: by either a'principat executive officer or ranking elected official.
Page 6 of 7
t SWW229707122011
NCG140000 N.O.I.
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 tact in a ruiemaking 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 bust of my knowledge
and belief such information is true, complete, and accurate,
Printed Name of Person.Signim.. VI I U(.l_f'1
Title: -se-IN
L.%GU1U.tt-�'tr �3 Z�i�
(Sign Wure of Applicant) (Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to: NCDENR
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DWQ Regional Office for your area.
Asheville Office ..,...
(828) 296-4500
Fayetteville Office ...
(910) 433-3300
Mooresville Office ...
(704) 663-1699
Raleigh Office ........
(919) 791-4200
Washington office ...
(252) 946-6481
Wilmington Office ...
(910) 796-7215
Winston-Salem ......
(336) 771-5000
Central Office .........(919)
807-6300
Page 7 of 7
SW tt-229-07122011
Wade, Larry
From: Bou-ghazale, Samar
Sent: Wednesday, March 12, 2014 3:38 PM
To: Wade, Larry
Cc: Khan, Zahid
Subject: RE: NCG140433 Zachry Construction Corp. -Portable Central Mix Concrete Batch Plant
518-502
Hi Larry,
We offer no objections for issuing a COC for the subject facility.
Thanks,
Samar
From: Wade, Larry
Sent: Friday, February 21, 2014 11:00 AM
To: Bou-ghazale, Samar
Cc. Khan, Zahid
Subject: NCG140433 Zachry Construction Corp. -Portable Central Mix Concrete Batch Plant 518-502
Hello Samar,
Find attached, the NOI for the subject facility. Please review this submittal and let me know if you have any concerns for
issuing a stormwater permit for this facility.
If a response is not received within 30 days from the date of this email, we will proceed to issue the permit contingent
upon a favorable review in the central office.
If you have any questions or need additional information, please let me know.
Larry W. Wade PE Telephone: (919) 807-6375
Fax: (919) 807-6494
stormwater Permitting Program
North Carolina Department of Environment & Natural Resources
Division of Energy Mineral and Land Resources
1612 Mail Service Physical Address - 512 N. Salisbury St. Room
9425
Raleigh, NC 27699-1612 Raleigh, NC 27604
************************ThlS is a government E-mail
*********E-mails sent and received from this address can be disclosed to third parties*"'**********
NC�lyv�33
0067505 11-24 PERSONAL MONEY ORDER 6750502346
Office AU a 1210(8)
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Operator W.: nc003092 nc00305Z
January 10, 2014
PAY TO THE ORDER OF ***NCDENR*** 8
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WELLS FARGO BANK, N.A. `VOIoIVRUS$ 100.00 T
140 TURNERSEURG HWY !/ /
STATESVILLE, NC 26625
FOR INQUIRIES CALL (480) 394-3122 1
. rchaser's Signature
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ORDER0067505 11-24
PERSONAL MONEY f
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Opemior M.: nc003092 =003092
January 10, 2014
PAY TO THE ORDER OF ***NCDENR***
***One hundred dollars and no cents***
WELLS FARGO BANK, N.A.
140 TURNERSBURG HVVY
STATESVILLE. NC 28625
FOR INQUIRIES CALL (480) 3943122
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