NCS000570_APPLICATION_20190808

ROY COOPER
Qovernor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Interim Director
Mr. David Waters
Fuji Silysia Chemical USA LTD
1215 Sugg Parkway
Greenville, NC 27834
Dear Mr. Waters:
NORTH CAROLINA
Environmental Quality
August 8, 2019
Subject: Application Resubmittal
Permit No. NCS000570
Fuji Silysia Chemical USA LTD
Pitt County -
I have been working through DEMLRs extensive Individual Industrial NPDES Permit
backlog and 1 began drafting the Fuji Silysia permit this morning. I have included the
permit application as an attachment (originally received on January 2, 2014).
DEQ is responsible for the time that has lapsed between now and the receipt of the
permit; however, 1 am unable to draft the permit with just the information provided:
• EPA Fonn I, Section XII, Nature of Business: A brief description has not been
provided to the specifications of the directions found on page 1-5 of the instructions
provided with the Form. Examples of the description have been provided on the same
page.
• EPA Form 2F, Section I, Outfall Location: City water is listed as the receiving body
of water.
• EPA Form 2F; Section 11, Improvements: This section was left blank.
• EPA Form 2F, Section 111, Site Drainage Map: A Site Drainage Map was not
provided with the application.
• EPA Form 2F, Section IV, Narrative Description of Pollutant Sources: This section
was not completed.
• EPA Fonn 2F, Section V, Non-stonmwater Discharges: This section was left blank
and the required signature was not provided.
• EPA Fonn 2F, Section VI, Significant Leaks of Spills: This section was left blank.
• EPA Form 2F, Section VII, Discharge Information: This section was not completed to
the specifications of the directions found on page 2F-3 of the instructions provided
with the Form.
Oft_E Q: North Carolina Department of Environmental Quality 1 Division of Energy. Mineral and Land Resources
512 North Salisbury Street 1 1612 Mail Service Center 1 Raleigh, North Carolina 27699-1612
919.707.9200

• EPA Form 2F, Section VII, Discharge Information Continued, Parts A, B, C, and D:
These sections were all left blank.
Given the state of the application and the amount of time that has passed, I have been
advised to have you to resubmit the application within 30 days. I have included the blank
forms as an attachment. These completed forms can be returned to me by email at
Iauren.garciaPncdenr.gov or by mail at address:
DEMLR Stormwater Program
512 N. Salisbury Street Suite 640K
1612 Mail Service Center
Raleigh, NC 27699-1612
More information about the application process can be found here:
https://deq.nc. gov/about/divisions/energy-mineral-land-resources/nydes-stormwater-individual.
As soon as 1 have received the updated application, 1 can finish drafting the permit and
submit it to you for a 30-day comment period. I am aware that the original parties who
.submitted this application are no longer with the company, and again, I am very sorry to
have dumped this in your lap. If you have any questions, please email me or call me at
[phone].
(Sincerely,
I 1pvd�tti- o+v�f.��
Lauren Garcia
DEMLR Stormwater Division
Attachment:
Original EPA Fenn 1 — 2014
Original EPA Form 2F — 2014
Blank EPA Form 1
Blank EPA Form 2F
I
N4mt D��O NorthCuotltWUtparmum of Envirafmmrnl QralltY lUiNvlard Energy, h4neral andtand Rtsaircts
512 North Sellsbury Street 11b12Mag Sttvlct Certter I Raleigh North Carodlna27699-1612
919.707.4200

EPA IdenGflcabon Number NPDES Permit Number Facility Name Form Approved 03105/19
OMB No. 2040-0004
Form U.S Environmental Protection Agency
2F ®�O��A Application for NPDES Permit to Discharge Wastewater
NPDES OA STORMWATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY
1.1 Provide information on each of the facili 's outfalls in the table below
Number
u . s gi
Number �RecelvingWaterMime ` °Latitude „" longitude '
0
b.
O'
Q
e ••e .r
2.1 Are you presently required by any federal, state, or local authority to meet an implementation schedule for constructing,
upgrading, or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
❑ Yes No 4 SKIP to Section 3.
2.2 Briefly identify each applicable project in the table below.
-z - 'final Compliance Dates
Brief Identification and Affected outfalls . °:Source(s) of Discharge
Description of Project. (list oudall numbers). �o -
Required Projected
/V
b.,
C •:
E
m, "7
r
E
E:
2.3Have you attached sheets describing any additional water pollution control programs (or other environmental projects
that may affect your discharges) that you now have underway or planned? (Optional Item)
❑ Yes No
EPA Form 3510-2F (Revised 3-19) Page 1

Form Approved 03105/19
OMB No. 2040-0004
.',. 3.1 Have you attached a site drainage map containing all required information to this application? (See instructions for
o- specific guidance.)
g
Yes ❑ No
4.1 Provide information on the
Outfallr .. ,?I
in the table below.
I
the
r
Provide a narrative description of the facility's significant material in the space below. (See instructions for content
requirements.) C' ,)r 5.1 Gr.ta a9 /Svc(, : 1l,�ycProz,�
S✓ICP; C.L i'of-U9i�a. C,t loa9e.� CU4" f1G5Cc, -Ai J+ eIV-7-44'rr3'
Eo lr.�+•rr...t rr..l..-r G.,r p{1 C-e jj •rn Ew'7'. �'1-orn .�.c 'iur../c Ct /�Vr,;.�,w
iyr Q/l�ccc. -Lr�F 5U1.1�.,'� C.-crGBrriocCit�r�'- ln�yiolr'otir��.c, 1311/{Plan-Y//dre.:iis.
V . G SGCX I v:•r. I,{. y Cit /•P ;f"r N e' U
Yu'�o7�✓. t ,SIG . /1c lgd:u -)0 C s5-
17- j),J tf c Cc;•�ru •-r•. n�:r,..T.' /%'N''� �3 cr'LT/� Yal ri fl: it ,f 'TPs<i'tf h� �l6r-^
Provide the location and a description
stormwater runoff. (See instructions to
outfall
Number
IN
xisling structural and non-structural control measures to reduce pollutants in
ecific guidance.)
„Stormwater,Treatment d: ,�
Codes:
rom
Control 11 Measures and Treatment 1 _Exhibit
2F-1
EPA Fonn 3510.2F (Revised 3-19) Page 2
r—

s
NPDES Permit Number
Form Approved 03/05119
OMB No. 2040-0004
_c 5.1 I cedi(y under penalty of law that the cuttall(s) covered by this application have been tested or evaluated for the
presence of non-sformwater discharges. Moreover, !certify that the out(alls identified as having non-stormwafer
discharges are described in either an accompanying NPDES Form 2C, 2D, or 2E application.
Name (print of type first and last name) Official title
-N u i -D P 161, ; )411 ,a
S' natrlre Dale signed
V—-4 Z7g/3O t I?
5.2 Provide the testing information requested in the table below.
Outfall -, , Onsite Drainage Points'
.Number , :�i Description o6Testing Method Used Dates) of Testing , Directly Observed ,.
burin Test
U o-T- l� L«3 t
oS"1-75�—�3Dc 52
U' C. )Lpvra ✓i1T' ti ie iti'R
6.1 N Describe any significant leaks or spills of toxic or hazardous pollutants in file last three years. hh pp
N(� ),l 9
G \
N'
Y
W
J
C
N
o-
T
rn
in
_ See the instructions to determine the pollutants and parameters you are required to monitor and, in turn, the tables you must
2 - complete. Not all applicant need to complete each table.
A 7.1 Is this a new source or new discharge?
do❑ Yes 4 See instructions regarding submission of r G No 4 See instructions regarding submission of
a.
estimated data. l actual data.
�- Tables A, B, c and D=
7.2 Have you completed Table A for each outfall?
o. Yes ❑ No
EPA Form 3510-2F (Revised 3.19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name -
Form Approved 03105/19
OMB No. 204MG04
7.3
Is the facility subject to an effluent limitation guideline (ELG) or effluent limitations in an NPDES permit for its process
t
wastewater?
Yes (,U `l`Z7 ,� f�N �6. ❑ No 4 SKIP to Item 7.5,
7.4
Have you completed Table B by providing quantitative data for those pollutants that are (1) limited either directly or
indirectly in an ELG and/or (2) subject to effluent limitations in an NPDES permit for the facility's process wastewater?
Yes Sz.- a-t-rrAcG.;�l [INo
j2"rw ci {-c,
7.5
Do you know or have reason to believe any pollutants in Exhibit 2F-2 are present in the discharge?
❑ Yes No 4 SKIP to Item 7.7.
7.6
Have you listed all pollutants in Exhibit 2F-2 that you know or have reason to believe are present in the discharge and
provided quantitative data or an explanation for those pollutants in Table C?
❑ Yes ❑ No
7.7
Do you qualify for a small business exemption under the criteria specified in the Instructions?
❑ Yes 4 SKIP to Item 7.18. No
7.8
Do you know or have reason to believe any pollutants in Exhirbiit-t,�2F-3 are present in the discharge?
-
❑ . Yes No 4 SKIP to Item 7.10.
,.. -
7.9
Have you listed all pollutants in Exhibit 2F-3 that you know or have reason to believe are present in the discharge in
.
Table C?
0
❑ Yes ❑ No
`g
7.10
Do you expect any of the pollutants in Exhibit 2F-3 to be discha�ed in concentrations of 10 ppb or greater?
€
❑ Yes No -> SKIP to Item 7.12. .
0
- =
7.11
Have you provided quantitative data in Table C for those pollutants in Exhibit 2F-3 that you expect to be discharged in
concentrations of 10 ppb or greater?
O
` �
i N
❑ Yes ❑ No
'
7.12
Do you expect acrolein, acrylonitrile, 2,4-dinitrophenol, or 2-methyl-4,6-dinitrophenol to be discharged in concentrations
of 100 ppb or greater?
❑ Yes ,� No 4 SKIP to Item 7.14.
7.13
Have you provided quantitative data in Table C for the pollutants identified in Item 7.12 that you expect to be
..
discharged in concentrations of 100 ppb or greater?
❑ Yes ❑ No
7.14
Have you provided quantitative data or an explanation in Table C for pollutants you expect to be present in the
discharge at concentrations less than 10 ppb (or less than 100 ppb for the pollutants identified in Item 7.12)?
ElYes 11KNo
7.15
Do you know or have reason to believe any pollutants in Exhibit 2F4 are present in the discharge?
❑ Yes No 4 SKIP to Item 7,17,
r
7.16
Have you listed pollutants in Exhibit 2F-4 that you know or believe to be present in the discharge and provided an
explanation in Table C? .
'
❑ Yes ❑ No
7.17
Have you provided information for the storm event(s) sampled in Table D?
❑ Yes ,.] No
EPA Form 3510.2F (Revised 3.19) Page4

or
EPA Identification Number NPDES Permit Numher
- Facility Name
Form Approved 03/05119
OMB No. 2040-0004
`Used orManufacturedToxics'.',-
••
?
7.18
Is any pollutant listed on Exhibits 2F-2 through 2F-4 a substance or a component of a substance used or
o,
manufactured as an intermediate or final product or byproduct?
" -
❑ Yes No 4 SKIP to Section 8.
o
>P-'Z(
:,.
7.19
List the pollutants below, including TCDD if applicable.
1. - 4. Z.
d,
`, ...A
s .
2. 5. 8.
U
o
3. 6. 9.
8.1
Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made on
any of your discharges or on a receiving water in relation to your discharge within the last three years?
0
�'
❑ Yes No 4 SKIP to Section 9.
�>
8.2
Identify the tests and their purposes
below.
..
'o_
Test(s),. -
Purpose of Test(s),;Date
Submitted to NPDES!'
Permitlin Authbri ?
Submitted
F
' A
u
❑ Yes ❑ No
i3i .
❑ Yes El No
o
m.
❑ Yes ❑ No
9.1
Were any of the analyses reported in Section 7 (on Tables A through C) performed by a contract laboratory or
consulting firm?
Yes ❑ No 4 SKIP to Section 10,
9.2
Provide information for each contract laboratory or consulting firm below.
'-"
Laboratory Number l .
LaboratoryNumber2
Laboratory Number 3.'
Name of laboratory/firm
-
_:,ci."Iv
Unela ME.vy"T
.PSG'
o..
0
Laboralo address
'Zi
� d. I SC '7
..
a:
`
_
Phone number
Pollulant(s) analyzed
A',
� �1
To
EPA Form 3510-2F (Revised 3�19)
Page 5

A
EPAldentifica6on Number NPDES Permit Number Facility Name roan Approved umuur sa
OMB No. 2040-0004
1 'FILgi 0
10.1 In Column 1 below, mark the sections of Form 2F that you have completed and are submitting. with your application. For
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all a licants are required to com fete all sections or provide attachments.
Column , .. ,.. ,.,..
Section 1
Section
❑ wl attachments (e.g., responses for additional outfalls)
© Section 2
❑ wl attachments
Section 3
wl site drainage map
Section 4
❑ wl attachments
�'- Section 5-
'©
wl attachments
I
c,
Section 6
❑ wl attachments
d',
N
Er Section 7
❑ Table A ❑ w/ small business exemption request
�
8 Table ❑ .� wl analytical results as an attachment
c
-
;.
❑ Table C ❑ Table D
C�
Section
❑ w/attachments
9'
Section 9
K wlattachments e.
❑ (g., responses for additional contact laboratories or firms)
Y
d;•,
I
❑
t
Section10
10.2
Certification Statement
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 property gather and evaluate the information
•�
submitted. Based on my inquiry of the person or persons who manage the system or those 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 fine
and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
j144-1 % 1 1,/) C.J 8
Signature
11
D to signed v
c-1 ,,;
EPA Form 3510-21' (Revised 3-19) Page 6

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F-C-0000

Permit: NCS000570 Effective:
SOC: Effective:
County: Pin
Region: Washington
Compliance Inspection Report
Expiration: Owner: Fuji Silysia Chemical USA LTD
Expiration: Facility: Fuji Silysia Chemical USA, LTD.
1215 Sugg Pkwy
Contact Person: Yasushi Shimatani Title:
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 02123/2017 Entry Time: 10:OOAM
Primary Inspector: Thom Edgerton
Secondary Inspector(s):
Reason for Inspection: Other
Permit Inspection Type: Stormwater Discharge, Individual
Facility Status: ❑ Compliant ❑ Not Compliant
Question Areas:
Storm water
(See attachment summary)
Greenville NC 27834
Phone: [phone]
Certification: Phone:
Exit Time: 10:30AM
Phone: [phone]
Inspection Type: Compliance Evaluation
Page: 1

Pemit: NCS000570 Owner- Facility: Fuji Silysia Chemical USA LTD
Inspection Date: 02/23/2017 Inspection Type : Compliance Evaluation Reason for Visit: Other
Inspection Summary:
I had heard mention of this opeartion but was not sure where it was. I see that this will require additional investigation and
action. The facitlity had sent an application, but processing was never completed. Another visit to the site and the area is
required in order to determine if this site also negatively impacts others, such as Hyster Yale.
Page: 2

permit NCS000570 Owner- Facility: Fuji Silysia Chemical USA LTD
Inspection Date: 02/23/2017 Inspectlon Type : Compliance Evaluation Reason for Visit: Other
Stormwater Pollution Prevention Plan
Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan?
❑ ❑ ❑ ❑
# Does the Plan include a General Location (USGS) map?
❑ ❑ ❑ ❑
# Does the Plan include a "Narrative Description of Practices'?
❑ ❑ ❑ ❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
❑ ❑ ❑ ❑
# Does the Plan include a list of significant spills occurring during the past 3 years?
❑ ❑ ❑ ❑
# Has the facility evaluated feasible alternatives to current practices?
❑ ❑ ❑ ❑
# Does the facility provide all necessary secondary containment?
❑ ❑ ❑
# Does the Plan include a BMP summary?
❑ ❑ ❑ ❑
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
❑ ❑ ❑ ❑
if Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
❑ ❑ ❑
# Does the facility provide and document Employee Training?
❑ ❑ ❑ ❑
# Does the Plan include a list of Responsible Party(s)?
❑ ❑ ❑ ❑
# Is the Plan reviewed and updated annually?
❑ ❑ ❑ ❑
# Does the Plan include a Stormwater Facility Inspection Program?
❑ ❑ ❑ El
Has the Stormwater Pollution Prevention Plan been implemented?
❑ ❑ ❑ ❑
Comment
Qualitative Monitoring
Yes Na NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? ❑ ❑ ❑ ❑
Comment:
Analytical Monitoring Yes No NA NE
Has the facility conducted its Analytical monitoring? ❑ ❑ ❑ ❑
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas? ❑ ❑ ❑ ❑
Comment:
Permit and Outfalls
Yes No NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site?
❑ ❑ ❑ ❑
# Were all outfalls observed during the inspection?
❑ ❑ ❑ ❑
# If the facility has representative outfall status, is it properly documented by the Division?
❑ ❑ ❑ ❑
# Has the facility evaluated all illicit (non stormwaler) discharges?
❑ ❑ Q ❑
Comment
Page: 3

Patterson, Robert D
From: Edgerton, Thom
Sent: Friday, June 23, 2017 4:34 PM
To: Patterson, Robert D
Subject: Fuji Silysia Chemical USA, LTD. - Greenville
Hello,
You can go ahead with your staff report process. That will help to get us out there for an inspection and on the right
path toward getting them permitted. I just mentioned that the fee was noted as waived in BIMS. I have no reason or
interest in them not being required to be placed under the standard fee structure.
Please let me know if you need more information or would like to discuss.
Sincerely,
Thom , /10y /k( �i0,
Thom Edgerton V"' ` j�/ ,
Environmental Engineer
Division of Energy, Mineral and Land Resources/Land Quality Section
Department of Environmental Quality
252 946 6481 office `' l•
thom.edgerton(alnodenr.aov `5 l
Washington Regional Office
943 Washington Square Mall
Washington, North Carolina 27889
Ac. 7"Nothtng Compame
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
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FUJI SILYSIA CHEMICAL USA LTD.
ATTN: MELISSA BRAXTON
1215 SUGG PARKWAY
GREENVILLE ,NC 27834
Stormwater Analysis Method
PARAMETERS (#I, Grab) Date Analyst Code
BOD, mg/1
3.9
11/27/13 TRB
5210B-01
COD, mg/l
31
12/02/13
TRB
H8000-79
Total Suspended Residue, mg/i
38
12/02113
11MB
2540D-97
Total Kjcldahl Nitrogen as N,mg/I
1.26
12/OS/13
ANO
351.2 R2-93
Nitrate -Nitrite as N, mg/l
0.11
12/04/13
ANO
353.2 R2-93
Total Phosphorus as P, mg/l
0.17
12/05/13
ALB
365.4-74
Oil & Grease (HEM), mg/l
<5.0
12/02/13
SEJ
1664B
ID#: 23 A
DATE COLLECTED: 11/27/13
DATE REPORTED : 12/06/13
REVIEWED BY:�

Environment 1, Inc.
P Q,B� 7085. 114 Oakmont Dr.
Greenville, NC 27858
CHAIN OF CUSTODY RECORD
Page I of 1
Phone [phone] • Fax [phone]
( ) ( )
DISINFECTION
CHLORINE NEUTRALIZED ATCOLLECTION
CHLORINE
n
)
pH CHECK (LAB)
CLIENT: 23A Week:2
UV
P
P
P
P
P
P
G
CONTAINER TYPE, P/G
FUJI SILYSIA CHEINUCAL USA LTD.
III
NONE
ATTN: TVIELISSA BRAXTON
1215 SUGG PARKWAY
GREENVILLE NC 27834
J
A
C
A
C
C
C
C
CHEMICAL PRESERVATION
-
A -NONE D-NAOH
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G-NATHIOSULFATE
SAMPLE LOCATION
DATE
TIME
Stormwater (NI, Grab)
) 1-27-r3
ID!C a
/0
6
..
..
:.
..
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CLASSIFICATION:
Qj WASTEWATER(NPDES)
JDRINKINGWATER
Ij DWO/GW
SOLID WASTE SECTION
CHAIN OF CUSTODY MAINTAINED
DURING SHIPMENT/DELIVERY
Y N
SAMPLES COLLECTED BY:
(Please Print)
U -bG
SAMPLES RECEIVED IN LAB AT_� (p °C
ELINQUISH (S G.) (SAMPLER)
DATE/�/P E
REC V BY (SIG
) DATUTIME
COMMENTS:
EUNO ED BY (SIG.)
DA1E/I1ME
RECENEDBY( G.)
DATE/TIME
RELINQUISHED BY (SIG.)
DATFrrIME
RECEIVED BY (SIG.)
DATFJTIME
PLEASE READ Instructions for completing this form on the reverse side. Sampler must place a "C" for composite sample or a "G" for NO- 2 6 8 8 % 2
FORM #5 Grab sample in the blocks above for earh naramatar rpnooctorl

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j )c S 0610S70
Form Approved. OMS No. 2040-0086, •-!
FORM
". "" U.S. ENVIRONMENT11 PROTECTION wGE CY
I. EPA I.D. NUMBER
GENERAL INFORMATION
Consolidated Permits Program
\�iL�/`/�
F
D.
GENERAL
(Read Iho' General Inslruelioni"
before eta nns.l
AR
L TE
GENERALINSTRUCTIONS
It a preprinted label 'has been provided -affix`
1. EPA LO. NUMBER
it in the designated space, Review the inform-':
\ \
-
\
ation carefully if any .of it is incorrect, cross;
through it and enter the'coirect data in the
appropriate fill-in area below. Also, if any of,
.the preprinted data is absent (the area to the:
label lists information
III. FACILITV NAME
FACILIT�^
V. MAILING ADDRESS
\\\�
\ PLEASE PLACE LABEL IN
THIS SPACE
deft of the space the
that should appear),please provide it in the'
proper fill—in area(a).,below. If the label Is'', complete and correct, you need not complete;
\\ \\
\\
Items I, III; V, and 91 (except V1-8 ,which '..
'must be completed regardless). Complete all',
FACILITY\
items if no label hes been provided. Refer to-
VI
LOCi1TION
'\
the instructions for ._detailed . item. descnp;"
:tions and for -the legai:. authorizations under'.
which this data Is toll acted. •..,
II. POLLUTANT CHARACTERISTICS-
. .. -.:
INSTRUCTIONS: Complete A through J to determine,whether you need to
... .... ,.::
submit any permit application forms to the EPA. 'If you'anwer "yes" to any
questions, you must submit this form and the supplemental form listed in the parenthesis fallowing the question. Mark "X" in the box in the third column ,.
if the supplemental form is attached. if you answer "no":to each..question, "you
need not submit any ofthese forms. Youmay answer "nd";if your activity z
is excluded from permit requirements; see Section C of the _itistructigns. See also, SedioKO.ot the instructions for definitions of bold=faced terms. x,�t
MARK
X•
SPECIFIC QUESTIONL
Y
SPECIFIC QUESTION a
.c�eP
A. Is this facility a'publicly owned treatment.world
'which
✓
B. Does orwill'.this facility either existing or proposed).,'
..,include a coiicantrated animal feeding operation r: p:
/
results in a discharge to waters of the U.S.?
.(equitic animal production facility which results In,a.'
J
(FORM 2A)
' discharge to waters of the U.S.? (FORM 2BI
C. Is this a facility whit t currently results In discharges
described
�
D.. Is this a prop d facility other than those described
in 'a discharge
to waters of the 'U.S. other than those in
A or 8 above? IFORM 2C1 -"'^
in 'A or B above) which will result to'
waters of theU.S.? (FORM 2D)"
�
I V
s
ilr al dr,''
inject at toowermost
F. Do yoipal
se
E. Does or will this facility vw[, store, or dispose of
` municipal effluent below the lowermost stratum con:'
of nt 'atum
hazardous wastes? (FORM 3)
taming, .within one :quarter. mile of.the well.bore;
- underground iourees'of drinking water? (FORM 41
o you or will you inject at this facility any produced
'
H', Do you or, will you mlect et this facility' fluids for spe
water or other fluids which are brought to the surface
cial processes such es mining of sulfur by the Frisch
in connection will, conventional oil or natural gaspro-
for
;
';process solution rnir M msit minerals,:,u combus
'
., ductlon, inject fluids used enhanced recovery,of,
;✓Uon of fossil'fuel or recovery of geothermof energy?,,:
g
;
J
. oil or natural,gas; or miect fluids�ton.storage of Ilquid,
+ I
41y` �rrt y ('
r
` h drocitrb0ons, (FORM4) '�' '�tpP'•
,(FORM ,
I. Is this as rty a _propose statlonaty s uree w is rs
one of ;h'e 28 industrialcatego ies`listed in the
J. is this: facility a propose stationary source winch ei.
-.,NOT one of,;the 28 ndustnal categonei; fisted m the;
i structions and which -'will potentially, 100 tons
end which will Potentially emit 260 tons
'per "of any a r r, pollutant regulat12 underltfne
J
rfinrtruttlons
:per year of any av pollutant regulated under the Clean
.year
Clean"Air `Act and 'may affector..tie located man
laJie'�a-i
g"H5_
,
fE'qu Att'an'd,rnay effect or'.be located Iran ottamment'
=_eL t.l F O R M': 5141kV:.}t '.t':z[ ?,'sir"µa,6. S'Y,..a�.}riY%
+"attainmentarea�.IFO RM' 5) hP .3:>
.
.x.+v
area
v I II
.III: NAME OF FACILITY
1 SHIP Fti
P
IV. FACILITY CONTACT
A. NAME 6 TITLE (fail(. fl Rf, &'hllC) .'L
"" AC r'�` YI, B. PHONE (.,cu Cf f $ IV)
2SH-1
A.T.M PL.AfvT
A r.I 252 41
uoo3 ,
V. FACILITY MAILING ADDRESS
A. STREET OR P.O BOXid:'
!P
s i 21'S �uGG_PARKWAY_,���
B. CITY OR, TOWN
"' C:STATE 0. ZIP CODE -' F
Tl-11T(-1TT........ —ITI-1T1
-
aCREEKVZLL'c
►�C 2�$3
VI. FACILITY LOCATION
A. STRCET. ROUTE NO. OR OTHER SPECIFIC IDENTIFIER
•`I ��
JAN 2 2 20114
B. COUNTY NAME
TI—T—i-1--1 -"i—
t'.L T T
n NR - Wi AuTy <
C. CITY OR TOWN '.' '•?�^
..
''`%Is�D6TATE-/E
v
...w,
121P CODE
F'COUA,II Ill
6
—r—r--r—r—r—r—rr—'-r—T—m—rrsTr—t
C ;Z:C e"
EPA Form 3510-1 (8.90) CON TINUe ON HEVEHb6

CONTINUED FROM THE FRONT
VII. SIC CODES (4-digit, in order of priority)
A. FIRST r. .. ... .. ... B,SECONO .. ) ,ii. :,i[•+,1GIvC
T
rtvccifi')
1
/specify
. C. THIRD `o O.TOURTH-
(SPrcif) upecifl'I '
7
7
Villa OPERATOR INFORMATION
p, NAME .'
B. I, the bame Ilat.d In
IMT VII I
e'U3i
SiL(SiA CHtN1iCAL USA LTD.
-A al3 t11e
C] YES EN`k
O`
C. BTMTUS OF OPERATOR (Enter the aPpropnu it'Ie.... t,IIU the aA3 KCr 62i: if"Ot/ti/ tpecifl•.J.
D. PHONE fa)ea Cade8110.1 YY(!
. F.=FEDERAL ' M =PUBLIC (other than federal arstare/
- OTHER
t�
r
/sproifcl
A
'.'
ZS 214
1 134
V 3
j'.
S = STATE •'O Oprcify)
P=PRIVATE
11
a
s�,
'E, STREET OR P.O. BOX
yy--
1I 1 rnfi{4
ro.4)
„1fx"3
-vsa N
F, CITY OR TOWN - "
O.STAT
HrZIP coo
IX. INDIAN LAND
C Is the facility located ,O_n,..Vdean Iands7
B.(jQEEFiVZLLE- t`(G 27S�J1} DYES
32
X. EXISTING ENVIRONMENTAL PERMITS
y
" A,'NPDES (Dlsclnz ges to SW.,i, N'atP/) .0. ASO_ (,tir Endssiom iroont Proposed Sony"s)
u1f4 L'
9 9 P Q a% 2
N
-'B.LIC((Inde/$YOn11dInjection Uf )"luids)
--",' '- E. OTHER_(tPCCff)J .;,-- µ'
(Specify/
9
U
9
C. RCRA (Ha:ardans Wastes) _
E: OTHER upeCifl') ,;-' 1 - '.;rv?"s-i.
/tprcifl•)
9
R
9
XI. MAP
Attach to thls'apphcation. a topographic map of,tlie area extending to of least:. one mile beyond property boundenes The map must showtg
the outline of . 4helfacdity,-the location of each of:Its existing and proposed intakeiend dlscharge�Structures-'each of its hazardous waste a 0.
treatment storage or disposal facilities and each well where: it Injects fluids underground !include all springs, rivers and other surface,
n the and area See In5tfl1C11,,n5 lot feClSe re Ulfement5 A'lei�n ' :.F �1 n{ Ct, T.yS.�,t ��f) r , tl (t f11h S
"water bodlei:i01
f?,,+. Q `"fieii-eF*'`
,. ,p� ..w, tf +.."-Z:-,,kc-Sw4,i��•
XI I::NATURE OF. BUSINESS (provide a brief description
CC
XIII. CERTIFICATION/see instructions/
/ certify under penalty. of law, that l have personally examined and am famihar'with the information submitted in this appbcauon and al!
-attachments and that;•tiased on my inquiry of those persons immediately responsible for obtaining !tie information'contamed in thee.
`,
application, / believe that the information is true, accurate and complete:? am aware that there are significant penalties for submitting ..
false information, including the possibility of fine and imprisonment. `•,#
A. 6 OFFICIAL TITLE ((tape or Print B. SIGNATURE - C. DATE SIGNED
j(NAME
—/-
/RASceS/7. L1�7ima/Gumi P�w/ /`%Ctfu,"( ,N"G`i✓�i� Jai,, /6S Zo/�
COMMENTS FOROFFICIAL USE ONLY.
EPA Form 3510.1 (8-90)

EPA 10 Number (copy from film I of form 1) 'r'u Forte Apprmretl.
OMB No.2040-00&6.
Please printer type in tM unshaded areas only I Approval expires 8-31-H.
Form
2 F
NPDES
unitetl States Environmental o""ion Agency
Washington. OC M460
IIKPFEPAMApplication for Permit To Discharge Stormwater
Dischar es Associated with Industrial Activity
Paperwork Reduction Act Notice
Public reporting burden for this application is estimated to average 2A.A hears per application, including time for reviewing instructions.
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding the burden estimate, any other aspect of this collection of information, of suggestions for improving this form, including
suggestions which may increase or reduce this burden to: Chief. Information Polity Branch, PW223. U.S. Environmental Protection Agency,
401 M St.. SW. Washington, OC 20460, or Director. Office of Information and Regulatory Affairs. Office of Management and Budget
Washington. DC 20503.
I. Outtall Location
For each outtalllist the latitude and Ion itude of its IOcation 10 the nearest 1 seconds and the name 1 th (oCeiving water.
A. Oudall Number
Ilsr
B. Latitude
C. Lon iWde
D. Receiving Water
name
I
o
—ivaLer
II, In, rovements
A. Are you now regwrerl by any Federal. State, or local authority to meat any implementation schedule for the construction, upgrading or
operation of wastewater treatment equipment of practices or any Other environmental programs which may affect the discharges
descnbed in this application? This includes, but is not limited to. permit conditions, administrative Or enforcement orders, enforcement
compliance schedule leners. stipulalions. court orders, and grant or loan conditions.
1. Identilkation of Conditions.
A acamen s. Etc.
2. Affected Outfalls
3. Brief Description of Project
4. Final
Compliance Date
number
source o1 discharge
a. req.
b. proj.
B. you may attach additional sheets describing any additional water pollution (of other environmental projects which may &fleet your
discharges) you now have under way or which you plan. Indicate whether each program is now under way or planned. and indicate your
actual or planned schedules for construction.
Ill. Site Drainalpfe Map M
Attach a site map showing topography (or Indicating Me outline of drainage mu served by the outtall(s) covered In the application it
topographic map is unavailable) depicting the facility including: each of its intake and disehargqe structures; the drainage area of each storm
water outtall; paved areas and buildings within the drainage area of each storm water curtail, each known pest or present weas used tar
outdoor storage or Oispoul of significant materials, each existing structural control measure to reduce pollutants in storm water runoff,
materials loading and access areas, areas whore pesticides, herbicides, soil conditioners and fertilisers we applied; each of its hazardous
waste treatment, storage or disposal units (including each area not required to have a RCRA permit which is used for accumulating hazardous
waste under 40 CFR 262.34); each well where fluids from the facility we injected underground; springs, and other surface, water twdiea which
receive Storm water dischar es lion, the lacili .
EPA Form 3310.21F (11-e0)
Page I of 3
Continue on Pape 2

..',iti.5' ... ...� i..
Continued from the Front
A>cm eV
Oni ,n 7
A. For each oudall, provide an estimate of the area pnclude units) im ryious fu pndudinp paved seas and Duiltlinq roofs drain d
to the outlall, and An estimate of the total surface area drained by the ouffill.
Outla11
Numpef
kao of Impervious Surface
to U17W
Total Area Drained
1provido units)
Ovtlall
Number
Yves of Impervious Surface
(provide aftq I
Total Area Drained
(provide units?
C, OCO 5Cj S-r
I t C Lces
r
I
B. Provide a narrative description of significant materials that are currently or in the past three years have been treated, slored or disposed in j
a manner to allow exposure to storm water; method of treatment, storage, Or disposal: past and present materials management practices
employed, in the last three years. to minimize contact by these materials with storm water runoff; materials loading and access areas; and
the location, manner, and frequency in which pesticides. herbicides. soil conditioners, and fertilizers are applied.
C For each eutla9 prn',ee the location and a description of existing structural and nonstructural contra measures to reduce pollutants in
storm Hater rune': and a description of the treatment the storm water receives, incluom the fchetlule antl type of maintenance for control
6 treatment moligures &=he ultimate disposal of ang solid of fluid willies other cis a
Ounall
Ust Codes from
Number
re atment
Table 2F.1
// ,{,
IVl `— �/� I V PG I n By �o� VjAeCl S uL" a�fi
2
V. N nstormwater Olschar es
A. I certify under penalty of law that the ou all(s) covered by this application have been tested or evaluated for the presence of
nOnStormwater Ascher es, antl that all nonstormwater discharges from these outlall(s) an identified in either en eCCOmpanying Form 2C
F rm
Name end On�dal ftlir hype or print)
Signature
Date Signed
B, Provide a OeScrlpadn of the method used. the date al testing and the onsits drainage points that ware dirictly Observeo during A tea
VI. Sionificanit Le ks or SON
Provide existing information regarding the history, of significant leaks or apices of toxic or hazardous pollutants At the facility in the last three
years, including the approximate data and location Of the spill or leak. and the type and amount of material released.
EPA Form 3110.212 (11•10, Page 2 of 3 Continue on Page 3

Continued from Patti i 1
EPA ID Number (Copy from Mom I of Form p
A.B.C. 5 D: See instructions before procaleding. Complete one set of tables for each oudall. Annotate the outtall number in the space provided.
Tables \ 4A. MI-S, and YII-C an Included on separate Meets numbered Vl4 t and W-2.
E. i Potential discharcesinol coveted by analysis • Is any pollutant listed in Table 2F•2 a substance or a component of a substance which you
e or manufacture as an�intormediste)br final product or byproduct?
Yes I';gt all such Pollutants below No (o to Section Vlll
//'�
5o{iu Sµ( C i S ovna`<wFc� �' o S byre pT (Ile V?ac7- ,I, ZO" IC4[' Woc✓,
><NAzu1 HMSO ,( S`oz f AJOt- Sd t H2sv� f KZ�
Yeb 7a5t r@g�'Ig DelCwl'
No (o to Secton IX)
IX. Contract AnafyMs Informabon
GYes
No (go to Section X)
A. Name
B. Address
C. Area Code.b Phone No.
! O. Pollutanis Aha!yzed
A Name 5 Olfic,al Title (We or pnnt) -�-
�GSuS�j i V /J�ln0.7-t, i
n
/ /4� /�I.HCI�PV`
B. Area Code and Phone No
2�� - q13 -DDO�3
C, Signature
D. Date Signeo
c h
EPW'Form 3510.21c (11-00) Page 3 of 3

EPA ID Number (copy from Nam r of Form tl i
VII. Discharge In ton onrin ed from Page 3 of Form 2F
Part A- You must provide the results of at least one analysis for every pollutant in this table. Complete one table for each outlall. See
instructions for additional details.
Pollutant
and
CAS Number
W avai4t le/
Maximum Values
(include units)
Average Values
(include units)
Number
of
Storm
Events
Sampled
-
Sources of Pollutants
Grab Sample
Taken Outing
First 30
Minutes
Flow -weighted
Composite
Grab Sample
Taken During
First 30
Minutas
Flow -weighted
Composite
OI and Grease
B.ological Oxygen
Demand 00D5i
'
Chemical Oxygen
Demand (COD)
Total Suspended
Solids (TSSI
'
Total Kjeldahl
Nitrogen
Nwaie plus
%'Wre Nitro en
"oia
=^csrncrs
—im Max-nvm Minimum Maximum
art B - :Js: ea]h pe:.utant :fat is :,m.nec in an effluent gwoerine which Ih! facility is suo(ea! :o or any ocnmani osietl in the fatony a N ITEr
permit for its process wastewa:et (if the facility is operaling untler an existing NPOES peimill. Cempiate one table for each outfa0.
hfor Adnij One, details anga
Maximum Values I Average Values I Number
Po%:a^a frUude unrsi (include units) of
a^^_ Grab Sample j Grab Sample Storm
,,. f,yr.ce, . Taker. Da^ing Flow weighed I Taken During Flow -weighted Events
Fasi .. First 30
f::%!esCcmposite Minutes Composite Sampled Sources of Pccu!ants
I
I
I
I
I
i
I
I
i
r
i
if
i
I
i
I
EPA Form 35110-21F (11.90) Page vll.t

Continued tram the Front
Part C - Ust each pollutant Mown in Tables 2FQ. 2F•3, and 2F•4 that you know or have reason to beliwt is present. See the instructions for
additional details and requirements. Complete one table for each outfafl.
Pollutant
and
CAS Number
(if available)
Maximum Values Average Values
0ne1 units) (include units)
Number
of
Storm
Events
Sampladl
Sources of Pollutants
Grab Sample
Taken During
Fire
Minutes
Grab Sample
Taken Ourinp
Flow-wsipntad Frtt 30
Composite Minutes
Flow -weighted
Composits
I
I
I
I
i
!
I
I
I
i
I
I
�
I
I
i
I
I
I
i i
I
I i i
I
l
i
I
I
I
i
i
i
I
I
I
PertD • Provide data for the storm events
which resulted in the maximum values for the lbw wen hted com osits
sample
t.
Date of
Storm
Event
2.
Duration
of Storm
(in minutes
3.
Total rainfall
during storm event
fin inches)
4.
Number of hours between
beginning of storm mews•
ured and and of previous
measurable rain event
S.
Maximum Hoe rate
during rain event
(pa/bna/minute or
a unit
d.
Total flow from
rain event
(gallons or
units
7.
Season
sample was
a
taken
8.
Form of
Precipitation
(rainfall,
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9. Provide a description of the method of flow measurement or animate,
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