NCG030726_Application_20220322

RECEIVE®
FOR AGENCY USE ONLY
NCG03 Q 1 Z _� MAR 2 2 202i
Assigned to: jov
ARO FRO RO RRO WARO WIRO WSRO ®EW-StumiyaterPlmgmm
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG030000 Notice of Intent
This General Permit covers STORMWA TER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC 335 [Rolling, Drawing, and Extruding of Nonferrous Metals], SIC 3398 [Metal Heat
Treating], SIC34 [Fabricated Metal Products], SIC35 [Industrial and Commercial Machinery], SIC36 ]Electronic
and Other Electrical Equipment], SIC 37[Transportation Equipment], and SIC 38[Measuring, Analyzing, and
Controlling Instruments]. You can find information on the DEMLR Stormwater Program at deq. nc.gov/SW.
Directions: Print or type all entries on this application. Send the original, signed application with all required
items listed in Item (6) below to: NCDEMLR Stormwater Program,1612 MSC, Raleigh, NC 27699-2612. The
submission of this application does not guarantee coverage under the general permit. Prior to coverage under this
General Permit a site inspection will be conducted.
1. Owner/Operator (to whom all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (7) below:
Turbocoating Corporation DBA Lincotek Surface Solutions
MiAelp,
Street address:
City:
State:
Zip Code:
1928 Main Avenue Southeast
Hickory
NC
28602
Telephone number:
Email address:
828)382-8726
[e-mail]
Type of Ownership:
Government
OCounty OFederal OMunicipal [3State
Non -government
OBusiness (If ownership is business, a copy of NCSOS report must be included with this application)
Olndividual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
Turbocoating Corporation DBA Lincotek Surface Solutions
Thomas Ortega
Street address:
City:
State:
Zip Code:
1928 Main Avenue Southeast
Hickory
NC
28602
Parcel Identification Number (PIN):
County:
371207695031 LRK/REID 41732
Catawba
Telephone number:
Email address:
[phone]
[e-mail]
4-digit SIC code:
Facility is:
Date operation is to begin or began:
I
3471
O New O Proposed O Existing
January 2011
Latitude of entrance:
Longitude of entrance:
35.730249
1 -81.30951
Brief description of the types of industrial activities and products manufactured at this facility:
Coating and post -coating treatments using thermal spray technology for OEM land based gas and aircraft engines.
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the M54:
13 N/A
Page 1 of 5

3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Beth Morton
Morton Environmental Consulting, Inc.
Street address:
City:
State:
Zip Code:
127 Brookmead Court
Advance
NC
27006
Telephone number:
Email address:
[phone]
[e-mail]
4. Outfall(s) (at least one outfall is required to be eligible for coverage):
3-4 digit identifier:
Name of receiving water:
Classification:
1
O This water is impaired.
001
Clarks Creek
C
0 This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35.731081
-91.304608
Brief description of the industrial activities that drain to this outfall:
Above ground storage and 55yallon drum storage of oils and chemicals
3-4 digit identifier:
Name of receiving water:
Classification:
17 This water is impaired.
❑ This watershed has a TMDL
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
3-4 digit identifier:
Name of receiving water:
Classification:
0 This water is impaired.
0 This watershed has a TMDL
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
3-4 digit identifier:
Name of receiving water:
Classification:
D This water is impaired.
E3 This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
3-4 digit identifier:
Name of receiving water:
Classification:
O This water is impaired.
O This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
All outfalls must be listed and at least one outfall is required. Additional outfalls may be added in the section
"Additional Outfalls" found on the last page of this NO1.
Page 2 of 5

S. Other Facilitv Conditions (check all that apply and explain accordingly):
0 This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
0 This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
O This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
Above ground storage in double -walled steel tank, 55-gallon drum storage on spill pallets with spill kits available.
O This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
April 1, 2022
O This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
0 This facility is a (mark all that apply)
O Hazardous Waste Generation Facility
0 Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
0 Hazardous Waste Disposal Facility
If checked, indicate:
Kilograms of waste generated each month:
Type(s) of waste:
1800lbs
Hydrochloric acid waste
How material is stored:
Where material is stored:
55-gallon drums
Stored on concrete area with spill containment pads
Number of waste shipments per year:
Name of transport/disposal vendor:
12
HA -MAT En m mental Services, Inc.l Republic Environmental systems trans group LLCI
Transport/disposal vendor EPA ID:
Vendor address:
NCD048461370/PAD982661381/PAD085690592
2869 Sandstone artfield PA 19440
0 This facility is located on a Brownfield or Superhard site
If checked, briefly describe the site conditions
6. Required Items (Application will be returned unless all of the following items have been included):
O Check for $100 made payable to NCDEQ
M Copy of most recent Annual Report to the NC Secretary of State (if applicable)
O This completed application and any supporting documentation
O A site diagram showing, at a minimum, existing and proposed:
a) outline of drainage areas
b) surface waters
c) stormwater management structures
d) location of stormwater outfalls corresponding to the drainage areas
e) runoff conveyance features
f) areas where industrial process materials are stored
g) impervious areas
h) site property lines
O Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 3 of 5

7. Applicant Certification:
North Carolina General Statute 143-215.6E (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 ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($50,000).
Under penalty of law, I certify that:
O I am the person responsible for the permitted industrial activity, for satisfying the requirements of this permit, and for any
civil or criminal penalties incurred due to violations of this permit.
O The information submitted in this N01 is, to the best of my knowledge and belief, true, accurate, and complete based on
my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information.
El I will abide by all conditions of the NCG030000 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.
0 I hereby request coverage under the NCG030000 General Permit.
Printed Name of Applicant: Michele Cassin
Title: Man ing Director of North America
4 G� 31101Z 2
(Signature of Applicant) (Date Signed)
Mail the entire package to: DEMLR —Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4 of 5

Turbocoating Corporation DBA Lincotek Surface Solutions Site Map
Stormwater sources
Source
Description
Content
Capacity
Subject
ID
(Gallons)
to
SWPPP
I
Double wall AST
Kerosene
2 000
Yes
la
Off-loading Area
Off-loading
150 gpm
Yes
Kerosene
Kerosene
hose spill
2
Covered clumpster
Metals
NA
Yes
3
Used Oil drums 55 gal)*
Used oil
165
Yes
4
Waste drams (55 gal)*
Hydrochloric
825
Yes
acid mixture
5
Recycled Materials (55
Ceramic
55
Yes
gal) *
Powders and
Black silicon
carbide
6
Storage drums (55 gal)*
Hydrochloric
55
Yes
acid
7
Air Pollution Control
Particulate
NA
Yes
Devices
Matter
*Drummed materials are placed on spill pads or in the vicinity of a spill kit. Spill
kits am located at Source ID Nos. 1 and 3 and are mobile See SPCC TIER I Plan
Source
Description
Content
Capacity
Subject
ID
(Ibs)
to
SWPPP
NA
Bulk Storage Tank
Argon
17,445
No
NA
Bulk Storage Tank
Nitro en
10,118
No
NA
Bulk Storage Tank
oxygen
57,164
No
NA
Bulk Storage Tank
I Hydrogen
860
No
Oil Filled operational ' meM-OFOE
See SPCC
TIER I Plan
Source
Description
Content
Capacity
Subject
ID
(Gallons)
to
SWPPP
NA
Protee 3 phase Pad
Transformer oil
15
No <55
mounted transformer
gal
NA
Protec 3 phase Pad
Transformer oil
15
No <55
mounted transformer
Rai
Impervious Areas (Tax Parcel ID 371207695031 Owner:Charis Hickory, LLC)
Total Tract = 8.4 Acros
Leased portion outlined in Gruen = 500 ft x175 ft=875,000 ft =2.0 acres
Outfall
latitude'Longitude of
Impervious
Pervious
Total
Discharge Point
Acres
Acres
Acreage
No.
35.73I081,-8I.304608
2
0
2
001

Service Agreement
Uncotek
Thomas Ortega
828-639-4076
1928 Main Ave SE
Hickory, NC 28602
PART NUMBER DESCRIPTION
&LUNG/AP INFORMATION
Contact Name
Billing Address
City, Slate, Zip
Phone #
Email
PO#
Blanket PO?
OTHOMPSONAYUEi
THOMPSON SAFETY REPRESENTATIVE
Kayla Lemke
704-756-2026
klemke @thomoson-safetv.com
8715 Sidney Ck #700
Charlotte, NC 28269
Term PRICE OTY TOTAL
SRV-FA-CS
Safety Works MOnthly FlOt-Rate First Aid Service. Per Cabinet Includes:
-Cleaning and Orgammrig Fiat Aid Cabinet �
-Checking Fxpkation Dates -Zrj
-Verifying ANSI Compliance
-Fixed Prka Irrcbdes Me tort of All Restocked product
-Never any Service charges iff
$99.99
2
$199.98
535-439 SMBW83
New Thompson Four Shen Fist Aid Cabirse. Fully Stocked
$199,99
2
$399.98
Monihlyiotal
$19t.9B
By signing, I have read and agree to the terms and conditions on the back of this agreement
Customer Name 1-ln604 41Qe'1-
Signature
www.thamason-safetv.com
877,506.4291

Terms & Conditions 4;THOMPSON
SAFETY WORKS I BUSINESS THRIVES
SeM<e Comm"Th is n5ompson Safety(aka seller)will performoloeclions/sevuh, an Itemsspecavolly Isled in Iris agreement whin a service beauencyand term If
noted a,o seloo.ma Item. froli Salary will pertainIreperUi surn III ... ies as recommended by local code w within raasonrale service intervals.Far
items TCI I 'too with aIalllorrd Se"'no Ireppemfie5 W lars, Tramoson Safely will not be held earposthae for momtenanCe usameop. C care of these Items
COncelleXon of Slake or Agreements. Your sofisfocliuo with our brobbl s and servirais hor top plarlty at Thompson Safely. If you ever need to cancel our Berm,
we ask That you glue us a chance to after the progmm to barer suit Too, Teems. If we cannot meet your neeas, the <oiXBIla1Wn tamtl are Ilslea below'.
O. Ford ad Ssi Aymemeol- Remaining Months due on Agreement
b- Fie Edil,kne,Agreement - Remains, Months dui an Aymemenl
c AED ServiceAgreement - Remaining Months due on Agteemanl
d. Eye Wosn Station Agreement- Reshasaq Mrntt, dot on Agseemem
e. Salary Stollen ASK cement- Remoiral Months duo on Agreement
Teri Sarni Agr9emenh: Pleate note cancellation farmsbyeonly applicable Ia ServlCes IfWt'refuse a numeric value in the'Tems column If term is TeX blank or
maikaA os 0, then cusiwtar con cancel it 3se sarvrCes with 30.doVs^ofica fay any rRosas, wlln no concellMion penalRes. Ce,lornerwfll,lillbams,bros eIW payment
an any services That Hasa been raldered odar to cbocalalran
Renewal d Agreereenh: For formed agmerltenlz, offer the Ialiol 12. TV 36-month lean, Me agreement outoBn,i for 12-mMfM1s'If hat Cancelled 30 do, in
oovanca. Dunn, the ztibzed, yet 12-month IF-r131. This customer .01 owa the remoian, months left on the Limit they choose to cancel.
ReKmh of LeaFed m itim" Goods: we will never ask ftt leased d renlea Items bark. If You hove met the Firms of canbefoliol rou own Ire items If terms hnve not
been rnet Me avtame' will aura IM1e renraiMng mcnfns left on fne ugraenrenl.
Accapiable Cancelbtion NOXIcaRon Methotls fail/Voice Message/IerW/Email/Live Prone Call. Simply Mve your OmauM number antl confacl us fo cancel
zar.iro
Pyl<ia¢' imom{,rson So191y rerorvos fne 6gM to price increases.
ART. Our fermi Om ne130. Our team oM teGnndIXJy rnahe it searin enroll In ACE. CC. crAvlOyoy ar flNther Rnblltiiy
Un dWilimmi Because of Me Mrmber and sanely of aVartalool la which ,.11o.s'WLMr di gesso, and services am pumrmsed. Seller dcez Hal
recanmend ,pecifb application, or nSvme any mspanAbiity tor Use results obloined or s st,fla ity Iw specific appliYatgm P•xChasp a cautioned IO tleleimine Ire
opprOpgteness of Skills, i goads and Al or Purchasers specific dedication before WJe ring orsJ to test and evaluate IhrroLVIN, oil goad, before LW Seller
varronh that "a To ail goods sod by Seller shall be good and marketable. THERE ARE NO OTHER WARRANTIES EXPRESSED OR IMPLIED IN CONNECIION WIN ME SAL£
OF PRODUCTS, DEVICES. GOODS AND SERVICES. INCLUDING MY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE NO D6CLAIMER,
EXCLUSION, LIMITATION OR MODIFICATION OF ANY OF ME AFORESAID WARRANTIES SHALL BE DEEMED EFFECTIVE UNLESS IN WRITING SIGNED BY SELLER.
Inds ca On CUSTOMER AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THOMPSON SAFETY. ITS OWNERS EMPLOYEES. AND ASSIGNS. FROM AND AGAINST ANY
AND ALL CLAIMS, ULABILIUES. EXPENSES BNCLUDING REASONABLE ATTORNEYS FEESI, LOSSES. DAMAGES. DEMANDS, FINES AND CAUSES OF ACTION CAUSED BY. ARISING
OUT OF OR RELATED TO THE USE OF THE AED UNITS. FIRE EXTINGUISHERS. SAFETY PRODUCTS, EYE WASH STATIONS. FIRST AID CAEINER. SAFETY TRAINING, AND MY OTHER
PRODUCT SOLD TO CUSTOMER BY THOMPSON SAFETY, ME FAILURE OF THE PRODUCTS LISTED TO FUNCTION PROPERLY. THE FAILURE Of ANY PERSON TO PROPERLY USE
ANY PRODUCTS ME LOCATION OF ANY PRODUCTS. ANY ALLET3i THAT ME NUMBER OF PRODUCTS ORDERED HEREUNDER 61NSUFFICIENT, OR THE ACTUAL OR
ALLEGED ACTS OR OMISSIONS OF THOMPSON SAFETY, WHETHER OR NOT THOSE ACTS OR OMISSIONS ARE JOINT OR CONCURRENT WITH ANY OTHER PARTY. PROVIDED.
HOWEVER, THAT CUSTOMER'S OBLIGATIONS HEREUNDER SHALL NOT APPLY TO ANY CLAIM LIABILITY, EXPENSE, LOSS. DAMAGE DEMAND, FINE OR CAUSE OF ACTION
ESTABLISHED TO BE ME RESULT OF ME SOLE NEGLIGENCE OF THOMPSON SAFETY. THE CUSTOMER'S DEFENSE HOLD HARMLESS AND INDEMNIFICATION OBLIGATIONS
SHALL ALSO EXTEND TO INJURIES OR DEATH SUSTAINED BY CUSTOMER'S EMPLOYEES AND SHALL NOT BE LIMITED BY ANY APPLICABLE WORKERSCOMPENSATION LAW AND
CUSTOMER EXPRESSLY WAIVES ANY STATUTORY OR CONSPIDOONAL WORKERS' COMPENSATION IMMUNITY UNDER APPLICABLE LAW WHICH WOULD OTHERWISE LIMIT ITS
INDEMNIFICATION OBLIGATIONS HEREUNDER
UmB OI ❑abflry- THE LIABILPY OF SELLER FOR ANY CLAIM WHICH CUSTOMER, M AGENTS. OFFICERS. DIRECTORS. EMPLOYEES OR INVXEES MAY HAVE AGAINST SELLER
PURSUANT TO THIS AGREEMENT, IN ME EVENT IT IS OETERMINED MAT THOMPSON SAFETY HAS ANY LIABILITY SHALL BE UMIIED TO $1 00U AS LIQUIDATED DAMAGE
SeMee AtFeemeM MCWFbne Below is whal is generally included with service Ogreamaors on Al F sl tom Cab'Inelz. Eyewash Stnlrons, Training or any other Type at
service conhoet. Service Canha<tz wdl always be ckINly nolatl wifn o hepeency and tens.
Fist Ad Service Agreement -Me rerdl of off aid Cabinet items on a monthly Uosif Anytimeexceow.reagecaimh R10lnpSOn Salary Tors llo ngnl
to cess W l b peritem blllsog, If this oc—, The customer wll b, notified rnM the reoctumng Service mra, whll her longer he filled. CvU.. wBl be
charged to only the Items MAY puchose.
b_ Eve Extygunner Agreement- Covers mostri and annual•mpebhom per NFPA to standard. AS Fire Edy,wRners reed oclMrgiM Pleural
mostenonce and hydrdsti testing, these ear ices will he Ordi additionally as headed.
a ADD (Heart DOXbrIlatuc Agreement - Covers all pads, vionale,.,4 AED proglamnranogamant. if Customer c.mi or lases the AED.
aplaceme.ni cast will be $1595 dLdng Ire inffiol lean WNy FDA leories, lm<klrg of AED Ico otion. A customer must hasty Monti Safety I the fit is
relocated. Repai W wonanty issues era ho Wed by the manufacM1n of Me device. R erebra Safety will TRIP to Wgisfically expos ire the repw as a
ianpfemenbry sarvrce and customer NN cover Cosf of Iepaks nOn wanonfy lB afed Customer 6 aware that any use of tte device that is Hal in
nc<ordonCe wifT The montAochmer W FDA gWdallnes cWld result In inNrY and ostumas all dsk. CLOamer agraez to aswmR all as of loss m canner, tf W t
With The use of an AED.
d. Eye w®st, Stolom Agreement- Monthly inspec ismi cleaning and firming as needed.
e. Safety Stri- loardes Safely SteXon.&vetoath lock. mad sollwurebatlminisfar lock.
www.Thomoson-Safatv.com IFIIBOIS V 12,21 877 506.4291

This process will limit waste generation qualifying us to apply for a small waste generator that would
save us time, money and red tape.
Wane Management
morn«n«u�avurtr
North Carolina Department of Environmental Quality
Division of Waste Management
Hazardous Waste Section
Summary of Generator Requirements
Regulatory
Very Small Quantity Generator
Small Quantity Generator
Large Quantity Generator
Provision
(1ISQG)
(SQG)
(LQG)
Hazardous waste
<100 kg (220 bsj lwo-aarto tiW;
<_1
> 100 kg (2201Ls) but <I,000 kg
ronawN
> 1,000 kg (2,200 [be) non-ande IfW:
generation ale
ante HW;
k9 (22 lbs)20
<1kg (22 bs)aade HW;
1 kg (.2l
> 1 kg (22Its) acute IM;
(per caferldar month)
i
<100 kg (2201hs) residues from
.,
S 100 kg(220 bs) resduesfrom
> 100 kg(220 lbs) residues from
40 CFR 260.108262.13
dearupofacutaliW
cleanup of emote HW
demup of acute HW
Notify of HW activity and
Not Required
Required
Required
obtain EPA ID number
40 CFR 26210(a)(1)O and(a)(2) 01
40UR262.18(ab)
40 CFR 26218(a-b)
Every 4 years starting in 2021, due
-
By Mardi 1 of every even numbered
R"oti'icatim of HW
by Sept l ofeachyearre.
year(usng8700-12form). BbvU
activity
Not required
notification is required (using 8700•
report submittal meets this
12 form)
requirement
40 CFR 2621 d)(I)
40CFR26218(dHZ)
Maximum accumulation
18D days(270 days 8vaste is -
90days
time Emits
No lane brit
shipped200mlesormxm)
40CFR26217(a)
mcenhalaccumuationarea
40 CFR 262.1 H
1,000 kg(2.200 CIA) no amta
6.000 kg(13.2DO ens) at any time:
at any time;
1 kg (221bs) acute HW al any
Maximumon-sbawaste
1 kg(22bs) acute MN at any fins;
6me:
No quantity limit
accumulation
100kg(22(IIbs)resduesbom
100 kg(220 bs) sale HW from a
deanup ofacuto NW at any tone
deanw at any time
40CFR26214aH3)mxI(4)
40 CFR 262.1 11 & 262-11faj
Hazardous waste
Required
Required
Required
determination
I 40CFR26211(aXd)
40 CFR 262.It
40 CFR262.11
MarlNo
tngllaber
maddr9flabeEg requirement
Recommend idmtifyog contents of
Required an each conlanerand
tank
Rewired an each container and tank
(conContainersBTanks)
containers
40 CFR 262.158262.16h
40 CFR 262.158262.17(a)(5)
Date most be vale for inspection
Data- =atbe visible for inspection on
Accumulationstart date
No fegti l to narknabel wdh
on each mrdanermcorded in
each container, recorded in faaWog
markingnabeling
a nammuationstaddam
faddy log for tanks
fortardm drip pads, and containment
40 CFR 262.16(b)(
hid s. 40 CFR 26217(a)(5
Pre -transportation
Not RequiredforRCRA
Required
Required
requirements(Prepering to
ship HW off -site)
40 CFR 26210(a)(1)O and(aH2Ki)
M1 Ee required by DOT
40 CFR262.30-_262.33
40CFR262.30-262.33
Containerlocation
Nate
None
At least 50 rent ham property rme for
standards
40 CFR 262.10(a)(I)O�(aH2)O
40 CFR 26210(aj(1)( &&(a)(2)(ul
40CFR 26217(table and ea�j(�tos
rl
Not Required
_.
Use of manifest to ship
40 CFR 26210(a)(1)0 and
Required
Required
waste off -site
Recommend keeping
40 CFR 26220.26223
40CFR262.20-26223
manifesttslrpoiN doaanents
_
Use transporters with EPA
Nod Required
Required
Required
IDnumbers
40 CFR 262.10(a)(1)O and(a)(2)O
40 CFR 26Z18(c)
40CFR26218(c)
nofficationslcertificalions
OCFR�262f0(aHt)O and(a)(2M
Required
40CFR26216(h)(r)iefererres
Required
40 CFR 26217(a)(9)referer�ces
11
CO CFR268
40 CFR 268
Effective: 0310112018 1 Revised: 021052018

Summary of Generator Requirements (continued)
Regulatory
Very Small Quantity Generator
Small Quantity Generator
Large Quantity Generator
Provision
(VSQG)
(SQG)
(LQG)
Exception reports
Not Required
40 CFR 262.1D(aH1)(i) and (a)(2)()
Required
40 CFR 262.42(b)
Required
40 CFR 26242(a)
Waste minimUMion
Not Required
Good faith efforttequared
Program in place required
40CFR26210(a)(1)(i)and(a)2 r
40CFR 26227 ).
40CFR 2622T(a
Personnel training
NotRegrdred
Be* Wining required
RCRA training with documentation
OCFR 26210(a)ft)i &(a)I u
40CFR2621 )(9)Cv)
40CFR 26217(a
Preparedness and
Not Required
Required
Required
prevention including
Emergency Arrangements
40CFR 26210(a)(1)O&(aH2K)
40CFR262.16(b)(8}(9)
40 CFR 267 17(a)(6) references
40 CFR 262 subpart M
Contingency plan and
Not Required
Basic planning required
Full contingency plan required
40CFR 26217(aH6)references 40
emergency procedures
40 CFR 262.10(a)(1)O&(a)RXi)
40CFR 262.16(b)(9)
-.:.-.
CFR 262 subpart M
Weekly inspections
Not
Not Required
CFR 26210(a)(1)O&(eH2)()
Required
40 CFR 262.16(b)(2)(n)&
Required
40 CFR 26217(aH1Hv)&
15ANCAC13A.0107
15ANCACI3A.O1D7(d
Maintain records,
No regulatory requiremuenls but
recommend keeping hazardous
_.
Required
Required
Prepareffile records
waste identification records and
0 CFR 26211(0 2624D(a, c, d),
262.42(b), 262.43,262.44
40 CFR 26211(f) 2620, 262.41,
26242(a), 262A3
mardes6htdping documents
Biennial Report
Not 140 FR
Not ired
Required laof even numbered
262.10(a)(1)O&(aH2Hi)
40 Cuired
FR 26210a 1 8 a 2
( )( )(� ()( )(�
CFR
years) OCFR262.47
Meet Subparts AA, BB, CC
organic airemission
Not Required
Not Required
Required
40 CFR 26217(a)(1)Di and(a)(2)
standards
40 CFR 26210(a)(1)O&(a)(2H)
0 CFR 26210(a)(1)n&(a)(2)((d)
references 0 CFR 265 mbpart AA,
BB and CC
- Permitted or interim status HW
fadmes
-HWreryclingladi5es
- State-pernitted, licensed, or
- Permitted or interim status HW
- permitted or bterhn status HW
Allowable classes of
registered municipal cr industrial
- recycling fadities
HW f cirA
facilities
facilities to receive off -site
waste facE ies 0 CFR
- 40 C� ted
- HW recycling facilities
shipment
26214(a)(5)
Fadity'
- 0CFR260.10-Designated
-ALOGurderthecontrolofthe
kaW
same person asuSQG must
meelco rdi5os in 40 CFR
262.1d(a)(S)(vci)
- Required for tanks, drip pads
and cantaumnernl bu7&ngs
- Required for hazardous waste
Not Required
-For tanks only 40 CFR
accumulation units)
Closure
0 CFR 26210(a)(1)O&(aH2H)
262.16(bH3)(w)
- General§2621T(a)(B)
- Unit specific Part265, subpart W
- Unit speudfic40 CFR 265 subpart
& OD forddp pads and
Wlordrip pads
containment buldigs
Used Oil
Required
Required
Required
40 CFR 279 applies
0 CFR 279 applies
40CF11279apples
Universal Waste
Required
Required
Required
40 CFR 273 apples
40CFR 273 gglies
40CFR273apples
Annual Fee
No annual fee
5175
Stdoo and 60.70 par ton
N.C.G.S.130A 241.1
N.QG.S.130A-294.1(e) and (9)
Effective: 03101/2018 2 Revised: 00612018

NC Department of Environmental Quality
Division of Energy, Mineral and Land Resources
NORTH CAROIINA
Enr4•mxnld Q•atlry
Stormwater Permit Delegation of Signature Authority Form
Directions are in red.
=> This form shall be used to delegate signature authority from the permit Owner (Permittee) to
another party. Only the Responsible Official defined below may submit permit applications and
reports required by the permit (such as Data Monitoring Reports and Annual Reports) until this
form is completed and submitted to the DEMLR Stormwater Program. Please note that delegating
signature authority does not relieve the Permit Owner from the responsibility for permit
compliance.
The permit Owner is the legal entity to which whom a permit has been issued, and maybe an individual
or an organization such as a company or government agency. Every Owner is required to have a
Responsible Official who meets the legal signature authority requirements in 40 CFR 122.22 summarized
below.,
• For a corporation, the Responsible Official shall be a president, secretary, treasurer, or vice-
president in charge of a principal business function, or another individual who performs similar
functions for the corporation, or the manager of one or more manufacturing, production, or operating
facilities who is authorized to make management decisions about the facility operation.
• For a partnership or sole proprietorship, the Responsible Official shall be a general partner or the
proprietor, respectively; or
• For a municipality, State, Federal, or other public agency, the Responsible Official shall be either a
principal executive officer (City/County Manager] or ranking elected official (Mayor].
Even if delegated signatory authority has been delegated to another individual, the Responsible Official
retains responsibility for compliance with permit conditions.
Permittee:
Permit Number:
Responsible Official Title:
Email Address:
Phone:
Mailing Address:
City:
State:
Zip:
Stormwater Delegation of Signature Authority Form
Page 1

A. Persons to Receive Signatory Authority
=> The signatures of the persons listed below indicates their acceptance of signatory authority.
Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
State:
Zip:
Signature of Delegated Parry indicating
acceptance of Signatory Authority:
Date:
Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
State:
Zip:
Signature of Delegated Parry indicating
acceptance of Signatory Authority:
Date:
Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
State:
Zip:
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
State:
Zip:
Signature of Delegated Party indicating
of Signatory Authority:
Date
Date:
Stormwater Permit Delegation of Signatory Authority Form
Page 2

B. Responsible Official Signature
The Responsible Official, as identified in accordance with 40 CFR 122.22, is the appropriate
individual with the authority to sign and submit reports for the organization.
As the Responsible Official, I,
(printed name),
have the authority to enter into this Agreement for
(Owner/Organization Name).
I request that the DEMLR Stormwater Program include the persons listed in Part A of this form
signatory authority for the above -named permit.
I acknowledge that I, and the persons listed in Part A of this form work attfor my organization
and have authority to act as a signatory for purposes of the NCDEQ's electronic document
systems.
By submitting this application, I, (printed name),
have read, understand, and accept the terms and conditions of the stormwater permit(s) for
which I am the Responsible Official.
Responsible Official Signature
Title Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3