NCG060095_Representative Outfall Status Renewal Request_20220504

FOR AGENCY USE ONLY
NC
ARO FRO MRO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
Representative Outfall Status (ROS) Renewal Certification Form
Please complete this form if you want to maintain current ROS designations.
Directions: Print or type all entries on this certification form. Attach this form and a copy of the original ROS
approval documentation to the Stormwater Upload Form.
North Carolina General Statute 143-215.6B (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 ($10,000).
Under penalty of law, I certify that:
I, as an authorized representative, request renewal of the ROS designations currently granted to the subject
facility.
❑✓ No site or activity modifications that impact the characteristics of stormwater discharges from the
representative outfalls have occurred at the subject facility.
❑✓ I am familiar with the information contained in this request and to the best of my knowledge and belief such
information is true, complete, and accurate.
Facility Name: Goulston Technologies, Inc.
Permit Number: NCG060095
Printed Name of Person Signing: Bruce Robinson
Title: G.M. Operations
5/4/22
(Signature of Permittee) (Date Signed)
NORTH CAHCLINA
Department of Environmental Quality

NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
February 23, 2015
Goulston Technologies, Incorporated
Attention: Mr. Dale Stoller
700 North Johnson Street
Monroe, North Carolina 28110
Subject: NPDES Stormwater Permit
Stormwater Permit Certificate of Coverage No. NCG060095
Representative Outfall Status Request
Goulston Technologies
Union County
Dear Mr. Stoller:
Donald van der Vaart
Secretary
The Mooresville Regional Office staff have reviewed your request dated January 30, 2015 received in the
Mooresville Regional Office on February 5, 2015, for a determination that the following stormwater
discharge outfall (SDO) be granted representative outfall status for the following stormwater outfalls:
1. SDO 3 requested to be representative for Outfalls 1, 2, 3, 4, 5, and 6.
2. SDO 7 requested to be representative for Outfalls 7 and 8.
3. SDO 10 requested to be representative for Outfalls 9, 10, and 11.
4. SDO 12 requested to be representative for Outfalls 12 and 13.
Based on the information and maps provided and the site visit performed on February 23, 2015, we are
approving this request. In accordance with 40 CFR §122.21(g)(7), you are authorized to sample outfall
number 003, 007, 010, and 012 as a representative outfalls. This approval is effective with the next sampling
event. We also want to remind you that the permit still requires Qualitative Monitoring be performed at all
SDOs, regardless of representative status.
Please remember that any actions you initiate in response to benchmark exceedences as directed in the tiered
response provisions of your permit must address all drainage areas represented by SDO 3, SDO 7, SDO 10,
and SDO 12 where appropriate.
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
Mooresville Regional Office
610 East Center Avenue, Suite 301, Mooresville, North Carolina 28115
Telephone: [phone] FAX: [phone] a Internet: http:llportal.ncdenr.org/web/ir/land-quality
An Equal Opportunity 1 Affirmative Action Employer w 50% Recycled 110% Post Consumer Paper

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February 23, 2015
Mr. Dale Stoller
NCG060095/ROS
Please append this letter to your Stormwater Pollution Prevention Plan (SPPP) or permit to
document that representative outfall status has been approved. if changes in drainage areas,
structures, processes, storage practices, or other activities occur that significantly alter the basis of
this approval, representative outfall status may no longer be valid. You should either resume
sampling at all SDOs, or reapply to this office for representative outfall status based on updated
information. if you have any questions or comments concerning this letter, please contact our
Office at (704) 663 -1699.
Sincerely,
Zahid S. Khan, CPM, CPESC, CPSWQ
Regional Engineer
Land Quality Section

Compliance Inspection Repor#
Permit: NCG060095 Effective: 12/01/12 Expiration: 10/31/17 Owner : Goulston Technologies Inc
SOC: Effective: Expiration: Facility: Goulston Technologies
County: Union 700 N Johnson St
Region: Mooresviile
Monroe NC 28110
Contact Person: Fred Edwards Title: President Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 02/19/2015
Primary Inspector: Donna Hood
Secondary Inspector(s):
Certification:
Entry Time: 01:OOPM Exit Time: 01:45PM
Phone:
Phone: [phone] Ext.2193
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Food/Tobacco/Soaps]Cosmetics/Public Warehousing Stormwater Discharge COC
Facility Status: Compliant Not Compliant
Question Areas:
■ Storm Water
(See attachment summary)
Page: 1

permit: NCGO60095 Owner - Facility; Goulston Technologies Inc
Inspection Date: 02/1912015 inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
The inspection was performed as a response to the facility's request for Representative Outfall Status (ROS). The last
inspection at the facility was performed December 19, 2014 and the facility was found to be in compliance. Per the package
submitted the facility asked for the following:
1. Outfall 3 requested to be representative for Outfalls 1, 2, 3, 4, 5, and 6.
2. Outfall 7 requested to be representative for Outfalls 7 and 8.
3. Outfall 10 requested to be representative for Outfalls 9, 10, and 11.
4. Outfall 12 requested to be representative for Outfalls 12 and 13.
A site review was performed in addition to the review of sampling data presented in the submitted package to determine
applicability of outfalls to represent the associated areas as requested. At the conclusion of the site visit it was determined
that the ROS can be approved as requested.
Please be advised that site modifications could require a change in sampling points and any change in ROS sampling
would need approval from the Division of Energy, Mineral, and Land Resrouces.
Page: 2

Permit: NCG060095 Owner - Facility: Goulston Technologies Inc
Inspection Date: 0211912015 inspection Type : Compliance Evaluation
Reason for Visit: Routine
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"?
❑ ❑ ❑ N
# 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?
❑ ❑ ❑ 0
# 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)?
❑ ❑ ❑ ■
# 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 ?Ian reviewed and updated annually?
❑ ❑ ❑ 0
# Does the Plan include a Stormwater Facility Inspection Program?
❑ ❑ ❑ E
Has the Stormwater Pollution Prevention Plan been implemented?
❑ ❑ ❑ N
Comment: See summary section
Qualitative Monitoring Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? ❑ ❑ ❑ ■
Comment: See summary section.
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: See summary section.
Permit and dutfalls Yes No NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site? ❑ ❑ ❑ E
# Were all outfalls observed during the inspection? ❑ ❑ ❑ 0
# If the facility has representative outfall status, is it properly documented by the Division? ❑ ❑ ❑
# Has the facility evaluated all illicit (non stormwater) discharges? ❑ ❑ ❑ N
Comment: See summary section.
Page: 3