NCG070015_ROS Request for Outfall 008_20231113

FOR AGENCY USE ONLY
AVM
Division of Water Quality / Surface Water ProtectionDate Recened
Year Month Uap
NCDENRNational Pollutant Discharge Elimination System
NCRT+CAROLNA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES REPRESENTATIVE OUTFALL STATUS (ROS)
REQUEST FORM
If a facility is required to sample multiple discharge locations with very similar storm water discharges, the
permittee may petition the Director for Representative Outfall Status(ROS). DWQ may grant Representative
Outfall Status if storm water discharges from a single outfall are representative of discharges from multiple
outfalls. Approved ROS will reduce the number of outfalls where analytical sampling requirements apply.
If Representative Outfall Status is granted, ALL outfalls are still subject to the qualitative monitoring
requirements of the facility's permit—unless otherwise allowed by the permit(such as NCG020000)and DWQ
approval. The approval letter from DWQ must be kept on site with the facility's Stormwater Pollution
Prevention Plan. The facility must notify DWQ in writing if any changes affect representative status.
For questions, please contact the DWQ Regional Office for your area(see page 3).
(Please print or type)
1) Enter the permit number to which this ROS request applies:
Individual Permit (or) Certificate of Coverage
N C G 0 7 0 0 0 0 N C G 0 7 0 0 1 5
2) Facility Information:
Owner/Facility Name
Facility Contact
Electric Glass Fiber America, LLC
Terry Steinert
Street Address 940 Washburn Switch Road
City Shelby State NC Zip Code 28150
County Cleveland E-mail Address [e-mail]
Telephone No. 704-434-2261 Fax
3) List the representative outfall(s) information (attach additional sheets if necessary):
Outfall(s) 008 is representative of Outfall(s) 004, 005, 006, and 009
Outfalls drainage areas have the same or similar activities? x Yes ❑ No
Outfalls drainage areas contain the same or similar materials? x Yes ❑ No
Outfalls have similar monitoring results? Yes ❑ No x No data*
Outfall(s) is representative of Outfall(s)
Outfalls drainage areas have the same or similar activities? o Yes ❑ No
Outfalls drainage areas contain the same or similar materials? o Yes ❑ No
Outfalls have similar monitoring results? ❑ Yes ❑ No No data*
Outfall(s) is representative of Outfall(s)
Outfalls drainage areas have the same or similar activities? ❑ Yes ❑ No
Outfalls drainage areas contain the same or similar materials? ❑ Yes o No
Outfalls have similar monitoring results? ❑ Yes ❑ No ❑ No data*
*Non-compliance with analytical monitoring prior to this request may prevent ROS approval. Specific
circumstances will be considered by the Regional Office responsible for review.
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Representative Outfall Status Request
4) Detailed explanation about why the outfalls above should be granted Representative Status:
(Or, attach a letter or narrative to discuss this information.) For example, describe how activities
and/or materials are similar.
Outfalls 004, 005, 006, 008, and 009 are grouped because they have either 1) no industrial activity
and are completely covered in natural vegetation (006, 009), 2) have only employee parking on paved
surfaces (004, 005), or 3) have limited industrial activity (008). Outfall 008 is selected as the outfall to
be monitored as it has very light industrial activity limited to indoor material storage, trailer parking,
2 bullet-type propane tanks, and one waste dumpster that receives packaging waste, damaged
product, and miscellaneous personal waste such as drink containers, food wrappers and paper waste
5) 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 fact in a rulemaking 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 Representative Outfall Status for my NPDES Permit. I understand that ALL outfalls are still
subject to the qualitative monitoring requirements of the permit, unless otherwise allowed by the permit
and regional office approval. I must notify DWQ in writing if any changes to the facility or its operations take
place after ROS is granted that may affect this status. If ROS no longer applies, I understand I must resume
monitoring of all outfalls as specified in my NPDES permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: Alan Toney
Title: Plant Manager
4 (267-- // �/ z3
(S gnature of Applicant) Date Signed)
Please note: This application for Representative Outfall Status is subject to approval by the
NCDENR Regional Office. The Regional Office may inspect your facility for compliance with the
conditions of the permit prior to that approval.
Final Checklist for ROS Request
This application should include the following items:
I ❑ This completed form.
❑ Letter or narrative elaborating on the reasons why specified outfalls should be granted representative
status, unless all information can be included in Question 4.
❑ Two (2) copies of a site map of the facility with the location of all outfalls clearly marked, including the
drainage areas, industrial activities, and raw materials/finished products within each drainage area.
❑ Summary of results from monitoring conducted at the outfalls listed in Question 3.
1 Any other supporting documentation.
Mail the entire package to:
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Representative Outfall Status Request
NC DENR Division of Water Quality
Surface Water Protection Section
at the appropriate Regional Office (See map and addresses below)
Notes
The submission of this document does not guarantee Representative Outfall Status (ROS) will be granted as
requested. Analytical monitoring as per your current permit must be continued, at all outfalls, until written
approval of this request is granted by DWQ. Non-compliance with analytical monitoring prior to this request
may prevent ROS approval. Specific circumstances will be considered by the Regional Office responsible for
review.
For questions,please contact the DWQ Regional Office for your area.
W;nston'Sole m
Raleigh
Asheville Moorosvihe
e
Wilrpingtnn
Asheville Regional Office Washington Regional Office
2090 U.S. Highway 70 943 Washington Square Mall
Swannanoa, NC 28778 Washington, NC 27889
Phone [phone] Phone [phone]
FAX [phone] FAX [phone]
Fayetteville Regional Office Wilmington Regional Office
Systel Building, 127 Cardinal Drive Extension
225 Green St., Suite 714 Wilmington, NC 28405
Fayetteville, NC 28301-5094
Phone [phone]
Phone [phone] FAX [phone]
FAX [phone]
Winston-Salem Regional Office
Mooresville Regional Office 585 Waughtown Street
610 East Center Ave. Winston-Salem, NC 27107
Mooresville, NC 28115 Phone [phone]
Water Quality Main FAX [phone]
Phone [phone]
FAX [phone] Central Office
1617 Mail Service Center
Raleigh Regional Office Raleigh, NC 27699-1617
1628 Mail Service Center
Raleigh, NC 27699-1628 Phone [phone]
FAX [phone]
Phone [phone]
FAX [phone]
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SWU-ROS-2009 Last revised 12/30/2009