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Home My WebLink AboutNC0082970_Permit Issuance_20120118AAA IO EM North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Governor Mr. William S. Baker Jr., Vice President CTI of North Carolina Inc. PO Box 576 Savannah, GA 31402-0576 Dear Mr. Baker: Charles Wakild P.E. Director January 18, 2012 Subject: Issuance of NPDES Permit No. NCO082970 CTI of North Carolina Inc. WWTP - PC —1 New Hanover County Dee Freeman Secretary Division personnel have reviewed and approved your application for renewal of the subject permit. Accordingly, we are forwarding the attached NPDES discharge 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 U.S. Environmental Protection Agency dated October 15, 2007 (or as subsequently amended). This final permit contains the following changes from your existing permit: • Parameter codes have been added to the effluent limitations page. • The waterbody classification for your discharge has been amended to indicate SC (PNA) If any parts, measurement frequencies or sampling requirements contained in this permit are unacceptable to you, you have the right to an adjudicatory hearing upon written request within thirty (30) days following receipt of this letter. This request must be in the form of a written petition, conforming to Chapter 150E of the North Carolina General Statutes, and filed with the Office of Administrative Hearings (6714 Mail Service Center, Raleigh, North Carolina 27699-6714). Unless such demand is made, this decision shall be final and binding. Please note that this permit is not transferable except after notice to the Division. The Division may require modification or revocation and reissuance of the permit. This permit does not affect the legal requirements to obtain other permits, which may be required by the Division of Water Quality, or permits required by the Division of Land Resources, the Coastal Area Management Act or any other Federal or Local governmental permit that may be required. If you have any questions concerning this permit, please contact Bob Guerra at tele a number (919) 807-6387 or email at (bob.guerra at7.ncdenr.gov). Enclosure: NPDES Permit NCO082970 (Final) cc: NPDES Unit Wilmington Regional Office / Surface Water iim.gregson(a)ncdeor.gov (ecopy) Aquatic Toxicity— cindy moore(a)ncdenr.gov (e-copy) 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Location: 512 N. Salisbury SL Raleigh, North Carolina 27604 Phone: 919-807-63871 FAX:919-807.64951 Customer Servim: 1-877.623-6748 Internet: http.11portal.ncdenr.orgANebAvgmome An Equal Opportunity 1Afinnative Action Employer One NorthCarolina Naturallm Permit NCO082970 STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF .WATER QUALITY PERMIT TO DISCHARGE WASTEWATER UNDER THE 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, CTI of North Carolina, Inc. is hereby authorized to discharge wastewater from a facility located at CTI of North Carolina 1002 South Front Street Wilmington, North Carolina New Hanover County to receiving waters designated as the Cape Fear River in the Cape Fear River Basin in accordance with effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III and IV hereof. This permit shall become effective February 1, 2012. This permit and authorization to discharge shall expire at midnight on December 31, 2016. Signed this day January 18, 2012. C les Wakild P.E. O ivision of Water Quality By Authority of the Environmental Management Commission Permit NCO082970 SUPPLEMENT TO PERMIT COVER SHEET All previous NPDES Permits issued to this facility, whether for operation or discharge are hereby revoked, and as of this issuance, any previously issued permit bearing this number is rio longer effective. Therefore, the exclusive authority to operate and discharge from this facility arises under the permit conditions, requirements, terms, and provisions included herein. CTI of North Carolina, Inc. is hereby authorized to: 1. Continue to discharge stormwater runoff, diesel tank water bottoms, and boiler blowdown from a treatment system consisting of the following components: • a gravity type oil/water separator, • mechanical skimmer, and • product holding tank 2. Continue to discharge treated groundwater from a 0.014 MGD treatment system consisting of the following components: • an oil/water separator, • air stripper, • particulate filters, and • activated carbon These discharges are combined and discharged through Outfall 001. 3. Continue to discharge treated stormwater and product storage tank runoff from a treatment system consisting of a gravity flow oil/water separator with a mechanical skimmer and product storage tank discharging through Outfall 003, 4. Discharge from said treatment works, located at 1002 Front Street, Wilmington, New Hanover County, at the locations specified on the attached map into the Cape Fear River, classified SC (PNA) waters in the Cape Fear River Basin. �r • •.l / rung -'F wT j=� � �'^--' 'V -•��, i av� anus Outfall 001 �Outfall003[` A�, ,\ e S C7 ; r� D I I% T3 kS ?IDAI *�T�� ll�l�Jl®nai�` �i�1E311'/J�dld3�f E I CTI of North Carolina, Inc. Facility A Wilmington Facility WWTP Location;) Outfall 001: Latitude: 340 13' 19" N Outfall 003: Latitude: 340 13' 17" N not to scale Longitude:77' 57' 05" W L.ongitude:770 57' 06" W Receiving Stream: Cape Fear River Drainage Basin: Cape Fear River Basin uad: Wilmington, NC Stream Class: SC { North North NPDES Permit NO. N00082970 New Hanover County Permit NCO082970 A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS - Outfall 001 During the period beginning on the effective date of this permit and lasting until expiration, the Permittee is authorized to discharge treated wastewater and treated groundwater from outfall 001. Such discharges shall be limited and monitored by the Permittee as specified below: :EFFLUENT ` ` BUT MONITORING REQUIREMENTS -CI3ARACTERISTICS Monthly Daily alieasurement Sample Sample Average MaRiinum Frequency Type ° `Locatoa 00 0 Flowl .oaLE .Y 7o.(W Monthly See 1 footnote Effluent 00556-Oil and Grease2 30.0 mg/L 60.0 mg/L 2/Month Grab Effluent 00530-Total Suspended 45.0 mg/L Monthly Grab Effluent Solids 34030-Benzene Monthly Grab Effluent 34010-Toluene Monthly Grab Effluent 34371-Ethyl Benzene Monthly Grab Effluent 81551-Xylenes Monthly Grab Effluent 34696-Naphthalene Quarterly Grab Effluent 22417-MTBE (Methyl- Quarterly Grab Effluent tertiary -butyl -ether) EPA Method 624/625 Semi annually Grab Effluent Acute Toxicit? Annually Grab Effluent Footnotes: 1. Flow- Flow shall be monitored with every discharge event. During periods of no flow, the Permittee shall submit a monthly Discharge Monitoring Report (DMR) indicating "No discharge." Flow may be monitored in one of four ways: a) measure flow continuously; b) calculate flow based on total rainfall per area draining to the outfall; exclude built -upon area (best method for facilities with large runoff -collection ponds); c) estimate flow at 20-minute intervals during the entire discharge event; or d) report flow based on discharge pump logs. 2. Oil and Grease - Where possible, the grab sample for oil and grease should be skimmed from the surface of a quiescent (calm water) zone. I. Acute Toxicity - Whole effluent toxicity shall be monitored annually using the acute toxicity (fathead minnow, 24-hour) test. Please see Part A. (3).. There shall be no discharge of floating solids or visible foam in other than trace amounts. There shall be no direct discharge of tank solids, tank bottom water, or the rag layer. There shall be no direct discharge of tank contents following hydrostatic testing unless benzene concentration is less than 71.4 µg/L and toluene concentration is less than 11 µg/L. Permit NCO082970 Got �Oudt A. (2.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS - Outfall 003 During the period beginning on the effective date of this permit and lasting until expiration, the Permittee is authorized to discharge treated stormwater and product storage tank runoff from outfall 003. Such discharges shall be limited and monitored by the Permittee as specified below: `EFFLUENT C-.�RACTERISTICS ,z Moj ithly ; r Daily" �' Measurement Sample` f ° ganiple _ Ave e. . NIa"xium Fre uenc Q y' e`. T9p. :Location See EEffluentv� 0 0- lows 5005 c� Monthly footnote1 00530-Total Suspended 45.0 mg/L Monthly Grab Effluent Solids Effluent 00556-0il and Greases Monthly Grab 34030-Benzene Grab Effluent annual 34696-Naphthalene nu — Grab Effluent ai ally 81551-Xylenes Semi Grab Effluent annually EPA Methods 8015 Grab Effluent annual Acute To2dcity3 Annually Grab Effluent Footnotes: 1. Flow - Flow shall be monitored with every discharge event. During periods of no flow, the Permittee shall submit a monthly Discharge Monitoring Report (DMR) indicating "No discharge." Flow may be monitored in one of four ways: a) measure flow continuously; b) calculate flow based on total rainfall per area draining to the outfall; exclude built -upon area (best method for facilities with large runoff -collection ponds); c) estimate flow at 20-minute intervals during the entire discharge event; or d) report flow based on discharge pump logs. 2. Oil and Grease - Where possible, the grab sample for oil and grease should be skimmed from the surface of a quiescent (calm water) zone. 3. Acute Toxicity - Whole effluent toxicity shall be monitored annually using the acute toxicity (fathead minnow, 24-hour) test. Please see Part A. (3). There shall be no discharge of floating solids or visible foam in other than trace amounts. Permit NCO082970 A. (3.) ACUTE TOXICITY MONITORING (ANNUAL) The Permittee shall conduct annual toxicity tests using protocols defined as definitive in EPA Document EPA/600/4-90/027 entitled "Methods for Measuring the Acute Toxicity of Effluents to Freshwater and Marine Organisms." The monitoring shall be performed as a Fathead Minnow (Pimephales promelas) 24-hour static test. Effluent samples for self - monitoring purposes must be obtained below all waste treatment. The permittee will conduct one test annually, with the annual period beginning in January of the calendar year of the effective date of the permit. The annual test requirement must be performed and reported by June 30. If no discharge occurs by June 30, notification will be made to the Division by this date. Toxicity testing will be performed on the next discharge event for the annual test requirement. The parameter code for this test is TAE6C. All toxicity testing results required as part of this permit condition will be entered on the Effluent Discharge Form (MR-1) for the month in which it was performed, using the appropriate parameter code. Additionally, DWQ Form AT-1 (original) is to be sent to the following address: Attention: North Carolina Division of Water Quality Environmental Sciences Section 1621 Mail Service Center Raleigh, North Carolina 27699-1621 Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Section no later than 30 days after the end of the reporting period for which the report is made. Test data shall be complete and accurate and include all supporting chemical/physical measurements performed in association with the toxicity tests, as well as all dose/response data. Total residual chlorine of the effluent toxicity sample must be measured and reported if chlorine is employed for disinfection of the waste stream. Should any test data from either these monitoring requirements or tests performed by the North Carolina Division of Water Quality indicate potential impacts to the receiving stream, this permit may be re -opened and modified to include alternate monitoring requirements or limits. NOTE: Failure to achieve test conditions as specified in the cited document, such as minimum control organism survival and appropriate environmental controls, shall constitute an invalid test and will require immediate follow-up testing to be completed no later than the last day of the month following the month of the initial monitoring. A. (4.) PERMIT RE -OPENER: TMDL IMPLEMENTATION The Division may upon written notification to the Permittee, re -open this Permit in order to incorporate or modify effluent limitations, monitoring and reporting requirements, and other permit conditions when it deems such action is necessary to implement TMDL(s) approved by the U. S. EPA. FACT SHEET EXPEDITED PERMIT RENEWAL Permit Writer/Date Bob Guerra / 1-9-12 Permit Number NCO082970 Facility Name CTI of NC Inc WWTP Basin Name/Sub-basin number Cape Fear River / 03-06-17 Receiving Stream Cape Fear River Stream Classification in Permit SC PNA Does permit need Daily Max NH3 limits? No Does permit need TRC limits/language? New language added Does permit have toxicity testing? Yes Does permit have Special Conditions? Just Tox testing Does permit have instream monitoring? No Is the stream impaired on 303 d list)? No Any obvious compliance concerns? None Any permit mods since lastpermit? None Current expiration date 12-31-2011 New expiration date 12-31-2016 Comments received on Draft Permit? NC Marine Fisheries comment that discharge is located in PNA waters. No comments from permittee. Changes to the Previous Permit: This draft permit contains the following changes from your existing permit: • Parameter codes have been added to the effluent page. • Stream classification augmented with PNA BIMS Downloads: Permit enforcement history: None during present permit cycle DMR Parameter Values Export: (2006 — 2011) TSS O&G Monthly 5.59 mg/L Average Daily 15,95 mg/L 5.81 mg/1 Max op% a - �, Old -Zgu!-oAk6.- Or* OW! Me stellar t /UCOO ��70 23546 I MGM ET 20„ 0MF-HABITAT PROTECT;ON t: NEVV HANOVER- - DEC `o 1 20111 From: Jeanne Hardy DMFNA8CATPFO FCTIOIV Habitat Protection Section Applicant/Project Name: NPDES NC0082970 CTI NC WVVTP REPLY: Jo comment. I ❑ This office supports the project as proposed �? i i Comments to this project are below or attached. This office objects to the project as proposed. SIGNED:% ( `_� -- DATED: �i North Carolina �� rr=z�✓lxfllP"ll�l f A. AFFIDAVIT OF PUBLICATION STATE OF NORTH CAROLINA COUNTY OF NEW HANOVER North Carolina Environmental anagement Commission/NPDES Jniq 1617 Mail Service Center Raleigh, NC 27699-1617 otice of Intent to Issue a NPDE5 Wastewater Permit North Carolina Environmental rage ment Commission proposes Issue a NPDES wastewater dis- ugge permit to the persons) ed below. tten comments regarding the posed permit will be accepted al 30 days after the publish date of this notice. The Director of the NC Division of Water Quality (DWQ) may hold a public hearing should there be a significant deree of public com-ments [information gg requests to and/or to DWQ at the above address. in- terested persons may visit the DWQ at 512 N, Salisbury Street. Raleigh, NC to review information on tile. Additional Information on NPDES pernits and this notice may be found on our website; hflp'l/portal.ncdenr.orgN Wwc/swplpslnpdasl calendar, or by calling (919) 807-6304. Cfl of NC requested renewal of permit NCO082970 for CTI of NC WWTP in New Hanover County; this permitted discharge is treated groundwater/wastewater to Cape fear River. Cane Fear River Basin. Flint Hills Resources requested re- newal of :permit NCO076732 for New Hanover Terminal in New Hanover County; this permitted dis- charge is treated groundwater/ wastewater to Cape Fear River. Cape Fear River Basin. Vopak Terminal Wilmington re- quested renewal of permit NCO073181 for South Wilmington Terminal in New Hanover County; this permitted discharge is treated stmmiwater/wastewater to UT to Vopak Terminal Wilmington re- quested NCO073172 for Wilmington Terminal in New Hanover County; this per- mitted discharge is treated storm- water/wastewater to Cape Fear River Cape Fear River Basin. Hess Corporation requested re- newal of permit NCO066711 for Wilmington Terminal in New Hano- ver County; this permitted dis- charge is treatetl stonnwater/ wastewater to UT to Cape Fear River Cane Fear River Basin. Before the undersigned, a Notary Public of Said County and State, Keith Raffone Who, being duly sworn or affirmed, according to the law, says that he/she is Controller of THE STAR -NEWS, a corporation organized and doing business under the Laws of the State of North Carolina, and publishing a newspaper known as STAR -NEWS in the City of Wilmington Public Notice North Carolina Environmental Management Commission/NPDES Unit, 1617 Mail Service Center Raleigh, NC 27699-1617 Notice of Intent to Issue a NPDES Wastewater Permit The North Carolina Environmental Management Commission proposes to issue a NP was inserted in the aforesaid newspaper in space, and on dates as follows: 10129 Ix And at the time of such publication Star -News was a newspaper meeting all the requirements and qualifications prescribed by Sec. No. 1-597 G.S. of N.C. f/l t4v Title: Controller a"r'O O CO S` orn�or/�ffirmed to, and subscribed before me this JA)4 ' _tiSdd�, A.D., _ 'tu` OTAR y In Testimony Whereof, I have hereunto set my hand and affixed my gfcial eal, the day year aforesaid. My commission expires day of ,20_ MY COMMISSION EXPIRES91122012 — Beau Rivage Plantation WWTP in New Hanover County; this permit - red discharge is treated wastewater to the Cape Fear Rivet, Cape Fear ping affidavit with the advertisement thereto annexed it is adjudged by the Court that the said River Basin. pl Aqua North Carolina, Inc. requested y made and that the summons has been duly and legally served on the defendant(s). renewal of permit NCO057703 for The Cape WWTP In New Hanover T County; this permitted discharge is treated wastewater to the Cape I Fear River; Cape Fear River Basin. Clerk of Superior Court CTI OF NORTH CAROLINA, INC. TERMINAL 1002 South Front Street Wilmington. NC 28401 Phone 910-251-1020 Fax 910-762-2359 July 1, 2011 Mrs. Dina Sprinkle NC DENR I DWQ Point Source Branch 1617 Mail Service Center Raleigh, N.C. 27699-1617 RE: NPDES Permit No NCO082970 CTI of North Carolina, Wilmington Terminal New Hanover County Dear Mrs. Sprinkle: CORPORATE Post Office Box 576 Savannah. GA 31402-0576 Phone 912-236-1331 Fax 912-235-3873 VIA FED-X Please find attached an application for renewal of the NPDES permit for wastewater discharges from our storage terminal. The terminal is a bulk liquid petroleum storage terminal and has no refining or production capability. There have not been any significant changes at our facility since the last permit was issued. Please feel free to call me at (912) 443-6690 or call Bob Welch, Terminal Manager, at (910) 251-1020 if you have any questions about the system or this application. Please continue to direct correspondence to me at the corporate address. Thank you, Rodriguez Environmental, Health and Safety Specialist RR/vee Cc: Mr. Bob Welch, Terminal Manager Enclosures Lf ( sites^•-� r� �7 r JUL ` 6 201i G1;,... NPDES PERMIT APPLICATION - SHORT FORM C - Minor Industrial Minor industrial, manufacturing and commercial facilities. Mail the complete application to: N. C. Department of Environment and Natural Resources Division of Water Quality / NPDES Unit 1617 Mail Service Center, Raleigh, NC 27699-1617 NPDES Permit Number INCO082970 1. Contact Information: Owner Name Facility Name Mailing Address City State / Zip Code Telephone Number Fax Number e-mail Address Please print or type. CTI OF NORTH CAROLINA, INC. CTI OF NORTH CAROLINA, INC. P. O. BOX 576 SAVANNAH GA 31402 (912) 236-1331 (912) 235-3885 RRODRIGUEZC3COLONIALGROUPINC.COM 2. Location of facility producing discharge: Check here if same as above ❑ Street Address or State Road 1002 S. FRONT STREET City WILMINGTON State / Zip Code NC 28401 County NEW HANOVER 3. Operator Information: Name of the firm, consultant or other entity that operates the facility. (Note that this is not referring to the Operator in Responsible Charge or ORC) Name CTI OF NORTH CAROLINA, INC. Mailing Address 1002 S. FRONT STREET City WILMINGTON State / Zip Code NC 28401 Telephone Number (910) 251-1020 ' JUL Fax Number (910) 762-6154 4. Ownership Status: Federal ❑ State ❑ Private ® Public ❑ Page 1 of 6 C-MI 10108 NPDES PERMIT APPLICATION - SHORT FORM C - Minor Industrial Minor industrial, manufacturing and commercial facilities. 5. Standard Industrial Classification (SIC) code(s): 4226 6. Number of employees: 14 ?. Describe the treatment system List all installed waste treatment components with capacities, describe the processes that generate wastewaters. If the space provided is not sufficient attach a separate sheet of paper with the system description. OUTFALL 001 DISCHARGES TREATED WASTEWATER FROM DIESEL TANK WATER BOTTOMS, BOILER BLOW DOWN OR STEAM CONDENSATE, AND STORM WATER FROM VARIOUS COLLECTION POINTS AND TANK FIELD CONTAINMENT AREAS. TREATMENT IS PROVIDED BY A GRAVITY TYPE OIL/WATER SEPARATOR WITH A MECHANICAL SKIMMER PRIOR TO DISCHARGE. THIS OUTFALL ALSO DISCHARGES GROUNDWATER FROM AN ON -SITE REMEDIATION SYSTEM. TREATMENT CONSISTS OF BAG FILTRATION, A STRIPPING TOWER, AND ACTIVATED CARBON FILTRATION. THIS TREATMENT SYSTEM DOES NOT GENERATE ANY SLUDGE. THE TREATMENT PLANT EFFLUENT IS ROUTED THROUGH THE OIL WATER SEPARATOR PRIOR TO DISCHARGE TO THE CAPE FEAR RIVER. WHEN NECESSARY TO CLEAN OUT THE OIL WATER SEPARATOR BASIN, THE GROUNDWATER TREATMENT SYSTEM EFFLUENT AND ANY STORM WATER IN THE TANK FIELDS WILL BE HELD IN CONTAINMENT, UNTIL THE OIL WATER SEPARATOR IS OPERATIONAL. CLEANING OF THE OIL WATER SEPARATOR IS ANTICIPATED ANNUALLY. OUTFALL 003 DISCHARGES STORM WATER AND PRODUCT STORAGE TANK RUNOFF FROM A TREATMENT SYSTEM CONSISTING OF A GRAVITY FLOW OIL WATER SEPARATOR WITH A MECHANICAL SKIMMER. S. Is facility covered under federal effluent limitation guidelines? No ® Yes ❑ If yes, specify the category?, 9. Principal product(s) produced: NONE Principal raw material(s) consumed: NONE Page 2 of 6 C-MI 10108 NPDES PERMIT APPLICATION - SHORT FORM C - Minor Industrial Minor industrial, manufacturing and commercial facilities. Briefly describe the manufacturing process(es): THIS TERMINAL IS A BULK LIQUID PETROLEUM/CHEMICAL STORAGE TERMINAL AND HAS NO REFINING OR PRODUCTION CAPABILITY. THE FACILITY OPERATES A GROUND WATER REMEDIATION SYSTEM. 10. Amount of principal product produced or raw material consumed List specific amounts consumed and/or units of production over the Iasi three years) Product Produced or Raw Material Consumed AVERAGE Product Produced or Raw Material Consumed PEAK per Day NONE NONE per Month per Year 11. Frequency of discharge: Continuous If intermittent: Days per week discharge occurs: Intermittent ❑ Duration: Page 3 of 6 GMT 10108 NPDES PERMIT APPLICATION - SHORT FORM C - Minor Industrial Minor industrial, manufacturing and commercial facilities. 12. Types of wastewater discharged to surface waters only Discharge Flow GALLONS PER PAT) Sanitary - monthly average NONE Utility water, etc. - monthly average NONE Process water - monthly average NONE Stormwater - monthly average STORM WATER FLOW FROM COLLECTION POINTS AND TANK FARM CONTAINMENT. Other - monthly average Explain: GROUNDWATER 3,333 gal / day REMEDIATION - 100,000 gal / month Monthly Average VARIABLE total discharge (all types) 13. Number of separate discharge points: 2 Outfall Identification number(s) 001 003 14. Name of receiving stream(s) (Provide a map showing the exact location of each outfall, including latitude and longitudep. CAPE FEAR RIVER Page 4 of 6 C-MI 10108 NPDES PERMIT APPLICATION - SHORT FORM C - Minor Industrial Minor industrial, manufacturing and commercial facilities. 15. Effluent Data [for new or proposed discharges] Provide data for the parameters listed. Temperature and pH shall be grab samples, for all other parameters 24-hour composite sampling shall be used. V more than one analysis is reported, report daily maximum and monthly average. If only one analysis is reported, report as daily maximum. NOTE: Permittees requesting renewal should complete the table ONLY for the parameters currenttu monitored_ Summarize the nest 3 up -era nf OffLupnt date_ Parameter Daily Maximum Monthly Average Units of Measurement Biochemical Oxygen Demand (BOD5) N/A Chemical Oxygen Demand (COD) N/A Total Organic Carbon N/A Total Suspended Solids N/A 13.76 mg/L Ammonia as N N/A Temperature (Summer) N/A Temperature (Winter) N/A pH N/A Fecal Coliform (If sanitary waste is present) N/A Total Residual Chlorine (if chlorine is used) N/A 16. List all permits, construction approvals and/or applications (check all that apply and provide permit numbers or check none if not appUcabler Type Permit Number Type Permit Number Hazardous Waste (RCRA) UIC (SDWA) NPDES PSD (CAA) Non -attainment program (CAA) NESHAPS (CAA) Ocean Dumping (MPRSA) Dredge or fill (Section 404 or CWA) Other 17. List any chemicals that may be discharged (Please list and explain source and potential amounts.) OIL GREASE Page 5 of 6 C-MI 10I08 NPDES PERMIT APPLICATION - SHORT FORM C - Minor Industrial Minor industrial, manufacturing and commercial facilities. 18. Is this facility located on Indian country? (check one) Yes ❑ No 19. Applicant Certification I certify that I am familiar with the information contained in the application and that to the best of my knowledge and belief such information is true, complete, and accurate. Gam✓ � � � l/ Printed name of Peyson Signing Title Signature of Apl5licant North Carolina General S tute 143-215.6 (b)(2) provides that: Any person who knowingly makes any false statement representation, or certification in any application, record, report, plan, or other document files or required to be maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.S.C. Section 1001 provides a punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.) Page 6 of 6 C-MI 10108