NC0079090_Permit Issuance_20050808

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Envirormtest and Natural Resources
Alan W. Klimek P.E. Director
Division of Water Quality
August 8, 2005
Mr. Steve Hargis, President
Coldwater Farms, Inc.
1199 Crantock Road
Smithfield, North Carolina 27577
Subject: Issuance of NPDES Permit NCO079090
Coldwater Trout Farm
Graham County, Robbinsville, NC
Dear Mr. Hargis:
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 May 9, 1994 (or as subsequently amended). This permit includes no major
changes from the draft permit sent to you on June 8, 2005.
The Division realizes that operation of this facility is exclusively done through leasing the property/facility to
various entities. As the owner/permittee you need to be aware of the ongoing responsibilities and liabilities associated with
this NPDES permit. Mr. Bob Guerra of the Western NPDES Program has explained these liabilities to you during
conversations on 3-15-05, 4-25-05 and 5-17-05. As the permit is written, Coldwater Farms, Incorporated is the
responsible entity for all permit conditions.
There are various methods used to monitor NPDES permit conditions. The permit will require the facility/permittee
to sample its discharges and report these results to the Division. In addition, the permit will require the facility/permittee to
report to the Division of Water Quality when the facility/permittee determines it is not in compliance with the requirements
of a permit. Also, the Division's regional offices conduct periodic compliance inspections of all permitted facilities to
determine if they are in compliance with the conditions imposed under their permits.
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 150B 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 Mr. Guerra at telephone number [phone], extension 539.
Sincerely,
ORIGINAL SIGNED BY
Alai) IWIAek; PEON
cc: Central Files
Asheville Regional Office I Surface Water Protection
NPDES Unit
No�ne nt1Caro 'na
,ivatural
North Carolina Division of Wate Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Indxnet h2o.enrslate.nc.us 512N.SalsbusySt Raleigh, NC 27604 FAX [phone]B-6748
An Equal OpporNnitylAfirmative Action Employe-50% Recycledl10% Post Consumer Paper

Permit NCO079090
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,
Coldwater Farms Incorporated
is hereby authorized to discharge wastewater from a facility located at the
Coldwater Trout Farm
Snowbird Road
Robbinsville
Graham County
to receiving waters designated as Snowbird Creek in the Little Tennessee River Basin
in accordance with effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, and III and IV hereof.
The permit shall become effective September 1, 2005
This permit and the authorization to discharge shall expire at midnight on November
30, 2007.
Signed this day August 8, 2005.
ORIGINAL SIGNBD BY
SUSAN A. WILSON
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Permit NCO079090
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPDES Permits issued to this facility, whether for operation or discharge
are hereby revoked. As of this permit issuance, any previously issued permit bearing
this number is no longer effective. Therefore, the exclusive authority to operate and
discharge from this facility arises under the permit conditions, requirements, terms,
and provisions included herein.
Coldwater Trout Farm Inc. is hereby authorized to:
1. Continue to operate an existing trout farm facility. The facility is located at
Coldwater Trout Farm, Snowbird Road, Robbinsville, Graham County.
2. Coldwater Trout Farm consists of settling chambers at the end of raceways and a
final settling pond.
3. Discharge from said treatment works into Snowbird Creek, classified C-Trout
waters in the Little Tennessee River Basin, at the location specified on the attached
map.

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Latitude: 35°18'S5" NC0079090 Facility
Longitude: 83'51'50" Location - -
Quad# F3SE
Stream Class:C-Tmut Coldwater Farms Inc.
Subbasin: 040404
Receiving Stream: Snowbird Creek North SALE 1.24000

Permit NCO079090
A. (I.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS -DRAFT
Beginning on the effective date of this permit and lasting until expiration, the
Permittee is authorized to discharge treated wastewater from Outfall 001. Such
discharges shall be limited and monitored by the Permittee as specified below:
fki%'�,z,M I..:• «.., .r•.j�}!«j��".it :y�a ..,.
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Flow (MGD)
Quarterly
Estimate
E
Total Suspended
mg. L
45.0 mg/ L
Quarterly
Grab
E
Solids
Settleable Matter
5.0 ml/l
10.0 ml/1
Quarterly
Grab
E
NH3-N
Quarterly
Grab
E
TKN
Quarterly
Grab
E
NO2 + NO3
Quarterly
Grab
E
Total Phosphorus
Quarterly
Grab
E
rPO4
Quarterly
Grab
E
Footnotes:
1. Sample Locations: E - Effluent
There shall be no discharge of floating solids or visible foam in other than trace amounts.
All samples must be collected from a typical discharge event.
Waste from the production facility shall be disposed of properly either by land application at agronomic
rates or by another environmentally safe manner.
Special permit conditions applicable to the subject permit are listed in the Supplement to Effluent
Limitations and Monitoring requirements Page.

Permit NCO079090
Supplement to Effluent Limitations
And Monitoring Requirements
Special Conditions
A. (2.) PERMIT REOPENER CONDITION
Upon findings by the Division of Water Quality that impacts on the receiving stream by
the operation of this facility are sufficient to cause or contribute to violations of water
quality standards, including algal blooms of other nutrient enrichment problems in
Lake Santeetlah, this permit shall be revoked and issued or modified to require such
measures, including but not limited to additional effluent and stream monitoring,
additional fish management plan implementation, reduction of total pounds of trout
grown yearly or construction and operation of additional treatment.
A. (3.) PRODUCTION CONDITION
There shall be no additional construction for the purpose of increasing production at
this facility without prior approval by the Division.

WATER OUALITY SECTION
L CURRENT PERMIT INFORMATION:
Permit Number. N/C/ 0 / 0 / 7 / 9 / 0 / 9 Lk / or
Certificate of Coverage Number:
1. Permit holder's name _Wide Creek Trout Sales - Howard Garver
2. Permit's signing official's name and title:Howard Garver
(Person legally responsible for
permit)
Manner/ O erator
(Title)
3. Mailing address: 442 Buchanan Branch Rd. City: Robbinsville
State: NC Zip Code: 28771 Phone: ( 828 )_
479-8621
IL - NEW 10""Eftff -+A*= RWOPAIA-MON., "M AM) ie-,-oec ra ArrP741-ro;�1
1. This request for change is a result of:
Change in ownership of company Name change for company
Change in ownership of property/facility _ Name change for
property/facility
XX Other (please explain): Chan_gelessee _
2. Owner Information
Company or Owner Name: CR Brown
Enterprises
(name to be put on permit / certificate of coverage)
Owner's/operator's or signing official's name: Howard Brown Title:
President
Company Contact: Howard Brown
President
Title:
Owner Mailing address: 235 Milton Mashburn Dr _City: Andrews
State: NC Zip Code: 28901 Phone:( 828 )
321-3335
E-mail address:
[e-mail]
3. Facility Information
Facility Name:

f L k/10 T�o6.f Frvvc
Facility Contact: Aawflal GiOW11) Title: �i e5 .
Facility Mailing address: -i765- Rd. City: o .�15d/%ACi
State: Zip Code: 3 7'71 Phone: (yV) 3aJ-333 i
E-mail address: /
�r
PERMIT NAME / OWNERSHIP CHANGE FORM
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF WATER
QUALITY UNLESS ALL OF THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED
WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application
2. Legal documentation of the transfer of ownership (such as a contract, deed, articles of
incorporation)
Certification must be completed and signed by both the current permit holder and the new applicant in the
case of change of ownership. For name change only, complete and sign the application certification.
Current Permittee's Certification:
name/ownership change has been reviewed and is
understand that if all required parts of this appQlica
information and attachments are notjndu" 4+1
• Signature:
JL--f, attest that this application for
g.pomplete to the best of my knowledge. I
completed and that if all required supporting
package will be returned as incomplete.
I, HoMrd K. ro ., t C . bf. L -ow a Ej, fernrr5et )'wc. . attest that this application for a
nametownership change has been reviewed and is accurate and complete to the best of my knowledge. I
understand that if all required parts of this application are not completed and that if all required supporting
information and attgchments are not includeA this application package will be returned as incomplete.
Signature: Date: o
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION &
MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:

PUBLIC NOTICE
of
AFFIDAVIT OF PUBLICATION
BUNCOMBE COUNTY
SS.
NORTH CAROLINA
Before the undersigned, a Notary Public of said
County and State, duly commissioned, qualified and
authorized by law to administer oaths, personally
appeared Darryl Rhymes, who, being first duly
sworn, deposes and says: that he is the Legal
Billing Clerk of The Asheville Citizen -Times,
engaged in publication of a newspaper known as
The Asheville Citizen -Times, published, issued,
and entered as second class mail in the City of
Asheville, in said County and State; that he is
authorized to make this affidavit and sworn
lays after the
statement; that the notice or other legal
ate of this no,
comments re -
or to that tlate
for
advertisement, a true copy of which is attached
in the fi-
re-
'the
hereto, was published in The Asheville Citizen -
the proposed
Prop
he Director r
Times on the following date: June 9, 2005
vision of Water
to
lay meeting
tpermit
newspaper in which said notice, paper, document or
,osed
rased on re-
Division re
legal advertisement were published were, at the
:ignif icant tle-
3iic interest.
time of each and every publication, a newspaper
he draft permit
meeting all of the requirements and qualifications of
supporting in -
an file used ns pre-
conditions. Pre
Section 1-597 of the General Statues of North
-raft cerreq est
span request
Carolina and was a qualified newspaper within the
cot of the costs
'o;do ;eq�
meaning of Section 1-597 of the General Statues of
Rion to the NC
Water oaaiity
North Carolina.
Signed this 9th, June 20 5
(Signature of per n making afft it
erNcog wo, 'ice Sworn to and subscribed before me the 9th day of
far facility
aT s June 2005
Toro afacility 1 la
,)OYF
quality limited. However, NolaryPu ic) Sr h -�
thhis discharge may affect - r�,y,�
future discharges m this My C mission expires the 3rd day of •*^lYbl.IC
port .on of the basin. _
.lane y, 2u0.5 2008. c

DENR/DWQ
FACT SHEET FOR NPDES PERMIT DEVELOPMENT
NPDES Permit NCO079090
Facility Information
Applicant/Facility Name:
Steve Hargis / Coldwater Trout Farm
Applicant Address:
1199 Crantock Road, Smithfield, NC 27577
Facility Address:
Snowbird Road, Robbinsville, North Carolina 28771
Permitted Flow
No Limit
Type of Waste:
100% A uaculture
Additional permits required
NC Department of Agriculture / Aquaculture Permit Number
617. Expires December 31, 2008
Facility Class/Permit Status:
NA / Renewal
County:
Graham
Miscellaneous
Receiving Stream:
Snowbird Creek
Regional Office:
Asheville
Stream Classification:
C-Trout
USGS TooQuad:
F3SE / Graham, NC
303 d Listed?:
No
Permit Writer:
Bob Guerra
Subbasin:
04-04-04
Date:
June 3, 2005
Drainage Area mi2):
-
Summer 7Q10 cfs)
Unknown
Winter 7Q10 cfs):
Unknown
Average Flow(cfs):
IWC (%) 0.4 MGD:
-
SUMMARY OF FACILITY
Coldwater Trout Farms is a Trout propagation aquaculture facility located on Snowbird Road,
Robbinsville, Graham County. The facility consists of settling chambers at the end of raceways
and a final settling pond. Material is settled in screened areas at the tail of each raceway and
transferred to 1 of 2 settling ponds by pumps. The settling area at the tail of each raceway is
cleaned every 7 to 10 days when the facility is operating. When either settling pond is filled to
capacity dewatered sludge is machine loaded onto dump trucks and transported to near by farms
and gardens for reuse as soil amendments. Discharge from said treatment works into Snowbird
Creek, classified C-Trout waters in the Little Tennessee River Basin, at the location specified on
the attached map.
COMPLIANCE SUMMARY:
This facility remained in compliance with all effluent limitations for the past four years (1999
through 2004). No reasonable potential analyses (RPA) were required. Monitoring has been on a
quarterly basis with TSS and Settleable solids reporting required testing
TOXICITY TESTING:
Current Requirement: None required.
Recommended Adjustment: None.
Cold Water Farms Inc. Fact Sheet
NPDES Renewal
Page I

PROPOSED CHANGES:
This facility initially operated under a General Permit NCG530077 that expired on
July 31, 1997, which covered Aquaculture operations statewide. In accordance with /
the proposed permitting policy for trout farms on tributaries to Lace Santeetlah the ✓
was renewe as an rndivt ua Hermit N 0 090. The facility has
opera a rn a pas un Erthe names o o a er rout arms"and "Wide Creek
Trout Sales". The facility is owned by Mr. Steve Hargis, Smithfield, NC and has
been and will continue to be leased to different individuals who are in the business of
trout production. The existing permit was issued to the Lessee Mr. Howard Garner
who no longer leases the property from Mr. Hargis. Mr. Hargis was required to
resubmit an application under his name and was informed of the regulations and his
role as the permit holder.
PROPOSED SCHEDULE FOR PERMIT ISSUANCE:
Draft Permit to Public Notice: June 8, 2005
Permit Scheduled to Issue: August 1, 2005
STATE CONTACT:
If you have any questions on any of the above information or on the attached permit, please
contact Bob Guerra at [phone] ext. 539.
NAME: DATE:
REGIONAL OFFICE COMMENTS:
TE:
REGIONAL SUPERVISOR COMMENTS:
NAME: DA
NPDES SUPERVISOR COMMENTS:
NAME: DATE:
Cold Water Farms Inc. Fact Sheet
NPDES Renewal
1'agc 2

6/13/05
NPDES permit N.C.0079090
This permit was originally issued to a Howard Garver who leased the trout farm from
Steve Hargis. Your department has now issued the permit directly to Mr. Hargis. We
(Howard Brown of C.R. Brown Enterprises Incorporated) will be now leasing the farm
from Mr. Hargis and would like for our name to be used as the contact people for this
particular permit. We will begin stocking fish into the facility on or about 7/l/05.
Yesterday I discussed this issue with Mr. Robert Guerra. If you have any questions please
call me at 1-828-321-3335.
Sincerely,
Howard R. Brown
J U N 2 0 2005
UEHR - WATER QUALITY
POINT SOURCE BRANCH

Re: Non submittal of NPDES permit renewal NCO079090
Subject: Re: Non submittal of NPDES permit renewal NCO079090
From: Susan Wilson <[e-mail]>
Date: Thu, 12 May 2005 16:55:30 -0400
To: Bob Guerra <[e-mail]>
CC: Charles Weaver <[e-mail]>, Bob Sledge <[e-mail]>, Roger
Edwards <[e-mail]>
Bob G - here's what I think we should do based on my conversation with Bob S. this
morning. Probably - since the "renter" appears to be no longer operating the trout
farm and doesn't want a permit (and I'm assuming the previous permit was issued to
him - Mr. Garver). I'd :
1) ask Mr. Garver to request rescission of the permit (and he should do this since
he says he is no longer operating the trout farm and no longer wants the permit).
You may want to discuss this with him over the phone and also send him a letter
stating the circumstances (w/copy to the owner, Mr. Hargis). You may also want to
get the region to confirm that it is no longer in operation (so I'm copying Roger)
after he requests rescission.
2) Give the owner, Mr. Hargis, an opportunity to have the permit in his name (as
the owner, in case he still wants to rent the property out for a trout farm). I
would discuss this with him over the phone. If he does not want the permit - and
we rescind Mr. Garver's permit - there will be no permit and whoever wants to
operate a trout farm again will have to apply for a new permit. Does Mr. Hargis
plan to lease the land again to someone who will operate a trout farm? If so, this
could be a problem.
We can discuss further if we need to (and Bob S can also discuss it with you).
Thanks for handling this Bob G - it's a bit confusing.
Charles Weaver wrote:
Bob - I discussed this with Susan. When we spoke yesterday I didn't recall that
the "renter" had submitted a renewal application back in June 2004. Thus I
can't send an NOV for "failure to renew" - an application was submitted and the
Division accepted it.
However, the issue of ownership at this site needs further discussion. Susan
wants to discuss this with you and Bob Sledge [who has experience dealing with
such questions].
Check with Susan on how/when to proceed. Sorry if I confused things.
CHW
1 of 1 5/13/2005 11:16 AM

Rd: Late December 2004 DMR's: RE: NC0079090/Wide Creek Trou...
Subject: Re: Late December 2004 DMR's: RE: NC0079090/Wide Creek Trout Sales
From: Janet Cantwell <[e-mail]>
Date: Tue, 15 Mar 2005 09:29:58 -0500
To: Bob Guerra <[e-mail]>
Hi Bob ---Re: NC0079090/Wide Creek Trout Sales:
Back on October 11, 2004, Howard Garver (828-479-6267)/Wide Creek Trout Sales requested the
"Change of Ownership" form to change it from his name to Coldwater Farms( the owner is Steve
Hargis who lives near Raleigh). Garver is no longer in business. I mailed him the form to fill out and
have the owner sign it. He said he wanted to make sure it was not in his name anymore.
On 1/13/05 I spoke with Mr. Garver: there are still no fish and no new business at the farm. Mr.
Garver said he told Steve Hargis to call us when he was ready to start the business back. He did not
have a phone number for Mr. Hargis but had an address.
On 3/8/05 I spoke with Steve Hargis, the owner of the property from whom Howard Garver was
leasing his fish farm. Mr. Hargis said Mr. Garver told him that he (Garver) did not send the change
of address form because he didn't understand it, but instead, sent a letter (to whom we do not know: it
did not come here.)
Steve Hargis wants to keep the permit (and have it reissued in his name) and would like you to send
the information and renewal form to him.
His address is: Steve Hargis/Coldwater Farms (919-934-3814)
1199 Crantock Road
Smithfield, NC 27577
Thanks! ---Janet
Bob Guerra wrote:
After reviewing the files and DMRs located in Central Files the following list reflects DMR's
which are not found in the system. If you get a chance by the end of the week, please add
comments to your respective sites. This is my first crack at this task and your input will be
invaluable towards my understanding of the sites status and your knowledge that the DEC DMR's
have or have not been submitted.
Thanks in advance for your responses.
0(2 3/15/2005 10:47 AM

. Sep: •1'6 ' 04 13: 46 HARG I S FAX [phone] P. 2
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
PERMIT'NAME/OWNERSHIP CHANGE FORM
Any changes made to this form wilt result in the application being returned.
(THIS FORMMAYBE PHOTOCOPIED FOR USE ASAN ORIGINAL)
For more information, visit our web site at.- h2o.ennstate.ne.us/ndpul
1.
I. Submit one original of the completed. and appropriately executed Permit Name/Ownership Change Form. For a
change of ownership, the certification must be signed by both the current permit holder and the new applicant.
For a name change only, the certification must be signed by the applicant.
2. Provide legal documentation of the transfer of ownership (such as a contract, deed, article of incorporation, etc.)
for ownership changes. A copy of the Association Bylaws and Declarations should be submitted for a change of
ownership to a Homeowner's Association.
3. Submit a properly executed Operation and Maintenance Agreement for all Single Family Spray/Drip Irrigation
permits requesting a change of ownership.
1. Permit number: 0 71121P
2. Permit holder's name: 11,owAkn 4 e5wt w:*
3. Permit's signing official's name and
(Person legally responsible for permit)
(title)
4. Mailing address: 'y'y tN 44)
City' b state: / � zip: _ S 77/
Telephone number: -eG.2 Facsimile number:
L This request for a permit change is a result of:
a. Change in ownership of propertylconipany
b. Name change only
c. Other (please explain): A4&jV0a JJO
46/ -4 e.
i
FORM: PNOCF 06/00 Page 1 of 2

. Sep:•16 '04 13:50 HARGIS
2. New owner's name (name to be used in permit):
3. New owner's or signing official's name and title:
FAX [phone]
1�AO"SM, t*hdp 0
yw
MAI ore;
responsible fif permit)
dy SOW
(title)
4. Mailing address: oe /00.-
City: State: Zip:w Ae
did
_ __-- ----- --- - - - . .
...�-- -
�"'rerepone f� - Facsimile number:
TV. CERTWIC n- 0-
1. - Current Permittee's Certification:
attest that this application for name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this application are
not completed and that if all required supporting information and attachments are not included, this application
package will be returned as incomplete. I understand I will continue to be responsible for compliance with the
current permit until a new permit is issued.
Signature: Date:
2. Applicant's Certification:
attest that this application for name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this application are
not completed anti tliat_if all r uired s ortin information ihaclim0.are noI included, this. application
package w
Signature:
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
NON-DISCHARGB PERMITTING UNIT
Pastel Serviee:
1617 MAIL SERVICE CENTER 512 NORTH SALISBURY STREET, SUITE 1219
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGM NORTH CAROLINA 27604
TELEPHONE NUMBER: [phone]
P. 6
FORM: PNOCF 06/00 Page 2 of 2

Sep:'16 '04 13:46 HARGIS FAX [phone] P. 3
STATE OF NORTH- CAROLINA
DEPARTMENT OF AGRICULTURE
W. Britt Cobb, Jr., Interim Commissioner
Raleigh, North Carolina
In accordance with tea pr©Ai ns i3fGS 106•761" l Batt CoJr .
1. > >' ,
do hereby grri
Wid Leek T-TI
ou�.S alp
the foil •• � -a uacul .' ... _ s : - - • •.� t ��..` j .. • � •_..
q torese �€or
H*CViopaggtiofi.au
-t ,Prodion Fa.' 'ti'es tncl4din�Aqua
odg Pona/Tann
5- omfqercial Gatclio �t P c t
a !i' !• �'
t.. Cl:�om tion'Aquaculture and Catc oui fern i
,
't 'lid iaai+l' M i;ond/.
V.
Theseicenses are co -di :, upon cripli�rice Wit�i' 10C7id the re ` ations
imple i+ n+brig tlu : .t t as• pied by the North. Ca i Board­-bf Agripx4 e
` 'c' �fit, � . s !:, -.S, .. _ R•
The abov c'scried lisron' FF
a . ;biro ber
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_' .: Conerc1 C*•tchout'er Number: , ,
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Date: 12/11 /2003 .
W. Britt Cobb, Jr
Commissioner of Agriculture

Sep16 104 13:52 HARGIS FAX [phone] P. 7
NPDES PERMIT MPLICA►TION - SHORT FORM C-ManufacturWg
For manufacturing or commercial facilities with a discharge < 1 MOD
N. C. Department of Environment and Natural ftsources
Division of Water Quality / NPDZ13 Unit
1617 Mil Service Center, Raleigh, NC 27699-1617
http:/ /h2o.onr.state.nc.=/NPDRO/
NPDES Permit Number NCOO MAL
Please print or type
1. Contact Information:
Facility Name
Owner Name ,
Street Address
City
State / Zip Code
Telephone Number
Fax Number
e-mail Address
Operator Name
Street Address
City
State / Zip Code
County
Telephone Number
2. Location of facility producing discharge:
Check here if same as above o
Facility Name Uf different from above)
Street Address or State Road
City
State / Zip Code
County
3. Ownership Stat= ;
Federal 0StateEl Private EU�/
Public F-1
4. Standard IndustcI I Classification (SIC) aode(sh
Or
a. Number of employees:
6.
Principal produot(s) produced:_1i�lG. .�r�•�
Principal

NPDES PERMIT APPLICATION - SHORT FORM C-Mang
For manufacturing or commercial facilities with a discharge < 1 MGD
S. Amount of principal product produced or raw material consumed
ff.ici onaw4f^ nrnmmfe nnncomod nmil nr unite of nrndvr_ *nn)
Product Produced or Raw Material
Product Produced or Raw Mat=W
Coasua�ed
Consumed
AMRAGE
EAK
per DayAL
per Month
per Year
9. Check here if dischMe occurs, an ear [] , or circle mouthful in which, discharge
occurs: A00A 0094C
January February March April May June
July August September October November December
Days per week discharge acvurs: -
JVDTB. If the facility has separate discharge points (outfalls) or multiple industrial processes,
include a schematic diagram of wastewater flow at the facility.
10. Types of wastewater discharged to sudkee watery only
Dischaw per operating month
Flow
GALLONS PER OPERATING MONTH
Sanitary - monthly average
Utility water, etc. - monthly average
Process water - monthly average
Monthly Average
total discharge (all types)
11. Ust all permits, eon- traation approvals and/or applications (dwk aB that apply and provide permit
numbers or du do none if not
1r pe't Number
Q None
CD UIC
NPDES
C7 PSD
C7
NESHAPB
M BMA Numh a
Q Non -Attainment
Q Ocean Dumping
MDredge/ Fill Permits
Q RCRA
Other

Sep.16 904 13:4e HARGIS FAX [phone] P. 5
B"M PERMIT APPLICATION - BHORT FORD C-Manufacturing
For manufacturing or commercial facilities with a discharge < 1 MOD
12. Number of separate discharge points:
13. Name of receiving streangs) (Provide a mqp showfng the exact location of each outfalij incheding
latitude and longitudes
14. Do you Add any chemicals that may be discharged? (Please fist and explain source and
potential amounts.)
15. Is this facility located on Native American lands? (check one)
YES 1::1 NO
I oesfy that I am bmillet with the —6- rmation cant -timed in the application and that to the
best of my knowledge and belief such infostnadon Is true, complete, and aecrtrate.
Printed name of Person Signing 'Title 1.
North Carolina General Statute 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 $10,000, or by imprisonment not to e=eed six months, or by both. (18 U.S.C. Section
1001 provides a punishment by a fine of not more than $10,000 or imprisonment not more than 5 years, or both,
for a similar offense.)
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