NCG510390_Permit issuance_20060929

Michael F. Easley
Governor
William G. Ross, jr., Secretary
North Carolina Department of Environment and Natural Resources
w v� j
Alan W. Klimek, P.E., Director
Division of Water Quality
September 29, 2006
Rhoda Willis
Conocophillips
1600 Perimeter Park Drive, Suite 400
Morrisville, NC 27560
Subject: General Permit NCG510000
Certificate of Coverage NCG510390
Circle K Store #8379
Gaston County
Dear Permittee:
The Division received your request for renewal of the subject Certificate of Coverage (CoC) on March
16, 2006. The revised General Permit was signed on September 20th, 2006 and takes effect October 1, 2006.
Accordingly, we are forwarding the attached CoC to discharge under NCG510000. This CoC is issued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of
Agreement between North Carolina and the US Environmental Protection agency dated May 9, 1994.
A copy of the renewed General Permit is enclosed, as well as an updated Technical Bulletin. The
Technical Bulletin summarizes the changes from the previous version of NCG510000. If any parts,
measurement frequencies or sampling requirements contained in this permit are unacceptable to you, you
have the right to request an individual permit by submitting an individual permit application. Unless such
demand is made, this Certificate of Coverage shall be final and binding.
The CoC is not transferable except after notice to the Division. You must notify the Division if you
sell or otherwise transfer ownership of the permitted facility. The Division may require modification or
reissuance of the CoC.
If your facility ceases discharge of wastewater before the expiration date of this permit, contact the
Regional Office listed below. Once discharge from your facility has ceased, this permit may be rescinded.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Water Quality, the Division of Land Resources, Coastal Area Management Act or any other
Federal or Local government. If you have any questions concerning this permit, please contact Charles
Weaver at the telephone number or e-mail address listed below.
Sincerely,
Alan W. Klimek
cc: Central Files
Mooresville Regional Office — Surface Water Protection
1617 Mail Service Center, Raleigh, North Carolina 27699.1617 919 733-5083, extension 511 (tax) 919 733-0719
An Equal Opportunity Affirmative Action Employer e-mail: charles.weaver®ncmail.net

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NCG510000
CERTIFICATE OF COVERAGE NCG510390
TO DISCHARGE PETROLEUM CONTAMINATED GROUNDWATER AND SIMILAR WASTEWATERS
UNDERTHE
NATIONAL POLLUTANT DISCHARGE ELEMONATION 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,
Conocophillips
is hereby authorized to operate a groundwater remediation system for petroleum -contaminated groundwater
or similar waste streams that will discharge treated wastewater from the
Circle K Store #5379
Gaston County
to receiving waters designated as an unnamed tributary to Fites Creek, a class WS-IV CA stream
in subbasin 30834 of the Catawba River Basin.
All discharges shall be in accordance with the effluent limitations, monitoring requirements, and
other conditions set forth in Parts I, II, III and IV of General Permit NCG510000 as attached.
This certificate of coverage shall become effective October 1, 2006.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day, September 29, 2006.
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

(YVATC
A S S O C I A T E S
OF NORTH CAROL
March 14, 2006
Mr. Charles H. Weaver, Jr.
2725 E. Millbrook Road, Suite 121
Raleigh, NC 27604
www.atc-enviro.com
919.871.0999
Fax [phone]
North Carolina Department of Environment and Natural Resources
Division of Water Quality - NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: NPDES Permit Renewal Application
Circle K Store #8379
101 Belmont -Mount Holly Road
Belmont, North Carolina 28012
Facility ID No. 0-017110
NCDENR Incident No. 10848
NPDES Certificate of Coverage NCG510390
Site Risk: High (H180D)
ATC Project No. 45.75000.8379
Dear Mr. Weaver:
ATC Associates of North Carolina, P.C. (ATC), on behalf of ConocoPhillips, is submitting
the enclosed NPDES Permit Renewal Application for the Circle K Store #8379. The
Application includes a site map showing the path of the remediation system effluent from
the remediation system to the NPDES discharge point. In addition, the Application includes
documentation from ConocoPhillips indicating that ATC has been designated as an
Authorized Representative for the NPDES Permit. If you have any questions or require
additional information, please contact us at [phone].
Sincerely,
ATC Associates of North Carolina, P.C.
Christopher
Staff Scientist
Cc: Mr. Blake Hall, ConocoPhillips
Rick Meinfelter, P.E.
Project Manager

62/23/2006 10:49
7045836281
CIRCLE:K
PAGE 03
474
NC DENR I DWQ / Water Quality Section
_ National Pollutant Discharge Elimination System
NCDERR NCG510000
r+c cn.e�w. �cw•�.+r or
E!rvinoNMn!tt nN0 Ymn!l RE![LTc[e
RENEWAL application for coverage under General Permit NCG510000
[remediation projects treating petroleum -contaminated groundwater]
(Please print or type)
1) Mailing address of site Owner:
Company Name:
Company Contact:
Street Address:
e-mail. address:
2) Location of remediation site producing discharge:
Facility Name:
Facility Contact:
Street Address:
City:
County:
Telephone No.:
e-mail address:
8) System operator / Consultant ID [if different from Owner):
Company Contact:
Street Address: �2 S fr M/llb Sxt
City:
County:
Telephone No.: R _
e-mail address: �'
4) Site ranking & ID:
GW incident M
Site Ran1dug (A E): 1 o 1)
Date of most recent site ranking:r.
ZauS
pate of most recent discharge:
'/ ,
ZIP Code:
CI)M
Additional data required:
path of the remediation system effluent from the site to its
a) A site map clearly showing the
discharge point. include
b) If this application is being submitted by a consulting engineer (or engineering firm),
documentation from the current permittee showing that the person[&] submitting the
application has been designated an Authorized Representative.
Page 1 of 2

f
1
• NCG510000 renewal 'application
CERTIFICATION:
I certify that I a.m. 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 P rson Sig�;�g: c. Lc�RALL
Title: cs� r rAk3jkc-vr
s�
- k
(Signature of Applicant) (Date Signed)
.North Carolina General Statute 148-216.6 E (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
Article 21 or regulations of the Environmental Management. Comm' w—d'oh 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
exceed 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 Mmilar offense.)
Mail THIS COMPLETED FORM to:
Mr. Charles H. Weaver, Jr.
NC•DENR / DWQ / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
►1!�D�Sd�®�s►�(!its,►�!�D[�Sl►��p�'►�D�Dl�f►1l�UC�.1�L�D�f►1�D�s
For electronic copies of this form or the NCG510000 Fact Sheet, send a request to:
[e-mail]
Page 2 of 2

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TITLE FIGURE 1 j
SITE TOPOGRAPHIC MAP ," ASSOCIATES INC.
CIRCLE K STORE #8379
i O 1 MOUNT HOLLY ROAD ENNRONMENTAL, GEOTECHNICAL AND MATERIALS PROFESSIONALS
BELMONT. NORTH CAROLINA 28012 Raleigh. North Carolina 27615 [phone] FAX [phone]
TYPE CODE PREP. aY REV, BY SCALE DATE PROJECT NO.
23E.DGN _4,000 04-1`-97 85445.8379

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PLANTATION PIPELINE R/W�
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TENT
SYSEMIT E
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0 0 0 JJ
WOODS 0
WATER S
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0
0
0
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0 0
0
0
WOODS
WATER SUPPLY WELL
LEGEND:
0 MONITORING WELL
4 MONITORING WELL (DEEP) BELMONT ABBEY COLLEGE
I& RECOVERY WELL
TITLE FIGURE 2
SITE VICINITY MAP
CIRCLE K STORE #8379
101 BELMONT - MOUNT HOLLY ROAD
BELMONT, NORTH CAROLINA 28012
CAD FILE TYPE CODE PREP. BY REV. BY
125223E.DGN
GRASS
FIELD
ABBEY
CEMETERY
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WOODS
PLANTATION PIPELINE R/W
WOODS
(WkTc
ASSOCIATES INC.
Raleigh, North Carolina 27604 [phone] FAX (919)871-aM
SCALE DATE PROJECT NO.
1" = 160' 05-20-2004 45.75000.8379

i
a
ConocoPhillips
Blake Hall
Contract Site Manager
Risk Management and Remediation
February 23, 2006
To Whom It May Concern:
ConocoPhillips
P. O. Box 2197
Houston TX 77252-2197
832-379-6417 Fax [phone]
[e-mail]
ATC Associates of North Carolina is authorized to perform environmental and engineering
services on behalf of ConocoPhillips in the State of North Carolina.
If you have any questions please contact me.
Sincerely, t
�i
Blake Hall
S:IBDOIRM&RIBHALLILETTERHEAD FORM BLAKE HALL.DOC