NCS000043_COMPLIANCE_20150715

—STORIVIINATER-DIVISfON"CODING-SHEET ---
PERMIT NO.
NCC) 000 4;5
DOC TYPE
El FINAL PERMIT
0 MONITORING INFO
❑ APPLICATION
'f�COMPLIANCE
0 OTHER
DOC DATE
❑ 'Zol S 0-1 I �
YYYYMMDD

on
Permit Number
NCS000043
Central Files: APS — SWP _
7/13/2015
Permit Tracking Slip
Program Category
Status
Project Type
NPDES SW
In draft
Renewal
Permit Type
Version
Permit Classification
Stormwater Discharge, Individual
RL.�CL��VL,�
Individual
Primary Reviewer
grt
JUL 15 Z015
Permit Contact Affiliation
julie.ventaloro
CENTRAL FILES
John Harris
Coastal SWRule
DWR SECTION
Operations P v
109 Hinnant Rd
Goldsboro
NC 27530
Permitted Flow
0
Facility
Facility Name
Major/Minor Region
Airgas USA, LLC - Goldsboro Regional Plant `
Minor Washington
Location Address
County
109 Hinnant Rd
Wayne
Goldsboro NC 27530
Owner
Facility Contact Affiliation
Robbie Chase
109 Hinnant Rd
Goldsboro NC 27530
Owner Name
Owner Type
Airgas USA LLC "
Non -Government
Owner Affiliation
John Harris
Operations P V
109 Hinnant Rd
Dates/Events
Goldsboro
NC 27530
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Iss a Effective
Expiratioi
8/31/1994 12/5/2013 3/4/2015
4/29/2015 7�15�1015 9'11 120 5
1
-7 J;)f aZ-0
Regulated Activities
Requested /Received Events
_
Stormwater (activities not covered)
Region comments on draft requested
4/8115
Region comments on draft received
7/10/15 y
Outfall 001
Waterbody Name Streamindex Number Current Class Subbasin
Granny Branch 27-86-14-1-1 C;Sw,NSW 03-04-07

•
AAiv
KNEW
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
July 15, 2015
Mr. John Harris
V.P. Operations
Airgas USA, LLC
109 Hinnant Rd
Goldsboro, NC 27530
John E. Skvada, III
Secretary
Subject: Final NPDES Stormwater Permit'
Permit No. NCS000043
Airgas USA, LLC— Goldsboro Regional Plant
Wayne County
Dear Mr. Harris:
In response to your renewal application for continued coverage under NPDES stormwater permit
NCS000043, we are forwarding herewith the subject state NPDES 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).
Monitorin; . This final permit contains one major change from the draft permit that was noticed on
April 29, 2015. Total Suspended Solids (TSS) was added to your requirements for analytical
monitoring. TSS monitoring is typically required at industrial facilities, and we believe it was
omitted from your previous permit in error. TSS monitoring is already required at other Airgas
facilities in North Carolina. Please begin monitoring for TSS at this facility with your first sample
under the new permit cycle.
The monitoring strategy remains the same (semi-annual) as the previous term of the permit.
Please note that analytical and qualitative monitoring is required in this permit. Failure to complete
the monitoring as required is a violation of the permit and any permit noncompliance constitutes a
violation of the Clean Water Act. Reference Part III, Section A, Item 2 "Duty to Comply", Item 9
"Penalties for Tampering" and Item 10 "Penalties for Falsification of Reports" of your permit for
further information.
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
512 North Salisbury Street, Raleigh, North Carolina 27604 - Internet: htta:/Ioortal.ncdenr.orolwebllrl
Mailing Address:1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-92001 FAX: [phone]
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

NCS000043
Page 2 of 2
Change in Ownership: Please take notice this permit is not transferable. Part III, B.2. addresses
the requirements to be followed in case of change in ownership or control of this discharge. This
permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Energy, Mineral, and Land Resources, or permits required by the Division of Water
Resources, Coastal Area Management Act or any other federal or local governmental permit that
may be required.
Appeal; 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, Post Office Drawer 27447, Raleigh, North Carolina 27611-
7447. Unless such demand is made, this decision shall be final and binding.
If you have any questions or comments concerning this permit, contact Julie Ventaloro at (919)
807-6370 or at [e-mail].
Sincerely,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
Attachment: Permit NCS000043
cc: DEMLR Washington Regional Office, Bill Moore
Sam Sampath, Ph.D., EPA Region IV, 61 Forsyth Street, Atlanta, GA 30303
Stormwater Permitting Program
DWR Central Files
ecc: Rob Duffy, Antea Group, [e-mail]

, *mrga& I
0,�ff-� 3/11114
December 3, 2013
DEC 4 5 2O13
-1k QUALM
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VEL40 ANDS� �
SW Individual Permit Coverage Renewal
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, NC 27699-1612
Re: SW Individual Permit Coverage Renewal — Permit No. NCS000043
Airgas, LLC— Goldsboro, NC
Stormwater Permitting Program:
Jerrell G. Cook
Manager Packaged Gases
Atrgae USA, LLC
5313 Old Dowd Rd
Charlotte, NC 28208
[phone] Fax: [phone]
hHpIlwww.airgas.com
[e-mail]
Please find enclosed a Stormwater Individual Permit Renewal Application for the referenced
facility and permit number.
If you have any questions or require assistance on projects in the future, please do not hesitate
to contact me at [phone]. — Rb6 bL4 Am k*- 6r---r
Sincerely,
G�
3errell G. Cook
Manager — Packaged Gases
Airgas, LLC
—s,c pl,uh�� -9- 4.�o Pi, sx-c ti
Cc: Mr. Robbie Chase, Airgas, LLC
Mr. John Harris, Airgas, LLC
Mr. Rob Duffy, Antea Group
Enclosure

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Stormwater Permit Renewal
Airgas USA,
LLC
;~.;;Goldsboro,
North Carolina
is
Anted Group Project"No `E030705122;'
-December 2013
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Prepored•for.
Prepared by: "
Airgas,USA;LLC�'
,"AnteaT""Group�''
109 Hinnant Road
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8008 Corporate/Center,Drive, Suite 100 '
;' , Goldsboro;.NC27530 Ci£arlotte, NC 28226�
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' Stormwater Permit Renewal Q
Airgas USA, LLC
Goldsboro, NC a n to a g ro u p
Antea Group Project No. E03070S122
Table of Contents
1.0 SITE MAP..................................................................................................................................................................... 1
2.0 ANALYTICAL MONITORING RESULTS........................................................................................................................... 1
3.0 VISUAL MONITORING RESULTS......................................................................................................................I............1
4.0 BEST MANAGEMENT PRACTICES................................................................................................................................. 2
5.0 SIGNIFICANT CHANGES...............................................................................................................................................3
5.0 SUPPORTING DOCUMENTATION................................................................................................................................ 3
Figures
Figure 1
Appendices
Appendix A
Site Map
Renewal Application Form
www.anteagroup.com

Stormwater Permit Renewal
Airgas USA, LLC
Goldsboro, North Carolina
1.0 SITE MAP
A copy of the facility's site map has been included as Figure 1. The site map includes the location of industrial
activities, drainage structures, drainage areas for each outfall, building locations, and impervious surfaces.
2.0 ANALYTICAL MONITORING RESULTS
The facility regularly samples for oil and grease and pH per their current Individual Permit. The results of the
analytical monitoring are described below in Table 1.
Table 1 : Laboratory Analytical Results Summary 2009 - 2013
Sampling
Period
Date
Collected
Outfall
Rainfall
(inches)
Oil & Grease
(mg/1)
pH
(std. units)
Comments
BENCHMARK
30
6.0 -- 9.0
--
2" Half 2009
11/11/09
OF001
2.42
<5.0
6.7
NA
1' Half 2010
4/21/10
OF001
0,22
5.3
7.5
NA
2 nd Half 2010
12/16/10
OF001
0.13
<5.0
7.0
NA
15 Half 2011
7/1/11
OF001
--
--
--
No Flow
2 nd Half 2011
1/1/12
OF001
--
--
--
No Flow
1' Half 2012
'5/30/12
OF001
0.54
<5.0
8.0
NA
2 ndHalf 2012
9/18/12
OF001
0.46
<5.0
8.6
NA
1' Half 2013
6/7/13
OF001
1.71
<5.0
5.6
Tier 1
3.0 VISUAL MONITORING RESULTS
The facility regularly performs visual monitoring at the outfall per their current individual storm water permit. The
results of their visual monitoring inspections are provided in Table 2.
Table 2: Visual Monitoring Results Summary for Outfall 0012009 - 2013
Date
Color
Odor
Clarity*
Floating
Solids*
Suspended
Solids*
Foam
Oil Sheen
Erosion
11/11/09
None
None
1
1
1
No
No
No
4/21/10
None
None
1
1
1
No
No
No
12/16/10
None
None
1
1
1
No
No
No
1
www.anteagroup.com

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Storm water Permit Renewal
Airgas USA, LLC
Goldsboro, NC
Antea Group Project No. E03070S122
1 4
Za ntea`g ro up
7/1/11
None
None
1
1
1
No
No
No
1/1/12
None
None
1
1
1
No
No
No
5/30/12
None
None
1
1
1
No
No
No
9/18/12
None
None
1
1
1
No
No
No
6/7/13
None
none
1
1
1
No
No
No
* Scaled of 1 to 10 where 1 is clear.
4.0 BEST MANAGEMENT PRACTICES
Airgas minimizes contact of significant materials with storm water by:
1, Applying paint with brushes and rollers to avoid overspray;
2. Practicing regularly scheduled preventative maintenance on mechanical equipment, and heating and air
conditioning equipment on -site;
3. Periodically inspecting and testing fire detection and suppression equipment including smoke detectors,
fire hoses, and sprinkler systems;
4. Practicing procedures for proper handling and storage of significant materials such as acetone, acetylene,
paint and paint thinner to prevent the incidence of fire;
5. Implementing procedures for responding to spills of significant materials; and
6. Annual spill response employee training.
Existing structural and non-structural control measures at Airgas to reduce pollutants in storm water discharges
include:
1. Secondary containment of acetone;
2. Secondary containment of heating oil;
3. Storage of paint in an enclosed structure;
4. Detention pond for erosion and sedimentation control;
5. Covered loading docks;
6. Secondary containment for drum oil storage at compressors;
7. Curbing and secondary containment around lime decant tanks;
B. Inside storage of liquid chemicals;
9. Used oil (aside from outdoor compressor oil); and
10. Gravel covered roadway and storage area
The following 8MPs were selected to minimize the impacts of the potential pollutants identified and are both
technically and economically feasible:
N
www.anteagroup.com

Stormwater Permit Renewal
Airgas USA, LLC
Goldsboro, NC
Antea Group Project No. E030705122
1 0
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antea*group
1. All outdoor liquid chemical/oil storage shall be inspected monthly for potential or existing leaks or spills.
2. The helium radiators will be inspected for cracks, leaks, spills or any signs of, potential antifreeze
discharge.
3. The shot blasting machine roof vent will be inspected periodically for particulate break through. The
drum storage area at the field service building is covered to eliminate exposure to storm water and with
secondary containment.
4. The miscellaneous outdoor equipment is not presently considered a significant pollutant source.
Therefore, eliminating storm water exposure is not economically feasible or justified. This area will be
inspected for signs of pollutants.
5.0 SIGNIFICANT CHANGES
The facility is currently undergoing construction of a new building. The facility has added a new outfall (Outfall 002)
as the result of this construction. Future analytical sampling and visual inspections will include this recently
installed outfall.
6.0 SUPPORTING DOCUMENTATION
Signed copies of the "Renewal Application Form" is included in Appendix A.
3 www.anteagroup.com

Stormwo ter Permit Renewal
Airgas USA, LLC
Goldsboro, NC
Antea Group Project No. E030705122
Figures
Figure 1 Site Map
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antea`group
www.anteagroup.com

LEGEND:
1. Bulk Chemical Storage (Nitrogen, Carbon
Dioxide)
2. 500 gallon Heating Oil AST with Secondary
Containment
3. Lime Decant System - Currently Not in Service
4. 250 gallon Diesel Fuel AST
5. (2) 1,000 gallon Acetone AST with Secondary
Containment
5. Propane AST
7. 2,000 gallon Propylene AST and 1,000 gallon
Water AST
B. Cylinder Storage on Open Bed Trailer
C - Covered Storage
D - Dumpster
;�DRAI NAG E"AREA; 001
I]RA NA9EAREA.002p"
XC- gas ao.p}
t
SEABQARA COASMAE -aROA4
1 i
Outfall 002
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Stormwater Permit Renewal
Airgas USA, LLC
Goldsboro, NC
Antea Group Project No. E030705122
Appendix A
Renewal Application Form
1 0
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anteaigroup
www.anteagroup.com

Permit Coverage
TRenewal Application Form
NCDENR National Pollutant Discharge Elimination System NPDES Permit Number
Stormwater Individual Permit NCS 000043
Please provide your permit number in box in the upper right hand corner, complete the information in the space provided
below and return the completed renewal form along with the required supplemental information to the address indicated.
Owner Information * Address to which permit correspondence will he malled
Owner / Organization Name: Air as, LLC
Owner Contact: Jerrell Cook
Mailing Address: 5313 Old Dowd Road
Charlotte, NC 28208
Phone Number: [phone]
Fax Number:
E-mail address: Terrell.Cook2@Airc[as.com
Facility Inform
Facility Name: Air as, LLC
Facility Physical Address: 1 A9 Ili I>aant Road NW
Cam] dsboro.__NC 27530
Facility Contact: Robbie Chase
Mailing Address: 109 Hinnant Road NW
Goldshoro, NC 27530
Phone Number: 919) 735-5276
Fax Number: [phone]
E-mail address: Eobbie,[e-mail]
Permit Inform
Permit Contact: Jarrell Cook
Mailing Address: 5313 Old Dowd Road
Charlotte, NC 28208
Phone Number:
Fax Number:
E-mail address: [e-mail]
Discharae Inf
Receiving Stream: Unnamed Tributary of Granny Branch
Stream Class: C, Sw, NSW
Basin: Neuse River
Sub -Basin: The Slough
Number of Outfalls: 2
Facillit►►/Activity Changes Please describe below any changes to your facility or activities since Issuance of your permit. Attached a
separate sheet if necessary.
The facility is currently undergoing construction of a new building. The facility has added
a new outfall (OF-002) as the result of the construction. Future analytical and qualitative
monitoring will include the newly added outfall. _
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 Informa s tru complet and accurate.
Signature 4 A Date Z
Jerrel Cook Manager - Packaged Gases
Print or type name of person signing above Title
SW Individual Permit Coverage Renewal
Please return this completed application form Stormwater Permitting Program
and requested supplemental information to: 1612 Mail Service Center
Raleigh, North Carolina 27699-1612

SUPPLEMENTAL INFORMATION REQUIRED FOR RENEWAL OF INDIVIDUAL
NPDES STORMWATER PERMIT
Two copies of each of the following shall accompany this submittal in order for the application
to be considered complete:
(Do not submit the site Stormwater Pollution Prevention Plan)
lni ' is
1. A current Site Map from the Stormwater Pollution Prevention Plan. The location of
17— industrial activities (including storage of materials, disposal areas, process areas and
loading and unloading areas), drainage structures, drainage areas for each outfall,
building locations and impervious surfaces should be clearly noted.
e--2' A summary of Analytical Monitoring results during the term of the existing permit
(if your permit required analytical sampling). Do not submit individual lab reports.
The summary can consist of a table including such items as outfall number,
parameters sampled, lab results, date sampled, and storm event data.
A summary of the Visual Monitoring results. Do not submit individual monitoring
reports. The summary can consist of a table including such items as outfall number,
parameters surveyed, observations, and date monitoring conducted.
A summary of the Best Management Practices utilized at the permitted facility.
Summary should consist of a short narrative description of each BMP's in place at
the facility. If the implementation of any BMP's is planned, please include
information on these BMP's.
5. A short narrative describing any significant changes in industrial activities at the
permitted facility. Significant changes could include the addition or deletion of
work processes, changes in material handling practices, changes in material storage
practices, and/or changes in the raw materials used by the facility.
Certification of the development and implementation of a Stormwater Pollution
Prevention Plan for the permitted facility (Sign and return attached form).
If the final year analytical monitoring of the existing permit term has not been completed
prior to filing the renewal submittal, then the last years monitoring results should be submitted
within 30 days of receipt of the laboratory reports. (i.e. do not withhold renewal submittal
waiting on lab results)

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North Carolina Division of Energy, Mineral, and Land Resources - Storm water Permitting
Facility Name: Ai rga.G £ r r C
Permit Number: NCS000043
Location Address: 109 Hinnant Road NW
Goldsbbr_Q, NC 2_7-53Q- - -
County:
Wayne
"I certify, under penalty of law, that the Stormwater Pollution Prevention Plan (SPPP) document and all
attachments were developed and implemented under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gather and evaluate the information required by the SPPP.
Based on my inquiry of the person or persons who manage the system, or those persons directly responsible
for gathering the information, the information gathered is, to the best of my knowledge and belief, true,
accurate and complete."
And
"I certify that the SPPP has been developed, signed and retained at the named facility location, and the SPPP
has been fully implemented at this facility location in accordance with the terms and conditions of the
Stormwater discharge permit."
And
"I am aware that there are significant penalties for falsifying information, including the possibility of fines and
imprisonment for knowing violations."
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Sigk,(acco.rding,toaperm�t signatary,rectulrements} and returngth�s Certlficat�on D0 NOT
K 0 < , ., ,. , ,,., ill „a. <: a _ ,.. 4_rt -1,,, ,P
.,SEND �ST.ORMWATER POLLUTION PREVENTION.PLAN. WITH .THIS CERTIFICATION u,
Signature `
Print type name of person signing above
Date 2'
-2,
Manager - acka ed Gases
Title
SPPP Certification 10/13

NORTH CAROLINA
WAYNE COUNTY
AFFIDAVIT OF PUBLICATION
Before the undersigned, a Notary Public of said County and State, duly
commissioned, qualified, and authorized by law to administer oaths, per-
sonally appeared Deborah White
who being first duly sworn, deposes and says: that he (she) is
Legal Clerk
(Publisher, or other officer or employee authorized to make affidavit) of
WAYNE PRINTING COMPANY, INC., engaged in the publication of a
newspaper known as GOLDSBORO NEWS-ARGUS, published, issued,
and entered as second class mail in the city of Goldsboro in said County
and State; that he (she) is authorized to •make this affidavit and sworn
statement; that the notice or other legal advertisement, a true copy of
which is attached hereto, was published in GOLDSBORO NEWS-
ARGUS on the following dates:
April 29, 2015
and that the said newspaper in which such notice, paper, document, or
legal advertisement was published was, at the time of each , and every such
publication, a newspaper meeting all of the requirements and
qualifications of Section 1-597 of the General Statutes of North Carolina
and was a qualified newspaper within the meaning of Section 1-597 of the
General Statutes of North Carolina.
This 29th day of April 20 15
(Signature of person making affidavit)
Sworn to and subscribed before me, this 2 R A day of
AUpt, 1— _ . - — - , 20 15
Notary Public
My Con nosslon Ellcp ms
My Commission expires: "Owtw 3. 2019
CLIPPING OF LEGAL
ADVERTISEMENT
ATTACHED HERE
PUBLIC NOTICE
SNC 'DIV. OF'" ENERGY;,,,, MIN-g
ERAL, AND!: » LAND w -AE=
SOURCES' [kitNT10 °ISSUE
A STORMWATER DISCHARGE'
PERMIT
Public comment or objection .i
to; the draft purnit(s) is in`
•vited: Submit'.written com=
ments to DEMLR at the ad-
dress below, ' AD comments
received prior to May 29.
2015 will be considered in
the final determination re-
&ding- permit 'issuance and
permit provisions.
Application: Airgas USA,, LLC,
109 Hinnant Rd, Goldsboro„
NC has applied for an NPDES '
permit to discharge storm;
water, from -an industrial-la-,t
sigty''at::AiroijUSAW.Lr -,,
Goldsboro Regional' •PI8n1,
109 Hinnant; Rd; - Goldsboro, '
NC, Wayne County. The facil7
ity discharges ,to UT toi°
Granny Branch. and UTAo Mill
Creek, both in the Nouse
River Basin,
Storinwater ' permitting Con-..
tact Julie Ventaloro
(9191807-6370 ,
Monai
avail-'
able for the rel
at:DEMLR Stan
Permitting Program
512 N, Sallsbury.Struet .
Raleigh, NC 27604
1612 Mail Service Center"
Raleigh, NC 27699-1612 ,
Legal #280
April 29,-2015 ' ,
RECEIVED
N ay 0 4- 2015
DEI-SR-1.A `iD O.UkE F iV
STORMVVK ER PERWI i li ate

NCS000043
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
TO DISCHARGE STORMWATER UNDER THE
In compliance with the provisions 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,
Airgas USA, LLC
is hereby authorized to discharge stormwater from a facility located at
Airgas USA, LLC - Goldsboro Regional Plant
109 Hinnant Rd
Goldsboro, NC
Wayne County
to receiving waters designated as UT to Granny Branch, a class C;Sw,NSW stream and to UT
to Mill Creek, a class WS-IV;NSW stream, both in the Neuse River Basin, in accordance with
the discharge limitations, monitoring requirements, and other conditions set forth in Parts
1,11,111, and IV hereof.
This permit shall become effective August 1, 2015.
This permit and the authorization to discharge shall expire at midnight on July 31, 2020.
Signed this day July 15, 2015.
DO
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

Permit No. NCS000043
TABLE OF CONTENTS
PART 1 INTRODUCTION
Section A: Individual Permit Coverage
Section B: Permitted Activities
Section C: Location Map
PART 11 MONITORING, CONTROLS, AND LIMITATIONS FOR PERMITTED
DISCHARGES
Section A: Stormwater Pollution Prevention Plan
Section B: Analytical Monitoring Requirements
Section C: Qualitative Monitoring Requirements
Section D: On -Site Vehicle Maintenance Monitoring Requirements
PART III STANDARD CONDITIONS FOR NPDES STORMWATER INDIVIDUAL PERMITS
Section A: Compliance and Liability
1. Compliance Schedule
2. Duty to Comply
3. Duty to Mitigate
4. Civil and Criminal Liability
S. Oil and Hazardous Substance Liability
b. Property Rights
7. Severability
8. Duty to Provide Information
9. Penalties for Tampering
10. Penalties for Falsification of Reports
11. Onshore or Offshore Construction,
12. Duty to Reapply

Permit No. NCS000043
Section B: General Conditions
1. Permit Expiration
2. Transfers
3. Signatory Requirements
4. Permit Modification, Revocation and Reissuance, or Termination
5. Permit Actions
6. Annual Administering and Compliance Monitoring Fee
Requirements
Section C: Operation and Maintenance of Pollution Controls
1. Proper Operation and Maintenance
2. Need to Halt or Reduce Not a Defense
3. Bypassing of Stormwater Control Facilities
Section D: Monitoring and Records
I.
Representative Sampling
2.
Recording Results
3.
Flow Measurements
4.
Test Procedures
5.
Representative Outfall
6.
Records Retention
7.
Inspection and Entry
Section E: Reporting Requirements
1.
Discharge Monitoring Reports
2.
Submitting Reports
3.
Availability of Reports
4.
Non-Stormwater Discharges
5.
Planned Changes
6.
Anticipated Noncompliance
7.
Spills
8.
Bypass
9.
Twenty-four Hour Reporting
10.
Other Noncompliance
11.
Other Information
PART IV DEFINITIONS

Permit No. NCS000043
PART I INTRODUCTION
I
SECTION A: INDIVIDUAL PERMIT COVERAGE
During the period beginning on the effective date of the permit and lasting until expiration,
the permittee is authorized to discharge stormwater associated with industrial activity.
Such discharges shall be controlled, limited and monitored as specified in this permit.
If industrial materials and activities are not exposed to precipitation or runoff as described
in 40 CFR §122.26(g), the facility may qualify for a No Exposure Exclusion from NPDES
stormwater discharge permit requirements. Any owner or operator wishing to obtain a No
Exposure Exclusion must submit a No Exposure Certification Notice of Intent (NO[) form to
the Division; must receive approval by the Division; must maintain no exposure conditions
unless authorized to discharge under a valid NPDES stormwater permit; and must recertify
the No Exposure Exclusion annually.
SECTION B: PERMITTED ACTIVITIES
Until this permit expires or is modified or revoked, the permittee is authorized to discharge
stormwater to the surface waters of North Carolina or separate storm sewer system that
has been adequately treated and managed in accordance with the terms and conditions of
this permit. All stormwater discharges shall be in accordance with the conditions of this
permit.
Any other point source discharge to surface waters of the state is prohibited unless it is an
allowable non-stormwater discharge or is covered by another permit, authorization, or
approval. The stormwater discharges allowed by this permit shall not cause or contribute
to violations of Water Quality Standards.
This permit does not relieve the permittee from responsibility for compliance with any
other applicable federal, state, or local law, rule, standard, ordinance, order, judgment, or
decree.
Part I Page 1 of 2

Permit No. NCS000043
SECTION C: LOCATION MAP
-- "• R Airgas USA, LLC
Goldsboro Regional Plant I �'
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NCGO00043 Airgas USA, LLC
Airgas US& LLC - Goldsboro Regional Plant
N Latltude: 350 28' 0.328" N
Longitude: 770 58' 54" W
w E County: Wayne
ReaeiVng Stream: UT to Granny Branch; UT to Mill Creek
S Index No: 27-57-20.7; 27-86-14-1-1
Stream Class: C;Sw,NSW; W5-IV;NSW
Map Scale 1.24,000 Sub -basin: 03-04-07; 03-04-06 (Neese River Basin) Fadlity Location
Part I Page 2 of 2

Permit No. NCS000043 '
PART II MONITORING, CONTROLS, AND LIMITATIONS FOR
PERMITTED DISCHARGES
SECTION A: STORMWATER POLLUTION PREVENTION PLAN
The permittee shall develop and implement a Stormwater Pollution Prevention Plan
(SPPP). The SPPP shall be maintained on site unless exempted from this requirement by
the Division. The SPPP is public information in accordance with Part 1I1, Standard
Conditions, Section E, paragraph 3 of this permit. The SPPP shall include, at a minimum,
the following items:
1. Site Overview. The Site Overview shall provide a description of the physical facility
and the potential pollutant sources that may be expected to contribute to
contamination of stormwater discharges. The Site Overview shall contain the following:
(a) A general location map (USGS quadrangle map or appropriately drafted equivalent
map), showing the facility's location in relation to transportation routes and surface
waters; the name of the receiving waters to which the stormwater outfalls
discharge, or if the discharge is to a municipal separate storm sewer system, the
name of the municipality and the ultimate receiving waters; and accurate latitude
and longitude of the points of stormwater discharge associated with industrial
activity. The general location map (or alternatively the site map) shall identify
whether any receiving waters are impaired (on the state's 303(d) list of impaired
waters) or if the site is located in a watershed for which a TMDL has been
established, and what the parameters of concern are.
(b) A narrative description of storage practices, loading and unloading activities,
outdoor process areas, dust or particulate generating or control processes, and
waste disposal practices. A narrative description of the potential pollutants that
could be expected to be present in the stormwater discharge from each outfall.
(c) A site map drawn at a scale sufficient to clearly depict: the site property boundary;
the stormwater discharge outfalls; all on -site and adjacent surface waters and
wetlands; industrial activity areas (including storage of materials, disposal areas,
process areas, loading and unloading areas, and haul roads); site topography and
finished grade; all drainage features and structures; drainage area boundaries and
total contributing area for each outfall; direction of flow in each drainage area;
industrial activities occurring in each drainage area; buildings; stormwater Best
Management Practices (BMPs); and impervious surfaces. The site map must
indicate the percentage of each drainage area that is impervious, and the site map
must include a graphic scale indication and north arrow.
(d) A list of significant spills or leaks of pollutants during the previous three (3) years
and any corrective actions taken to mitigate spill impacts.
Part 11 Page 1 of 12

Permit No. NCS000043
(e) Certification that the stormwater outfalls have been evaluated for the presence of
non-stormwater discharges. The permittee shall re -certify annually that the
stormwater outfalls have been evaluated for the presence of non-stormwater
discharges. The certification statement will be signed in accordance with the
requirements found in Part II1, Standard Conditions, Section B, Paragraph 3.
Stormwater Management Strategy. The Stormwater Management Strategy shall
contain a narrative description of the materials management practices employed which
control or minimize the stormwater exposure of significant materials, including
structural and nonstructural measures. The Stormwater Management Strategy, at a
minimum, shall incorporate the following:
(a) Feasibility Study. A review of the technical and economic feasibility of changing
the methods of operations and/or storage practices to eliminate or reduce exposure
of materials and processes to rainfall and run-on flows. Wherever practical, the
permittee shall prevent exposure of all storage areas, material handling operations,
and manufacturing or fueling operations. 4n areas where elimination of exposure is
not practical, this review shall document the feasibility of diverting the stormwater
run-on away from areas of potential contamination.
(b) Secondary Containment Requirements and Records. Secondary containment is
required for: bglk storage of liquid, materials; storage in gny amount of Section 313
of Title III of the Superfund Amendments and Reauthorization Act (SARA) water
r. rity chemicals: and storage in any amount of hazardous substances, in order to
prevent leaks and spills from contaminating stormwater runoff. A table or summary
of all such tanks and stored materials and their associated secondary containment
areas shall be maintained. If the secondary containment devices are connected to
stormwater conveyance systems, the connection shall be controlled by manually
activated valves or other similar devices (which shall be secured closed with a
locking mechanism). Any stormwater that accumulates in the containment area
shall be at a minimum visually observed for color, foam, outfali staining, visible
sheens and dry weather flow, prior to release of the accumulated stormwater.
Accumulated stormwater shall be released if found to be uncontaminated by any
material. Records documenting the individual making the observation, the
description of the accumulated stormwater, and the date and time of the release
shall be kept for a period of five (S) years. For facilities subject to a federal oil Spill
Prevention, Control, and Countermeasure Plan (SPCC), any portion of the SPCC Plan
fully compliant with the requirements of this permit may be used to demonstrate
compliance with this permit.
(c) BMP Summary. A listing of site structural and non-structural Best Management
Practices (BMPs) shall be provided. The installation and implementation of BMPs
shall be based on the assessment of the potential for sources to contribute
significant quantities of pollutants to stormwater discharges and on data collected
through monitoring of stormwater discharges. The BMP Summary shall include a
Part 11 Page 2 of 12

Permit No. NCS000043 '
written record of the specific rationale for installation and implementation of the
selected site BMPs. The BMP Summary shall be reviewed and updated annually.
3. Spill Prevention and Response Procedures. The Spill Prevention and Response
Procedures (SPRP) shall incorporate an assessment of potential pollutant sources based
on a materials inventory of the facility. Facility personnel responsible for implementing
the SPRP shall be identified in a written list incorporated into the SPRP and signed and
dated by each individual acknowledging their responsibilities for the plan. A
responsible person shall be on -site at all times during facility operations that have
increased potential to contaminate stormwater runoff through spills or exposure of
materials associated with the facility operations. The SPRP must be site stormwater
specific. Therefore, an oil Spill Prevention Control and Countermeasure plan (SPCC)
may be a component of the SPRP, but may not be sufficient to completely address the
stormwater aspects of the SPRP. The common elements of the SPCC with the SPRP may
be incorporated by reference into the SPRP.
4. Preventative Maintenance and Good Housekeeping Program. A preventative
maintenance and good housekeeping program shall be developed and implemented.
The program shall address all stormwater control systems (if applicable), stormwater
discharge outfalls, all on -site and adjacent surface waters and wetlands, industrial
activity areas (including material storage areas, material handling areas, disposal areas,
process areas, loading and unloading areas, and haul roads), all drainage features and
structures, and existing structural BMPs. The program shall establish schedules of
inspections, maintenance, and housekeeping activities of stormwater control systems,
as well as facility equipment, facility areas, and facility systems that present a potential
for stormwater exposure or stormwater pollution where not already addressed under
another element of the SPPP. Inspection of material handling areas and regular
cleaning schedules of these areas shall be incorporated into the program. Timely
compliance with the established schedules for inspections, maintenance, and
housekeeping shall be recorded and maintained in the SPPP.
5. Facility Inspections. Inspections of the facility and all stormwater systems shall occur
as part of the Preventative Maintenance and Good Housekeeping Program at a
minimum on a semi-annual schedule, once during the first half of the year (January to
June), and once during the second half Quly to December), with at least 60 days
separating inspection dates (unless performed more frequently than semi-annually).
These facility inspections are different from, and in addition to, the stormwater
discharge characteristic monitoring at the outfalls required in Part 11 B, C, and D of this
permit.
6. Employee Training. Training programs shall be developed and training provided at a
minimum on an annual basis for facility personnel with responsibilities for: spill
response and cleanup, preventative maintenance activities, and for any of the facility's
operations that have the potential to contaminate stormwater runoff. The facility
personnel responsible for implementing the training shall be identified, and their
annual training shall be documented by the signature of each employee trained.
Part 11 Page 3 of 12

Permit No. NCS000043
7. Responsible Party. The SPPP shall identify a specific position or positions responsible
for the overall coordination, development, implementation, and revision of the SPPP.
Responsibilities for all components of the SPPP shall be documented and position
assignments provided.
8. SPPP Amendment and Annual Update. The permittee shall amend the SPPP
whenever there is a change in design, construction, operation, site drainage,
maintenance, or configuration of the physical features which may have a significant
effect on the potential for the discharge of pollutants to surface waters. All aspects of
the SPPP shall be reviewed and updated on an annual basis. The annual update
shall include:
(a) an updated list of significant spills or leaks of pollutants for the previous three
(3) years, or the notation that no spills have occurred (element of the Site
Overview);
(b) a written re -certification that the stormwater outfalls have been evaluated far
the presence of non=stormwater discharges (element of the Site Overview);
(c) a documented re-evaluation of the effectiveness of the on -site stormwater
BMPs (BMP Summary element of the Stormwater Management Strategy).
(d) a review and comparison of sample analytical data to benchmark values (if
applicable) over the past year, including a discussion about Tiered Response
status. The permittee shall use the Division's Annual Summary Data
Monitoring Report (DMR) form, available from the Stormwater Permitting
Program's website (See'Monitoring Forms' here:
http://porla_l.ncd_enr.org/web/•lr/npdes-stormwater).
The Director may notify the permittee when the SPPP does not meet one or more of the
minimum requirements of the permit. Within 30 days of such notice, the permittee
shall submit a time schedule to the Director for modifying the SPPP to meet minimum
requirements. The permittee shall provide certification in writing (in accordance with
Part ill, Standard Conditions, Section B, Paragraph 3) to the Director that the changes
have been made.
9. SPPP Implementation. The permittee shall implement the Stormwater Pollution
Prevention Plan and all appropriate BMPs consistent with the provisions of this permit,
in order to control contaminants entering surface waters via stormwater.
Implementation of the SPPP shall include documentation of all monitoring,
measurements, inspections, maintenance activities, and training provided to
employees, including the log of the sampling data and of actions taken to implement
BMPs associated with the industrial activities, including vehicle maintenance activities.
Such documentation shall be kept on -site for a period of five (5) years and made
available to the Director or the Director's authorized representative immediately upon
request.
Part 11 Page 4 of 12

Permit No. NCS000043
SECTION B: ANALYTICAL MONITORING REQUIREMENTS
Analytical monitoring of stormwater discharges shall be performed as specified in Table 1.
All analytical monitoring shall be performed during a measureable storm event at each
stormwater discharge outfall (SDO). Only SDOs discharging stormwater associated with
industrial activity must be sampled (See Definitions).
A measurable storm event is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a
shorter interval is representative for local storm events during the sampling period, and the
permittee obtains approval from the local DEMLR Regional Engineer. See Definitions.
Table 1, Analytical Monitoring Requirements
Disch
surem` ent
ple
5ainple'
Characteristcs' `�
Unitse
FFden - i °
eLo__catlnn
Fly,
Total Suspended Solids (TSS)
mg/L
semi-annual f
Grab
SDO
Non -Polar Oil & Grease
Grab
SDO
[EPA Method 1664 (SGT-HEM)]
mg/L
semi-annual
H
standard
semi-annual
Grab
SDO
Total Rainfall¢
inches
semi-annual
Rain
-
Gauge
Footnotes:
1 Measurement Frequency: Twice per year (unless other provisions of this permit prompt monthly
sampling) during a measureable storm event, until either another permit is issued for this facility or until
this permit is revoked or rescinded, If the facility is monitoring monthly because of Tier Two or Three
response actions under the previous permit, the facility shall continue a monthly monitoring and
reporting'schedule in Tier Two or Tier Three status until relieved by the provisions of this permit or
the Division.
2 Grab samples shall be collected within the first 30 minutes of discharge. When physical separation between
outfalls prevents collecting all samples within the first 30 minutes, sampling shall begin within the first 30
minutes, and shall continue until completed.
3 Sample Location: Samples shall be collected at each stormwater discharge outfall (SDO) unless
representative outfall status (ROS) has been granted. A copy of the Division's letter granting ROS shall be
kept on site.
4 For each sampled measureable storm event, the total precipitation must be recorded. An on -site rain gauge
is required. Where isolated sites are unmanned for extended periods of time, a local rain gauge reading
may be substituted for an on -site i eading.
The permittee shall complete the analytical samplings in accordance with the schedule
specified below in Table 2, unless adverse weather conditions prevent sample collection
(see Adverse Weather in Definitions). Sampling is not required outside of the facility's
Part 11 Page 5 of 12

Permit No. NCS000043
normal operating hours. A minimum of 60 days must separate Period 1 and Period 2
sample dates, unless monthly monitoring has been instituted under a "Tier Two"
response. Inability to sample because of adverse weather conditions must be documented
in the SPPP and recorded on the DMR. The permittee must report the results from each
sample taken within the monitoring period (see Part I11, Section E). However, for purposes
of benchmark comparison and Tiered response actions, the permittee shall use the
analytical results from the first sample with valid results within the monitoring period.
Table 2. Monitorina Schedule
Monitoring;perio
Sample Number
Sira� ,rta�?",
Snd.
Year 1- Period 1
1
August 1, 2M
December 31, 2015
Year 1- Period 2
2
January 1, 2016
June 30, 2016
Year 2 - Period 1
3
July 1, 2016
December 31, 2016
Year 2 - Period 2
4
January 1, 2017
June 30, 2017
Year 3 - Period 1
5
July 1, 2017
December 31, 2017
Year 3 - Period 2
6
January 1, 2018
June 30, 2018
Year 4 - Period 1
7
July 1, 2018
December 31, 2018
Year 4 - Period 2
8
January_1, 2019
June 30, 2019
Year 5 - Period 1
9
July 1, 2019
December 31, 2019
Year 5 - Period 2
10
January 1, 2020
July 31; 2020
Footnotes:
1 Maintain semi-annual monitoring until either another permit is issued for this facility or until this
permit is revoked or rescinded. The perNttee must submit an application for renewal of coverage
before the submittal deadline (180 days before expiration) to be considered for renewed coverage
under the permit. The permittee must continue analytical monitoring throughout the permit
renewal process, even if a renewal permit is not issued until after expiration of this permit.
2 If no discharge occurs during the sampling period, the permittee must submit a monitoring report
indicating "No Flow" or "No Discharge" within 30 days of the end of the sampling period.
Failure to monitor semi-annually per permit terms may result in the Division requiring
monthly monitoring for all parameters for a specified time period. "No discharge" from an
outfall during a monitoring period does not constitute failure to monitor, as long as it is
properly recorded and reported.
The permittee shall compare monitoring results to the benchmark values in Table 3.
Exceedances of benchmark values require the permittee to increase monitoring, increase
management actions, increase record keeping, and/or install stormwater Best Management
Practices (BMPs) in a tiered program. See below the descriptions of Tier One, Tier Two, and
Tier Three response actions below. In the event that the Division releases the permittee from
continued monthly monitoring and reporting under Tier Two or Tier Three, the Division's
release letter may remain in effect through subsequent reissuance of this permit, unless the
release letter provides for other conditions or duration.
Part 11 Page 6 of 12

Permit No. NCS000043
Table 3. Benchmark Values for Anal 'cal Monitorin
nDischa e°Characteristcs T, ,_
�egUnis;
Benchmark
Total Suspended Solids (TSS)
mg/L
.100,
Non-Polar Oil & Grease
[EPA Method 1664 (SGT-HEM)]
mg/L
15
pH
standard
6-9
The benchmark values in Table 3 are not permit limits but should be used as guidelines for
implementation of the permittee's SPPP. An exceedance of a stormwater benchmark value
is not a permit violation; however, failure to respond to the exceedance as outlined in this
permit is a violation of permit conditions.
If: The first valid sampling results are above a benchmark value, or outside of the benchmark range, for
any parameter at any outfall;
Then: The permittee shall:
1. Conduct a stormwater management inspection of the facility within two weeks of receiving
sampling results.
2. Identify and evaluate possible causes of the benchmark value exceedance.
3. Identify potential, and select the specific feasible: source controls, operational controls, or physical
improvements to reduce concentrations of the parameters of concern, and/or to bring
concentrations within the benchmark range.
4. Implement the selected feasible actions within two months of the inspection.
S. Record each instance of a Tier One response in the SPPP. Include the date and value of the
benchmark exceedence, the inspection date, the personnel conducting the inspection, the selected
actions, and the date the selected actions were implemented.
6. Note: Benchmark exceedances for a different parameter separately trigger a tiered response.
Part 11 Page 7 of 12

Permit No. NCS000043
If: The first valid sampling results from.two consecutive monitoring periods are above the benchmark
values, or outside of the benchmark range, for an s ecific parameter at a specific discharge outfall;
Then: The permittee shall:
1. Repeat all the required actions outlined above in Tier One.
2. Immediately institute monthly monitoring and reporting for all parameters. The permittee shall
conduct monthly monitoring at every outfall where a sampling result exceeded the benchmark
value for two consecutive samples. Monthly (analytical and qualitative) monitoring shall continue
until three consecutive sample results are below the benchmark values or within benchmark range.
3. If no discharge occurs during the'sampling period, the permittee is required to submit a monthly
monitoring report indicating "No Flow" to comply with reporting requirements.
4. Alternatively, in lieu of steps 2 and 3, the permittee may, after two consecutive exceedances,
exercise the option of contacting the DEMLR Regional Engineer as provided below in Tier Three.
The Regional Engineer may direct -the response actions on the part of the permittee as provided in
Tier Three, including reduced, or additional sampling parameters or frequency.
5. Maintain a record of the Tier Two response in the SPPP.
6. Continue Tier Two response obligations throughout the permit renewal process.
If: The valid sampling results required fof the permit monitoring periods exceed the benchmark
value, or are outside the benchmark range, for any specific parameter at any specific outfall on four
occasions, the,permittee shall notify the DEMLR Regional Engineer in writing within 30 days of receipt of
the fourth analytical results;
Then: The Division may but is not limited to:
• require that the permittee revise, increase, or decrease the monitoring and reporting frequency for
some or all of the parameters herein;
• require sampling of additional;or substitute parameters;
• require the permittee to install structural stormwater controls;
• require the permittee to implement other stormwater control measures;
• require the permittee to perform upstream and downstream monitoring to characterize impacts
on receiving waters; or
• require the permittee implement site modifications to qualify for a No Exposure Exclusion;
• require the permittee to continue Tier Three obligations through the permit renewal process.
SECTION C: QUALITATIVE MONITORING REQUIREMENTS
The purpose of qualitative monitoring is to evaluate the effectiveness of the Stormwater
Pollution Prevention Plan (SPPP) and identify new potential sources of stormwater
pollution. Qualitative monitoring of stormwater outfalls must be performed during a
measurable storm event.
Qualitative monitoring requires a visual inspection of each stormwater outfall regardless of
representative outfall status. Qualitative monitoring shall be performed semi-annually as
specified in Table 4, and during required analytical monitoring events (unless the permittee
is required to perform further qualitative monitoring per the Qualitative Monitoring
Response, below). Inability to monitor because of adverse weather conditions must be
Part 11 Page 8 of 12

Permit No. NCS000043
documented in the SPPP and recorded on the Qualitative Monitoring Report form (see
Adverse Weather in Definitions). Only SDOs discharging stormwater associated with
industrial activity must be monitored (See Definitions).
In the event an atypical condition is noted at a stormwater discharge outfall, the permittee
shall document the suspected cause of the condition and any actions taken in response to
the discovery. This documentation will be maintained with the SPPP.
Table 4. Qualitative Monitorinje Requirements
Discha ge Characterimcs
'tiffs i •7P7#E� }' 7+ "%i vi(` �ifg
iiPE Y! 6;'
uencyl
� �A��Y7�%le f ✓ l .
Monitorstng�`` 1LOicatsQ F
Color
semi-annual
SDO
Odor
semi-annual
SDO
Clari
semi-annual
SDO
Floating Solids
semi-annual
SDO
Suspended Solids
semi-annual
SDO
Foam
semi-annual
SDO
Oil Sheen
semi-annual
SDO
Erosion or deposition at the outfall
semi-annual
SDO
Other obvious indicators
of stormwater pollution
semi-annual
SDO
Footnotes:
1 Monitoring Frequency: Twice per year during a measureable storm event unless other provisions of this
permit prompt monthly monitoring. See Table 2 for schedule of monitoring periods through the end of
this permitting cycle. The permittee must continue qualitative monitoring throughout the permit renewal
process until a new permit is issued.
2 Monitoring Location: Qualitative monitoring shall be performed at each stormwater discharge outfall
(SDo) regardless of representative outfall status.
A minimum of 60 days must separate monitoring dates, unless additional sampling has
been instituted as part of other analytical monitoring requirements in this permit.
If the permittee's qualitative monitoring indicates that existing stormwater BMPs are
ineffective, or that significant stormwater contamination is present, the permittee shall
investigate potential causes, evaluate the feasibility of corrective actions, and implement
those corrective actions within 60 days, per the Qualitative Monitoring Response, below.
A written record of the permittee's investigation, evaluation, and response actions shall be
kept in the Stormwater Pollution Prevention Plan.
Part II Page 9 of 12

Permit No. NCS000043
Qualitative monitoring is for the purposes of edaluating SPPP effectiveness, identifying new potential
sources of stormwater pollution, and prompting the permittee's response to pollution. If the
permittee repeatedly fails to respond effectively to correct problems identified by qualitative
monitoring, or if the discharge causes or contributes to a water quality standard violation, the
Division may but is not limited to:
• require that the permittee revise, increase, or decrease the monitoring frequency for some
or all parameters (analytical or qualitative)
• require the permittee to install structural stormwater controls;
• require the permittee to implement other stormwater coritrol measures;
• require the permittee to perform upstream and downstream monitoring to characterize
impacts on receiving waters; or
• require the permittee implement site modifications to qualify for a No Exposure Exclusion.
Part 11 Page 10 of 12

Permit No. NCS000043 -
SECTION D: ON -SITE VEHICLE MAINTENANCE MONITORING REQUIREMENTS
Facilities that have any vehicle maintenance activity occurring on -site which uses more
than 55 gallons of new motor oil per month when averaged over the calendar year
shall perform analytical monitoring as specified below in Table 5. All analytical
monitoring shall be performed during a measureable storm event at all stormwater
discharge outfalls (SDOs) that discharge stormwater runofffi-om vehicle maintenance areas,
and in accordance with the schedule presented in Table 2 (Section B).
Table S. Analytical Monitoring Requirements for On -Site Vehicle Maintenance
°Discharge Characterise s '
"'''Un'7'Meae
t
Ftre. 'uen_ 1
Sample
}T , ez
5 amp
Locations
Non -Polar Oil & Grease by
EPA Method1664 SGT-HEM
mg/L
semi-annual
Grab
SDO
Total Suspended Solids
mgZL
semi-annual
Grab
SDO
Total Rainfall4
inches
semi-annual
Rain gauge
New Motor Oil Usage
gallons/month
semi-annual
Estimate
-
Footnotes:
1 Measurement Frequency: Twice per year during a measureable storm event (unless other provisions of
the permit prompt monthly sampling), until either another permit is issued for this facility or until this
permit is revoked or rescinded. See Table 2 for schedule of monitoring periods through the end of this
permitting cycle. If the facility is monitoring monthly because of Tier Two or Three response actions
under the previous permit, the facility shall continue a monthly monitoring and reporting schedule in
Tier Two or Tier Three status until relieved by the provisions of this permit or the Division.
2 Grab samples shall be collected within the first 30 minutes of discharge. When physical separation
between outfalls prevents collecting all samples within the first 30 minutes, sampling shall be begun within
the first 30 minutes, and shall continue until completed.
3 Sample Location: Samples shall be collected at each stormwater discharge outfall (SDO) that discharges
stormwater runoff from area(s) where vehicle maintenance activities occur, unless representative outfall
status (ROS) has been granted. A copy of the letter granting ROS shall be kept on site.
4 For each sampled measureable storm event the total precipitation must be recorded. An on -site rain
gauge is required. Where isolated sites are unmanned for extended periods of time, a local rain guage may
be substituted for an on -site reading.
Failure to monitor semi-annually per permit terms may result in the Division requiring
monthly monitoring for all parameters for a specified time period, as provided in Part 11
Section B.
Monitoring results shall be compared to the benchmark values in Table 6. The benchmark
values in Table 6 are not permit limits but should be used as guidelines for the permittee's
Stormwater Pollution Prevention Plan (SPPP). Exceedances of benchmark values require
the permittee to increase monitoring, increase management actions, increase record
keeping, and/or install stormwater Best Management Practices (BMPs), as provided in Part
I1 Section B.
Part I I Page 1 l of 12

Permit No. NCS000043
Table 6. Benchmark Values for Vehicle Maintenance Analytical Monitoring
MEMOharacteristics
Units
Benchmark
Non -Polar Oil &Grease by
EPA Method1664 (SGT-HEM)
mg/L
15
Total Suspended Solids
mg/L
100
Part 11 Page 12 of 12

Permit No. NCS000043 .
PART III STANDARD CONDITIONS FOR NPDES STORMWATER INDIVIDUAL PERMITS
SECTION A: COMPLIANCE AND LIABILITY
The permittee shall comply with Limitations and Controls specified for stormwater discharges in
accordance with the following schedule:
Existing Facilities already operating but applying for permit coverage for the first time: The
Stormwater Pollution Prevention Plan shall be developed and implemented within 12 months of the
effective date of the initial permit and updated thereafter on an annual basis. Secondary
containment, as specified in Part 11, Section A, Paragraph 2(b) of this permit, shall be accomplished
within 12 months of the effective date of the initial permit issuance.
New Facilities applying for coverage for the first time: The Stormwater Pollution Prevention Plan
shall be developed and implemented prior to the beginning of discharges from the operation of the
industrial activity and be updated thereafter on an annual basis. Secondary containment, as specified
in Part II, Section A, Paragraph 2(b) of this permit shall be accomplished prior to the beginning of
stormwater discharges from the operation of the industrial activity.
Existing facilities previously permitted and applying for renewal: All requirements, conditions,
limitations, and controls contained in this permit (except new SPPP elements in this permit renewal)
shall become effective immediately upon issuance of this permit New elements of the Stormwater
Pollution Prevention Plan for this permit renewal shall be developed and implemented within 6
months of the effective date of this permit and updated thereafter on an annual basis. Secondary
containment, as specified in Part 11, Paragraph 2(b) of this permit shall be accomplished prior to the
beginning of stormwater discharges from the operation of the industrial activity.
The permittee must comply with all conditions of this permit Any permit noncompliance constitutes
a violation of the Clean Water Act (CWA) and is grounds for enforcement action; for permit
termination, revocation and reissuance, or modification; or denial of a permit upon renewal
application [40 CFR 122.41].
The permittee shall comply with standards or prohibitions established under section 307(a) of
the CWA for toxic pollutants within the time provided in the regulations that establish these
standards or prohibitions, even if the permit has not yet been modified to incorporate the
requirement [40 CFR 122.41].
The CWA provides that any person who violates section[s] 301, 302, 306, 307, 308, 318 or 405 of
the Act, or any permit condition or limitation implementing any such sections in a permit issued
under section 402, or any requirement imposed in a pretreatment program approved under
sections 402(a)(3) or 402(b)(8) of the Act, is subject to a civil penalty not to exceed $37,500 per
day for each violation [33 USC 1319(d) and 40 CFR 122.41(a)(2)).
The CWA provides that any person who negligently violates sections 301, 302, 306, 307, 308,
318, or 405 of the Act, or any condition or limitation implementing any of such sections in a
permit issued under section 402 of the Act, or any requirement imposed in a pretreatment
program approved under section 402(a)(3) or 402(b) (8) of the Act, is subject to criminal
penalties of $2,500 to $25,000 per day of violation, or imprisonment of not more than 1 year, or
both. In the case of a second or subsequent conviction for a negligent violation, a person shall be
subject to criminal penalties of not more than $50,000 per day of violation, or by imprisonment
of not more than 2 years, or both [33 USC 1319(c)(1) and 40 CFR 122.41(a)(2)].
Part III Page 1 of 9

Permit No. NCS000043
d. Any person who knowingly violates such sections, or such conditions or limitations is subject to
criminal penalties of $5,000 to $50,000 per day of violation, or imprisonment for not more than 3
years, or both. In the case of a second or subsequent conviction for a knowing violation, a person
shall be subject to criminal penalties of not more than $100,000 per day of violation, or
imprisonment of not more than 6 years, or both [33 USC 1319(c)(2) and 40 CFR 122.41(a)(2)].
e. Any person who knowingly violates section 301, 302, 303, 306, 307, 308,318 or 405 of the Act,
or any permit condition or Iimitation implementing any of such sections in a permit issued under
section 402 of the Act, and who knows at that time that he thereby places another person in
imminent danger of death or serious bodily injury, shall, upon conviction, be subject to a fine of
not more than $250,000 or imprisonment of not more than 15 years, or both. In the case of a
second or subsequent conviction for a knowing endangerment violation, a person shall be
subject to a fine of not more than $500,000 or by imprisonment of not more than 30 years, or
both. An organization, as defined in section 309(c)(3)(B)(iii) of the CWA, shall, upon conviction
of violating the imminent danger provision, be subject to a fine of not more than $1,000,000 and
can be fined up to $2,000,000 for second or subsequent convictions [40 CFR 122.41(a)(2)].
f. Under state law, a civil penalty of not more than $25,000 per violation may be assessed against
any person who violates or fails to act in accordance with the terms, conditions, or requirements
of a permit [North Carolina General Statutes § 143-215.6A].
g. Any person may be assessed an administrative penalty by the Administrator for violating section
301, 302, 306, 307, 308, 318 or 405 of this Act, or any permit condition or limitation
implementing any of such sections in a permit issued under section 402 of this Act.
Administrative penalties for Class I violations are not to exceed $16,000 per violation, with the
maximum amount of any Class I penalty assessed not to exceed $37,500. Penalties for Class 11
violations are not to exceed $16,000 per day for each day during which the violation continues,
with the maximum amount of any Class 11 penalty not to exceed $177,500 [33 USC 1319(g)(2)
and 40 CFR 122.41(a)(3)].
3. Duty to Mitigate
The permittee shall take all reasonable steps to minimize or prevent any discharge in violation of this
permit which has a reasonable likelihood of adversely affecting human health or the environment [40
CFR 122.41(d)].
4. Ci3dl,and Criminal Liability
Except as provided in Part 111, Section C of this permit regarding bypassing of stormwater control
facilities, nothing in this permit shall be construed to relieve the permittee from any responsibilities,
liabilities, or penalties for noncompliance pursuant to NCGS 143-215.3,143-215.6, or Section 309 of the
Federal Act, 33 USC 1319. Furthermore, the permittee is responsible for consequential damages,
such as fish ]ills, even though the responsibility for effective compliance may be temporarily
suspended.
Oil and Hazardous Substance Liability
Nothing in this permit shall be construed to preclude the institution of any legal action or relieve the
permittee from any responsibilities, liabilities, or penalties to which the permittee is or may be
subject to under NCGS 143-215.75 et seq. or Section 311 of the Federal Act, 33 USC 1321.
6. Property Rights
The issuance of this permit does not convey any property rights in either real or personal property,
or any exclusive privileges, nor does it authorize any injury to private property or any invasion of
personal rights, nor any infringement of federal, state or local laws or regulations [40 CFR 122.41(g)].
Part III Page 2 of 9

Permit No. NCS000043 ,
7. Severability
The provisions of this permit are severable, and if any provision of this permit, or the application of
any provision of this permit to any circumstances, is held invalid, the application of such provision to
other circumstances, and the remainder of this permit, shall not be affected thereby [NCGS 15013-23].
8. Duty to Provide Information
The permittee shall furnish to the Permit Issuing Authority, within a reasonable time, any
information which the Permit Issuing Authority may request to determine whether cause exists for
modifying, revoking and reissuing, or terminating the permit issued pursuant to this permit or to
determine compliance with this permit The permittee shall also furnish to the Permit Issuing
Authority upon request, copies of records required to be kept by this permit [40 CFR 122.41(h)].
9. Penalties for Tampering
The Clean Water Act provides that any person who falsifies, tampers with, or knowingly renders
inaccurate, any monitoring device or method required to be maintained under this permit shall, upon
conviction, be punished by a fine of not more than $10,000 per violation, or by imprisonment for not
more than two years per violation, or by both. If a conviction of a person is for a violation committed
after a first conviction of such person under this paragraph, punishment is a fine of not more than
$20,000 per day of violation, or by imprisonment of not more than 4 years, or both [40 CPR 122.41].
10. Penalties for Falsification, gf Reports
The Clean Water Act provides that any person who knowingly makes any false statement,
representation, or certification in any record or other document submitted or required to be
maintained under this permit, including monitoring reports or reports of compliance or
noncompliance shall, upon conviction, be punished by a fine of not more than $10,000 per violation,
or by imprisonment for not more than two years per violation, or by both [40 CFR 122.41].
11. QnshorC gr Offshore Construction
This permit does not authorize or approve the construction of any onshore or offshore physical
structures or facilities or the undertaking of any work in any navigable waters.
12. Duly to Rea.p&
If the permittee wishes to continue an activity regulated by this permit after the expiration date of
this permit, the permittee must apply for and obtain a new permit [40 CFR 122.41(b)].
SECTION B: GENERAL CONDITIONS
1. Permit Expiration
The permittee is not authorized to discharge after the expiration date. In order to receive automatic
authorization to discharge beyond the expiration date, the permittee shall submit forms and fees as
are required by the agency authorized to issue permits no later than 180 days prior to the
expiration date, unless permission for a later date has been granted by the Director. (The Director
shall not grant permission for applications to be submitted later than the expiration date of the
existing permit) [40 CFR 122.21(d)]. Any permittee that has not requested renewal at least 180 days
prior to expiration, or any permittee that does not have a permit after the expiration and has not
requested renewal at least 180 days prior to expiration, will be subjected to enforcement procedures
as provided in NCGS §143-215.35 and 33 USC 1251 et seq.
Part II I Page 3 of 9

Permit No. NCS000043
2. Transfers
This permit is not transferable to any person without prior written notice to and approval from the
Director in accordance with 40 CFR 122.61. The Director may condition approval in accordance with
NCGS 143-215.1, in particular NCGS 143-215.1(b)(4)b.2., and may require modification or revocation
and reissuance of the permit, or a minor modification, to identify the new permittee and incorporate
such other requirements as maybe necessary under the CWA [40 CFR 122.41(I)(3),122.61] or state
statute. The Permittee is required to notify the Division in writing in the event the permitted
facility is sold or closed.
3. Signatory Requirements
All applications, reports, or information submitted to the Permitting Issuing Authority shall be signed
and certified [40 CFR 122.41(k)].
a. All permit applications shall be signed as follows:
(1) For a corporation: by a responsible corporate officer. For the purpose of this Section, a
responsible corporate officer means: (a) a president, secretary, treasurer or vice president
of the corporation in charge of a principal business function, or any other person who
performs similar policy or decision making functions for the corporation, or (b) the manager
of one or more manufacturing, production, or operating facilities, provided, the manager is
authorized to make management decisions which govern the operation of the regulated
facility including having the explicit or implicit duty of making major capital investment
recommendations, and initiating and directing other comprehensive measures to assure
long term environmental compliance with environmental laws and regulations; the manager
can ensure that the necessary systems are established or actions taken to gather complete
and accurate information for permit application requirements; and where authority to sign
documents has been assigned or delegated to the manager in accordance with corporate
procedures.
(2) For a partnership or sole proprietorship: by a general partner or the proprietor,
respectively; or
(3) For a municipality, state, federal, or other public agency: by either a principal executive
officer or ranking elected official [40 CFR 122.22).
b. All reports required by the permit and other information requested by the Permit Issuing
Authority shall be signed by a person described in paragraph a. above or by a duly authorized
representative of that person. A person is a duly authorized representative only if:
(1) The authorization is made in writing by a person described above;
(2) The authorization specified either an individual or a position having responsibility for the
overall operation of the regulated facility or activity, such as the position of plant manager,
operator of a well or well field, superintendent, a position of equivalent responsibility, or an
individual or position having overall responsibility for environmental matters for the company.
(A duly authorized representative may thus be either a named individual or any individual
occupying a named position.); and
(3) The written authorization is submitted to the Permit Issuing Authority [40 CFR 122.221.
c. Changes to authorization: If an authorization under paragraph (b) of this section is no longer
accurate because a different individual or position has responsibility for the overall operation of
the facility, a new authorization satisfying the requirements of paragraph (b) of this section must
be submitted to the Director prior to or together with any reports, information, or applications to
be signed by an authorized representative [40 CFR 122.22].
Part Ill Page 4 of 9

Permit No. NCS000043
d. Certification. Any person signing a document under paragraphs a. or b. of this section, or
submitting an electronic report (e.g., eDMR), shall make the following certification [40 CFR
122.221. NO OTHER STATEMENTS OF CERTIFICATION WILL BE ACCEPTED:
"I certify, under penalty of law, that this document and all attaehments were prepared under my
direction orsupervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or
persons who manage the system, or those persons directly responsible forgathering the
information, the information submitted is, to the best of my knowledge and belief, true, accurate,
and complete. I am aware that there are significant penalties forsubmitting false information,
including the possibility of fines and imprisonment for knowing violations "
e. Electronic Reports. All electronic reports (e.g., eDMRs) submitted to the Permit Issuing
Authority shall be signed by a person described in paragraph a. above or by a duly authorized
representative of that person as described in paragraph b. A person, and not a position, must be
delegated signatory authority for eDMR or other electronic reporting purposes.
The Permit Issuing Authority may require the permittee to begin reporting monitoring data
electronically during the term of this permit The permittee may be required to use North
Carolina's Electronic Discharge Monitoring Report (eDMR) internet application for that purpose.
For eDMR submissions, the person signing and submitting the eDMR must obtain an eDMR user
account and login credentials to access the eDMR system.
4. Permit Modification, Revocation and Reissuance. or Termination
The issuance of this permit does not prohibit the Permit issuing Authority from reopening and
modifying the permit, revoking and reissuing the permit, or terminating the permit as allowed by the
laws, rules, and regulations contained in Title 40, Code of Federal Regulations, Parts 122 and 123;
Title 15A of the North Carolina Administrative Code, Subchapter 21-1.0100; and North Carolina
General Statute 143-215.1 et al.
Permit Actions
The permit may be modified, revoked and reissued, or terminated for cause. The notification of
planned changes or anticipated noncompliance does not stay any permit condition [40 CFR
122.41(f)].
5. Annual Administering and Compliance Monitoring Fee Requirements
The permittee must pay the administering and compliance monitoring fee within 30 (thirty) days
after being billed by the Division. Failure to pay the fee in timely manner in accordance with 15A
NCAC 2H .0105(b)(2) may cause the Division to initiate action to revoke the permit.
SECTION C: OPERATION AND MAINTENANCE OF POLLUTION CONTROLS
Proper Operation and Maintenance
The permittee shall at all times properly operate and maintain all facilities and systems of treatment
and control (and related appurtenances) which are installed or used by the permittee to achieve
compliance with the conditions of this permit. Proper operation and maintenance also includes
adequate laboratory controls and appropriate quality assurance procedures, This provision requires
the operation of back-up or auxiliary facilities or similar systems which are installed by a permittee
only when the operation is necessary to achieve compliance with the conditions of this permit [40
CFR 122.41(e)].
2. Need to Halt or Reduce Not a Defense
It shall not be a defense for a permittee in an enforcement action that it would have been necessary
to halt or reduce the permitted activity in order to maintain compliance with the condition of this
permit [40 CFR 122.41(c)].
PartI I I Page 5 of 9

Permit No. NCS000043
Bypassing of Stormwater Control Facilities
Bypass is prohibited and the Director may take enforcement action against a permittee for bypass
unless:
a. Bypass was unavoidable to prevent loss of life, personal injury or severe property damage; and
b. There were no feasible alternatives to the bypass, such as the use of auxiliary control facilities,
retention of stormwater, or maintenance during normal periods of equipment downtime or dry
weather. This condition is not satisfied if adequate backup controls should have been installed in
the exercise of reasonable engineering judgment to prevent a bypass which occurred during
normal periods of equipment downtime or preventive maintenance; and
c. The permittee submitted notices as required under, Part III, Section E of this permit
If the Director determines that it will meet the three conditions listed above, the Director may
approve an anticipated bypass after considering its adverse effects.
SECTION D. MONITORING AND RECORDS
Representative Sampling
Samples collected and measurements taken; as required herein, shall be characteristic of the volume
and nature of the permitted discharge. Analytical sampling shall be performed during a measureable
storm event Samples shall be taken on a day and time that is characteristic of the discharge. All
samples shall be taken before the discharge joins or is diluted by any other waste stream, body of
water, or substance. Monitoring points as specified in this permit shall not be changed without
notification to and approval of the Permit Issuing Authority [40 CFR 122.41(j)].
2. Recording Results
For each measurement or sample taken pursuant to the requirements of this permit, the permittee
shall record the following information [40 CFR 122.41]:
a. The date, exact place, and time of sampling or measurements;
b. The individual(s) who performed the sampling or measurements;
c. The date(s) analyses were performed;
d. The individual(s) who performed the analyses;
e. The analytical techniques or methods used; and
f. The results of such analyses.
Flow Measurements
Where required, appropriate flow measurement devices and methods consistent with accepted
scientific practices shall be selected and used to ensure the accuracy and reliability of measurements
of the volume of monitored discharges.
4. Test Procedures
Test procedures for the analysis of pollutants shall conform to the EMC regulations published
pursuant to NCGS 143-215.63 et. seq, the Water and Air Quality Reporting Acts, and to regulations
published pursuant to Section 304(g), 33 USC 1314, of the Federal Water Pollution Control Act, as
Amended, and Regulation 40 CFR 136.
To meet the intent of the monitoring required by this permit, all test procedures must produce
minimum detection and reporting levels and all data generated must be reported down to the
minimum detection or lower reporting level of the procedure. if no approved methods are
determined capable of achieving minimum detection and reporting levels below permit discharge
requirements, then the most sensitive (method with the lowest possible detection and reporting
level) approved method must be used.
Part III Page 6 of 9

Permit No. NCS000043
Representative Outfall
If a facility has multiple discharge locations with substantially identical stormwater discharges that
are required to be sampled, the permittee may petition the Director for representative outfall status.
If it is established that the stormwater discharges are substantially identical and the permittee is
granted representative outfall status, then sampling requirements may be performed at a reduced
number of outfalls.
6. Records Retention
Visual monitoring shall be documented and records maintained at the facility along with the
Stormwater Pollution Prevention Plan. Copies of analytical monitoring results shall also be
maintained on -site. The permittee shall retain records of all monitoring information, including
o all calibration and maintenance records,
o all original strip chart recordings for continuous monitoring instrumentation,
o copies of all reports required by this permit, including Discharge Monitoring Reports (DMRs)
and eDMR or other electronic DMR report submissions,
o copies of all data used to complete the application for this permit
These records or copies shall be maintained for a period of at least S years from the date of the
sample, measurement, report or application. This period may be extended by request of the Director
at any time [40 CFR 122.411.
7. Inspection and Entry
The permittee shall allow the Director, or an authorized representative (including an authorized
contractor acting as a representative of the Director), or in the case of a facility which discharges
through a municipal separate storm sewer system, an authorized representative of a municipal
operator or the separate storm sewer system receiving the discharge, upon the presentation of
credentials and other documents as may be required by law, to:
a. Enter upon the permittee's premises where a regulated facility or activity is located or conducted,
or where records must be kept under the conditions of this permit;
b. Have access to and copy, at reasonable times, any records that must be kept under the conditions
of this permit;
c. Inspect at reasonable times any facilities, equipment (including monitoring and control
equipment), practices, or operations regulated or required under this permit; and
d. Sample or monitor at reasonable times, for the purposes of assuring permit compliance or as
otherwise authorized by the Clean Water Act, any substances or parameters at any location [40
CFR 122.41(i)].
SECTION E: REPORTING REQUIREMENTS
Samples analyzed in accordance with the terms of this permit shall be submitted to the Division on
Discharge Monitoring Report (DMR) forms provided by the Director or submitted electronically to
the appropriate authority using an approved electronic DMR reporting system (e.g., eDMR). DMR
forms are available on the Division's website httl2:Ilportal.ncdenr.org/webllr/ni2des-sLQUnwa=),
Regardless of the submission method (paper or electronic), submittals shall be delivered to the
Division or appropriate authority no later than 30 days from the date the facility receives the
sampling results from the laboratory.
Part III Page 7 of 9

Permit No. NCS000043
When no discharge has occurred from the facility during the report period, the permittee is required
to submit a discharge monitoring report, within 30 days of the end of the specified sampling period,
giving all required information and indicating "NO FLOW" as per NCAC T15A 02B .0506.
If the permittee monitors any pollutant more frequently than required by this permit using test
procedures approved under 40 CFR Part 136 and at a sampling location specified in this permit or
other appropriate instrument governing the discharge, the results of such monitoring shall be
included in the data submitted on the DMR.
The permittee shall record the required qualitative monitoring observations on the SDO Qualitative
Monitoring Report form provided by the Division and shall retain the completed forms on site.
Qualitative monitoring results should not be submitted to the Division, except upon the Division's
specific requirement to do so. Qualitative Monitoring Report forms are available at the website
above.
2. Submitting Reports
Two signed copies of Discharge Monitoring Reports (DMRs) shall be submitted to:
Central Files
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
The Permit Issuing Authority may require the permittee to begin reporting monitoring data
electronically during the term of this permit. The permittee may be required to use North Carolina's
eDMR internet application for that purpose. Until such time that the state's eDMR application is
compliant with.EPA's Cross -Media Electronic Reporting Regulation (CROMERR), permittees will be
required to submit all discharge monitoring data to the state electronically using eDMR and will be
required to complete the eDMR submission by printing, signing, and submitting one signed
original and a copy of the computer printed eDMR to the address above.
3. Availability of Reports
Except for data determined to be confidential under NCGS 143-215.3(a)(2) or Section 308 of the
Federal Act, 33 USC 1318, all reports prepared in accordance with the terms of this permit shall be
available for public inspection at the offices of the Division. As required by the Act, analytical data
shall not be considered confidential. Knowingly making any false statement on any such report may
result in the imposition of criminal penalties as provided for in NCGS 143-215.613 or in Section 309 of
the Federal Act.
4. Non-Stormwater Discharges
If the storm event monitored in accordance with this permit coincides with a non-stormwater
discharge, the permittee shall separately monitor all parameters as required under all other
applicable discharge permits and provide this information with the stormwater discharge
monitoring report
Planned Chances
The permittee shall give notice to the Director as soon as possible of any planned changes at the
permitted facility which could significantly alter the nature or quantity of pollutants discharged [40
CFR 122.41(1)]. This notification requirement includes pollutants which are not specifically listed in
the permit or subject to notification requirements under 40 CFR Part 122,42 (a).
6. Anticipated Noncompliance
The permittee shall give advance notice to the Director of any planned changes at the permitted
facility which may result in noncompliance with the permit (40 CFR 122.41(1)(2)].
Part III Page 8 of 9

Permit No. NCS000043
bm
The permittee shall report to the local DEMLR Regional Office, within 24 hours, all significant spills
as defined in Part IV of this permit Additionally, the permittee shall report spills including: any oil
spill of 25 gallons or more, any spill regardless of amount that causes a sheen on surface waters, any
oil spill regardless of amount occurring within 100 feet of surface waters, and any oil spill less than
25 gallons that cannot be cleaned up within 24 hours.
8. Bypass
Notice [40 CFR 122.41(m)(3)1:
a. Anticipated bypass. If the permittee knows in advance of the need for a bypass, it shall submit
prior notice, if possible at least ten days before the date of the bypass; including an evaluation of
the anticipated quality and effect of the bypass.
b. Unanticipated bypass. The permittee shall submit notice within 24 hours of becoming aware of
an unanticipated bypass.
9. Twenty-four Hour Reporting
a. The permittee shall report to the central office or the appropriate regional office any
noncompliance which may endanger health or the environment Any information shall be
provided orally within 24 hours from the time the permittee became aware of the circumstances.
A written submission shall also be provided within 5 days of the time the permittee becomes
aware of the circumstances.
The written submission shall contain a description of the noncompliance, and its causes; the
period of noncompliance, including exact dates and times, and if the noncompliance has not
been corrected, the anticipated time compliance is expected to continue; and steps taken or
planned to reduce, eliminate, and prevent reoccurrence of the noncompliance [40 CFR
122.41(1) (6)].
b. The Director may waive the written report on a case -by -case basis for reports under this section
if the oral report has been received within 24 hours.
c. Occurrences outside normal business hours may also be reported to the Division's Emergency
Response personnel at [phone], [phone] or [phone].
10. Other Noncompliance
The permittee shall report all instances of noncompliance not reported under 24 hour reporting at
the time monitoring reports are submitted [40 CFR 122.41(1)(7)].
11. Other Information
Where the Permittee becomes aware that it failed to submit any relevant facts in a permit
application, or submitted incorrect information in a permit application or in any report to the
Director, it shall promptly submit such facts or information [40 CFR 122.41(1)(8)].
Part III Page 9 of 9

NCS000043
PART IV DEFINITIONS
1. Aa
See Clean Water Act.
2. Adverse Weather
Adverse conditions are those that are dangerous or create inaccessibility for personnel, such as local
flooding, high winds, or electrical storms, or situations that otherwise make sampling impractical.
When adverse weather conditions prevent the collection of samples during the sample period, the
permittee must take a substitute sample or perform a visual assessment during the next qualifying
storm event. Documentation of an adverse event (with date, time and written narrative) and the
rationale must be included with your SPPP records. Adverse weather does not exempt the permittee
from having to file a monitoring report in accordance with the sampling schedule. Adverse events
and failures to monitor must also be explained and reported on the relevant DMR.
3. Allowable Non-Stormwater Discharges
This permit regulates stormwater discharges. However, non-stormwater discharges which shall be
allowed in the stormwater conveyance system include:
a. All other discharges that are authorized by a non-stormwater NPDES permit.
b. Uncontaminated groundwater, foundation drains, air -conditioner condensate without added
chemicals, springs, discharges of uncontaminated potable water, waterline and fire hydrant
flushings, water from footing drains, flows from riparian habitats and wetlands.
c. Discharges resulting from fire -fighting or fire -fighting training, or emergency shower or eye
wash as a result of use in the event of an emergency.
4. Best Management Practices (BMPs)
Measures or practices used to reduce the amount of pollution entering surface waters. BMPs may
take the form of a process, activity, or physical structure. More information on BMPs can be found at:
http: / /cfp ub.epa.gov /npdeslstormwaterlmenuofbmi2s lind ex.cfmcfm.
5. Bypass
A bypass is the known diversion of stormwater from any portion of a stormwater control facility
including the collection system, which is not a designed or established operating mode for the facility.
6. Bulk Storage of Liquid Products
Liquid raw materials, intermediate products, manufactured products, waste materials, or by-
products with a single above ground storage container having a capacity of greater than 660 gallons
or with multiple above ground storage containers located in close proximity to each other having a
total combined storage capacity of greater than 1,320 gallons.
7. Certificate of Coverage
The Certificate of Coverage (COC) is the cover sheet which accompanies a General Permit upon
issuance and lists the facility name, location, receiving stream, river basin, effective date of coverage
under any General Permit and is signed by the Director.
B. Clean Water Act
The Federal Water Pollution Control Act, also known as the Clean Water Act (CWA), as amended, 33
USC 1251, et. seq.
9. Division or DEMLR
The Division of Energy, Mineral, and Land Resources, Department of Environment and Natural
Resources.
Part 1V Page 1 of 4

Permit No. NCS000043
r
10, Direct
The Director of the Division of Energy, Mineral, and Land Resources, the permit issuing authority.
11. �
The North Carolina Environmental Management Commission.
12. Grab Samu]g
An individual sample collected instantaneously. Grab samples that will be analyzed (quantitatively
or qualitatively) must be taken within the first 30 minutes of discharge.
13.
Any substance designated under 40 CFR Part 116 pursuant to Section 311 of the Clean Water Act
14. Landfill
A disposal facility or part of a disposal facility where waste is placed in or on land and which is not a
land treatment facility, a surface impoundment, an injection well, a hazardous waste long-term
storage facility or a surface storage facility.
15. MeaSUCCgble Storm Event
A storm event that results in an actual discharge from the permitted site outfall. The previous
measurable storm event must have been at least 72 hours prior. The 72-hour storm interval may not
apply if the permittee is able to document that a shorter interval is representative for local storm
events during the sampling period, and obtains approval from the local DEMLR Regional Office. Two
copies of this information and a written request letter shall be sent to the local DEMLR Regional
Office. After authorization by the DEMLR Regional Office, a written approval letter must be kept on
site in the permittee's SPPP.
16.
A Stormwater collection system within an incorporated area of local self-government such as a city or
town.
17. No Exposure
A condition of no exposure means that all industrial materials and activities are protected by a storm
resistant shelter or acceptable storage containers to prevent exposure to rain, snow, snowmelt, or
runoff. Industrial materials or activities include, but are not limited to, material handling equipment
or activities, industrial machinery, raw materials, intermediate products, by-products, final products,
or waste products [40 CFR 122.26 (b)(14)]. DEMLR may grant a No Exposure Exclusion from NPDES
Stormwater Permitting requirements only if facility complies with the terms and conditions
described in 40 CFR §122.26(g).
18. Notice of Intent
The state application form which, when submitted to the Division, officially indicates the facility's
notice of intent to seek coverage under a General Permit
19. Permit Issuing Authority
The Director of the Division of Energy, Mineral, and Land Resources (see "Director" above).
20. Egrmittee
The owner or operator issued this permit
21. Point Source Discharge of Stormwater
Any discernible, confined and discrete conveyance including, but not specifically limited to, any pipe,
ditch, channel, tunnel, conduit, well, or discrete fissure from which Stormwater is or may be
discharged to waters of the state.
Part IV Page 2 of 4 Pages

Permit No. NCS000043
22. Representative Outfall Status
When it is established that the discharge of stormwater runoff from a single outfall is representative of the
discharges at multiple outfalls, the Division may grant representative outfall status. Representative outfall
status allows the permittee to perform analytical monitoring at a reduced number of outfalls.
23. Secondary Containment
Spill containment for the contents of the single largest tank within the containment structure plus
sufficient freeboard to contain the 25-year, 24-hour storm event.
24. Section 313 WaWE Priority Chemical
A chemical or chemical category which:
b. Is listed in 40 CFR 372.65 pursuant to Section 313 of Title III of the Superfund Amendments and
Reauthorization Act (SARA) of 1986, also titled the Emergency Planning and Community Right -
to -Know Act of 1986;
c. Is present at or above threshold levels at a facility subject to SARA title III, Section 313 reporting
requirements; and
d. Meets at least one of the following criteria:
i. Is listed in appendix D of 40 CFR part 122 on Table 11(organic priority pollutants), Table
III (certain metals, cyanides, and phenols) or Table IV (certain toxic pollutants and
hazardous substances);
ii. Is listed as a hazardous substance pursuant to section 311(b)(2)(A) of the CWA at 40 CFR
116.4; or
iii. Is a pollutant for which EPA has published acute or chronic water quality criteria.
25. Severe Proper Damage
Substantial physical damage to property, damage to the control facilities which causes them to
become inoperable, or substantial and permanent loss of natural resources which can reasonably be
expected to occur in the absence of a bypass. Severe property damage does not mean economic loss
caused by delays in production.
26. Significant Materials
Includes, but is not limited to: raw materials; fuels; materials such as solvents, detergents, and plastic
pellets; finished materials such as metallic products; raw materials used in food processing or
production; hazardous substances designated under section. 101 (14) of CERCLA; any chemical the
facility is required to report pursuant to section 313 of Title III of SARA; fertilizers; pesticides; and
waste products such as ashes, slag and sludge that have the potential to be released with stormwater
discharges.
27. Significant SO 1-,z
Includes, but is not limited to: releases of oil or hazardous substances in excess of reportable
quantities under section 311 of the Clean Water Act (Ref: 40 CFR 110.3and 40 CFR 117.3) or section
102 of CERCLA (Ref: 40 CFR 302.4).
28. Stormwater Discharge Outfall (SDO)
The point of departure of stormwater from a discernible, confined, or discrete conveyance, including
but not limited to, storm sewer pipes, drainage ditches, channels, spillways, or channelized collection
areas, from which Stormwater flows directly or indirectly into waters of the State of North Carolina.
29. Stormwater Runoff
The flow of water which results from precipitation and which occurs immediately following rainfall
or as a result of snowmelt.
Part IV Page 3 of 4 Pages

Permit No. NCS000043
30. Stormwater Associalcd with Industrial Activity_
The discharge from any point source which is used for collecting and conveying stormwater and
which is directly related to manufacturing, processing or raw material storage areas at an industrial
site. Facilities considered to be engaged in "industrial activities" include those activities defined in
40 CFR 122.26(b)(14). The term does not include discharges from facilities or activities excluded
from the NPDES program.
31. Stormwater Pollution Prevention Plan
A comprehensive site -specific plan which details measures and practices to reduce stormwater
pollution and is based on an evaluation of the pollution potential of the site.
32. Total Maximum Daily Load (T,P'
TMDLs are written plans for attaining and maintaining water quality standards, in all seasons, for a
specific water body and pollutant A list of approved TMDLs for the state of North Carolina can be
found at htW:///nortal.ncdenr.org,/web/wa/ns/mtu/tmdl.
33. TQxjr, Pollutant
Any pollutant listed as toxic under Section 307(a)(1) of the Clean Water Act
i
34. y_Cbj,Cle Maintenance Activity
Vehicle rehabilitation, mechanical repairs, painting, fueling, lubrication, vehicle cleaning operations,
or airport deicing operations.
35. Visible Sedimentation
Solid particulate matter, both mineral and organic, that has been or is being transported by water,
air, gravity, or ice from its site of origin which can be seen with the unaided eye.
36. 25--nar. 24 hour Storm Event
The maximum 24-hour precipitation event expected to be equaled or exceeded, on the average, once
in 25 years.
Part IV Page 4 of 4 Pages

Ventaloro, Julie
From: Rob Duffy [Rob. [e-mail]]
Sent: Tuesday, March 10, 2015 11:57 AM
To: Ventaloro, Julie
Subject: RE: Name/Ownership Change form - NPDES Stormwater permit
Attachments: NPDES- Name-Owner-Change-20120423-DWQ-SPU.doc; NPDES-Name-Owner-Change-
DEMLR-SW.pdf
Follow Up Flag: Follow up
Flag Status: Flagged
Hi Julie,
Attached is the completed Name/Ownership Change Form — original in Word and signed in pdf. Please let me know if
you need anything else or if you have any questions.
Thanks again for all of your help,
Rob
Rob Duffy I Senior Project Manager I USA
Antea®Group
Direct: [phone] f Mobile: [phone]
8008 Corporate Center Drive, Suite 100 Charlotte, NC 28226
[e-mail] .I www.Anteagroup.com
anteagroup
Member of InogenO I www.inoizenet.com
From: Ventaloro, Julie[mailto:[e-mail]]
Sent: Thursday, March 05, 2015 11:15 AM
To: Rob Duffy
Subject: FW: Name/Ownership Change form - NPDES Stormwater permit
Rob,
I forgot to mention that.you don't need to worry about getting the signature of the last permit holder as instructed on
Page 2 of the ownership change form. That will not be necessary for us to move ahead with the renewal.
Julie
From: Ventaloro, Julie
Sent: Wednesday, March 04, 2015 3:33 PM
To: '[e-mail]'
Subject: Name/Ownership Change form - NPDES Stormwater permit
Rob,

z. -,
As we discussed, attached is a name/ownership change form for NPDE5 stormwater permits. I will update our database
with the most current owner and facility information and proceed with the permit renewal process once I receive the
signed form.
Here's what we have on record now (you'll use this for Section 11 of the form):
Permit No. NCS000043
Permit issued to: National Welders Supply Company, Inc.
Person legally responsible for permit: Mr. John Harris, V.P, Packaged Gas Operations, 109 Hinnant Rd, Goldsboro, NC
27530
Facility name: Airgas National. Welders — Loxco Division
Facility address: Highway 117 North, Goldsboro, NC
Facility contact person: Robbie Chase, 919-735-5315
From our conversation, it sounds like there has been a change in ownership, and the facility name has changed.
For your convenience in filling out the ownership change form, here is the information that was provided on the renewal
application:
Owner/Organization Name: Airgas, LLC
Owner Contact: Jerrell Cook (owner contact = person legally responsible for permit)
Owner Mailing Address: 5313 Old Dowd Rd, Charlotte, NC 28208
Owner Phone #: [phone]
Facility Name: Airgas, LLC
Facility address: 109 Hinnant Rd, NW, Goldsboro, NC 27530
Permit Contact: Jerrell Cook
Thanks for your assistanceI
Julie Ventaloro
Stormwater Permitting Program
NC Division of Energy, Mineral, and Land Resources
1612 Mail Service Center, Raleigh, NC 27699-i6iz
Phone: [phone]o Fax: [phone]
Website: http://watersupllywatershed.nc.go
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third
parties.
This e-mail is personal. For our full disclaimer, please visit http://www.anteagroup.com/confidentiality.

Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
NCDENR
National Pollutant Discharge Elimination System
PERMIT NAMEIOWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
ate Reeeived
Year
I Month Da
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Covera e
0 10 10 4 3EIAM
II. Permit status prior to requested change.
a. Permit issued to (company name): NATIONAL WELDERS SUPPLY COMPANY INC
b. Person legally responsible for permit: JOHN HARRIS
First MI Last
V.A. PACKAGED GAS OPERATIONS
Title
109 HINNANT RD
Permit Holder Mailing Address
GOLDSBORO NC
27530
City State
Zip
91( 9) 735-5315 _(919)
734-6256
Phone
Fax
c. Facility name (discharge):
AIRGAS NATIONAL WELDERS-LOXCO
DIVISION
d. Facility address:
HWY 117 NORTH
Address
GOLDSBORO NC
27530
City State
Zip
e. Facility contact person:
ROBBIE CHASE 704
735-5315
First / MI / Last
Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of Change in ownership of the facility
X Name change of the facility or owner
If ocher please explain:
b.
Permit issued to (company name):
AIRGAS USA, LLC
✓
c.
Person legally responsible for permit:
_ _
JOHN HARRIS
First MI Last
V .P. OPERATIONS
Title
109 HINNANT RD
Permit Holder Mailing Address
✓
GOLDSBORO NC 27530
City State Zip
/
[phone] [e-mail]
V
Phone E-mail Address
AIRGAS USA, LLC — GOLDSBORO REGIONAL ✓
d:
Facility name (discharge}:
PLANT
e.
Facility address:
109 HINNANT RD.
Address
GOLDSBORO NC 27530
-
City state Zip
✓
f.
Facility contact person:
ROBBIE _ CHASE_
_
First MI Last
/
(919 735.5315 ROBBIE.CHASERAIRGAS.COM
_
Revised Jan. 27, 2014

Awl.
NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Phone Email Address
W. Permit contact information (if different from the person legally responsible for the permit)
Permit contact:
First Ml Last
Title
Mailing Address
city State Zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the'same industrial activities conducted prior
to this ownership or name change?
X Yes
❑ . No (please explain)
V1. Required Items: THIS APPLICATION WILL HE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
X This completed application is required for both name change and/or ownership change
requests.
X Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by k2* the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1, , attest that this application for a name/ownership change has been reviewed and is accurate and complete
to the best of my knowledge. 1 understand that if all required parts of this application are not completed
and that if all required supporting information is not included, this application package will be returned as
incomplete_
Signature Date
APPLICANT CERTIFICATION
1, JOHN HARRIS. attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. 1 understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package vyill be returned as incomplete.
r
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27.2014

I.
II.
��— L
DEC 3 O.�u08
W.
QUAll
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C 0 0 4* 3 * N G W
Permit status prior to status change.
a. Permit issued to (company name): National Welders Supply Co. Inc
b. Person legally responsible for permit: John Harris
First MI Last
V.P. Packaged Gas Operations
Title
109 Hinnant Rd
Permit Holder Mailing Address
Goldsboro NC 27530
City State Zip
[phone] [phone]
Phone Fax
c. Facility name (discharge): LOXCO
d. Facility address: 109 Hinnant Rd.
Address
Goldsboro NC 27530
City State Zip
e. Facility contact person: Robbie Chase [phone]
First / MI / Last Phone
Please provide the following for the requested change (revised permit).
a. Request for change is a result of ❑ Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
National Welders Dba Airgas National Welders
John
Harris
First
MI Last
V.P. Packaged Gas Operations
Title
109 Hinnant Rd
Permit Holder Mailing Address
Goldsboro
NC 27530
City
State Zip
[phone]
[e-mail]
Phone
E-mail Address
LOXCO
109 Hinnant Rd.
Address
Goldsboro
NC 27530
City
State Zip
Robbie
Chase
First
MI Last
[phone]
robbie.chase ,airgas.com
Phone
E-mail Address
Revised 812008

•r PERMIT NAME/OWNERSHIP CHANGE FORM
,a Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: Jerrell G Cook
First MI Last
Manager Packaged Gases
Title
5313 Old Dowd Rd
Mailing Address
Charlotte NC 28208
City State ,Zip
[phone] [e-mail]
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, Jerrell G. Cook, attest that this application for a 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 is not included, this application
packageV] be returned as incomplete.
(> 1.U\— December 18, 2008
Signature Date
CANT CERTIFICATION
Y , attest that this application for a 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 is not included, this application package will be
returned as incomplete.
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 712008

Michael F. Fasley, Covemor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
I. Please enter the permit number for which the change is requested.
NPDES Permit
(or) Certificate of Coverage
0 0 10 4 1 3
N
11. Permit status prior to status change.
a. Permit issued to (company name):
National Welders Supply Co. Inc
b. Person legally responsible for permit:
John Harris
First MI Last
V.P. Packaged Gas Operations
Title
109 Hinnant Rd
Permit Holder Mailing Address
Goldsboro NC 27530
City State Zip
[phone] [phone]
Phone Fax
c. Facility name (discharge):
LOXCO
d. Facility address:
109 Hinnant Rd.
Address
Goldsboro NC 27530
City State Zip
e. Facility contact person:
Robbie Chase [phone]
First / MI I Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of.
❑ Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
National Welders Dba Airgas_N_ational Welders
c. Person legally responsible for permit:
John Harris
`
First MI Last
V.P. Packaged Gas Operations
Title
109 Hinnant Rd
Permit Holder Mailing Address
Goldsboro NC 27530
City state Zip
[phone] john,harrispairgas.com
Phone E-mail Address
d. Facility name (discharge):
LOXCO
e. Facility address:
109 Hinnant Rd.
Address
Goldsboro NC 27530
City State Zip
f. Facility contact person:
Robbie Chase
First MI Last .
[phone] robbie.chase a air as.com
_
Phone _. E-mail Address
Revised 812008

4
PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
1V. Permit contact Information (if different from the person legally responsible for the permit)
Permit contact: Jerrell G Cook
First M1 Last
Manager Packaged Gases
Title
5313 Old Dowd Rd
Mailing Address
Charlotte NC 28208
City State Zip
[phone] jerrell.c0ok2@airgas,com
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, Jerrell G, Cook, attest that this application for a 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 is not included, this application
package will be returned as incomplete.
December 18. 2008
Signature Date
APPLICANT CERTIFICATION
1, , attest that this application for a 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 is not included, this application package will be
returned as incomplete.
Signature
; Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 7/2008