NCG030704_Application_20190710

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Division of Energy, Mineral and band Resources
Laud Quality Section
National Pollutant Discharge Elimination System
Environmental' NCG030000
Quality
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year
Mont
Month
Da
1
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Certificate ofCovera e
N C G 0 3 C)I-11014
Check k
1 Amount
W Y
100
Pemut Assi uedto
S. 54r c t
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG030000:
STORMWATER DISCHARGES associated with activities classified as:
l�o
SIC (Standard Industrial Classification) 335 Rolling, Drawing, and Extruding of Nonferrous Metals
SIC 3398 Metal Heat Treating �g ,r�
SIC 34 Fabricated Metal Products 1Ti ...
SIC 35 Industrial and Commercial Machinery 911` ,.a (1 �
SIC 36 Electronic and Other Electrical Equipment -'
SIC 37 Transportation Equipment
DENR-LAND QUALITY
SIC 38 Measuring, Analyzing, and Controlling Instruments ST0RNiUVA11`rR PERIVli r-i ING
V-X-A For questions, please contact the DEMLR Regional Office for your area. See page 4.
(Please print or type)
1) Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name Du Bose National Energy Services, Inc.
Street Address 900 Industrial Drive
City Clinton State NC ZIP Code 28328
Telephone No. [phone] Fax: [phone]
2) Location of facility producing discharge:
Facility Name DuBose National Energy Services, Inc.
Facility Contact Tim Shepard
Street Address 307 Industrial Drive
City Clinton State NC ZIP Code 28328
County Sampson
Telephone No. [phone] Ext. 260 Fax: [phone]
Email [e-mail]
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). Traveling via 1-40 E, take exit 343 for US-701 toward
Clinton, take the exit towards US-421 N/Dunn and turn right onto North Blvd, turn right onto Superior Drive in 0.4 mi, at
the end of the road turn left onto Industrial Drive and the facility is on the right.
(A copy of a county map or USGS quad sheet with the facility clearly located must be submitted with this application.)
4) Latitude 35' 1'18.70"N Longitude78`20'41.84"W (deg, min, sec)
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
F71 Existing
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NCG030000 N.0.1.
6) Standard Industrial Classification:
Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility.
SIC Code: 3 4 9 8
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: Welding, fabricating, blasting, and painting.
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? one
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Williams Old Mill Branch to Great Coharie Creek
Receiving water classification: C; Sw
Is this a 303(d) listed stream? No Has a TMDL been approved for this watershed? No If
the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer). NA
List discharge points (outfalls) that convey discharge from the site (both on -site and off -site) and location
coordinates. Attach additional sheets if necessary, or note that this information is specified on the site plan.
Stormwater Outfall No. of
Latitude (degrees/minutes/seconds): 35" 1-16z5"
N
Longitude (degrees/minutes/seconds): 78*W42.65"
W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds):
N
Longitude (degrees/minutes/seconds):
W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds):
N
Longitude (degrees/minutes/seconds):
W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds):
N
Longitude (degrees/minutes/seconds):
W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds):
N
Longitude (degrees/minutes/seconds):
W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds):
N
Longitude (degrees/minutes/seconds):
W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds):
N
Longitude (degrees/minutes/seconds):
W
9) Does this facility have any other NPDES permits?
d No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
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NCG030000 N.O.I.
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
11 No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
11) Does this facility employ any best management practices for stormwater control?
MI No
❑ Yes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe:
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
11 Yes
If yes, when was it implemented? June 1, 2019
13) Are vehicle maintenance activities occurring at this facility?
11 No ❑ Yes
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
11 No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
❑ No d Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
d No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
11 No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: Paint and solvent waste (F003, F005, D001, D005, D007)
How is material stored: 55-gal. metal drums
Where is material stored: In designated secondary containment storage area
How many disposal shipments per year: 1-2 shipments per year
Name of transport / disposal vendor: Safety-Kleen Systems Inc.
Vendor address: 3700 Lagrange Road, Smithfield, KY 40068
15) Certification:
North Carolina General Statute 143-215.613 (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report,
plan, or other document filed or required to be maintained under this Article or a rule implementing this Article; or who
knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Article; or
who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be
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NCG030000 N.O.I.
operated or maintained under this Article or rules of the Commission implementing this Article shall be guilty of a Class 2
misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing
Title: Fabrication Division Manager
Tim Shepard
(Signature of Appli ant) (Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDEQ
RF:CPV
I tui1
DLNR-LAND QUALITY
STORMEWI R PERI` Il TING
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NCG030000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NCDEQ.
❑ This completed application and all supporting documents.
❑ A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
(f) impervious areas, (g) site property lines.
❑ Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map.
Mail the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee coverage under the General Permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
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