NCG030670_COMPLETE FILE - HISTORICAL_20190213

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO:
IV U& 0-7 O
DOC TYPE
HISTORICAL FILE
O MONITORING REPORTS
DOC DATE
o Jol % Oc;� I
YYYYMMDD

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
February 5, 2019
Fontaine Modification
Attention: Nate Eichinger
9827 Mt Holly Road
Charlotte, North Carolina 28214
Subject: NPDES Stormwater Permit
Stormwater Certificate of Coverage No. NCG030670
Representative Outfall Status Request
Mecklenburg County
Dear Mr. Eichinger:
ROY COOPER
Govemor
MICHAEL S. REGAN
Secremry
S. DANIEL SMITH
Interim Direewr
PFCRVED
FEB 13 2019
DcNR-LAND QUALITY
STORMWATER PERMITTING
The Mooresville Regional Office staff have reviewed your January 18, 2019 request for a determination that
stormwater discharge outfalls 1 and 2 be granted representative outfall status for stormwater outfall 3. Based on
the information provided and a December 6, 2018 site inspection, we are approving this request. In accordance
with 40 CFR. § 122.2 1 (g)(7), you are authorized to sample outfalls number I and 2 as representative for the
entire site. This approval is effective with the next sampling event.
Please append this letter to your Stormwater Pollution Prevention Plan (SPPP) or permit to document that
representative outfall status has been approved. If changes in drainage areas, structures, processes, storage
practices, or other activities occur that significantly alter the basis of this approval, representative outfall status
may no longer be valid. You should either resume sampling at all SDOs, or reapply to this office for
representative outfall status based on updated information. If you have any questions or comments concerning
this letter, please contact our Office at [phone].
Sincerely,
Zahid S. Khan, CPM, CPESC, CPSWQ
Regional Engineer
Land Quality Section
JMIZSKIcys
cc: feucastormw r Petttzmng�PrograinCG0306�0
State of North Carolina I Environmental Qualiry ! Energy, Mineral and land Resources
Mooresville Regional Office 1 610 East Center Ave Ste 301 j Mooresdl It, NC 28115
704 663 1699 T

Central Files: APS — SWP
5/31/2016
r
Permit Number NCG030670
Permit Tracking Slip
Program Category
Status Project Type
NPDES SW
In review New Project
Permit Type
Version Permit Classification
Metal Fabrication Stormwater Discharge COC
RECEIVED
CDC
Primary Reviewer
Permit Contact Affiliation
julie.ventaloro "
JUN U 2 2016
Coastal SwRule CENTRAL FILES
DWR SECTION
Permitted Flow
Facility
Facility Name Major/Minor Region
Fontaine Modification Company Minor Mooresville
Location Address County
9827 Mount Holly Rd Mecklenburg
Facility Contact Affiliation
Charlotte NC 28214 David Hambrick
9827 Mount Holly Rd
Owner
Charlotte NC 28214
Owner Name
Owner Type
Fontaine Modification Company
Non -Government
Owner Affiliation
Nathan Eichinger
Operations President Vice
9827 Mount Holly Rd
Dates/Events
Charlotte NC 28214
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration y 4/8/2016 (, `r II2OI l0 (oil 1?�O(lj /0'3/ l%7-d1 1
Regulated Activities Requested /Received Events
Transportation equipment manufacture RO staff report received 5/18/16
RO staff report requested 5/4/16
Outfal I 001
Waterbody Name Streamindex Number Current Class Subbasin
Long Creek 11-120-(2.5) WS-IV 03-08-34

1�
Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
June 1, 2016
Mr. Nathan Eichinger
Fontaine Modification Company
9827 Mount Holly Road
Charlotte, NC 28214
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
TRACY DAVIS
Director
Subject: General Permit No. NC6030000
Fontaine Modification Company
COC No. NCG030670
Mecklenburg County
Dear Mr, Eichinger:
In accordance with your application for a discharge permit received on April 8, 2016, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state —
NPDES general 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 US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval of the
Division of Energy, Mineral and Land Resources. The Division of Energy, Mineral and Land
Resources may require modification or revocation and reissuance of the certificate of coverage.
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, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
If you have any questions concerning this permit, please contact Julie Ventaloro at telephone number
[phone] or by emailjulie.ventaloro@n_cdenr.gov.
Sincerely,
�J fit&
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Zahid Khan
Central Files
Stormwater Permitting Program Files
Mecklenburg County DEP, Water Quality, 700 N. Tryon Street, Charlotte, NC 28202
State of North Carolina j Environmental Quality I Energy, Mineral and Land Resources
1612 Mail Service Center j 512 North Salisbury Street I Raleigh, NC 27699.1612
919 707 9200 T

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG030000
CERTIFICATE OF COVERAGE No. NCG030670
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Fontaine Modification Company
is hereby authorized to discharge stormwater from a facility located at
Fontaine Modification Company
9827 Mount Holly Road
Charlotte
Mecklenburg County
to receiving waters designated as UT to Long Creek, a class WS-IV water in the Catawba River
Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, III, and IV of General Permit No. NCG030000 as attached.
This certificate of coverage shall become effective June 1, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 1, 2016.
for Tracy E. Davis, P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

NCDENR_
EWNIiOMML4f M1G 1'{glliAl (bYf.�rfs
NOTICE OF INTENT
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG030000
I FOR AGENCY USE ONLY
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG030000:
STORMWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) 335 Rolling, Drawing, and Extruding of Nonferrous Metals
SIC3398
Metal Heat Treating
RECEIVED
SIC 34
Fabricated Metal Products
SIC 36
Industrial and Commercial Machinery
APR 08 2076
SIC 36
Electronic and Other Electrical Equipment
S� IC.37)
L__portation Equiptnent3
L;,� { Q 1{ 1'
SIC 38
Measuring, Analyzing, and Controlling Instruments4�`�,�
V,K I 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
Street Address
City
Telephone No.
Fontaine Modification Co.
9827 Mount Hotly Road
Charlotte
[phone]
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
Fontaine Modification Co.
David Hambrick
State NC ZIP Code 28214
Fax:
9827 Mount Holly Road
Chartotte State NC ZIP Code 28214
Mecklenburg
[phone] Fax:
[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). Take exit 14 off 1-485, head west on Mount Holly Road, after 0.1 miles
turn left onto Rhyne Road, after crossing railroad tracks turn right onto access road, facility is on left (approwmately 0.1 miles)
(A copy of a county map or USGS quad sheet with the facility clearty located must be submitted with this application.)
4) Latitude 35°17'27.58-N Longitude 80'58'15.77W (deg, min, sec)
351 OL-7) 11 o u 7V,3
Page t of 4
SWU-218-071408 Last revised 712114

NCG030000 N.O.I.
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility
® Existing
6) Standard Industrial Classification:
Date operation is to begin
Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility.
SIC Code: 3 7 1 3
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: The facility takes new trucks and performs modifications on the cab interior and exterior. The facility adds second
steering locations, and/or reconfigures truck cab height or configuration. The facility cuts metal, performs welding, sanding and painting.
All modifications are performed indoors.
8) Discharge points I Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 3
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? LonQ Creek
Receiving water classification: w5-1V
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). Mecklenburg County
9) Does this facility have any other NPDES permits?
® No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
® 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?
(91 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
® Yes
If yes, when was it implemented? upon permit coverage
13) Are vehicle maintenance activities occurring at this facility?
® No ❑ Yes Facility modifies body and cab configuration of newly manufactured vehicles
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
® No ❑ Yes
Page 2 of 4
SWU-218-071408 Last revised 7/2/14

NCG030000 N.O.I.
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
❑ No ® Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
® No ❑ Yes
d) Is hazardous waste stared in the 100-year flood plain?
® 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 waste
How is material stored: 55 gallon barrels or smaller
Where is material stored: Inside building
How many disposal shipments per year: 12
Name of transport/ disposal vendor: Safety -Kieen
Vendor address: 230 Yadkin Ave., Charlotte, NC
15) Certification:
North Carolina General Statute 143-215.6B (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
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: Nathan Eichinger
Title: vice President Opera 'ons
(Signature of
(Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDENR
Page 3 of 4
SWU-218-071408 Last revised 7014

NCG030000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
0?isCheck for $100 made payable to 'C NC DEQ
I� " 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.
De Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map.
Mail the entire package to:
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
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 ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 4 of 4
5WU-218-071408 Last revised 712114

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Notes:
1. Stormwater Outfalls 1,2 & 3 discharge to unnamed tributary of Long Creek
2. Stormwater Outfall 1 is located at 350 17' 27" N Lat. and 80° 58' 15" W Long.
3. Stormwater Outfall 2 is located at 35' 17' 27" N Lat. and 806 58' 20" W Long.
4. Stormwater Outfall 3 is located at 35° 17' 24" N Lat. and 80° 58' 15" W Long.
5. Long Creek is listed as supporting according to North Carolina's 2014 integrated Report
Figure C-2 Site Location Map
C-3

Bank of 70-2MB 101081
VOCATIONAL SERVICES 719
=i]IVTi411VE 9827 MT. HOLLY RD. cwrn erc4i p n Arew� • emn� oak, uiws
�IF1CATmN CHAF[LOTTE, NC 28214
704-391-1355 CHECK
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DATE AMOUNT g
THESUI*h'of One Hundred S 001100 Dollars z
RDER OF
04/07/2016 US$ 100.00 8
.NC DEQ Checks Z
L
0 or more require 2 Signatures
STORMWATER PERMITTING UNIT PROGRAM 0""N
1612 MAIL SERVICE CENTER
RALEIGH NC 27699-1612
wrHogrzeo scNnTuae nr
v10WEILti'

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG030000
CERTIFICATE OF COVERAGE No. NCG030670
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Fontaine Modification Company
is hereby authorized to discharge stormwater from a facility located at
Fontaine Modification Company
9827 Mount Holly Road
Charlotte
Mecklenburg County
to receiving waters designated as UT to Long Creek, a class WS-IV water in the Catawba River
Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, 1I, III, and IV of General Permit No. NCG030000 as attached.
This certificate of coverage shall become effective June 1, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 1, 2016.
ORIGINAL SIGNED W
KEN PICKLE
for Tracy E. Davis, P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
June 1, 2016
Mr. Nathan Eichinger
Fontaine Modification Company
9827 Mount Holly Road
Charlotte, NC 28214
PAT MCCRORY
Govemor
DONALD R. VAN DER VAART
Seewary
TRACY DAVIS
Director
Subject: General Permit No. NCG030000
Fontaine Modification Company
COC No. NCG030670
Mecklenburg County
Dear Mr. Eichinger:
In accordance with your application for a discharge permit received on April 8, 2016, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state —
NPDES general 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 US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval of the
Division of Energy, Mineral and Land Resources. The Division of Energy, Mineral and Land
Resources may require modification or revocation and reissuance of the certificate of coverage.
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, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
If you have any questions concerning this permit, please contact Julie Ventaloro at telephone number
[phone] or by email [e-mail].
Sincerely,
ORIGINAL SIGNED 8)
KEN PICKLE
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Zahid Khan
Central Files
Stormwater Permitting Program Files
Mecklenburg County DEP, Water Quality, 700 N. Tryon Street, Charlotte, NC 28202
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1 512 North Salisbury Street I Raleigh, NC 27699-1612
919 707 9200 T

Ventaloro, Julie
From: Khan, Zahid
Sent: Wednesday, May 18, 2016 1:18 PM
To: Ventaloro, Julie
Subject: RE: Review Request NCG030670 Fontaine Modification Co
Follow Up Flag: Follow up
Flag Status: Flagged
No Objection. Thanks
From: Ventaloro, Julie
Sent: Wednesday, May 04, 2016 10:41 AM
To: Khan, Zahid <[e-mail]>
Subject: Review Request NCG030670 Fontaine Modification Co
Zahid,
We've received an NOI for an existing metals manufacturing facility in your region:
NCG030670 Fontaine Modification Company in Mecklenburg County. This site discharges stormwater at 3 points to UT
to Long Creek (Class WS-IV). NOl is attached.
Please let me know if the Mooresville Regional Office has any concerns about issuing this COC.
Thanks!
Julie Ventaloro
Stormwater Permitting Program
NC Division of Energy, Mineral, and Land Resources
1612 Mail Service Center, Raleigh, NC 27699-1612
Phone: [phone] Fax: [phone]
Website: httpalwatersupplywatershed.nc.gov
-- ` Nothing Compares
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.

i
NCDENR
pk-C�W--
r-�d
NOTICE OF INTENT
Division of Energy, NUneral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG030000
.•
mom�
MlafaiMEW14W
t•1�47�
National Pollutant Discharge Elimination System application for coverage under General Permit
NCGO30000:
STORMWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) 335 Rolling, Drawing, and Extruding of Nonferrous Metals
SIC 3398 Metal Heat Treating t
SIC 34 Fabricated Metal Products
SIC 35 Industrial and Commercial Machinery APR 4 8 2016
SIC 36 Electronic and Other Electrical Equipment
S�lC3i) raft?; s" iic nuip4n nti
SIC 38 Measuring, Analyzing, and Controlling Instruments
,Ka
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 Fontaine Modification Co.'
Street Address
City
Telephone No.
9827 Mount Holly Road
Charlotte State NC
[phone] Fax: —
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Email
Fontaine Modification Co.
David Hambrick
ZIP Code 28214
9827 Mount Holly Road
Charlotte State NC ZIP Code 28214
Mecklenburg
[phone] Fax:
d"[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). Take exit 14 off 1485, head west on Mount Holly Road, after 0.1 miles
turn left onto Rhyne Road, after crossing railroad tracks turn right onto access road, facility is on left (appro)dmately 0.1 miles)
(A copy of a county map or USGS quad sheet with the facility hearty located must be submitted with this application.)
4) Latitude 35°17'27.58-N
a93,51 I 1g1
Longitude 80'58'15.77'W (deg, min, sec)
Page 1 of 4
SWU-218-071408 Last revised 712/14

NCG030000 N.O.I.
6) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
® Existing
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 7 1 3
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: The facility takes new trucks and performs modifications on the cab interior and exterior. The facility adds second
steering locations, and/or reconfigures truck cab height or configuration. The facility cuts metal, performs welding, sanding and painting.
All modifications are performed indoors.
8) Discharge points I Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 3
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? _ Long Creek
Receiving water classification: ws-lv
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). Mecldenburg County
9) Does this facility have any other NPDES permits?
® No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
® 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?
® No
❑ Yes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe:
12) Does this facility have a Stonmwater Pollution Prevention Plan?
❑ No
® Yes
If yes, when was it implemented? Upon permit coverage
13) Are vehicle maintenance activities occurring at this facility?
® No ❑ Yes Facility modifies body and cab configuration of newly manufactured vehicles
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
® No ❑ Yes
Page 2 of 4
SWU-218-071408 Last revised 7014

NCG030000 N.O.I.
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
❑ No ® Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
® No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
® 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 waste
How is material stored: 55 gallon barrels or smaller
Where is material stored: Inside building
How many disposal shipments per year: 12
Name of transport / disposal vendor. safety-Kleen
Vendor address: 230 Yadkin Ave., Charlotte, NC
15) Certification:
North Carolina General Statute 143-215.68 (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 Arficte; or who
knowingty 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
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 discharges) 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: Nathan Eichinger
Title: Vice President Opera 'ons
(Signature of Applicant) (Date Signed)
This Notice of Intent must be accompanied .by a check or money order for $100.00, made payable to:
NCDENR
Page 3 of 4
SWU-21IM71408 Last revised 7/2114

NCG030000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
��
I Check for $100 made payable to NGDEE IR NC DEQ
Fif 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.
i� Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map.
Mail the entire package to:
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
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 .........(919)
807-6300
Page 4 of 4
SWU-218-071408 Last revised 7/2l14

Figure C-1 Facility Site Map or-,
C-2 Vl�

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Data® to 6cemse. ' mi
B DeLomne. Topo USAS B. 0 Y.
www.dek me-com MN (7.5- W) Data 2oom3 12-5
Notes:
1. Stormwater Outfalls 1,2 & 3 discharge to unnamed tributary of Long Creek
2. Stormwater Outfall 1 is located at 35° 17' 27" N Lat. and 80° 58' 15" W Long.
3. Stormwater Outfall 2 is located at 35° 17' 27" N Lat. and 80° 58' 20" W Long.
4. Stormwater Outfall 3 is located at 35° 17' 24" N Lat. and 80° 58' 15" W Long.
S. Long Creek is listed as supporting according to North Carolina's 2014 Integrated Report
Figure C-2 Site Location Map
C-3