NCG050190_COMPLETE FILE - HISTORICAL_20170626

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ a d V-) ()
YYYYM M DD

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Programs
is
National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources ENVIRONMENTAL QUALITY(Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY U5£ ONLY
Date Received
Year
Month
Day
NO CH A'AGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
Wnat [toes "legally responsible individual" mean.
fhe person is either:
JUN 2 6 2017
• the responsible corporate officer (for a corporation); DEN
• the principle executive officer or ranking elected official (for a municipality I �blic
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
N C 1. S
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage
N I C. I G 1 0 1 5 [0j 1 1 9 1 0
Elite Comfort Solutions
_ Elite Comfort Solutions
1115 Farrington St
Address
Conover NC 28613
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
hitp//de .nc.gov/about/divisions/energy-mineral-land-resources/eugW-mineral-land-permits/stormwater-prrogam
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual:
Rick
First
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit:
Velotta
MI Last
Chris Bagley
First Mi Last
SWU-OWNERAFFIL-23March2017
Page l of 2

i .
NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
Senior EHS Manager
Title /
1 1 15 Farrington �r/
Street
Mailing Address
Conover NC 28613
City State Zip
[phone] [e-mail] -
Telephone E-mail Address
[phone]
fax Number
5) Reason for this change:
A result of: ® Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I, Chris Ba lgleey, attest that this application for this change in Owner Affiliation (person legally responsible
for the permit) has been reviewed and is accurate and complete to the best of my knowledge. I understand
that if all re u ed parts of this form are not completed, this change may not be processed.
June 19, 2017
t ure Date
�\ea.se ASO c.L.o,nrt o.j+'*r �o�:\:�-j, aKJ VCrV'\N c00A-"A �crs�� o� ecrr�•'1k b:�1:r' c�n�«,.}
-6 44 50-0w �ni�1'y �� PLEASE SEND THE COMPLETED FORM TO:
kw- he.u. ow�
Division of Energy, Mineral, and Land Resources
Stormwater Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website at:
http: //deg .nc. gov/about/divisions/ener,gy-mineral-land-resources/stormwater
Page 2 of 2
5W U-OW N E RAFF I L-23Mar2017

T
5

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
r:
National Pollutant Dischaige Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
EWIROMENTALQUALffY (Individual Legally Responsible for Pennit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Rcceind
Year
Mas�th
Day
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual' mean?
The person is either:
• the.responsible corporate officer (for a corporation);
the:principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the.permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit (or) Certificate of Coverage
INICIS1 I I I INICIG1015101119101
2) Facility Information:
Facility name: Elite Comfort Solutions
Company/Owner Organization: Elite Comfort Solutions
Facility address: 1115 Farrington St
Address
Conover NC 28613
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
bM-//deg. nc.gov/abdutldivisions/energy-mi nemi-land-resources/energy-m ineral-land-Wrmits/stormwater-program
and run ihe.Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previbus legally responsible individual: Rick Velotta
First M1 Last
4) NEW OWNER AFFILIATION (legally responsible for, the permit):
Person legally responsible for this permit:
Chris Bagley
First MT Last
SWU-OWNERAFFIL-23March2017
Page t of 2.

r � -
NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name(Ownership Change)
Senior EHS Manager
Title
1115 Farrington
Street
Mailing Address
Conover NC 28613
City State Zip
[phone] [e-mail]
Telephone E-mail Address
(828) 3244715
Fax Number
5) Reason for this change:
A result of: ® Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTMCATION:
I, Chri�iex, attest that this application for this change in Owner Affiliation (person legally responsible
for the permit) has been reviewed and is accurate and complete to the best of my knowledge. I understand
that if all regured parts of this form are not completed, this change may not be processed.
June 19, 2017
ure Date
TAt4xt owa ptrw►. tonta,� �u-sv� a►�.J eu b:t1►1+* �vn�,µ,}
Rio Soa+ afi^�►ad.. PLEASE SEND THE COMPLETED FORM TO: •1
prb�rilt� �n,r {�,Q�., owrvcf
�^ Division of Energy, Mineral, and Land Resources
Stormwater Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
- For more information or staff contacts, please call (919) 70.7-9220 or visit the website at:
h ://de .nc. ovlabout/divisionslener -mineral-land-resources/storm,.vater
Page 2 of 2
SWU-0WNERAFFI L-23Ma2oi 7

a rc'rpT dnyt f C P - oar C j
f1
&/ State of North Carolina
D artment of Environment and Natural Resources
f 1 Division of Water Quality
STATE STORMWATER PERMIT NAMEIOWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION
1. Stormwater Management Permit Number: General Permit No. NCGO50000
2. Project Name: Not Applicable
3. Current Permit Holder's Company Name/Organization: Hickory Springs Manufacturing Company
4. Signing Official's Name: James J. Bush
5. Mailing Address: 235 2nd Avenue NW
City: Hicko
6. Phone: ( 828 1 328-2201 Fax: (
Title: President
State: NC Zip:
28601
II. PROPOSED PERMITTEE / OWNER / PROJECT / ADDRESS INFORMATION
This request is for: (please check all that apply)
❑ Name change of the owner (Please complete Items 1, 2 and 3 below)
❑ Name change of project (Please complete Item 5 below)
0 Change in ownership of the property/company (Please complete Items 1, 2, 3, and 4 below)
❑ Mailing address / phone number change. (Please complete Item 4 below)
X Other (please explain): only_a portion of the original property has been purchased - see attached diagram
1. Proposed permittee's company name/organization:
Elite Comfort Solutions
2. Proposed permittee's signing official's name: Rick Velotta
3. Proposed permittee's title: Corporate EHS Director
4. Mailing Address: 1545 Deborah Herman Road
City: Conover State: NC Zip
Phone: ( 480 ? 620-0712 Fax: (
5. New Project Name to be placed on permit: Not Applicable
28613
Please check the appropriate box. The proposed permittee listed above is:
❑ HOA or POA (Attach documentation showing that the HOA or POA owns, controls, or has a
recorded easement for all areas that contain stormwater system features. Print name of HOA or
POA in #1 above and provide name of HOA/POA's authorized representative in #2 above)
❑ The property owner
❑ Lessee (Attach a copy of the lease agreement and complete Property Owner Information on
page 4)
x❑ Purchaser (Attach a copy of the pending sales agreement. Final_ approval of this transfer will be
granted upon receipt of a copy of the recorded deed)
❑ Developer (Complete Property Owner Information on page 4)
SSW N/O Change Rev24Sept2012 Page 1 of 4

Ill. REQUIRED ITEMS
A request to transfer a permit will not be approved by the Division of Water Quality (DWQ) unless all
of the applicable required items listed below are included with the submittal. Failure to provide the
listed items may result in processing delays or denial of the transfer.
1. This completed and signed form. This certification must be completed and signed _by both the
current_ permit holder and the new applicant if this is a change_ of ownership.
2. Legal documentation of the property transfer to a new owner.
3. A copy of any recorded deed restrictions, covenants, or easements, if required by the permit.
4. The designer's certification (DWQ Engineer and Designer Certification Forms are available from
each DWQ Regional office), if required by the permit and if not already submitted to DWQ_
5. If the proposed permittee is a firm, partnership, association, institution, corporation, limited liability
company, or other corporate entity, provide documentation showing the authority of the named
representative to act on behalf of the proposed permittee.
6. The $40.00 processing fee. If this is an initial transfer from the original permittee the processing
fee is not required. Subsequent ownership transfers will require the $40.00 processing fee_
IV. CURRENT PERMITTEE'S CERTIFICATION
Please check one of the following statements and fill out the certification below that statement.
❑ Check here if the current permittee is only changing his/her/its name, the project name, or mailing
address, but will retain the permit. I, , the current
permittee, hereby notify the DWQ that I am changing my name and/or I am changing my mailing
address and/or I am changing the name of the permitted project. I further attest that this application
for a name/ownership change is accurate and complete to the best of my knowledge. I understand
that if all required parts of this application are not completed or if all required supporting information
and attachments listed above are not included, this application package will be returned as
incomplete.
x] Check here if current permittee is transferring the property to a new owner and will not retain
ownership of the permit.
the current permittee, am submitting this application
for a transfer of ownership for permit # NCG050000 . I hereby notify DWQ of the sale or
other legal transfer of the stormwater system associated with this permit. I have provided a copy of
the most recent permit, the designer's certification for each BMP, any recorded deed restrictions,
covenants, or easements, the DWQ approved plans and/or approved as -built plans, the approved
operation and maintenance agreement, past maintenance records, and the most recent DWQ
stormwater inspection report to the proposed permittee named in Sections II and V of this form.
further attest that this application for a name/ownership change is accurate and complete to the best
of my knowledge. I understand that if all required parts of this application are not completed or if all
required supporting information and attachments listed above are not included, this application
package will be returned as incomplete. I assign all rights and obligations as permittee to the
proposed permittee named in Sections 11 and V of this form. I understand that this transfer of
ownership cannot be approved by the DWQ unless and until the facility is in compliance with the
permit. / A /j
Signature:
_ r+
Date: 5 r8 16P
a Notary Public for the State of
o�ZCCU , County of rC.o \ v1 _ _ _ , do hereby certify that
personally appeared before me this the
t
day of , 20\�q , and acknowledge the due execution of the
fo oing instrument. Witness my A
hand and official seal, -.(Notarry Seal)
01
Notary Signature
Q VCA 'E� g
SSW N/O Change Rev24Sept2012 Page 2 of 4

V. PROPOSED PERMITTEE CERTIFICATION: (This section must be completed by the
Proposed Permittee for all transfers of ownership)
I, t< <4k t`, (r-&OTrA hereby notify the DWQ that I have acquired
through sale, lease or legal transfer, the responsibility for operating and maintaining the permitted
stormwater management system, and, if applicable, constructing the permitted system.
acknowledge and attest that I have received a copy of: (check all that apply to this permit)
❑X the most recent permit
❑ the designer's certification for each BMP
X❑ any recorded deed restrictions, covenants, or easements
❑ the DWQ approved plans and/or approved as -built plans
❑ the approved operation and maintenance agreement
epast maintenance records from the previous permittee (where required)
DWQ stormwater inspection report showing compliance within 90 days prior to this transfer
have reviewed the permit, approved plans and other documents listed above, and I will comply with
the terms and conditions of the permit and approved plans. I acknowledge and agree that I will
operate and maintain the system pursuant to the requirements listed in the permit and in the
operation and maintenance agreement. I further attest that this application for a name/ownership
change is accurate and complete to the best of my knowledge. I understand that if all required parts
of this application are not completed or if all required supporting information and attachments. listed
above are not i ded, is pplication package will be returned as incomplete.
Signature: Date: /Or/;14f z o/6
a Notary Public for the State of
County of \--L , r-,r__cA `-\ , do hereby certify that
cP VE'L o A personally appeared before me this the
day of 20X�p and acknowledge the due.execution of the
forgoing instrument. Witness my hand and official seal,
(Notary!E )
Notary Signature
Additional copies of the original permit and the approved Operation and Maintenanceagreement can
be obtained from the appropriate Regional Office of the Division of Water Quality.
This completed form, including all supporting documents and processing fee (if required), should be
sent to the appropriate Regional Office of the North Carolina Department of Environment and Natural
Resources, Division of Water Quality, as shown on the attached map.
Please note that if the Proposed Permittee listed above is not the property owner, the property owner
must complete and sign page 4 of this document. Both the lessee / developer and the property
owner will appear on the permit as permittees_
SSW N/O Change Rev24Sept2012 Page 3 of 4

VI.' PROPERTY OWNER CONTACT INFORMATION AND CERTIFICATION
If the Proposed Permittee listed in Sections I! and V of this form is not the Property Owner, the
Property Owner must provide his/her Contact Information below and sign this form:
Printed Name: Not Applicable
Organization:
Title within the Organization:
Street Address:
City:
Mailing Address:
City: _
Phone:
Email:
State:
(if different from street address)
State:
Fax:
Zip:
Zip:
I certify that I own the property identified in this permit transfer document and have given permission
to the Proposed Permittee listed in Sections 11 and V to develop and/or, lease the property. A copy
of the lease agreement or other contract, which indicates the party responsible for the construction
and/or operation and maintenance of the stormwater system, has been provided with the submittal.
As the legal property owner I acknowledge, understand, and agree by my signature below, that I will
appear as a permittee along with the lessee/developer and I will therefore share responsibility for
compliance with the DWQ Stormwater permit. As the property owner, it is my responsibility to notify
DWQ by submitting a completed Name/Ownership Change Form within 30 days of procuring a
developer, lessee or purchaser for the property. I understand that failure to operate and maintain the
stormwater treatment facility in accordance with the permit is a violation of NC General Statute
(NCGS) 143-215.1, and may result in appropriate enforcement action including the assessment of
civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature of the property owner
Date:
a Notary Public for the State of
County of , do hereby certify that
personally appeared before me this the
day of , 20 , and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
(Notary Seal)
Notary Signature
SSW N/O Change Rev24Sept2012 Page 4 of 4

ATTACHMENT 4
Facility Diagrams

ATTACHMENT 5
Proof of Sale

EXECUTION VERSION
BILL OF SALE AND ASSIGNMENT
This BILL OF SALE AND ASSIGNMENT (this `Bill of Sale"), dated as of April 15, 2016, is
executed by Hickory Springs Manufacturing Company, a North Carolina corporation ("ISM"), and
Hickory Springs of California, LLC, a North Carolina limited liability company ("Hickory CA" and,
together with HSM, "Sellers"), in favor of Elite Comfort Solutions LLC (f/k/a Specialty Foam Holdings
LLC), a Delaware limited liability company (`Buyer"), as contemplated by that certain Asset Purchase
Agreement dated as of March 16, 2016, by and among HSM, Hickory CA, and Buyer (the "Purchase
Agreement"). Capitalized terms used but not otherwise defined herein will have the meanings ascribed to
such terms in the Purchase Agreement.
NOW, THEREFORE, THIS INSTRUMENT WITNESSETH:
1. For good and valuable consideration, the receipt, adequacy, and legal sufficiency of
which are hereby acknowledged, Sellers do hereby sell, transfer, assign, convey, grant and deliver to
Buyer, all right, title, and interest, legal or equitable, of Sellers in and to all of the Acquired Assets, free
and clear of all Liens, other than Permitted Liens.
2. Sellers hereby constitute and appoint Buyer, its successors and assigns, for the limited
purpose of enabling Buyer to complete, insure, and perfect the transfer, conveyance, and assignment to
Buyer of all the right, title, and interest of Sellers in and to the property hereby granted, bargained, sold,
conveyed, and assigned, or intended to so be, the true and lawful attorney, irrevocably, of Sellers, with
full power of substitution, in the name of Sellers or otherwise, and on behalf of, for the benefit of, its
successors and assigns, including but not limited to the following: (a) to demand and receive from time to
time any and all property hereby granted, bargained, sold, conveyed, and assigned or intended so to be,
and to give receipts, releases, and acquittances for and in respect of the same or any part thereof; and (b)
from time to time, to institute, prosecute, compromise, and settle, as Sellers' assignee, any and all
proceedings at Law, in equity, or otherwise, which Buyer, its successors and assigns, may deem proper to
collect, assert, or enforce any claim, title, or right hereby granted, bargained, sold, conveyed, and
assigned, or intended so to be, that Buyer, its successors and assigns, shall deem desirable.
3. Nothing in this instrument, express or implied, is intended or will be construed to confer
upon or give to any Person other than the parties hereto and their respective successors and assigns any
remedy or claim under or by reason of this instrument or any term, covenant, or condition hereof, and all
the terms, covenants, conditions, and agreements contained in this instrument will be for the sole and
exclusive benefit of the parties hereto and their successors and assigns.
4. Sellers acknowledge and agree that the representations, warranties, covenants,
agreements, and indemnities contained in the Purchase Agreement will not be superseded, expanded,
modified or supplemented hereby, but will remain in full force and effect to the full extent provided
therein. In the event of any conflict or inconsistency between the terms of the Purchase Agreement and
the terms of this Bill of Sale, the terms of the Purchase Agreement will govern and control.
5. This Bill of Sale and the rights and duties of the parties arising hereunder shall be
governed by, and construed and enforced in accordance with, the internal laws of the State of Delaware
without giving effect to the principles of conflicts of Law thereof.
EASn 122122078.3

6. This Bill of Sale may be executed in any number of counterparts, by original or by ".pdf'
or similar electronic copies of signatures sent via email, each of which shall be deemed an original, but all
of which taken together shall constitute one and the same instrument.
[Signatures Follow]
EAS'n 122122078.

IN WITNESS WHEREOF, Sellers have caused this Bill of Sale and Assignment to be executed
effective as of the date first set forth above.
SELLERS:
HICKORY SPRINGS MANUFACTURING
COMPANY
By:
Nam - Jbhn R. M
Title: we President,General Counsel & S
HICKORY SPRINGS OF CALIFORNIA,
LLC
By:
Nae're
Titlry
[Signature Page to Bill of Sak and. Assignment]

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
June 29, 2016
Mr. Rick Velotta
Elite Comfort Solutions
1545 Deborah Herman Road
Conover, NC 28613
PAT MCCRORY
Govemor
DONALD R. VAN DER VAART
Secretary
TRACY DAVIS
Director
RECEIVED
JUL 1 1 2016
CENTRAL FILES
I)VVR SECTION
Subject: NPDES Stormwater Permit NCG050190
Elite Comfort Solutions
Formerly Hickory Springs
Manufacturing Company
Catawba County
Dear Mr. Velotta:
Division personnel received your request to revise your stormwater permit Certificate of
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained
in the General Permit remain unchanged and in full effect. This revised Certificate of
Coverage is issued under the requirements of North Carolina General Statutes 143-215.1 and
the Memorandum of Agreement between North Carolina and the U.S. Environmental
Protection Agency.
If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sincerely,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land
Resources
cc: Mooresville Regional Office
Stormwater Permitting Program Files
Central Files
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1 512 North Salisbury Sure I Raleigh, North Carolina 27699-1612
919 707 9220 T

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG050000
CERTIFICATE OF COVERAGE No. NCG050190
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,
Elite Comfort Solutions
is hereby authorized to discharge stormwater from a facility located at:
Elite Comfort Solutions
1115 Farrington Street
Conover
Catawba County
to receiving waters designated as UT to Cline Creek, a class C water, in the Catawba River
Basin; in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, I1I, and IV of General Permit No. NCG050000 as attached.
This certificate of coverage shall become effective June 29, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 29, 2016.
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

ccrpfdnW7 extvw ba .
State of North Carolina }'
D artment of Environment and Natural Resources
Division of Water Quality
STATE STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION
o
1. Stormwater Management* Permit Number: General Permit No. NCGO50000 kkrr0 sa«o
2. Project Name: Not Applicable
3. Current Permit Holder's Company Name/Organization: Hickory Springs Manufacturing Company
4. Signing Official's Name: James J. Bush
5. Mailing Address: 235 2nd Avenue NW
City. Hicko
6. Phone: [phone]
Title: President
State: NC Zip: 28601
Fax: {�)
II. PROPOSED PERMITTEE / OWNER / PROJECT / ADDRESS INFORMATION
This request is for: (please check all that apply)
❑ Name change of the owner (Please complete Items 1, 2 and 3 below)
❑ Name change of project (Please complete Item 5 below)
x❑. Change in ownership of the property/company (Please complete Items 1, 2, 3, and 4 below)
❑ Mailing address / phone number change. (Please complete Item 4 below)
0 Other (please explain): Only a portion of the original property has been purchased - see attached diagram
1. Proposed permittee's company name/organization: Elite Comfort Solutions
2. Proposed permittee's signing official's name: Rick Velotta
3. Proposed permittee's title: Corporate EH5 Director
4. Mailing Address: 1545 Deborah Herman Road
City: Conover
State: NC Zip: 28613
Phone: [phone] Fax:
5. New Project Name to be placed on permit: Not Applicable
Please check the appropriate box. The proposed permittee listed above is:
❑ HOA or POA (Attach documentation showing that the HOA or POA owns, controls, or has a
recorded easement for all areas that contain stormwater system features. Print name of HOA or
POA in #1 above and provide name of HOA/POA's authorized representative in #2 above)
❑ The property owner
❑ Lessee (Attach a copy of the lease agreement and complete Property Owner Information on
page 4)
Purchaser (Attach a copy of the pending sales agreement. Final approval of this transfer will be
granted upon receipt of a copy of the recorded deed)
❑ Developer (Complete Property Owner Information on page 4)
SSW N/O Change Rev24Sept2012 Page 1 of 4

,7 ,.
f-
L,
A

III. REQUIRED ITEMS
A request to transfer a permit will not be approved by the Division of Water Quality (DWQ) unless all
of the applicable required items listed below are included with the submittal. Failure to provide the
listed items may result in processing delays or denial of the transfer.
1. This completed and signed form. This certification must be completed and signed by both the
current permit holder and the new applicant if this is a change of ownership.
2. Legal documentation of the property transfer to a new owner.
3. A copy of any recorded deed restrictions, covenants, or easements, if required by the permit.
4. The designer's certification (DWQ Engineer and Designer Certification Forms are available from
each DWQ Regional office), if required by the permit and if not already submitted to DWQ.
5. If the proposed permittee is a firm, partnership, association, institution, corporation, limited liability
company, or other corporate entity, provide documentation showing the authority of the named
representative to act on behalf of the proposed permittee.
6. The $40.00 processing fee. If this is an initial transfer from the original permittee the processing
fee is not required. Subsequent ownership transfers will require the $40.00 processing fee.
IV. CURRENT PERMITTEE'S CERTIFICATION
Please check one of the following statements and fill out the certification below that statement:
❑ Check here if the current permittee is only changing his/her/its name, the project name, or mailing
address, but will retain the permit. I, , the current
permittee, hereby notify the DWQ that I am changing my name and/or I am changing my mailing
address and/or I am changing the name of the permitted project. I further attest that this application
for a name/ownership change is accurate and complete to the best of my knowledge. I understand
that if all required parts of this application are not completed or if all required supporting information
and attachments listed above are not included, this application package will be returned as
incomplete.
❑x Check here if current permittee is transferring the property to a new owner and will not retain
ownership of the permit.
I, �� os 1, , the current permittee, am submitting this application
for a transfer of ownership for permit # NCG050000 . I hereby notify DWQ of the sale or
other legal transfer of the stormwater system associated with this permit. I have provided a copy of
the most recent permit, the designer's certification for each BMP, any recorded deed restrictions,
covenants, or easements, the DWQ approved plans and/or approved as -built plans, the approved
operation and maintenance agreement, past maintenance records, and the most recent DWQ
stormwater inspection report to the proposed permittee named in Sections II and V of this form.
further attest that this application for a name/ownership change is accurate and complete to the best
of my knowledge. I understand that if all required parts of this application are not completed or if all
required supporting information and attachments listed above are not included, this application
package will be returned as incomplete. I assign all rights and obligations as permittee to the
proposed permittee named in Sections II and V of this form. I understand that this transfer of
ownership cannot be approved by the DWQ unless and until the facility is in compliance with the
permit. z A /%
Signature:
Date:
I, _ \ c� , a Notary Public for the State of
V\ Ck. County of •Vnc,a� M�, , do hereby certify that
personally appeared before me this the
$� day of 'Ma , 20��, and acknowledge the due execution of the
fo oing instrument. Witness my hand and official seal, -,(Notary Seal)
CX_
Notary Signature ,
(zz" \ VA a-c> \,E�
SSW N/O Change Rev24Sept2012 Page 2 of 4 :'

V. PROPOSED PERMITTEE CERTIFICATION: (This section must be completed by the
Proposed Permittee for all transfers of ownership)
I, c RR h c o , hereby notify the DWQ that I have acquired
through sale, lease or legal transfer, the responsibility for operating and maintaining the permitted
stormwater management system, and, if applicable, constructing the permitted system.
acknowledge and attest that I have received a copy of: (check all that apply to this permit)
x❑ the most recent permit
❑ the designer's certification for each BMP
0 any recorded deed restrictions, covenants, or easements
❑ the DWQ approved plans and/or approved as -built plans
❑ the approved operation and maintenance agreement
❑past maintenance records from the previous permittee (where required)
DWQ stormwater inspection report showing compliance within 90 days prior to this transfer
I have reviewed the permit, approved plans and other documents listed above, and I will comply with
the terms and conditions of the permit and approved plans. I acknowledge and agree that I will
operate and maintain the system pursuant to the requirements listed in the permit and in the
operation and maintenance agreement. I further attest that this application for a name/ownership
change is accurate and complete to the best of my knowledge. I understand that if all required parts
of this application are not completed or if all required supporting information and attachments listed
above are not i ded, ris pplication package will be returned as incomplete.
Signature: Date: /r�l�y
I, �O�v.cti . �� o��So�r� , a Notary Public for the State of
oc off. r , County of , rc,=> r , do hereby certify that
S c HiM P [r VEc a 17' A personally appeared before me this the
day of G , 20\ p and acknowledge the due execution of the
forgoing instrument. Witness my hand and official seal,
Q`. (Notary Si~al)
Notary Signature ` rc
Additional copies of the original permit and the approved Operation and Maintenance agreement can
be obtained from the appropriate Regional Office of the Division of Water Quality.
This completed form, including all supporting documents and processing fee (if required), should be
sent to the appropriate Regional Office of the North Carolina Department of Environment and Natural
Resources, Division of Water Quality, as shown on the attached map.
Please note that if the Proposed Permittee listed above is not the property owner, the property owner
must complete and sign page 4 of this document. Both the lessee / developer and the property
owner will appear on the permit as permittees.
SSW N/O Change Rev24Sept2012 Page 3 of 4

VI.' PROPERTY OWNER CONTACT INFORMATION AND CERTIFICATION
If the Proposed Permittee listed in Sections ll and V of this form is not the Property Owner, the
Property Owner must provide his/her Contact Information below and sign this form:
Printed Name: Not Applicable
Organization:
Title within the Organization:
Street Address:
City:
Mailing Address:
City:
Phone:
Email:
State:
(if different from street address)
State:
Fax:
Zip:
Zip:
I certify that I own the property identified in this permit transfer document and have given permission
to the Proposed Permittee listed in Sections II and V to develop and/or, lease the property. A copy
of the lease agreement or other contract, which indicates the party responsible for the construction
and/or operation and maintenance of the stormwater system, has been provided with the submittal.
As the legal property owner I acknowledge, understand, and agree by my signature below, that I will
appear as a permittee along with the lessee/developer and I will therefore share responsibility for
compliance with the DWQ Stormwater permit. As the property owner, it is my responsibility to notify
DWQ by submitting a completed Name/Ownership Change Form within 30 days of procuring a
developer, lessee or purchaser for the property. I understand that failure to operate and maintain the
stormwater treatment facility in accordance with the permit is a violation of NC General Statute
(NCGS) 143-215.1, and may result in appropriate enforcement action including the assessment of
civil penalties of up to $25,000 per day, pursuant to NCGS 143-215.6.
Signature of the property owner
County of
day of
Date:
a Notary Public for the State of
do hereby certify that
personally appeared before me this the
20 , and acknowledge the due execution of the
forgoing instrument_ Witness my hand and official seal,
(Notary Seal)
Notary Signature
SSW N/O Change Rev24Sept2012 Page 4 of 4

ATTACHMENT 4
Facility Diagrams

t L�;y
. �Y
� vim'.

ATTACHMENT 5
Proof of Sale

:J ~
�4
a¥ .
..��y.
^�k
� {�\
�a
. yp� � � «
� �y� ±
e

EXECUTION VERSION
BILL OF SALE AND ASSIGNMENT
This BILL OF SALE AND ASSIGNMENT (this "Bill of Sale"), dated as of April 15, 2016, is
executed by Hickory Springs Manufacturing Company, a North Carolina corporation ("HSM"), and
Hickory Springs of California, LLC, a North Carolina limited liability company ("Hickory CA" and,
together with HSM, 'Sellers"), in favor of Elite Comfort Solutions LLC (f/k/a Specialty Foam Holdings
LLC), a Delaware limited liability company ("Buyer'), as contemplated by that certain Asset Purchase
Agreement dated as' of March 16, 2016, by and among HSM, Hickory CA, and Buyer (the "Purchase
Agreement"). Capitalized'terms used but not otherwise defined herein will have the meanings ascribed to
such terms in the Purchase Agreement.
NOW, THEREFORE, THIS INSTRUMENT WITNESSETH:
1. For good and valuable consideration, the receipt, adequacy, and legal sufficiency of
which are hereby acknowledged, Sellers do hereby sell, transfer, assign, convey, grant and deliver to
Buyer, all right, title, and interest, legal or equitable, of Sellers in and to all of the Acquired Assets, free
and clear of all Liens, other than Permitted Liens.
2. Sellers hereby constitute and appoint Buyer, its successors and assigns, for the limited
purpose of enabling Buyer to complete, insure, and perfect the transfer, conveyance, and assignment to
Buyer of all the right, title, and interest of Sellers in and to the property hereby granted, bargained, sold,
conveyed, and assigned, or intended to so be, the true and lawful attorney, irrevocably, of Sellers, with
full power of substitution, in the name of Sellers or otherwise, and on behalf of, for the benefit of, its
successors and assigns, including but not limited to the following: (a) to demand and receive from time to
time any and all property hereby granted, bargained, sold, conveyed, and assigned or intended so to be,
and to give receipts, releases, and acquittances for and in respect of the same or any part thereof, and (b)
from time to time, to institute, prosecute, compromise, and settle, as Sellers' assignee, any and all
proceedings at Law, in equity, or otherwise, which Buyer, its successors and assigns, may deem proper to
collect, assert, or enforce any claim, title, or right hereby granted, bargained, sold, conveyed, and
assigned, or intended so to be, that Buyer, its successors and assigns, shall deem desirable.
3. Nothing in this instrument, express or implied, is intended or will be construed to confer
upon or give to any Person other than the parties hereto and their respective successors and assigns any
remedy or claim under or by reason of this instrument or any term, covenant, or condition hereof, and all
the terms, covenants, conditions, and agreements contained in this instrument will be for the sole and
exclusive benefit of the parties hereto and their successors and assigns.
4. Sellers acknowledge and agree that the representations, warranties, covenants,
agreements, and indemnities contained in the Purchase Agreement will not be superseded, expanded,
modified or supplemented hereby, but will remain in full force and effect to the full extent provided
therein. In the event of any conflict or inconsistency between the terms of the Purchase Agreement and
the terms of this Bill of Sale, the terms of the Purchase Agreement will govern and control.
5. This Bill of Sale and the rights and duties of the parties arising hereunder shall be
governed by, and construed and enforced in accordance with, the internal laws of the State of Delaware
without giving effect to the principles of conflicts of Law thereof.
EAST%122122078.3

6. This Bill of Sale may be executed in any number of counterparts, by original or by ".pdf'
or similar electronic copies of signatures sent via email, each of which shall be deemed an original, but all
of which taken together shall constitute one and the same instrument.
[Signatures Follow]
EAST11221220783

14 f
14.

IN WITNESS WHEREOF, Sellers have caused this Bill of Sale and Assignment to be executed
effective as of the date first set forth above.
SELLERS:
HICKORY SPRINGS MANUFACTURING
COMPANY
By:
NamA'ident
Ma
TitleGeneral Counsel & Secretary
HICKORY SPRINGS OF CALIFORNIA,
LLC
By:
Naeohn Titl
(Signature Rage to Bill of Sale and Assignment]

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCGO50000
CERTIFICATE OF COVERAGE No. NCG050190
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,
Hickory Springs Manufacturing Company
is hereby authorized to discharge stormwater from a facility located at
Hickory Springs Manufacturing Company -70
Hwy 70-A East
Hickory
Catawba County
to receiving waters designated as a UT to Cline Creek, a class C stream, in the Catawba River
Basin in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, Il, ill, IV, V, and VI of General Permit No. NCG050000 as attached.
This certificate of coverage shall become effective May 1, 2003.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 28, 2003.
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

o�0F wa rF9Q�
7
" 6--. 6�
o Nc=1111p, -11�'
Calvin McGill
Hickory Springs Manufacturing Company -70
PO Box 128
Hickory, NC 28603
Dear Permittee:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
April 28, 2003
Subject: NPDES Stormwater Permit Renewal
Hickory Springs Manufacturing Company -70
COC Number NCG050190
Catawba County
In response to your renewal application for continued coverage under general permit NCG050000, the
Division of Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This
permit is reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between the state of North Carolina and the U.S. Environmental Protection
Agency, dated December 6, 1983.
The following information is included with your permit package:
A new Certificate of Coverage
• A copy of General Stormwater Permit NCG050000
A copy of the Analytical Monitoring Form (DMR)
A copy of the Qualitativel Monitoring Form
A copy of a Technical Bulletin for the general permit
Your coverage under this general permit is not transferable except after notice to DWQ. The Division
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 Department of
Environment and Natural Resources, or relieve the permittee from responsibility for compliance with any
other applicable federal, state, or local law, rule, standard, ordinance, order, judgment, or decree.
It you have any questions regarding this permit package please contact Aisha Lau of the Central Office
Stormwater and General Permits Unit at [phone], ext. 578.
cc: Central Files
Stormwater & General Permits Unit Files
Mooresville Regional Office
Sincerely,
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
lr—%�11Al
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1 800 623-7748

Energy, Mineral
and Lund Resources
ENVIRONMENTAL OVALITY
June 29, 2016
Mr. Rick Velotta
Elite Comfort Solutions
1545 Deborah Herman Road
Conover, NC 28613 '
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
seemary
TRACY DAVIS
Director
Subject: NPDES Stormwater Permit NCG050190
Elite Comfort Solutions
Formerly Hickory Springs
Manufacturing Company
Catawba County
Dear Mr. Velotta:
Division personnel received your request to revise your stormwater permit Certificate of
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained
in the General Permit remain unchanged and in full effect. This revised Certificate of
Coverage is issued under the requirements of North Carolina General Statutes 143-215.1 and
the Memorandum of Agreement between North Carolina and the U.S. Environmental
Protection Agency.
If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sincerely,
ORIGINAL SIGNED M
KEN PICKLE
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land
Resources
cc: Mooresville Regional Office
Stormwater Permitting Program Files
Central Files
State of North Carolina I Euvironmeotai Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1512 North Salisbwy Street I Raleigh, North Carolina 27699-1612
919107 9220 T

ri1 � t
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG050000
CERTIFICATE OF COVERAGE No. NCG050190
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,
Elite Comfort Solutions
is hereby authorized to discharge stormwater from a facility located at:
Elite Comfort Solutions
1115 Farrington Street
Conover
Catawba County
to receiving waters designated as UT to Cline Creek, a class C 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. NCGO50000 as attached.
This certificate of coverage shall become effective June 29, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 29, 2016.
ORIGINAL SIGNED 81
KEN PICKLE
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Mr. Rick Velotta
Elite Comfort Solutions
1545 Deborah Herman Road
Conover, NC 28613
Dear Mr. Velotta:
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secretary
ACY DAVIS
Director
I�G
June 29, 2016 �0
Ilk�'�QF2
�+0
m
Subject: NPDES Stormwater Permit NCG050190
Elite Comfort Solutions
Formerly Hickory Springs
Manufacturing Company
Catawba County
Division personnel received your request to revise your stormwater permit Certificate of
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained
in the General Permit remain unchanged and in frill effect. This revised Certificate of
Coverage is issued under the requirements of North Carolina General Statutes 143-215.1 and
the Memorandum of Agreement between North Carolina and the U.S. Environmental
Protection Agency.
If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sincerely,
ORIGINAL SIGNED 81
KEN PICKLE
for Tracy E. Davis, F.E., CPM, Director
Division of Energy, Mineral and Land
Resources
cc: Mooresville Regional Office
Stormwater Permitting Program Files
Central Files
State of North Carolina I Environmental Quality I Energy Mineral and Land Resources
1612 Mail Service Center 1 512 North Salisbury Street I Raleigh, North Carolina 27699-1612
919 707 9220 T

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERNUT NO. NCG050000
CERTIFICATE OF COVERAGE No. NCG050190
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,
Elite Comfort Solutions
is hereby authorized to discharge stormwater from a facility located at:
Elite Comfort Solutions
1115 Farrington Street
Conover
Catawba County
to receiving waters designated as UT to Cline Creek, a class C 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. NCG050000 as attached.
This certificate of coverage shall become effective June 29, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 29, 2016. OpJC4 .SHED IM
KEN PICKLE
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

NC Division of Water Quality
6 NPDES Stormwater Permit Contacts Summary
NC D%VO has the following contact Information in our Permit Database for vour verinit as of 12117/2012.
PermitHumber. NCGO50190
Permit Type: Apparel /PT1nt!ngtPaper[Leajbg[jRubbe r Stormwater pscha[ge Co
Fad0tv Name: Hick= sodogs-Conowr Complex
Fadnty Addressi: 1115 Farrington St
Fadlity Address2:
City, State SL Zip: Conover. NC 28613
OwnSr Inf2rmlltion Details;
Owner Name: Hickory Spriggs MaELbcturing r�MjMfty
Owner Type: Non -Government Owner Type Group* Organization
Owner Affiliation: mark Stenger Title:
AddTessl-. PO Box 12
AddressZ;
MY, state& Zip: Hickory, NC 26603
Work Phone: [phone] EXt-,IU Fax:
Email Address:
Contact Name I= Address phone Fax Email
77, 7-1
contact Na Ine Title Address on Fax Email
Stephen M PO Box 2948, Hickory, NC 28603 528-328-2213
Aidridqe EXL 4811
Contaa Name me Address Phone F —a jj
Randy S Walbel 235 2nd Ave. Hidcory, NC 28603 828-328-2201 828-328-4228 rswaibel@tUdwryspnn
Ext. 3244 05.CDM
12/37/2012 Page 60

I

Beverly Eaves Perdue
Governor
A�M rILM
NCDENR
North Carolina DePar#ment of Environment and Natural Resources
Division of Water Quality
Coleen H. Sullins
Director
Mr- Randy Waibel
Hickory Springs Manufacturing Company
1115 Farrington Street
Conover, North Carolina 28613
Dear Mr. Waibel:
June 10, 2011
Dee Freeman
Secretary
Subject: . Compliance Evaluation Inspection
Hickory Springs — Conover Complex
Stormwater Permit No. NCG050000
Certificate of Coverage NCG050190
Catawba County, N.C.
Enclosed is a copy of the Compliance Evaluation Inspection Report for the storrnwater
inspection conducted at the subject facility on May 25, 2011 by Mr. Lon Snider of this Office.
The report should be self-explanatory; however, should you have questions concerning
this report, please do not hesitate to contact Mr. Snider or me at [phone].
Sincerely,
Robert B. Krebs
Surface Water Protection Regional Supervisor
Enclosure
__-- - ­ccCentral,:Eiles�--
— - —--Mooresvil[e Regional Office
Location: 610 East Center Ave-, Suite 301 Mooresville, NC 28115 One
Phone: [phone] Fax: [phone] Customer Service: 1-877-623-6748 NorthCarohna
- Internet: www.ncwaterquality.org - 'VRtlll""r�jl, f
An Equal opportunity 1 Affirmative Action Employer — 50% Recycled/10% Post Consumer paper `bal ly

Compliance Inspection Report
Permit: NCGO50190 Effective: 06/01/08 Expiration: 05/31/13 Owner: Hickory Springs Manufacturing Company
SOC: Effective: Expiration: Facility: Hickory Springs -Conover Complex
County: Catawba 1115 Farrington 5t
Region: Mooresville
Conover NC 28613
Contact Person: Randy S Waibel Title: Phone: [phone]
Ext 3244
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 05/25/2011 Entry Time: 09:15 AM
Primary Inspector: Lon Snider
Secondary Inspector(s):
Certification:
Phone:
Exit Time: 12:45 PM
Phone: [phone]
Reason for Inspection: Routine . Inspection Type: Compliance Evaluation
Permit Inspection Type: Apparel/Printing/Paper/LeatherlRubber Stormwater
Discharge COC
Facility Status: ■ Compliant Cj Not Compliant
Question Areas:
■ Storm Water
(See attachment summary)
Page: 1

Permit: NCO050190 Owner - Facility: Hickory Spnngs Manufaduring Company
Inspection Elate: 0512512011 inspection Type: Compliance Evaluation reason for Visit: Routine
Inspection Summary:
Page: 2

M
Permit: NCG050190 owner • Facility: Hickory Springs Manufacturing Company
Inspection Date: 05125/2011 Inspection Type: Comoliance Evaivafion Reason for Visit: Routine
Stormwater Pollution Prevention Plan Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan? ® D D D
# Does the Plan include a General Location (USGS) map?
# Does the Plan include a "Narrative Description of Practices"?
# Does the Plan include a detailed site map including outfall locations and drainage areas?
# Does the Plan include a list of significant spills occurring during the past 3 years?
# Has the facility evaluated feasible alternatives to current practices?
# Does the facility provide all necessary secondary containment?
# Does the Plan include a BMP summary?
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
# Does the Flan include a Preventative Maintenance and Good Housekeeping Plan?
# Does the facility provide and document Employee Training?
# Does the Plan include a list of Responsible Party(s)?
# Is the Plan reviewed and updated annuaily?
# Does the Plan include a Stormwater Facility Inspection Program?
Has the Stormwater Pollution Prevention Plan been implemented?
Comment: Facility has had no spills in the last 3 years. Plan is up to date and kept in
good order.
Qualitative Monitoring Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? MOOD
Comment: All qualitative monitoring ispections are complete and documented.
Analytical Monitoring Yes No NA NE
Has the facility conducted its Analytical monitoring? ■ D D 0
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas? ■ D D D
Comment: Facility has had high TSS & PH results in 2 out of the last 3 events. They
are correctiing this problem by paving the gravel parking lot area that discharges to this
outfall. Construction was starting on the date of my inspection.
Permit and Outfalls Yes No NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site? ■ D D D
- - - — # Were -all outfalls observed during -the -inspection? ❑ n 0
# If the facility has representative outfall status, is it properly documented by the Division? D D ■ D
# Has the facility evaluated all illicit (non stormwater) discharges?
■000
Page: 3

S
Permit NCG050190 Owner - Facility: Hickory Springs Manufacturing Company
Inspection Date: 05/2512011 inspection Type: Compliance Evaluation
Comment: Facility has 6 outfalls.
Reason for Visit: Routine
Page: 4

NNA Michael F. Easley, Governor
`O�0 !QpG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
C7 7 Alan W. Klimek, P.E. Director
Division 80OWPA014M)ARONMENT
'C AND NATURAL RESOURCES
MOORESVIL! r ' :TONAL OFFICE
Ao6128 2003
Calvin McGill
Hickory Springs Manufacturing Company -70
PO Box 128
Hickory, NC 28603
Subject:
Dear Permittee:
` APR 3 0 2003
_1.
WATER 01lnl !TV
NPDES Stormwater Permit Renewal
Hickory Springs Manufacturing Company -70
COC Number NCGO50190
Catawba County
In response to your renewal application for continued coverage under general permit NCG050000, the
Division of Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This
permit is reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between the state of North Carolina and the U.S. Environmental Protection
Agency, dates! December 6, 1983.
The following information is included with your permit package:
• A new Certificate of Coverage
A copy of General Stormwater Permit NCG050000
• A copy of the Analytical Monitoring Form (DMR)
• A copy of the Qualitativel Monitoring Form
• A copy of a Technical Bulletin for the general permit
Your coverage under this general permit is not transferable except after notice to DWQ. The Division
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 Department of
Environment and Natural Resources, or relieve the permittee from responsibility for compliance with any
other applicable federal, state, or local law, rule, standard, ordinance, order, judgment, or decree.
If you have any questions regarding this permit package please contact Aisha Lau of the Central Office
Stormwater and General Permits Unit at [phone], ext. 578.
Sincerely,
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Stormwater & General Permits Unit Files
Mooresville Regional Office
N. C_ Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
NCOENR
Customer Service
1 800 623-7748

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG050000
CERTIFICATE OF COVERAGE No. NCG050190
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,
Hickory Springs Manufacturing Company
is hereby authorized to discharge stormwater from a facility located at
Hickory Springs Manufacturing Company -70
Hwy 70-A East
Hickory
Catawba County
to receiving waters designated as a UT to Cline Creek, a class C stream, in the Catawba River
Basin in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, III, IV, V, and VI of General Permit No. NCG050000 as attached.
This certificate of coverage shall become effective May 1, 2003.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 28, 2003.
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Michael F. Easley, Governor
William G .•Ross Jr-.Seofstary�*f
North Carolina Department of Environment;and�tVatu* al Resources�
Alan W Klimek, P-E.1, Direct F1Ct
,-- Wa
Division'o of terIIuaility
September 4, 2002
CALVIN MCGILL
HICKORY SPRINGS MANUFACTURING COMPANY - 70 EAST
PO BOX 128
HICKORY, NC 28603
Dear Permittee:
S EA 0 6 2002
3
Subject: NPDES Stormwater Permit Coverage Renewal
Hickory Springs Manufacturing Company - 70 East
COC Number NCG050190
Catawba County
Your facility is currently covered for stormwater discharge under General Permit NCG050000. This permit expires
on March 31. 2003. The Division staff is currently in the process of rewriting this permit and is scheduled to have
the permit reissued by early spring of 2003. Once the permit is reissued, your facility would be eligible for
continued coverage under the reissued permit.
In order to assure your continued coverage under the general permit, you must apply to the Division of Water
Quality (DWQ) for renewal of your permit coverage. To make this renewal process easier, we are informing you in
advance that your permit coverage will be expiring. Enclosed you will find a Permit Coverage Renewal
Application Form. The application must be completed and returned by October 2, 2002 in order to assure
continued coverage under the general permit. Due to staff and budget constraints, letters confirming our receipt of
the completed application willnotbe sent. L
Failure to request renewal within the time period specified, may result in a civil assessment of at least $250.00.
Larger penalties may be assessed depending on the delinquency of the request. Discharge of stormwater from your
facility without coverage under a valid stormwater NPDES permit would constitute a violation of NCGS 143-215.1
and could result in assessments of civil penalties of up to $10,000 per day.
Please note that recent federal legislation has extended the "no exposure exclusion" to all operators of industrial
facilities in any of the 1 1 categories of "storm water discharges associated with industrial activity." (except
construction activities). If you feel your facility can certify a condition of "no exposure", i.e. the facility industrial
materials and operations are not exposed to stormwater, you can apply for the no exposure exclusion. For additional
information contact the Central Office Stormwaler Staff member listed below or check the Stormwater & General
Permits Unit Web Site at http://h2o.enr.stale.ne-us/sulstormwater.himl
If the subject stormwater discharge to waters of the state has been terminated, please complete the enclosed
Rescission Request Form. Mailing instructions are listed on the bottom of the form. You will be notified when the
rescission process has been completed.
If you have any questions regarding the permit renewal procedures please contact Mike Parker of the Mooresville
Regional Office at 704-663-1699 or Aisha Lau of the Central Office Stormwater Unit at [phone], ext. 578
cc: Central Files
Sincerely.
-lei
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
Stormwater and General Permits Unit Files
Mooresville Regional Office VOW,
NCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1-800-623-7746

IN A TF Michael F. Easley, Governor
RQG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
co 7
Alan W. Klimek, P.E., Director
` Division of Water Quality
0 Y
September 4. 2002
CALVIN MCGILL
HICKORY SPRINGS MANUFACTURING COMPANY - 70 EAST
PO BOX 128
HICKORY, NC 28603
Subject: NPDES Stormwater Permit Coverage Renewal
Hickory Springs Manufacturing Company - 70 East
COC Number NCG050190
Catawba County
Dear Permittee:
Your facility is currently covered for stormwater discharge under General Permit NCG050000. This permit expires
on March 31, 2003. The Division staff is currently in the process of rewriting this permit and is scheduled to have
the permit reissued by early spring of 2003. Once the permit is reissued, your facility would he eligible for
continued coverage under the reissued permit.
In order to assure your continued coverage under the general permit, you must apply to the Division of Water
Quality (DWQ) for renewal of your permit coverage. To make this renewal process easier. we are informing you in
advance that your permit coverage will be expiring. Enclosed you will find a Permit Coverage Renewal
Application Form. The application must be completed and returned by October 2, 2002 in order to assure
continued coverage under the general permit. Due to staff and budget constraint~, letters confirming our receipt of
the completed application will not be sent.
Failure to request renewal within the time period specified, may result in a civil assessment of at least $250.00.
Larger penalties may be assessed depending on the delinquency of the request. Discharge of stormwater from your
facility without coverage under a valid stormwater NPDES permit would constitute a violation of NCGS 143-215.1
and could result in assessments of civil penalties of up to $10,000 per day_
Please note that recent federal legislation has extended the "no exposure exclusion" to all operators of industrial
facilities in any of the I I categories of "storm water discharges associated with industrial activity," (except
construction activities). If you feel your facility can certify a condition of "no exposure". i_e. the facility industrial
materials and operations are not exposed to stormwater, you can apply for the no exposure exclusion. For additional
information contact the Central Office Stormwater Staff member listed below or check the Stormwater & General
Permits Unit Web Site at http://h2o_enr.state,nc.us/su/%tormwater.btmI
If the subject stormwater discharge to waters of the state has been terminated, please complete the enclosed
Rescission Request Form_ Mailing instructions are listed on the bottom of the Dorm. You will be notified when the
rescission process has been completed.
If you have any questions regarding the permit renewal procedures please contact Mike Parker of the Mooresville
Regional Office at 704-663-1699 or Aisha Lau of the Central Office Stormwater Unit at [phone]. ext_ 578
Sincerely,
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Stormwater and General Permits Unit Files
Mooresville Regional Office ©��
NCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1- 800-623-7748

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State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
April 30, 1998
CALVIN MCGILL a
HICKORY SPRINGS MFG. CO.-HICKO
PO BOX 128
HICKORY, NC 28603
Mato
ID E N R
Subject: Reissued Stormwater General Permit for Certificate of Coverage No. NCG050190
Catawba County
Dear Permittee:
In response to your renewal application for continued coverage under the subject permit, the Division
of Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This permit
is reissued 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 December 6, 1983.
The following information is included with your permit package:
w A copy of the stormwater general permit.
m A Stormwater Pollution Prevention Plan Certification Form. This form certifies that you have
developed and implemented the Stormwater Pollution Prevention Plan (SPPP) required in your
permit. This form must be completed and returned to the Division within 30 days of receipt of
this letter. DO NOT send the SPPP with the signed form.
■ Five copies of Analytical Monitoring forms.
Five copies of Qualitative Monitoring forms.
0 A copy of a Technical Bulletin on the stormwater program which outlines program components
and addresses frequently asked questions.
■ A corrected Certificate of Coverage if you indicated a name or address change on the Renewal
Form returned to the Division.
Your certificate of coverage is not transferable except after notice to DWQ. The Division of Water
Quality 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
DWQ or permits required by the Division of Land Resources, Division of Air Quality, Coastal Area
Management Act or any other Federal or Local governmental permits that may be required.
If you have any questions concerning this permit or other attached documents, please contact the
Stormwater and General Permits Unit at telephone number [phone]
Sincerely,
-�
�AA�/
Z4 v,, e-* -
foA. Preston Howard, Jr., P. E.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

I
•
r State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
.tames B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
July 22, 1994
Calvin McGill
Hickory Springs Mfg. Co - Hickory
P O Box 128
Hickory, NC 28603
AI LT.R;TA
RV
DEHNR
Subject: General Permit No. NCG050000
Hickory Springs Mfg. Co - Hickory
COC NCG050190
Catawba County
Dear Mr. McGill:
In accordance with your application for discharge permit received on April 26, 1994, we are forwarding
herewith the subject certificate of coverage 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
December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division
of Environmental Management. The Division of Environmental Management 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 Environmental Management or permits required by the Division of Land Resources, Coastal Area
Management Act or any other Federal or Local governmental permit that may be required.
If you have any questions concerning this permit, please contact Ms. Aisha Lau at telephone number 919/733-
5083.
Sincerely,
Original Signed By
Coleen H. Sullins
A. Preston Howard, Jr_, P. E.
cc: Mooresville Regional Office
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Air
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO, NCG050009
CERTIFICAICE OF COVERAGE No. NCG050190
STORIVIWATER DISCHARGES
NATIONAL POLLUTANT DISi`HARGE ELIMINATION fYSTEM
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,
Hickory Springs Mfg. Co.
is hereby authorized to discharge stormwater from a facility located at
Hickory Springs Mfg. Co.
Hwy. 70-A East
Hickory
Catawba County
to receiving waters designated as Cline Creek in the Catawba River Basin in accordance with the effluent limitations,
monitoring requirements, and other conditions set forth in Parts 1, II, III and IV of General Permit No. NCG050000
as attached.
This certificate of coverage shall become effective July 22, 1994.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 22, 1994.
original Signed By
Coleen H. Sullins
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission

FACILITY 5��' ; h� 5-�y . Co.
M
COUNTY C a w 6 a
WES AVG 0Sd1 q0
MAP # /N h1
DSN FLOW j� 1i
SUB BASIN 0 3— b V -- 3 5
LATTITUDE 3 5 � 3 j / 6 !�
LOPIGIT:I!DE V 1" M/ 3 6
REcE-lVIi-,G STREAM
STREAM CLASS C
DISCHARGE CLASS b r �► w a7 e r
EXPIRATION DATE V11,1/ 17