NCG100207_COMPLETE FILE - HISTORICAL_20121204

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V C� �p Q
DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ j;;�� 0I a I a- 97
YYYYMMDD

A�z
NCDEE R
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
John Marina
Salvage Auto Supply LLC
3301 Robinson Cir
Charlotte, NC 28206
Dear Permittee:
Division of Water Quality
Charles Wakild, P. E.
Director
December 4, 2012
Dee Freemad
Secretary
Subject: NPDES Stormwater Permit Coverage Renewal
Salvage Auto Supply, LLC
COC Number NCG100207
Mecklenburg County
In response to your renewal application for continued coverage under stormwater General Permit NCG100000
the Division of Water Quality (DWQ) is forwarding herewith the reissued 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 October
15, 2007 (or as subsequently amended).
The following information is included with your permit package:
• A new Certificate of Coverage (COC)
• A copy of General Permit NCG100000
• A copy of the Technical Bulletin for the General Permit
• Two copies of the Discharge Monitoring Report (DMR) form
• Two copies of the Qualitative Monitoring Report Form
The General Permit authorizes discharges of stormwater, and it specifies your obligations for discharge
controls, management, monitoring, and record keeping. Please review the new permit to familiarize yourself
with all the changes in the reissued permit. Your facility has six (6) months from the time of receipt of the
permit to update your current SPPP to reflect all new permit requirements.
The first sample period of your permit begins January 1, 2013. Your facility must sample a "measureable
storm event" beginning during the periods beginning January 1 and July 1 of every year (or, if applicable,
report "No Flow," as outlined in Part III, Section E). Also, please note that Tier 3 Actions in Part 11 of your
permit are triggered by benchmark exceedances on four occasions beginning an the effective date of this
permit and do not count prior exceedances.
The more significant changes in the General Permit since your last COC was issued are noted either in the
Draft Permit Fact Sheet that accompanied the public notice (http://portal.ncdenr.orglweb/wq/ws/su/current-
notice ), or in the Response to Comments / Summary of Changes and Technical Bulletin documents that are
posted on the Stormwater Permitting Unit's website with the new General Permit. Please visit
http://Portal.ncdenr.org/web/wq/ws/su/npdessw (click on 'General Permits' tab) to review that information
for your specific General Permit carefully.
1617 Mail Seivice Center, Raleigh, North Carolina 27699.1617
Location: 512 N. Salisbury St. Raleigh. North Carolina 27604
Phone: 9V -807.63001 FAX: 919.807---•492
Inteme4: vAmmwalerguality.ona
An Equal Q,,,,nrimitt' 1 Affirmative Acton Employ :r
One
NorthCai!-olina
,,iVatura,'Z#

John Marina
December 4, 2012
Page 2 of 2
Some of the changes include:
Part II:
• Section A: The Stormwater Pollution Prevention Plan (SPPP) section, if applicable, has been updated
to the most current language of our permits. Additional conditions for specific industry sectors have
been added to the SPPP requirements in some cases.
• Sections B, C: Failure to perform analytical stormwater monitoring may result in the Division requiring
that the permittee begin a monthly sampling scheme.
• Sections B, C: A lower TSS benchmark of 50 mg/I for HQW, ORW, PNA and Tr Waters applies to these
more sensitive waters.
• Sections B, C. The monitoring parameter Oil & Grease (0&G) has been replaced by the parameter
Total Petroleum Hydrocarbons (TPH) for vehicle maintenance areas, and in some cases, other
analytical monitoring requirements.
• Sections B, C, D: Inability to sample due to adverse weather must be recorded in the SPPP, or in
separate on -site records if your General Permit does not require an SPPP. Adverse weather is defined
in the "Definitions" section of the permit.
• Sections B, C. The term "Representative Storm Event" has been replaced by "Measurable Storm
Event." A measurable storm event is defined in the permit.
• Section D: If the permittee fails to respond effectively to problems identified by qualitative
monitoring, DWQ may require the permittee to perform corrective action.
Please review Parts ill and IV to understand the Standard Conditions of your new NPDES General Permit,
including Compliance and Liability, Reporting, Monitoring and Records requirements; Operation and
Maintenance obligations; and Definitions. Please note that all samples analyzed in accordance with the terms
of this permit must be submitted to the Division on Discharge Monitoring Report (DMR) forms available on
the Stormwater Permitting Unit's website above. DMR forms must be delivered to the Division no later than
30 days from the date the facility receives the sampling results from the laboratory. Also note that existing
permittees do not need to submit a renewal request prior to expiration unless directed by the Division.
Your coverage under the General Permit is transferable only through the specific action of DWQ. This permit
does not affect the legal requirements to obtain other permits which may be required by DENR, nor does it
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 the Division's Stormwater Permitting Unit at [phone].
Sincerely,
tuile �
for Charles Wakild, P.E.
cc: DWQ Central Files
Stormwater Permitting Unit Files
Mooresville Regional Office

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG100000
CERTIFICATE OF COVERAGE No. NCGl00207
STORMWATER
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,
Salvage Auto Supply LLC
is hereby authorized to discharge stormwater from a facility located at:
Salvage Auto Supply, LLC
3301 Robinson Cir
Charlotte
Mecklenburg County
to receiving waters designated as Little Sugar Creek, a class C waterbody in the Catawba River
Basin in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts 1,11,111, and IV of General Permit No. NCG100000 as attached.
This certificate of coverage shall become effective December 4, 2012.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this 41h day of December, 2012.
for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

"A
+L...rwr�� .
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
July 16, 2010
Mr. John Marina
Salvage Auto Supply, LLC.
3301 Robinson Circle
Charlotte, NC 28206
Subject: General Permit No. NCG100000
Salvage Auto Supply, LLC
COC NCGl00207
Mecklenburg County
Dear Mr. Marina:
Dee Freeman
Secretary
In accordance with your application for a discharge permit received on June 15, 2010, 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 October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except after notice to
• - the Division of Water Quality. The Division of Water Quality may require modification o;: —
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 Water Quality 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 pen -nit, please contact Jennifer Jones at
telephone number [phone]
Sincerely,
ORIGINAL SIGNED BY
FTeMY�QOUAS
oenu�C
for ns
cc: Mooresville Regional Office, Rob Krebs
Central Files
Stormwater Permitting Unit Files
Mecklenburg County, Rusty Rozelle
Wetlands and Stormwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 NorthCaro.lina
Location: 512 N. Salisbury 5t. Raleigh, North Carolina 27604 �K
��11���`f�
Phone. [phone] FAX: [phone] Customer Service: 1.877-623-6748
Internet: www,ncwaterquality.org

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG1.00000
CERTIFICATE OF COVERAGE No. NCG100207
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,
Salvage Auto Supply, LLC
is hereby authorized to discharge stormwater from a facility located at:
Salvage Auto Supply, LLC
3301 Robinson Circle
Charlotte City
Mecklenburg County
to receiving waters designated as a UT to Little Sugar 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, IV, V, and VI of General Permit No. NCG100000 as
attached.
This certificate of coverage shall become effective July 16, 2010.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 16, 2010.
ORIGINAL SIGNED BY
BETHANY GEORGOULIAS
for Coleen H. Sullins., Director
Division of Water Quality
By the Authority of the Environmental Management Commission

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NCGIO0207 Salvage Auto Supply., LLC
Charlotte,, NC
N
Latitude: 350 15' 26" N
W E Longitude: 800 48'40" W
County: Mooresville
S Receiving Stream: UT to Little Sugar Creek
Stream Class: C
Map Scale 1:16,657 Sub -basin: 03-08-34 (Catawba River Basin)
Facility Location

Permit Number NCGl00207
Program Category
NPDES SW
Permit Type
Used Motor Vehicle Parts Stormwater Discharge COC
Primary Reviewer
rob.krebs
Coastal SW Rule
Permitted Flow
Central Files: AP5 SWP
07/15/10
Permit Tracking Slip
Status Project Type
In review New Project
Version Permit Classification
COC
Permit Contact Affiliation
Facility
Facility Name Major/Minor Region
Salvage Auto Supply, LLC Minor Mooresville
Location Address County
3301 Robinson Cir Mecklenburg
Charlotte NC 28206 Facility Contact Affiliation
Jahn Marina
3301 Robinson Cir
Charlotte NC 28206 -
Owner
Owner Name Owner Type
Salvage Auto Supply LLC Non -Government
Owner Affillation
John Marina
3301 Robinson Cir
Charlotte NC 28206
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
06/15/10
emulated Activities
Dismantling automobiles for scrap
Outfall 001
Watorbody Name
Little Sugar Creek
Requested/Received Events
RO staff report requested 06/18/10
RO staff report received 07/15/10
Stream Index Number Current Class
11-137-8 C
Subbasin
03-08-34

•
•
•
Section 7.1.1— Filtrexx SiltSoxiCrm - Sediment & Perimeter Control Technology
REFERENCES
Faucette, L.B., K. Kerchner, and A. Vick. 2006.
Sediment Storage Capacity of SiltSoxxTM vs. Silt
Fence. Filtrexx Tech Link 43314
Faucette, L.B., H. Keener, M Klingman, and K.
Kerchner, 2006. Design Capacity Prediction Tool
for SiltSoxxTM and Silt Fence. Filtrexx Tech Link
43313 (Description of Design Tool) and Filtrexx
Library #301 (Design Tool)
Faucette, L.B. 2006. Flow -Through Rate, Design
Height, and Design Capacity of SiltSoxxTM and
Silt'Fence. Filtrexx Tech Link 43304
Faucette, L.B. 2006. Design Height, Flow -
Through Rate, and Slope Spacing of SiltSoxxT"
and Silt Fence. Filtrexx Tech Link 4331 1
Faucette, L.B., and R. Tyler. 2006. Organic BMPs
used for Storm Water Management. Proceedings
of the International Erosion Control Association
Annual Conference, Long Beach, CA 2006.
Faucette, B, F. Shields, and K. Kurtz. 2006.
Removing storm water pollutants and determining
relations between hydraulic flow -through rates,
pollutant removal efficiency, and physical
characteristics of compost filter media. Second
Interagency Conference on Research in
Watersheds, 2006 Proceedings, Coweeta
Hydrologic Research Station, NC. Filtrexx Library
4106.
Faucette, B., Sadeehi, A., and K. Sefton. 2006.
USDA ARS = Evaluation of Compost Filter Socks
and Silt Fence in Sediment and Nutrient Reduction
from Runoff. Filtrexx Tech Link #3308
Fifield, J. 2001. Designing for Effective Sediment
and Erosion Control on Construction Sites,
Forester Press, Santa Barbara, CA.
Keener, H., B. Faucette, and M. Klingman. 2006.
Flow -through rates and evaluation of solids
separation of compost filter media vs. silt fence in
sediment control applications. 2006 American
Society of Agricultural and Biological Engineers
Annual International Conference, Portland, OR.
Paper No. 062060.
Sadhegi, A., K. Sefton, and B. Faucette. 2006..
Sediment and nutrient removal from storm water
with compost filter socks and silt fence. 2006
American Society of Agricultural and Biological
Engineers Annual International Conference,
Portland, OR. Paper No. 06XXXX
American Association of State Highway
Transportation Officials. 2003. Standard
Specification for Transportation Materials and
Methods of Sampling and Testing, Designation
M9-03, Compost for Erosion/Sediment Control.
Washington, DC
Faucette, L.B., A. Vick. 2006. LEED Green
Building Credits using Filtrexx Organic BMPs,
Filtrexx Tech Link #3301
Faucette, L.B. A. Vick, and K. Kerchner. 2006,
Filtrexx, Compost, Low Impact Development
(LID), and Design Considerations for Storm Water
Management. Filtrexx Tech Link #3306
Faucette L.B., C.F. Jordan, L.M. Risse, M.
Cabrera, D.C. Coleman, and L.T. West. 2005.
Evaluation of Storm Water from Compost and
Conventional Erosion Control Practices in
Construction Activities. Journal of Soil and Water
Conservation. 60:6: 288-297.
Faucette, L.B. 2005. Removal and Degradation of
Petroleum Hydrocarbons from Storm Water with
Compost. Filtrexx Tech Link #3307
Faucette, L.B. 2005. A Comparison of
Performance and Test Methods of SiltSoxxTM and
Silt Fence. Filtrexx Tech Link #3302.
Faucette, L.D., N. Strazar, A. -Marks. 2006.
Filtrexx Polymer and Flocculent Guide. Filtrexx
Library #601.
Marks, A., R. Tyler, and B. Faucette. 2005. The
Filtrexx Library. Digital publication of support
tools for the erosion industry.
www.filtrexxlibrarv.com.
Marks, A., and R. Tyler, 2003. Filtrexx
International Company Website. Specifications,
CAD drawings, case histories. www.filtrexx.com
Tyler, R.W., and A. Marks. 2004, Erosion Control
Toolbox CD Kit. A Guide to Filtrexx Products,
Educational Supplement, and Project Videos. 3
Filtrexx Standard Specifications and Design Manual — Version 7.0 US Patent 7,226,240 7

Jones, Jennifer
From: Jones, Jennifer .
Sent: Thursday, July 15, 2010 3:05 PM
To: Jones, Jennifer; Krebs, Rob
Subject: RE: ncg100207
Hi Rob,
I hadn't hear back from anyone on this so I will plan to issue the permit on the 161h.
Jen
From: Jones, Jennifer
Sent: Friday, June 18, 2010 2:18 PM
To: Krebs, Rob
Cc: Jones, Jennifer
Subject: ncg100207
Hi Rob,
We've received an N01 from Salvage Auto Supply, LLC for their facility in Charlotte (Mecklenburg County)
for coverage of their salvage yard under NCG10 (used motor vehicle parts permit). The site discharges
stormwater into a UT to little Sugar Creek ( C). The NOI is attached.
They are a small quantity generator of hazardous waste.
Does the Mooresville Regional Office have any concerns about issuing this facility a COC for this general •
permit? If we don't receive any objections, we'll issue the COC in 30 days.
Thanks,
Jen
Jennifer Jones
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting Unit
1617 Mail Service Center, Raleigh, NC -27699-1617
512 N. Salisbury St, Raleigh, NC 27604
Phone: [phone]
Fax: [phone]
Email: iennifer.iones(@ncdenr.eov
Website: http://Dortal.ncdenr.org/web/wq/ws/su
**E-mail correspondence to and from this address may be subject to the North Carolina Public
Records Law and may be disclosed to third
parties.**
0

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US Filter Bags
Geotextile Filter Bag
US Filter Bags are designed to collect silt and sediment from pumped water and are ideal for construction site
dewatering applications. To begin dewatering, simply cut an opening into the bag, insert the discharge hose and
secure the connection with a clamp, tie or tape. US Filter Bags are made from a nonwoven, needlepunched,
polypropylene geotextile that meets the following M.A.R.V, values except where noted:
PROPERTY
Weight - Typical
Tensile Strength
Elongation @ Break
Mullen Burst
Puncture Strength
CBR Puncture
Trapezoidal Tear
Apparent Opening Size
Permittivity
Water Flow Rate
UV Resistance @ 500 Hours
TEST METHOD
ASTM D-5261
ASTM D-4632
ASTM D-4632
ASTM D-3786
ASTM D-4833
ASTM D-6241
ASTM D-4533
ASTM D-4751
ASTM D-4491
ASTM D-4491
ASTM D-4355
ENGLISH
8 oz/sy
205 Ibs
50%
350 psi
120 Ibs
535 Ibs
85 Ibs
80 US Sieve
1.35 Sec-1
90 g/min/sf
70%
METRIC
271 g/sm
912 N
50%
2,413 kPa
534 N
2,381 N
378 N
0.180 mm
1.35 Sec-1
3,657I/min/sm
76%
ROLL SIZE AREA WEIGHT
15' x 10, 17 sys 20 Ibs
IS' x 15' 25 sys 30 Ibs
The above Information is to the best of our knowledge accurate, but it Is not intended to be considered a guarantee. Any Implied warranty
for a particular use or purpose is excluded. If the product does not meet the above properties, and notice is given to US Fabrics, Inc., the
product will be replaced or refunded (512010).
6/18/2010
r�

I\n(R o
Cry%Division of Water Quality 1 Surface Water Protection
Section
NCDENRNational Pollutant Discharge Elimination System
#40R CAROW— Down-tNr w
.WR0H.r.W AND 11M111AL RC9IXn1CU
NCG100000
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year
I Month
T Da
Certificate of Coverage
Check N
Amount
d
P rrnit Assi cd to
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG100000:
STORMWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) 5015 Used Motor Vehicle Parts
SIC 5093 Automobile Wrecking for Scrap, (except as specified below)
The following activities are specifically excluded from coverage under this General Permit:
Establishments primarily engaged in the wholesale trade of metal waste and scrap, iron and steel scrap, and
nonferrous metal scrap (hereafter referred to as the metal waste recycling industry)
I For questions, please contact the DWQ 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.
SALVAGE AUTO SUPPLY LLC
3301 ROBINSON CIR
CHARLOTTE StateNC ZIP Code 28206
980 3228722 Fax: [phone]
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No,
Email
SALVAGE AUTO SUPPLY LLC
JOHN, MARINA
3301 ROBINSON CIR
CHARLOTTE StateNC ZIP Code 28206
MECKLENBURG
704 421 0800 Fax: [phone] _
[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). Going on N. Tryon St. towards down -town, make
right turn to Atando ave. Then make first right turn to Robinson Cir. Then make first left turn, the place
will be on your left
Ac of n VDffit—qP1�!R111W ( opy a cou ty map or USGS quad sheet with facility clearly located must be submitted with this a--^—�}
4) Latitude35.257.088_Longitude_80.811.418_(deg, min, sec) R SUN 15 N"
5) This NPDES Permit Application applies to which of the following:
Page 1 of 4
SWU-225-071408 Last revised 7/14108

NCG 100000 N.O.I.
❑ New or Proposed Facility
X Existing
6) Standard Industrial Classification:
Date operation is to begin
Provide the:44git.Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 7
Provide a brief narrative description of the types of industrial activities and products manufactured at this
facili Salvage -yard; -we strip cars, store stripped cars at the yard. Car repair, container loading
7) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? D
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in?
Receiving water classification:
Is this a 303(d) listed stream? Has a TMDL been approved for this watershed?
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). CITY OF CHARLOTTE MUNICIPAL STORM
SEWER
8) Does this facility have any other NPDES permits?
X No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
9) Does this facility have any Non -Discharge permits (ex: recycle permit)?
X No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
10) Does this facility employ any best management practices for stormwater control?
X No
❑ Yes (Show structural BMPs on the site diagram.)
If yes, please briefly describe:
11) Does this facility have a Stormwater Pollution Prevention Plan?
X No
❑ Yes
If yes, when was it implemented?
12) Hazardous Waste:
a) is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
X No ❑ Yes
b) Is this facility a Small Quantity Generator ( ess than 1000 kg. of hazardous waste generated per month) of
hazardous,waste? %
No \,X Yes
Page 2 of 4
SWU-225-071408 Last revised 7/14108

NCG100000 N.O.I.
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
X 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:used motor oil, antifreeze, radiator fluid
How is material stored:in drums
Where is material stored:in the warehouse
How many disposal shipments per year:minimum 12
Name of transport I disposal vendor: Universal Environmental Services, LLC
Vendor address:642 Grooms Rd, Reidsville, NC 27320
14) 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: EVGENII DESIATNIKOV
Title: _?-R�SIDENT_
Applicant)
_06/03/2010_
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to:
NCDENR
Page 3 of 4
SWU-225-071408 Last revised 7114/08

NCG 1 00000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NCDENR
❑ This completed application and all supporting documents
❑ A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
(f) impervious areas, (g) site property lines.
❑ Copy of county map or USGS quad sheet with location of facility clearly marked on map
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee coverage under the NPDES General Permit.
For questions, please contact the DWQ Regional Office for your area.
DWQ Realonal 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 .........(919)
807-6300
Page 4 of 4
SWU-225-071408 Last revised 7/14/08

0IN
ALL -POINTS
w �
9 s \�`.
WASTE SERVICE, INC.
f.
March 30 2010
John Desiatuikov
Salvage Auto Supply
3301 Robinson Circle
Charlotte NC 28206
Dear Mr. Desiatuikov,
Thank you for the opportunity to submit the following proposal for your waste
removal requirements. All -Points Waste Service is a full service company with state-of-
the-art material handling systems that provide high levels of performance. Based on our
50+ combined years of experience in the waste industry, we have built a reputation of
providing flexible, dependable and environmentally sound service to our commercial
and industrial customers.
We are pleased to offer the following quote for your review.
* We only need 1 days'notice to have the.equipment!delivered.
Thank you again for allowing All -'Points Waste Service to. sub mit'th.is.proposal for our
services. If you have any questions regarding this information, please do not hesitate -.to
call me at 704-821-5424 or 704-235-8937 by cell phone, to reach me directly.
Sincerely,
Lisa Schultz
Account Manager
*ProposaHs guaranteed for 30"days*
P.Q. Box 2458, Indian Trait; NC 28079
Office: [phone] Fax: [phone]

P0
A N I 1� *".S`
w
ALL -POINTS
WASTE SERVICE, INC.
4 s \?L
March 30 2010
John Desiatuikov.
Salvage Auto Parts
3301 Robinson Circle
Charlotte NC 28206
Dear Mr. Desiatuikov,
S oR"se /0
P,q C, '0 /
Thank you for the opportunity to submit the following proposal for your waste
removal requirements. All -Points Waste Service is a full service company with state-of-
the-art material handling systems that provide high levels of performance. Based on our
50+ combined years of experience in the waste industry, we have built a reputation of
providing flexible, dependable and environmentally sound service to our commercial
and industrial customers.
We are pleased to offer the following quote for your review. No hidden Charges your
rate stays the same.
* We only need 1 days -notice to have the equipment delivered.
Thank you again for allowing All -Points Waste Service to submit this proposal for our
services..If you have any questions regarding this information, please do,,.not hesitate -to
call me at 704-821-5424 or.704-235-8937 by -tell phone to reach me directly.
_Sincerely,
Lisa Schultz
Account Manager
*Proposal. is guaranteed for 30days*
P.O. Box 2458, Indian Trail, NC 28079
Office: [phone]. -Fax: [phone]
a

Universal Environmental Services, LLC Manifest No. S00407283
Document Date 05/18/10
642 Grooms Road
Reidsville, NC, 27320
EPA No.: NCR000139667
" FAX
Generator Information: Salvage Auto
3301 Robinson Circle
Charlotte, NC 28206
Phone: 704-601
Halogen Content Checked By: Halogen Leak
SAL330 �`—
Truck Code SC19
Tank Size 0.00
Frequency. 4W
RECYCLE I TRANSPORTATION 1 RECEIVING MANIFEST
Chlor-D-Tect Detector
DESCRIPTION 1 CLASSIFICATION
O o d , ;` 65, 70 7
Oil, Flash Greater Than 200 F
GAL
card Required
Feedotor
ntifreeze, Flash Greater Than 200 F
card Required
��GAL
II Filters, Flash Greater Than 200 F
DRUMS
o Placard Required
her
Handling Coda
001 Description
BPECIAL HANDLING INSTRUCTIONS:
his USED OIL Is subject to
kvold akin and tissue contact. Wear gloves and eye
uiatlon by the Georgia
arotectIon. 11 undeliverable or unacceptable to recycle
NON -HAZARDOUS
NR/E.P.D. and the United States
Pause facility, return to generator.
, P.A. under
n come of emergency contact: On. Dept. of Natural Resources
CPR PART 279
lid Waste Division or Tenn. Dept. of Environment
rid Conservation and Universal En irortmental at ( 770 ► 49"816
EMERGENCY CONTACT
PHONE NUMBER: 770-486-8816
GENERATOR 1 SHIPPER CERTIFICATION
No, the generator of this product, hereby Certify that we have not mixed any hazardous waste in this product being picked up by the above company. This product is being transported to
he above company to be recycled in accordance with all faderet,state and local regulations. We, the generator, also certify that this product does not contain any detectable levets of
Ci8's (53 Fed. Reg. 24208, .tune 27. 19118). '
hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are ciessified,packed,marked and labeled and are In all
aspects In proper condition for transport by highway according to applicable intematfonet,natlonal, and state goverment regulations,
Mass I am a small quanf ly generator who has been exempted by statute or regulation from the duty to make a waste mfnimlzalion certification under Section 3002(b) of RCRA, I also
enlfy that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practical and I have selected the
,method of treatmenl,storage or disposal currently available to me which minimizes the present and future threat to human health and the environment.
Printed Name
Signature
Date
TRANSPORTER I FACILITY ACKNOWL EMENT OF RECEIPT OF MATERIALS
Printed Name
Signature
Date
Dennis Guill
Billing Information Receivables Payables .
Payment Received To Be Billed
YES NO YES NO - Quantity
Amount Unit Price Unit Price
PO !Number -
Check No. Total Total

Universal Environmental Services, LLC
642 Grooms Road
Reidsville, NC, 27320
EPA No,: NCR000139657
* FAX
Generator Information: Salvage Auto
3301 Robinson Circle
Charlotte, NC 28206
Phone: [phone]
Halogen Content Checked By Halogen Look
Customer is a:
Manifest No. S00400789
Document Date 04120/10
Truck Code SC19
Tank Size 0.00
RECYCLE ! TRANSPORTATION 1 RECEIVING MANIFEST
a Chlor-D-Toct Detector
SAL330
DESCRIPTION ! CLASSIFICATION
i5b
d Motor OII, Flash Oreater Than 200 F
GAL
o Placard Requlred
sod Antlkeese, Flash Greater Than 200 F
o Placard Required
GAL
sad Oil Filters, Flash Greater Than 200 F
DRUMS
o Placard Required
er
an nq a
bD'L Description
113SCIAL HANDLIN4 INSTRUCTIONS.
Is USED OIL is subf act to
void skin and ussus contact, Wear gloves and eye
egulatlon by the Georgia
3rotectlon. If undeliven3ble or unacceptable to recycle
NON -HAZARDOUS
NR1ER.D, and the United States
eusefacility, return to ge;neretor.
P.A. under
n case of emergency eontpal: Co. Dept. of Natural Reeourrm
CFFt PART 279
lid Waste Dlvletori orTena. Dept. of Environment
t1d
Conservation and Universal Emrironmentel at t 770) 4W-8111e
MERG NCY CONTACT
PHONE NUMBER: 770- 86-8816
GENERATOR 1 SHIPPER CERTIFICATION
NO, the generator of this prvdum hereby certify that we have not mixed any h4mcluus waste In We producf being picked up by Ine above oompany. This product Is being iraneponed to
he above oempany to be reoWcd In acboedenoe with all federal,slale and local regutet p+s, We, the generator, also certify (hot this product does not contain any detectebig levels of
(53 Fed. Reg. 242a8, Duns 27.198e ).
hereby declare that the pontenle of this consignment are fully and aocurataly dsscdlbed above by omper shipping name and are nlaSstfiad,patkad,marked and labeled end are in all
aspects In proper condition for transport by highway according to applicable intematlonal,nailanal, and state goverment regulatlom.
mess I am a small quarri ty generator who has been eampted by statute or roguialfon from the duty to make a waste minimiratlon cardfIcation under Soollon 3002(b) of RC,RA, I also
that I have a program in Moon io reduca the volume and loxldty of wasle generated to are degree I haw aeterminod to be economically practical and I nave selected the
iwood of tuftnl storage or (fleposal oxenfly available to me which minlmireb the present and future threat to trnnan health and the environment.
ntName
gnature
ate
TRANSPORTER ! FACILITY ACKNO LED EMEN: OF RECEIPT OF
MATERIALS
Rnted Narne
SIgnistUre
Dow
O?e)- 0
Dennis Gehl
Billing Information Receivables Payables
Payment Received To Be Billed
YES. NO YES NO Quantlty
Amount Unit Price Unit Price
PO Number
Check No. Total Total

Universal Environmental Services, LLC
642 Grooms Road
Reidsville, NC, 27320
EPA No.: NCR000139667
' FAX
Generator Information: Salvage Auto .
3301 Robinson Circle
Charlotte, NC 28206
Phone: [phone]
Halogen Content Checked By: 0"Halogen,Leak
Customer Is a:
Manifest No.
Document Date
Truck Code
Tank Size
S00400780
04/20/10
SC1g
0.00
RECYCLE 1 TRANSPORTATION 1 RECEIVING MANIFEST
❑ Chlor-D-Tect Detector
DESCRIPTION I CLASSIFICATION
SAL330
l<-3
Motor OII, Flash Greater Than 200 F
GAL
o Placard Required
Ised
sed Antifreeze, Flash Greater Than 200 F
GAL
o Placard Required
sed Oil Filters, Flash Greater Than 200 F
DRUMS
o Placard Required
her
Handling Code
DD'L Description
SPECIAL HANDLING INSTRUCTIONS:
his USED OIL is subject to
kvold skin and tissue contact. Wear gloves and eye
egulation by the Georgia
arotectIon. If undeliverable or unacceptable to recycle
NON -HAZARDOUS
NRIE.P.D. and the United States
use facility, return to generator.
.P.A. under
n case of emergency contact: Ga. Dept. of Natural Resources
D CFR PART 279
olld Waste Division or Tenn. Dept. of Environment
rut conservation and universal Environmental at 1770 j 486.11818
EMERGENCY CONTACT
PHONE NUMBER: 770-486-8816
GENERATOR I SHIPPER CERTIFICATION
e, the generator of this product, hereby certify that we have not mixed any hazardous waste in this product being picked up by the above company, This product Is being transported to
he above company to be recycled In accordance with all federal.stale and local regulations. We, the generator, also certify that this product does not contain any detectable levels d
CS's (53 Fad. Reg. 24206, June 27, 1988).
hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are casslfied,packed,marked and labeled and are in all
aspects In proper condition for tranepon by highway according to applicable Intemailonal,natlonal, and state goverment regulations.
Mass I am a small quantity generator who has been exempted by statute or regulation from the duty to make a waste minimization certification under Section 3002(b) of RCRA, I also
ertlfy that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practical and I have selected the
shod of treatmenl,storage or disposal currently available to me which minimizes the present and future thraal to human health and the environment.
Printed Name
Signature
Date
TRANSPORTER 1 FACILITY ACKNOWLEDGEMENT OF RECEIPT OF MATERIALS
Printed Name
Signature
Date
rr��
t ' Z21)' C)
Dennis Guilt
Billing Information Re abl Payables
Payment Received To Be Billed
'YES NO YES NO Quantity
Amount Unit Price Unit Price
PO Number
Check No. Total Total

Universal Environmental Services, LLC Manifest No. $00395821
Document Date 03/23/10
Truck Code scle
642 Grooms Road
Reidsville, NC, 27320
EPA No.: NCROD0139887 RECYCLE 1 TRANSPORTATION I RECEIVING MANIFEST
FAX
Generator Infwmatlon; Salvage Auto SAL330
3301 Robinson Clrcle
Charlotte, NC 28200
Phone: [phone]
Halogen Content Checked By: /Halogen Leak Chlor-D-Tect Detector
Customer is a: T�
DESCRIPTION 1 CLASSIFICATION
sad Motor Oil, Flash Greater 'Man 200 F
n
GAL
o Placard Requirgad
sod Antifreeze, Flesh Greater Than 200 F
o Placard Required
���
GAL
fled Oil Filters, Flash Oreater Than 200 F
DRUMS
o Placard R uired
her
HAndiJr19 COdd
OWL Doscrlptlon
SPECIAL HANDLING INSTRUCTIONS.
is USED OIL is subject to
kvold skin and tlasue contact. wear gloves and eye
uiation by the Georgia
Protection. M undeliverable or unacceptable to nacyela
NON -HAZARDOUS
NWE.P.D, and the United States
Ouse facility, return to generator.
PA. under
n trio of amargoney oohlattr on, Dept. of Natural Resources
CFR PART 279
Ild Waste Dlvlalon or Terry. Dept, of Ermkonmitl
nd Conservation and Universal ErrAranmante! at (770) 4464016
EMERGENCY CONTACT
PHONE
NUMBER: 7708816
GENERATOR
1 SHIPPER CERTIFICATION
a rtw generator of this p►NAA hereby certify thal we have not rrirxed any her;rdoua waste rn this produel being picked up by the above Company, This Droduct le being transported tc
he above company to be nb4tod In acocrdance with e(I federalAtals and local reguledons. We, the 9eftrator, also cenlfy that this product does not contain any detectable lever of
;ICEN (53 Pod. PAg.2A2A8, tuno 27, 198E).
hereby dedero that the oordeNa of this consignment are fully and accurately dandbed above by Muter ehipalng name and are clasalned, owked.awrked and fabsiao and are In all
pests in pauper eondillon for transport by highway wCardina to appilcabie Inteme(;onel,nanonal, and state govemoni regdatlons.
mess I am a ernau Quantity gwmratorwfw has treen a ompted by statute or regkAalion fmm Ina duty to make a waste minrrnitatton oertlfiradon under Section 3002(nl of RCRA, I also
rdry that I have a prwram in plo" to reduce the volume and toxidty of vmaa ra to the tle9rva I have dCtaminad to etonondnally prakxlGei and I have eo19CSed [tie
mthed of Ireatmeni aWrap or dlepMl cunsndy available to me which m1 1 and future great to human health and the environment.
me u Date
TRANSPORTER 1 FACILITY AMOU"DOJIMENT OF RECEIPT OF MATERIALS
Printed Name
9nsrture
Dennis Gut ll
Billing lnformatlon Receivables Payables
Payment RiCelved To!Be Billed
YES NO YES NO Quantity
Amount Unit Price R- unit Price
PO Number
Check No. Total Total

Universal Environmental Services, LLC
042 Brooms R020
Reldsvllle, NC, 27320
EPANo.: NCR000139667
" FAX
Generator Information: Selvage Auto
3301 Robinson Circle
Charlotte, NC 28206
Phone: [phone]
Halogen Content Chocked By: ZHaiogen Leak
Customer la a:
Manifest No, 500390047
Document Date 02/23/10
Truck Code SC19
RECYCLE 1 TRANSPORTATION 1 RECEIVING MANIFEST
❑ Chlor-D-Tect Detector
DESCRIPTION I CLASSIFICATION
SAL330
r7vaed
miowr 011, Flesh Greater Then 200 F
GAL
o Placard Required
sod Antifreeze, Flash Greater Than 200 F
GAL
o Placard'Requireq
Ze Ci
tied Oil Filters, Flash Greeter Then 200 F
DRUMS
a Placard Required
ther
ndling Code
150% l]aaoriptlon
PI:CIAL HANDLING I1149TRUCTIONS:
Ns USED OIL Is subject to
void akin and Ussw contact. Weer gloves and eye
egulation by the Georgia
rotsclion, If undeliverable or unacceptable to recycle
NON -HAZARDOUS
N1111e.P.D. and the United States
ruse facility, return to generator.
,P,A, under
n apse of emergency contaob Ga. Dept. of halunll Resources
CPR PART 279
Id waste Otvlslon or Tenn. Dept of Environmami
nd Conservation And Unlvereal environmental st (770) M-111a16
MERG NCY'CON
ACT PRONE NUMBER48 8816
GENERATOR I SHIPPER CERTIFICATION
4, (hv generator of ihis product, hereby eerufy that we have not rrkxed any hazardous weata In Ihla product being plek$d up by the above company. This product If being transported to
he above company to be recycled In scowdence with aft federalAws and local moulationa. We, the generator, also carnty that this product does not Contain any WNW* levels of
t Wji (53 Cad, Reg. 24206, June 27, 1066).
Hereby declare Cret the rant4ntS Of thin consignment are fully and ACWralely ducribed above by pmp4r shipping name and are nlaaDitled,DACked,marked and labeled and are In all
*spWo In proper condi0on for transport by highway aocording W applicable InternalJonal.nallonal, and state governmW regulations, .
mess I am a smart quantny generator who has been Axenspted by statute or regulation from the duly to make a waste mWmlretion coMfloation under Section 3002(b) of RCRA, I also
rtify that I have a program In Olson to % uce the voWme and loxiaity of waste goneratcd to the degree I have detwmined to be boonpmlcally practical end I have selected the
etnod or trestmenl,atorage or disposal currently Available 10 me which mlnimizsa the present end tenure threat 10 human health and the envlronmwt.
Printederne
Igna
e
TRANSPORTER I FACILM"AMN"OWLEDGrEMBNT OF RECEIPT OF MATERIALS
PrInM Nsrne
Signature
UAW
Dennis Guill
r
Billing'tnformation eceivab es Payable$
P6yment Received To Be Billed
YES NO YES NO Quantity
Amount _ Unit Pdre Unit Price
PO Number
Check'No. Total _ Total

l'�j a/7 f oo q0l91- � ,09'9 3 / 115 I
Universal Environmental Services, LLC manifest No. S00384481
Dowment Date 410110
Truck Code SC19
642 Grooms Road
R4idsallirs, NC, 27320
EPA No.: NCR000130667 RECYCLE 1 TRANSPORTATION 1 RECEIVING MANIFEST
FAX
Generetor Information; Salvage Auto
3301 Robinson Circle
Charlotte, INC 28206
Phone: [phone]
Halogen Content Cheoked By. Halogen Leak Ch[or-D-Tect Detector
C u8koni ur Is a:
DESCRIPTION 1 CLASSIFICATION
SAL330
asd Motor Oil, Flash {greater Than 200 F
-+
GAL
o Placard Required
/
sed Antifreeze, Flash'Greater Than 200 F
GAL
c Placard Required
sod Oil filters, Flash Greater Than 200 P �
_
DRUMS
o Placard Re2vired
NONI-IAA ARDOUS
U'I_ Description
s USES CYI. i , subject to
ulotion by the Geo4a
RIE.P.D, grid the United States
.P.A. under
) CFR PART 279
HANDLING IN
ro(d skin and tissue contact, wear ttloyea and aye
otect)on. If undellveruble or unacceptable to recycle
use faculty, return to t onorator.
case of omsrgonoy comtoot- Go, Dept, of Natural Resources
illd Kraete OMsIon or Tenn. Dept. of Emrironmont
d Conservailon end trn}vprwi nnwironmentel at ( 170) 450-ss15
_ _ GENERATOR 1 SHIPPER CERTIFICATION
r e Ihn girnerat0t Of thle prOduei, Hereby ogr* thgt we have not mixed any haLeroous waste In this product being picked up by the above company. Th31 prbduot is being tranisoprted to
he above ro:npr'ny to bo recycled In accordance with all faderal,etale and local rogutatione, we, the generator, ciao Ogrtdy that Ihla Product d00 not Cdnt*m any deteclable l"ll of
0b (53 Fad. Rap, 24200, June 27, 1900).
I heroby deGlar9 that the tAntarlts of tills COMIgnman) are fully anC aopumj-":y dowbad above by prODer ShiOoing name and are 0856119d.packed.mArked And IAhPiP.d And pre in ell
aaoecta in proper condition for Vam$w by highway according tO Appllcahte inlemepone',nellonal, and Stete gavarmant rigvlatlors.
n14tA' an , s"'W: •sva.r)ly gar.✓ator who has been exalnpied by statute or rggulallon from the duty to make a wosta mintmtzallon eeniflosl* vnder Section 3002(b) of RCR4, t also
erlifu lkat I hai0 a Ar09ratn In place to eaduce the valuing and toxldty of w?sto generated to the degree I have deterrnined to be rCvilovil sly PrHOW1 and I have ie W601 the
elnoc of tMatmentslOreQe or diipasal currently avasabla to roe which r Wi-xaa To present And future threat to human Malth and the AnvlrOnmem,
TRANSPORTER/ FACPLITY,a . EMENT OF'RECEIPT OF MATERIALS
�>�tiri+ea�Rlmfs ._
Derniis.Gr.pll.._... , _... L
rl3 in . niorm loon RncsivabIas Ppy ables
III g l a
Payment Received To Be Billed
YF.S NO YES NO Quantity
Amount � Unit Price - Unit Price
l PO Number
Chock No M.__ Total r Total
_ ^....,.�...-.^---^••—oar ^^•�+ .. ..o

Office of the Tax Collector PRIVILEGE LICENSE
P.O. Box 31577
Charlotte, NC 28231-6077
SALVAGE AUTO SUPPLY LLC
3301 ROBINSON CR
Charlotte, NC 28206
Licenses are not transferable, This includes changing from sole -proprietor to a
Corporation or Limited Liability Corporation. This would also include a Corporation
changing their Federal Identification Number. GS 105-366(d)(1)(a) - Requires
notification to the Tax Collector forty-eight (48) hours prior to going out of
business, the transfer of or pending sale to another party.
Changes in the license during the year: The business shall report a change in the
information contained in the license to the Tax Collector within ten (10) days after
the change occurs. The license must be surrendered to the Tax Collector when
reporting the change. The Tax Collector will reissue a license reflecting the change
upon payment of a fee of five dollars ($5.00), for each license that needs a change.
** The license shall be subject to cancellation for failure to comply with this
section of the Ordinances.
POST IN A CONSPICUOUS PLACE. Must be posted in a visible public area, where it can be
inspected at all times.
DO NOT REPRODUCE. DOCUMENT VOID IF NOT DUAL COLOR PRINT.
THIS IS NOT A BILL
0000 000940
CITY TAX ia
x:�COUNTY,,TAX,.'4
.t

NC DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
Received by: Signature
SCRAP TIRE CERTIFICATION
Complete parts / and l/ to qualify for free disposal. County may require proof that tires originated in NC. Used tire dealers,
wholesalers, brokers, retreaders, and others who sort, grade, or cull loads of tires which were removed from vehicles by
another NC dealer must provide the original certification from the individual who first removed the tire from a vehicle. Tires
stockpiled before January 1, 1994 are not eligible for free disposal. Used tires and casings obtained from out-of-state by
retreaders or used tire dealers are not eligible for free disposal.
PART 1: CERTIFICATION BY RETAILER OR OTHER PERSON DISPOSING OF SCRAP TIRES
Name j 4 141,4 C .P 4 c1Wv C II0 f /Y / L C
Address
3 3 0 1 1� C
b i iV. S� "i (I 4 R
Telephone Number 0 04) 333 7
City C
b,4 x, /O y- i-e
State AC
Zip Code 2— R- 2 0-b
CERTIFICATION: I hereby certify that 5-06 tires were collected for disposal as indicated below, and that these
(total numbed
tires originated in ( L - k County between and , 200_
Number of Tires Removed from Vehicles When Replacement Tires Were Sold in NC
(Provide copies of E50OG or E500 tax reports or other documentation if required by county).
Number of Tires Removed When Vehicles Were Repaired or Junked in NC
(Provide proof of eligibility for free disposal if required by county)
Number of Tires Removed from Fleet Vehicles in NC (e.g. School bus shop, trucking company garage)
IProvide proof tires were purchased in NC and proof of payment of disposal tax if required by county)
Number of Tires Collected by Other Methods (e.g. Cleanup projects, pre-1994 stockpiles)
LANDFILL FEES PAID FEES WAIVED BY COUNTY
(CHECK ONE)
Number of Tires That Originated out of State LANDFILL FEES PAID FEES WAIVED BY COUNTY
Signature.
PART IT CERTIFICATION BY SCRAP TIRE HAULER
Hauler Name r
Scrap tire hauling identification #
Mailing address:
City:
Date26 - f/ 013
or Merchant identification #: boollaq
(Applies only to retailers
Telephone Number (
State: r Zip Code:
(state sales tax II)
hauling their own tires)
1
CERTIFICATION: I hereby certify that this load contains tires that were received from the person
(num e-rr'Ttlres}
named above in Part I and no others.
Signature: i I t Date 1
PART III.• CERTIFICA TION 8Y CO LECTOR, PROCESSOR OR DISPOSER
Facility Name IA( 1 I V-e V&6E - Number of tires received S6)0
. Date % / /")
(r
PROVIDING FALSE OR INCOMPLETE INFORMATION ON THIS FORM IS SUBJECT TO A CIVIL PENALTY OF UP TO $5,000 PER VIOLATION PURSUANT TO N.C.G.S. 130A-22.
FALSIFYING THIS REPORT IS A CLASS 2 MISDEMEANOR AND SUBJECT TO A FINE OF UP TO $10,000 PURSUANT TO N.C.G.S. 130A-26.2 OENR 3733112101)

. I !
NC DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
SCRAP TIRE CERTIFICATION
Complete parts I and 11 to qualify for free disposal. County may require proof that tires originated in NC. Used tire dealers,
wholesalers, brokers, retreaders, and others who sort, grade, or cull loads of tires which were removed from vehicles by
another NC dealer must provide the original _certification from the individual who first removed the tire from a vehicle. Tires
stockpiled before January 1, 1994 are not eligible for free disposal. Used tires and casings obtained from out-of-state by
retreaders or used tire dealers are not eligible for free disposal.
PART I. CERTIFICATION BY RETAILER OR OTHER PERSON DISPOSING OF SCRAP TIRES
Name 5h\U(N6-i r\J10 Sip, ),,/ , LI C
Address
City
3 3
o; +y S oly
„ ...\� ,_..__.,...
2
_. ------....mbe
-hone Nu.,..., r{
Telephone
C k- r—\ 0- 1°
4 State
N
Zip Code Z Z0 C
74 3-?3 • /027
CERTIFICATION: 1 hereby certify that �� Otires were collected for disposal as indicated below, and that these
(total number)
tires originated in County between and 200
Number of Tires Removed from Vehicles When Replacement Tires Were Sold in NC
(Provide copies of E50OG or E500 tax reports or other documentation if required by county).
SD Number of Tires Removed When Vehicles Were Repaired or Junked in NC
(Provid4e proof of eligibility for free disposal if required by county)
Signature __
PART /1: CER
Hauler Name
Number of Tires Removed from Fleet Vehicles in NC fe.g. School bus shop, trucking cornpany,garage)
(Provide proof tires were purchased in NC and proof of payment of disposal tax if required byi county)
Number of Tires Collected by Other Methods (e.g. Cleanup projects, pre-1994 stockpiles)
LANDFILL FEES PAID FEES WAIVED BY COUNTY_
(CHECK ONE)
Number of T
That Originated out of State LANDFILL FEES PAID FEES WAIVED BY COUNTY _
TION BY SCRAP TIRE HA ULER
Scrap tire hauling identification #
Mailing address:
City:
State:
Date Q ,_ 7
or Merchant identification #: 60I l-S_z_9(r se sales tax IJI
(Applies only to retailers hauling their own tires)
Telephone Number ( }
Zip Code:
CERTIFICATION: I hereby certify that this Icad contains Sal) tires that were received from the person
(num e— r of —Tres)
named above in Part I and no others.
Signature:
PART 111.• CERTIFICATION BY COLLECTOR,
Facility Name
Received by: Signature
1 CS 1k -" izf� 2�
;LIP( �
Date
OR DISPOSER
Number of tires received 5a 0
Date ,v / /1' 0
PROVIDING FALSE OR INCOMPLETE INFORMATION ON THIS FORM IS SUBJECT TO A CIVIL PENALTY OF UP TO $5,000 PER VIOLATION PURSUANT TO N.C.G.S. 130A•22.
FALSIFYING THIS REPORT IS A CLASS 2 MISDEMEANOR AND SUBJECT TO A FINE OF UP TO $10,000 PURSUANT TO NZ.G.S. 130A•26.2 OENR 3733(12101)

NC DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
SCRAP TIRE CERTIFICATION
Complete parts / and H to qualify for free disposal. County may require proof that tires originated in NC. Used tire dealers,
wholesalers, brokers, retreaders, and others who sort, grade, or cull loads of tires which were removed from vehicles by
another NC dealer must provide the original certification from the individual who first removed the tire from a vehicle. Tires
stockpiled before January 1, 1994 are not eligible for free disposal. Used tires and casings obtained from out-of-state by
retreaders or used tire dealers are not eligible for free disposal.
PART l: CERTIFICATION BY RETAILER OR OTHER PERSON DISPOSING OF SCRAP TIRES
Name SA l ► in All y10 500 r
ly l l (
Address 93o i Rrob i NSoIN C I R Telephone Number (Vv) 3 3 J-/ de-7
City r r1 u i J1, 7-r r- State Zip Code z 2a G
CERTIFICATION: I hereby certify that J 0 0 tires were collected for disposal as indicated below, and that these
{total number)
tires originated in Me G County between and 200_
Number of Tires Removed from Vehicles When Replacement Tires Were Sold in NC
(Provide copies of E50OG or E500 tax reports or other documentation if required by county).
1z Number of Tires Removed When Vehicles Were Repaired or Junked in NC
(Provide proof of eligibility for free disposal if required by county)
Number of Tires Removed from Fleet Vehicles in NC le.g. School bus shop, trucking company garage)
(Provide proof tires were purchased in NC and proof of payment of disposal tax if required by county)
Number of Tires Collected by Other Methods (e.g. Cleanup projects, pre-1994 stockpiles)
LANDFILL FEES PAiD FEES WAIVED BY COUNTY
(CHECK ONE)
Number of Tires That Originated out of State LANDFILL FEES PAiD FEES WAIVED BY COUNTY
Signature
PART 11: CERTIFICATION BY SCRAP TIRE HAULER
Hauler Name
Scrap tire hauling identification #
Mailing address:
Date OG- Z - / U
or Merchant identification #:.r, 017 - 1 , _? -.,)' (state sales tax #)
(Applies only to retailers hauling their own tires)
Telephone Number ( )
City: State: Zip Code:
CERTIFICATION: I hereby certify that this Icad contains 50 D tires that were received from the person
(num ems` r oTfiras)
named above in Part I and no others.
Signature:
PART 111: CERTIFICATION BY COLLECTOR, PROCESSOR OR DISPOSER
Date
Facility Name �S ', / !� Number of tires received 5-0
Received by: Signature Y"r V�/� Date & 1.2 /� (0
PROVIDING FALSE OR INCOMPLETE INFORMATION ON THIS FORM IS SUBJECT TO A CIVIL PENALTY OF UP TO $5,000 PER VIOLATION PURSUANT TO N.C.G.S. 130A-22.
FALSIFYING THIS REPORT IS A CLASS 2 MISDEMEANOR AND SUBJECT TO A FINE OF UP TO $10,000 PURSUANT TO N.C.G.S. 13OA-26.2 DENR 37331121011

", ;,c_