NCG060233_COMPLETE FILE - HISTORICAL_20121214

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV
DOC TYPE
R HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
0 ao is /a ) q
YYYYMMDD

Vinson, Scott
From: Mavon Lam [[e-mail]
Sent: Friday, December 14, 2012 9:38 AM
To: Vinson, Scott
Subject: Old Feed Mill
Attachments: Millers Chapel Mill.pdf
Mavon L. Lam, Jr.
Wastewater/Fat Recovery Manager
��
The Chicken of Choice`
Case Farms --Goldsboro, NC
Office 919.580.3343
Cell 919.922.5217
[e-mail]
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CERTIFICATION
I have carefully reviewed the HUD-1 Setllement Statement and to the best of my knowledge and belief, it is a true and accurate
statement of all receipts and disbursemeuts made on my account or by me in this transaction. I further certify that I have received
a copy of the HUD-1 Settlement Stat enl.
GOLDSBORO MILL '.6 COMP - , CASE FARMS, LLC
BY: BY:
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I bavc caused or will cruse
the funds to be disbursed in accordance with this statement.
WARREN ERR, WALS , 3, TAYLOR & SMITH, L.L.f P.
By: ' L DATE: September 29, 2008
HLNf Y C. SMITH, Settlement Ageatt

Permit: NCG060233
SOC:
County: Wayne
Region: Washington
Compliance Inspection Report
Effective: 09/01/02 Expiration:08131/07
Effective: Expiration:
Contact Person: Johnny Milkovits
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Re prose ntative(s):
Related Permits:
Inspection Date: 12/13/2012
Primary Inspector: Scott A Vinson
Secondary Inspector(s):
Title:
Certification:
Owner: Case Farms LLC
Facility: Case Farms-Feedmill
761 Millers Chapel Rd
Goldsboro NC 27534
Phone: [phone]
Entry Time: 11:00 AM Exit Time: 11:45 AM
Phone:
Phone: [phone]
Ext.208
Reason for Inspection: Routine inspection Type: Compliance Evaluation
Permit Inspection Type: Food/TobaccolSoaps/Cosmetics/Public Warehousing
Stormwater Discharge COC
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
Storm Water
(See attachment summary)
Page: 1

Permit: NCGO60233 Owner - Facility: Case Farms LLC
Inspection Date: 12/13/2012 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
The site was sold to Goldsboro Milling in September 2008. Johnny Milkovits, with Case Farms had Lam Mavon email
DWQ (Scott Vinson) a copy of the September, 2008 Settlement Agreement between Case Farms and Goldsboro Milling
Co. to verify the sale and transfer of the Feedmill site. Site appears to be in active with little use, if any, of the grain bins
by current owner Goldsboro Milling.
Page. 2

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
May 22, 2006
Mr. Mavon L. Lam Jr.
Case Farms -Processing Plant
PO Box 1460
Goldsboro, NC 27533
Subject: Stormwater General Permit NCGO60000
Operations and Maintenance Reminder
Case Farms -Processing Plant
COC Number NCGO60227
Wayne County
Dear Permittee:
Our records indicate that you have been issued a Stormwater General Permit and a Certificate
of Coverage for your facility. These permits have specific conditions that must be met in order for you
to be in compliance with your permit. It is your responsibility, as the permit holder, to read and
comply with the conditions contained in the permit.
It is our responsibility, as the issuing authority, to make sure that the operation and
maintenance of your facility complies with the conditions contained in your permit. To assist you in
complying with these conditions, we are attaching a Technical Bulletin specific to your permit
requirements. We are currently in the process of developing our inspection schedule. Therefore, you
should have all of your records up to date as we may be contacting you in the near future to set up
an inspection of your facility.
If you have any questions, please do not hesitate to contact Samir Dumpor, Pat Durrett or
myself at [phone].
Sincerely
A..
L--�-'
Al Hodge, Supervisor
Surface Water Protection Unit
Encl.
CC: WaRO files
North Carolina Division of Water Quality Internet: •h2o,enr,state.nc.us
943 Washington Square Mall Phone: [phone]
Washington, NC 27889 FAX [phone]
An Equal OpportunitylAffirmative Action Employer— 50% Recycled/10% Post Consumer Paper
No e hcarolina
Naturally

MAVON L LAM JR
CASE FARMS -PROCESSING PLANT
PO BOX 1460
GOLDSBORO, NC 27533
Dear Permittee:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
r?;t!V!�#�LmeDMIT l irpctor
xis a of 1N lily
August 23, 2002 AUG 2 9 2002
DWQ-WARQ
Subject: NPDES Stormwater Permit Renewal
Case Farms -Processing Plant
COC Number NCG060227
Wayne County
In response to your renewal application for continued coverage under general permit NCG060000, 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 NCG060000
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 DENR 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
Washington Regional Office
TA
NCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1-800-623-7748

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
December 27. 2001
RANDY L PIPKIN
CAST: FARMS -PROCESSING PLANT
POSTOFI,ICE BOX 1460
GOL,DSBORO, NC 27533
Gregory J. Thorpe, Ph.D.
Acting Director
ECEWDivision of Water Quality
RED
MAR — a 2002
DWQ-WARO
Subject: NPDF1S Stormwater' Pei -mil Renews]
CASE FARMS -PROCESSING PLANT
COC Number NCG060227
Wayne County
Dear Permitice:
Your facility iS Currently COVCTed for- stormwatcr dischargC under General Permit NCC;000000. This permit expires
on AuL'ust 31, 2002. "het; Division staff is currently in the process of rewriting this permit and it scheduled to haVC
the pCrnlit reissued by title SunnnCr of-2002. Once the permit iS rciSSucd, your facility would hC CligihlC for
CmilIII ucd crwrra,c under the rciSSucd pCrnlit.
In order hr assure your CUr1tiI)LICd CovcragC under the gCncral permit. Vou must apply In (lie Division of Water
Quality ([)WQ) for renewal -of your permit Cover.ILIC. TO IlUke this renewal process easier. we are informing you in
advanCC that your permit will he expiring,, l nclosccl you will find a General Per•tnit Coverage Renewal
Application Form. The application must he Completed and returned by March 4. 2002 in order to assure continued
Coverage under the OCner'al permit.
Failure to request I'CIlCwal within (his tinge period lrrry result in a Civil assessntCnt of at least $250.00. Larger
ponaltics may he assessed depending on Illc clClindueney of IhM reduest. Disclmrue of storrnw.acr front your facility
without coverage under it valid storrnwater NPDI?S pu•rtlit would Cons(ilUlC ',I violation of NCGS 143-215.1 and
could result in .ISSMSSnICnls elf Civil penalties of up to $10,000 per clay.
Please note that rcccnl fccleral le,islation has extcnded the "no exposure CxClusion° to all operalorS of industrial
facilities in any of Ille I I CatCgurics of "storm water disclt,tr,Cs associated with industrial activity," (except
construction activities). 11' you I'CCI your facility can CCrlil'y it Condition of "nn CxposurC". i.e. 01C ]'Willy industrial
materials and operations are not exposed to stornlwatcr, you Can apply lilr the; no CxposurC exclusion. F'or additional
information Contact the Central Office Storrnwatcr Stal'f nicnibGr listed hclow or clleck the Storniwalcr & GMncral
Permits Unit Web Site al h(tpa/h2o.Cnr.state.nC.us/suls(ormwater.hlnll
11' the SuhjCCt Stornnvatcr clischM�aC ul wiltUt'S of (Ile SLIIC has hCCII ICr'minate(I. please Complete the enclosed
Rescission Retluest Form. Mailing instructions are listed on the bouom of the form. You will he mllitiCd when the
resCissioll proc'Css has [VCrl completed.
11' you hayC any yucstionS regarding the hermit rcncwal procedures please contact Robert Th tnkard of the
Washington Rcuional Office at 252-946-6491 or Aishu Lau of lhC Cenind OlTice 5tornnvater Unit al (919)
733-5083. exi. 578
Sincerely.
h�'!,&Z1 <ry t7r'• vvG�
Bradley 11CMICU, SuperviSOl'
Stornnvalcr and General 11crmils Unit
Cc: Centr,rl Files
Washill"lon Re�,ional Ofl7cc
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
j7A
NCDENR
Customer Service
1-800-623-7746

dzT
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
April 28, 2000
Mr. Randy L. Pipkin, Wastewater Manager
Case Farms, Processing Plant
PO Box 1460
Goldsboro, North Carolina 27533
L71.9;VA
'TJ 0
AAR&
NCDENR
�a Ll MAY 3 1 2000
WASHINGTON REGIONAL OFFICE
DWO
Subject: Permit Modification -Name Change
Case Farms, Processing Plant
Permit No. NCG060227
(formerly Wampler Foods, Goldsboro
Division)
Wayne County
Dear Mr. Pipkin:
In accordance with your request received September 21, 1998, the Division is forwarding the
subject permit. The changes in this permit are only with regard to the name of the facility. All other
terms and conditions in the original permit remain unchanged and in full effect. This permit
modification is issued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between North Carolina and the U. S. Environmental Protection Agency
dated December 6, 1983.
This permit does not affect the legal requirement 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 government permit that may be required.
If you have any questions concerning this permit, please contact Mr. Mack Wiggins at telephone
number [phone], extension 542.
Sincerely,
err T. Stevens
cc: Central Files
Washington Regional Office, Water Quality Section
Stormwater and General Permits Unit
Point Source Compliance Unit
1617 Mail Service Center, Raleigh, NC 27699-1617 Telephone [phone] FAX [phone]
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060227
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,
Case Farms, Processing Plant
is hereby authorized to discharge stormwater from a facility located at
Case Farms, Processsing Plant
330 Pecan Road
Dudley
Wayne County
to receiving waters designated as Caraway Creek in the Neuse River Basin in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, I1, III, IV, V, and VI of General
Permit No. NCG060000 as attached.
This certificate of coverage shall become effective April 28, 2000
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 28, 2000
ULCUZdw'
for Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

N /0-
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Mr. Mavon L. Lam, Jr.
Wampler Foods, Processing Plant
Post Office Box 1460
Goldsboro, North Carolina 27533
Dear Mr. Lam:
A&';J�A
[DEHNR
vEa
WASHINGTON'o
ar`Frtre
February 27,1998 MAR 0 5 1998
D. E. M.
Subject: General Permit No. NCG060000
Wampler Foods, Processing Plant
COC NCG060227
Wayne County
In accordance with your application for discharge permit received on November 25, 1997, 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 Water Quality. 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 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 permit, please contact Bill Mills at telephone number 919/733-5083
ext. 548.
Sincerely,
ORIGINAL SIGNED BY
BRADLEY BENNETT
A. Preston Howard, Jr., P. E.
cc: Washington Regional Office
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060227
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,
Wampler Foods, Goldsboro Division
is hereby authorized to discharge stormwater from a facility located at
Wampler Foods, Processing Plant
330 Pecan Road
Dudley
Wayne County
to receiving waters designated as Caraway Creek in the Neuse River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, 1I, III
and IV of General Permit No. NCG060000 as attached.
This certificate of coverage shall become effective February 27, 1998.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day February 27, 1998.
ORIGINAL SIGNED BY
BRADLEY BENNETT
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

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Case Farms Chicken
http://www.casefarrns.com/aboudfac-goldsboro.cfm
About US Facilities: Goldsboro, North Carolina ("Goldsboro Division")
Processing Plant & Administrative Office
History
330 Pecan Road
Dudley, North Carolina 28333
P.O. Box 1460
Quality Commitment
Goldsboro, North Carolina 27530
919-735-5010, telephone
Vision/Core Values
Par Fry Processing & Administrative Office
Facilities
330 Pecan Road
GoldsboroNC
Dudley, North Carolina 28333
P.O. Box 1460
Morganton, NC
Goldsboro, North Carolina 27530
919-735-5010, telephone
Winesburg. Oti
Hatchery
Cantor, Oli
259 Sandhill Drive
Goldsboro, North Carolina 27530
Troutman, NC
919-736-4498, telephone
Need More Information?
IF you have
a wELA
quesllolrs about ■V�Ti��
Case Farrns
products or services,
Contact Us >
Calypso Feed Mill
188 Broadhurst Road
Mount Olive, North Carolina 28365
919-635-2390, telephone
Calypso Live Production Office
602 Breazeale Ave.
Mt. Olive, North Carolina 28365
919-658-2252, telephone
IMC I AA out Us I Products I Poultry FAQ s I Careers I News & Events I Contact U,
of 1 12/ 12/2012 4:57 PM

North Carolina Department of Environment and Natural Resources
WarF
R°y Technical Bulletin for N.C. General Stormwater
7
Permit NCG060000
I Technical Bulletin for NCG060000 Last Revised 11/15/2012 I
What is regulated by this General Permit?
This General Permit regulates stormwater discharges from the following industrial manufacturing activities:
-'Food and kindred products; Tobacco products; Soaps, detergents and cleaning preparations; Perfumes, cos-
metics and other toilet preparations; Drugs; Public warehousing and storage; and like activities
What does my permit require me to do?
.,'Develop and implement a written Stormwater Pollution Prevention Plan (SPPP) (Part 11, Section A).
✓Develop and implement an assessment of best management practices associated with off loading, handling and
spill prevention of rendered fats and oils that are stored and used at the facility (Only facilities that use or process
animal fats / byproducts) (Part 11, Section E).
✓ Provide secondary containment for bulk storage of liquid materials (Part ll, Section A).
✓Conduct semi-annual self -monitoring of the pollutant content in stormwater discharges, and report the results to
DWQ (Part 11, Sections B and Q.
✓Conduct semi-annual visual inspections of stormwater pollutant sources, control measures, conveyances, and out -
falls (Part II, Sections A and D).
✓ Respond to monitoring results that exceed the numerical benchmarks with management actions to reduce the
level of pollutants in the stormwater discharges. The numerical benchmarks are considered as `action levels.'
Why?
✓The General Permit seeks to reduce industrial pollution in rainfall runoff from manufacturing businesses by re-
quiring site managers to be aware of, and control, the potential for polluted runoff.
✓Federal and state laws and regulations require the control of industrial pollution in stormwater runoff.
✓Those laws and regulations reflect the public's support for providing for clean natural waters in our state and
nation.
What has changed since_ the last renewal in 2007?
• The required content of the SPPP has been expanded slightly and clarified in minor ways in several paragraphs.
• The permittee may now sample discharges from any measureable storm event, rather than from a representative
event. This change should make it easier to obtain a sample from a qualifying rain event.
• The permit text now clarifies that failure to sample due to adverse weather, or due to no discharge during the nor-
mal monitoring period, may be excused. However, the permits now require additional monthly monitoring for un-
excused failures to monitor.
• Vehicle Maintenance Areas (VMA) shall be monitored for Total Petroleum Hydrocarbons (TPH) rather than Oil &
Grease (O&G).
• VMA monitoring is now triggered by the total oil usage for motor oil plus hydraulic oil. The trigger remains at a total
of 55 gallons per month, average.
• A lower TSS benchmark of 50 mg/L applies for discharges to especially protected water classifications.
• Facilities that use or process animal fats / byproducts must now complete an assessment of best management prac-
tices (BMPs) associated with off loading, handling and spill prevention of rendered fats and oils that are stored and
used at the facility (Part 11, Section E).

PAGE TECHNICAL BULLETIN FOR N.C. GENERAL STORMWATER PERMIT NCG060000 LAST REV. IIf1512012
Frequently Asked Questions
Do I have to monitor all outfalls?
Yes. However, you may request ROS
(Representative Outfall Status). If ROS is
approved, this status allows analytical
monitoring at fewer outfalls. To request
ROS, submit a ROS Request Form SWU-
ROS (from our website) to the DWQ
Regional Office.
What if I can't collect a storm -
water discharge in 30 minutes?
When distances separate multiple out -
falls and preclude collection within 30
minutes of each discharge event, begin
collection within 30 minutes and then
continue until all outfalls are sampled; -
Documentation must be kept in the
SPPP.
Can I take more samples than
is required by my permit?
Yes. The permittee may take multiple
samples at any time while under permit
coverage. The permittee may find the
extra sampling useful to quickly identify
causes of benchmark exceedances. All
sampling for the permit parameters
must be reported to DWQ on the DMR
forms.
What if I can't sample because
of bad weather?
Adverse weather is dangerous or it may
limit access for sampling personnel.
Your documentation of adverse weather
and the reasons for not sampling must
be included in your SPPP. A substitute
sample may be taken during the next
qualifying storm event.
What if I don't address visual
monitoring problems?
If you do not respond to problems seen
in visual monitoring, DWQ may require
that you increase the visual monitoring
frequency, apply for an individual per-
mit, implement in -stream monitoring,
install or modify structural stormwater
controls, or implement other controls.
What if 1 forget to monitor?
DWQ may require monthly monitoring
for a specified time period.
Why did you replace Oil &
Grease with TPH in VM areas?
The TPH test only targets chemicals de-
rived from crude oil. The Oil & Grease
(0&G) test recovers fats from animal &
vegetable sources and chemicals from
crude oil. Because TPH is more specific,
it is a better parameter for vehicle main-
tenance areas. The TPH method we are
specifying is EPA 1664A (SGT-HEM). It is
important to note that DWQ is not speci-
fying the more expensive Gas Chromato-
graph (GC) TPH method. DWQ found lab
costs for EPA 1664A (SGT-HEM) to be
comparable to 0&G test costs. To test
these parameters in stormwater, labs
must perform this test in accordance
with EPA procedures, but do not need to
be certified. Note: A lower benchmark
applies for TPH: 15 mg/I (not 30 mg/1).
Why are there two benchmark
values for TSS?
The 100 mg/L benchmark applies to
most rivers, lakes, and creeks in North
Carolina. However, some other waters
must receive special protection under
North Carolina water quality rules, and
in these two permits discharges to them
are subject to the more protective
benchmark of 50 mg/L. Those waters
classified as Trout Waters, High Quality
Waters, Outstanding Resource Waters,
and Primary Nursery Areas receive this
extra protection in these permits.
Where and when do I send the
monitoring reports?
See your permit text, Part lll, Section E.
Who can help me?
Division of Water Quality (DWQ) Offices:
Must I use a North Carolina
certified laboratory?
No. North Carolina water quality rules
do not require that analyses of storm -
water be accomplished by a certified
facility. Please note however, federal
rules at 40CFR136 do require that test-
ing for these two permits be by EPA -
approved lab methods. Analysis by a
North Carolina certified lab is often the
easiest way to insure compliance with
federal rules.
Note that pH is a special case, and
must be measured within 15 minutes
of the sample recovery. You must ei-
ther train on -site staff to conduct pH
testing, or contract with commercial
services to test pH in accordance with
EPA field testing methods.
Must a P. E. sign and stamp my
SPPP?
No. North Carolina water quality rules do
not require that the SPPP be the work
product of a North Carolina P.E.
Who inspects me, and for what?
Staff from the DWQ Regional Offices
shown below will inspect your facility.
They will typically ask to see your SPPP
and will check to see if it is complete and
up to date, They will typically ask to see
your recent monitoring results. They will
typically. tour the facility with a focus on
the stormwater discharge outfalls and on
your general housekeeping as a way to
assess the potential for polluted storm -
water discharges. Our staff will always
follow up their Compliance Evaluation
Inspection with a summary letter to you,
restating their findings and, if necessary
indicating whether enforcement action
will be considered in response to those
findings.
Asheville Office ............. [phone] Washington Office.......... [phone]
Fayetteville Office.......... [phone] Wilmington Office.......... [phone]
Mooresville Office......... [phone] Winston-Salem Office...... [phone]
Raleigh Officc_,_.. �........ (9i9) 741 4240 Central Offce,,. �.... {919 807 6300
D Stortnwater PetTnitting Unit; lrttp: //portal.rrcderir,org/web/wy/ws/su
R

I FOR AGENCY USE ONLY I
L74 9-WA
"71
NCDENR
E:—Ro,,EM �o NCR, RESOURCES
NOTICE OF INTENT
Division of Water Quality / Surface Water
Protection Section
National Pollutant Discharge Elimination System
NCG060000
N
of
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG060000:
STORMWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) 20 Food and Kindred Products
SIC 21 Tobacco Products
SIC 283 Drugs
SIC 284 Soaps, Detergents, & Cleaning Preparations; Perfumes, Cosmetics, & Other Toilet Preparations
SIC 422 Public Warehousing and Storage (except 4226)
For questions, please contact the DWQ Regional Office for your area. See page 4.
Do Not use this NOI for renewals.
(Please print or type)
1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed):
Name
Street Address
City
Telephone No.
2) Location of facility producing discharge:
Facility Name
Facility Contact
Facility Address
Facility City
Facility County
Telephone No.
Email
3) Physical Location Information:
State ZIP Code
Fax:
State ZIP Code
Fax:
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).
(A copy of a county map or USGS quad sheet with the facility clearly located must be submitted with this application.)
4) Latitude Longitude (deg, min, sec)
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility
❑ Existing
Date operation is to begin
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6) Standard Industrial Classification:
Provide the 4-digit Standard Industrial Classification code (SIC code) that describes the primary industrial
activity at this facility.
SIC code:
7) Activities
a) Provide a brief narrative description of the types of industrial activities and products manufactured
at this facility:
b) Check all activities occurring at this facility:
❑ use or process meats ❑ use or process animal fats/byproducts
8) Discharge points 1 Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property?
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).
9) Does this facility have any other NPDES permits?
❑ No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
❑ No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
11) Does this facility employ any best management practices for stormwater control?
❑ No
❑ Yes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe.
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
❑ Yes
If yes, when was it implemented?
13) Are vehicle maintenance activities occurring at this facility?
❑ No ❑ Yes
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14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
❑ No ❑ Yes
b) is this facility a Small Quantity Generator (less than 1000 kg, of hazardous waste generated per month) of
hazardous waste?
❑ No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
❑ No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
❑ No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) if you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal vendor:
Vendor address:
15) Certification:
North Carolina General Statute 143-215.6B (1) 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).
hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing:
Title:
(Signature of Applicant)
(Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDENR. Do not send the check or money order separately.
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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. Must be included with this application (not sent separately).
❑ 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,
loaded, and unloaded, (f) impervious areas, (g) site property lines.
❑ Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map.
Mail the entire package to:
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 General Permit.
For questions, please contact the DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
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