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NCG060335_COMPLETE FILE - HISTORICAL_20140102
STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. DOC TYPE 04STORICAL FILE 0 MONITORING REPORTS DOC DATE ❑ ��L� 01 4 -&-- YYYYMMDD ;„ N i l � Prestage e I •: • January 2, 2014 NCDENR-DWR NPDES Stormwater Permitting Unit 1612 Mail Service Center Raleigh NC 27699-1612 Subject: Assessment of Best Management Practices for facilities that use animal fats/byproducts' Prestage Farms Inc (Moltonville-Feed Mill) COC Number NCG060335 Sampson County To Whom It May Concern: Please find enclosed the Prestage Farms assessment of BMPS associated with off loading, handling and spill prevention of rendered fats at our location. We have attempted to complete this task as accurate as possible. Please let us know if more information is needed in this matter. Sincerely, Glenn Clifton Contact Person Technical Specialist Prestage Farms, Inc. cc: Fayetteville Regional Office F JAN 3 2014 I f HIGHWAY 421 SOUTH a P. 0. BOX 438 a CLINTON, N. C. 28329-0438 o PHONE (910) 592-5771 sc- Section E: Assessment of Best Management Practices (BMPS) for facilities that use or process Animal fats/byproducts. Prestage Farms, Inc. Moltonville Feed Mill. Located at 735 Moltonville Road , Clinton,NC is a facility where feed is manufactured along with grain purchasing for turkey and hog production. There is a 12,000 gallon above ground storage tank with a secondary containment that holds Diesel Fuel for the boiler back up fuel. There are 8 above ground storage tanks with secondary containment that holds liquid feed additives including choline, santaquin, alimet, lysine,betafin, and animal fat. The boiler room is attached to the containment structure. Steam is generated here for manufacturing feed. It is under roof and not exposed to stormwater. liquid feed additives are unloaded from trucks and rail cars and pumped to the tanks inside the secondary containment.This area is exposed to stormwater. All the secondary containment systems are equipped with a valve that remains closed at all times. It is only released once a visual inspection of the water has been done to be assured there is no contaiminents.There are 3 grain receiving stations at the facility. They receive bulk ingredients from trucks and or railcars. These areas are covered from stormwater. Grain and dust from grain unloading can be blown onto impervious areas and carried by storm water to surface drains. Potential spills could occur at the site to include the delivery point between tanker truck connection and receiving pipe. Care must be taken by vendor and Prestage Farms to insure that the connection are properly secured before transfer has begun. Absorbent material is available at site for clean up and proper disposal. A contractor will be called if further clean up is warranted above what we can do here as indicated in our stormwater permit. We do not feel that reduced exposure can be achieved at our site due to the way above ground storage tanks,boiler room, and delivery point were constructed. All systems are covered except the storage tanks and the delivery point. We feel that there is no indication of presence of animals/wildlife on our site that could cause a concentration of fecal coliform. Activity and noise around the mill could keep animals/wildlife from entering our site. We also have a good rat and mice eradication program at Prestage Farms, Inc To further reduce the potential for a spill at our site, we plant to add 10 inches to the top of the secondary containment wall that houses the diesel fuel. This would allow the containment to hold the contents of the entire tank should a rupture occur. Plans are to have this completed in December 2013. North Carolina Pat McCrory Governor Jim Carr, Manager Prestage Farms, Inc. Moltonville Feed Mill 735 Moltonville Road Clinton, NC 28328 . EN0090 a NCDENR Department of Environment and Natural Resources Division of Water Quality Thomas A, Reeder Acting Director June 28, 2013 Subject: COMPLIANCE EVALUATION INSPECTION Prestage Farms, Inc. Moltonville Feed Mill NPDES Stormwater General Permit-NCG060335 Sampson County Dear Mr. Carr: John E. Skvaria, III Secretary On June 18, 2013,1, Hughie White, from the Fayetteville Regional Office of the Division of Water Quality, conducted a site inspection for the Moltonville Feed Mill facility located at 735 Moltonville Road, Sampson County, North Carolina. A copy of the inspection report is attached for your review. I would like to thank you and Mr. Glenn Clifton, Environmental Manager, for your time and assistance during this inspection. Stormwater from the facility drains to ari unnamed tributary to Six Runs Creek, a Class C, Sw water located in the Cape Fear River Basin. The site visit and file review revealed that the subject facility is covered by NPDES Stormwater General Pernit-NCG060335, Accordingly, the following observations were noted during the Division of Water Quality inspection (please see the attached addendum for information about your permit): 1) Stormwater Pollution Prevention Plan (SPPP) A Stormwater Pollution Prevention Plan (SPPP) has been developed, recorded, and properly implemented. es ■ No ❑ 2) Qualitative Monitoring Qualitative monitoring has been conducted and recorded in accordance with permit requirements. Fy-es ■ No ❑ Location: 225 Green Street, Suite 714, Fayetteville, North Carolina 28301 Rhone: 910-033-33W 4 FAX: 910-086-07071 Customer Service: 1-877-623.6748 Internet: www,ncwater4Uality,org An Equal Opporlunity 5 Affirmative Action Employer one Nh Carolina Aawralll J 3) Analytical Monitoring Anal ical monitoring has been conducted and recorded in accordance with permit requirements. yes No El Please be advised that violations of the NPDES General Permit are subject to a civil penalty assessment of up to $25,000 per day for each violation. If you or your staff has any questions, comments, or needs assistance with understanding any aspect of your permit, please do not hesitate to contact me at (910) 433-3308. Sincerely, Hughie White Environmental Specialist Enclosure cc: Glenn Clifton, Environmental Manager, Prestage Farms FRO -Surface Water Protection WBS Compliance and Permits Unit Compliance Inspection Report Permit: NCG060335 Effective: 12/12/12 Expiration: 10/31/17 Owner: Prestage Farms Inc Moltonville Feed Mill SOC: Effective: Expiration: Facility: Prestage Farms Inc (Moltonville Feed Mill) County: Sampson PO Box 438 Region: Fayetteville 735 Moltonville Rd Clinton NC 28328 Contact Person: Jim Carr Title: Phone: 910-592-3531 Directions to Facility: from Clinton take Hwy 24 E approx 3.5 miles - turn right onto Moltonville Rd - go approx 0.4 miles - mill will be on the right System Classifications: Primary ORC: Certification: Phone: Secondary ORC(s): On -Site Representative(s): Related Permits: Inspection Date: 06/18/2013 EntryTime: 10:00 AM Exit Time: 12:30 PM Primary Inspector: Hughie White '01�— Phone: 910-433-3300 Ext,� Secondary Inspector(s): 330$ r �rlidtJW'• Mike Lawyer Phone: 910-433-3300 Exj7xe Reason for Inspection: Routine inspection Type: Compliance Evaluation �5 Permit Inspection Type: FoodfTobacco/Soaps/Cosmetics/Public Warehousing Stormwater Discharge COC Facility Status: ■ Compliant ❑ Not Compliant Question Areas: 0 Storm Water (See attachment summary) Page: 1 Permit: NCG060335 Owner - Facility: Prestage Farms Inc Moltonville Feed Mill Inspection late: 06/18/2013 Inspection Type: Compliance Evaluation Reason for Visit: -Routine Inspection Summary: This facility has had coverage under this permit for less th n a year. The facility has developed and implemented its stormwater pollution prevention plan. All required aspect*r the plan appear to be included. This facility has had no significant spills since coverage under this permit began. Employee training is scheduled to be conducted in September. Qualitative and analytical monitoring is being conducted, as required. This facility does not meet the requirement to perform analytical monitoring from vehicle maintenance areas. A copy of the permit and Certificate of Coverage were available for review and the only outfall this facility has was observed during this inspection. Page: 2 Permit: NCG060335 owner - Facility: Prestage Farms Inc Moltonville Feed Mill . . Inspection Date: 06/18/2013 Inspection Type: Compliance Evaluation Reason for Visit: Routine Stormwater Pollution Prevention Plan Yes No NA NE Does the site have a Stormwater Pollution Prevention Plan? ■ ❑ ❑ ,❑ # 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 Plan 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 annually? ❑ ❑ ■ ❑ # Does the Plan include a Stormwater Facility inspection Program? ■ ❑ ❑ ❑ Has the Stormwater Pollution Prevention Plan been implemented? ❑ ❑ ❑ Comment: It has been less than a year since this facility has been covered by this per It and had to develop and implement a Stormwater Pollution Prevention Plan. That is w`rthis facility has not yet been required to annually update the plan. Also, this facility has not had any significant spills since the plan has been implemented. Qualitative Monitoring Yes No NA NE Has the facility conducted its Qualitative Monitoring semi-annually? ■ ❑ ❑ Cl Comment: Analytical Monitoring Yes No NA NE Has the facility conducted its Analytical monitoring? ■ ❑ ❑ ❑ # Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas? ❑ ❑ ■ ❑ Comment: This facility does not meet the requirement to perform analytical monitoring from vehicle maintenance areas. Permit and Outfalls Yes No 'NA NE # Is a copy of the Permit and the Certificate of Coverage available at the site? ■ ❑ ❑ ❑ # Were all outfalls observed during the inspection? ■ ❑ ❑ ❑ # If the facility has representative outfall status, is it properly documented by the Division? ❑ ❑ ■ ❑ Page: 3 Permit: NCG060335 Owner • Facility: Prestage Farms Inc Maltonville Feed Mill Inspection Date: 06/18/2013 Inspection Type: Compliance Evaluation Reason for Visit: Routine # Has the facility evaluated all illicit (non stormwater) discharges? Comment: ■O00 Page: 4 DENR.-FRS' Beverly Eaves Perdue Governor Jim Carr MM HCD� North Carolina Department of Environment and Natural Resources Division of Water Quality Charles Wakild, RE, Director Prestage Farms, Inc. Moltonville Feed Mill 735 Moltonville Road Clinton, NC 28328 Dear Mr. Carr: 1 July 9, 2012 0Ue o Dee Freeman Secretary Subject: General Permit No. NCG060000 Moltonville Feed Mille COC No. NCG060335 Sampson County In accordance with your application for a discharge permit received on May 10, 2012 we are forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state — NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection Agency dated October 15, 2007 (or as subsequently amended). Please take notice that this certificate of coverage is not transferable except 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. Please note that the attached permit expires on October 31, 2012. Your COC will be automatically renewed to cover the full 5 year term of the soon to be reissued permit. In the interim you must abide by the terms of the expiring permit. You can review the proposed general pen -nit changes at (http://portal.ncdenr.org/web/wq/ws/su/public-notices). Wetlands and Stormwater Branch 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Location: 512 N. Salisbury St, Rateigh, North Carolina 27604 Phone: 9'9-807.63001 FAX: 919-807-6404 Internet: Z,nmaterquality.org An Eauaf Opoortunily I Affirmative Ac5on Employer NorthCarolina Aawivil f/ COC No. NCG060335 + Mr. Jim Carr July 9, 2012 If you have any questions concerning this permit please contact Bradley Bennett at telephone number (919) 807-6378. Sincerely, ORIGINAL SIGNED BI for Charl$IME cc: Fayetteville Regional Office Central Files Stormwater Permitting Unit Files Attachments STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF WATER QUALITY . GENERAL PERMIT NO. NCG060000 CERTIFICATE OF COVERAGE No. NCG060335 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, Prestage Farms, Inc. Moltonville Feed Mill is hereby authorized to discharge stormwater from a facility located at Prestage Farms, Inc. - Moltonville Feed Mill 735 Moltonville Road Clinton, NC Sampson County to receiving waters designated as UT to Six Runs Creek, a class C, SW water in the Cape Fear River Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, II, III, IV, V, and VI of General Permit No. NCG060000 as attached. This certificate of coverage shall become effective , July 9, 2012. This Certificate of Coverage shall remain in effect for the duration of the General Permit. Signed this day, July 9, 2012. ORIGINAL C� KEN P for Charles Wakild, P.E., Director Division of Water Quality By the Authority of the Environmental Management Commission LOCATION MAP: rcl� k ► - �. J � � ^.\',, _f -� Con � I �l,D . �• _ f���J ���?r.,. a,'• •i—y�� .�.ii!4 lEa• '��,J•j, �catet" Jr-.-_.. ,� � � I_I _ �•�, util,N1- '- �•"�iialt,�mli[la,. ij` {,� � � (Yr4'a { ':�'e _-..'/ ' �,�ilau !� - III j!!! (''1'! I'' .r 'i^"i'E,�•'`'^",� ,......... ...___-�I ii rs� f �v - 14!)�• } i Sri k�.:. t"• IN SPA I I kl� `y�••_... �''�i �'`ll �`.� .III I�i�1lh - - � L`J: "_,. } �� � %• t r. lye•3 \`.� 4 ',� •'-r {�•''�� �`' Ilya C.ba l �I7i', rye-�^ -_ �Ji � ti � �• I I ��I'. J'i��' i'-. I ry,f',F+<� --.. r� 1 �''�; ._' �tlrf,.•i Prestage Farms Inc— f - fi• �%Z Vic_ Moltonville Feed Mill com ,;1 f r/ _'•; 'I __— `~-�-. � I ; � :� j: -'i ��^Y I i dY• Il' l i N4' I _ •�I �'ti ' ��• r'� � . — � I ��� 1 i � II Y"""?--;--' �.�.t_ i,%•.,i�.�t-�-,l-.�, ,+,� J I't `' 4 �4 �L `'ty -� '� J1�" -,.l �'`� . � 4 -•.' _ r �.5 III. .r�,r_w-' �_ •� � 4\ ��� � .�o •6N ,RA f �•� �.-- ���a.;-I �)y l i _ 1i c`-' y �t �' .�A }'(tip � ,,,j �� - s :� ay-"�---f�•'� _ I �� fl. l7{�� � � 9. -- �-k � � jl • �'+; �_ ! :'f �•�1`,) l .+•.» ,ParkI , �,�:...�cti� i� III I =.t": • f�,:�y' __ `_.. ,k�. f I �``� ! it .I ��. �y+� i- i •�, e��'. rf ., I __ -_i ., u �f13__'^-l' __ � _ _ l `fir ,. .'- 1 - - �.. ,._� i I• , , I d "V'`�" ' "�I I "� `'1 ! .ti, '1-� `-_ _ _ `- -•„ - J • A �' � 3, , � -•""�_ + i'+IJ// _�}kr• �;�. I\ :fir. , I 12a t ati �/�`c-�'t ".."♦ ,' �-"+ '-�• rt .r I, •� I ,�Ce'�\ I �_ ',vl.' .I`., r I�, I.J•�, r.: ..t, : ' .�__— -,. - `�I� JT� :a i�`1y. 'y^'/�'�, .alv i S = 7Y tT`- ` - - ~ r75 •�'�!' �{ � .'-t-.- , t, }�' `/� f `m _� f ��� `- t Yam` III I `` , _ y • ��'--.-'' r� +�•Y �.J 1 � I � / � '* !% i - .,� `= J:'� ' I kr1 1 lc • '.�� ,� I�. i -. -' I `}� I . BM CY(f,; I '� �J�•f lilr'1• -»•i i�=" �� ���t�i if � '�' i ''4yICAM"1� r^ II,r- USGS'Map: Clinton South ,sM ,.fl l '��---r"�° 1 `` f%'�• ``' L�r �' ,`l :�(� i Latitude:: 34°59'14.14" N NCC060336 I FaCility Longitude: ' ,11.,J r 7Y' W R79 1t•� County: Sampson Prestage Farms Inc. —i' p Moltonvllle Feed Mill Location Stream Class: C, SW Receiving Stream: UT to Six Runs Creek Sub -basin: 03-06-19 (Cape Fear River Basin) cffou/1. Not to Scale V North Carolina Beverly Eaves Perdue Governor Jim Carr Prestage Farms, Inc. ,Moltonville Feed Mill 735 Moltonville Road Clinton, NC 28328 Dear Mr. Carr: w��rrr� NCDENR Department of Environment and Natural Resources Division of Water Quality Charles Wakild, RE, Director July 9, 2012 Dee Freeman Secretary JUL 1 9 2012 Subject: General Permit No. NCG060000 Moltonville Feed Mille COC No. NCG060335 Sampson County In accordance with your application for a discharge permit received on May 10, 2012 we are forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state — NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection Agency dated October 15, 2007 (or as subsequently amended). Please take notice that this certificate of coverage is not transferable except 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. Please note that the attached j)ermit expires on October 31, 2012. Your COC will be automatically renewed to cover the full 5 year term of the soon to be reissued permit. In the interim you must abide by the terms of the expiring permit. You can review the proposed general permit changes at (http;Hportal.ncdenr.org/web/wg/ws/su/public-notices). Wetlands and Stormwater Branch 1617 Mail service Center, Raleigh, North Carolina 27699-1617 One Location: 512 N. Salisbury St. Ralegh, North Carolina 27604 North Caroli na Phone: 919.807.63001 FAX: 91 M07-6494 Internet: www.ncwaterquality.org Amirally An Equal Opportunity 1 Affirmative Action Empleyer i COC No. NCG060335 Mr. An Carr July 9, 2012 If you have any questions concerning this permit please contact Bradley Bennett at telephone number (919) 807-6378. cc: Fayetteville Regional Office Central Files Stormwater Permitting Unit Files Attachments 11 Sincerely, for Charles Wakild r STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF WATER QUALITY . GENERAL PERMIT NO. NCG060000 CERTIFICATE OF COVERAGE No. NCG060335 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, Prestage Farms, Inc. Moltonville Feed Mill is hereby authorized to discharge stormwater from a facility located at Prestage Farms, Inc. - Moltonville Feed Mill 735 Moltonville Road Clinton, NC Sampson County to receiving waters designated as UT to Six Runs Creek, a class C, SW water in the Cape Fear River Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, II, III, IV, V, and VI of General Permit No. NCG060000 as attached. This certificate of coverage shall become effective , July 9, 2012. This Certificate of Coverage shall remain in effect for the duration of the General Permit. Signed this day, July 9, 2012. 0 for Charles Wakild, P.E., Director Division of Water Quality By the Authority of the Environmental Management Commission 1 LO�ATION MAP: r' i -ilia iF. a.r �r—'. i r...y...:: yam^•' ? i h -_r `^�♦-- k�1 a _ �• 1 Matto k 31 `2 fv� Presta a Farms Inc — r1 lit r� Moltonvi le Feed Mil o Too *to t.—,iy e'o tP of 167 V` •. Rom{ . El•.•�' "� w "'*M."� - lni. 1,1� f14~ `� � •� �.J�:�- f��b�� (-/}�.�.�:,_a � �. % 1 ' 11 'I r � �'."`'" �y � i:w'a'r/{J({y�[`.J•.j� , '-� �' '��.-%�'NP` `'1�'\ .i"'J I, 1/ LLV -�lt 1� .s.:._""' '�.�.+'"t "♦.. 1 ��l'• ���\\ ^.'� •+��ti`-'(..-.. � Fr) ..r.:_......:01� t w .N t �• � tl � Y . � A us GS,Map: Clinton South ��!!!_M, \14kW 9 I, k„ L -� ��• .\ �}, " Latitude: 34'59'14.14" N NCG060335 Facility Longitude: 791511.73 WPrestage County: Sampson Farms Inc. - Moltonville feed Mill Location ` olto Stream Class: C, SW Receiving Stream: UT to Six Runs Creek Sub -basin: 03-06-19 (Cape hear River Basin) [�O'tt�!I F Not to Scale Beverly Eaves Perdue Governor Jim Carr NICE IWR North Carolina Depaftment of Environment and Natural Resources Division of Water Quality Charles Wakild, RE, Director Prestage Farms, Inc. Molto le Feed Mill 735 Moltonville Roa Clinton, NC 28328 Dear Mr, Carr: o� =, r July 9, 2012 Dee Freeman Secretary Subject: General Permit No. NCG060000 Moltonville Feed Mille COC No. NCG060335 Sampson County In accordance with your application for a discharge permit received on May 10, 2012 we are forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state — NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection Agency dated October 15, 2007 (or as subsequently amended). Please take notice that this certificate of coverage is not transferable except 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. Please note that the attached hermit expires on October 31, 2012. Your COC will be automatically renewed to cover the full 5 year term of the soon to be reissued permit. In the interim you must abide by the terms of the expiring permit. You can review the proposed general permit changes at (http://portal.nedenr.org/web/wq/ws/su/public-notices), Wetlands and Stonnwater Branch 1617 Mail Service Center, Relei h, North Carolina 27699-1617 Location, 512 N. Salisbury St. Ralegh, North Carolina 27604 Phone: 919-807-6300 4 FAX: 919-807-6494 Internet, www.newaterquAty,org An Equal opportunity 4 Affirmative Action Employer One NorthCarolina naturally COC No, NCG060335 ` Mr. Jim Carr July 9, 2012 If you have any questions concerning this permit please contact Bradley Bennett at telephone number (919) 807-6378. ORIN&1GNED M KEN PICKLE for Charles Wakild cc, Fayetteville Regional Office Central Files Stormwater Permitting Unit Files Attachments 13 STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF WATER QUALITY . GENERAL PERMIT NO. NCG060000 CERTIFICATE OF COVERAGE No. NCG060335 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, Prestage Farms, Inc. Moltonville Feed Mill is hereby authorized to discharge stormwater from a facility located at Prestage Farms, Inc. - Moltonville Feed Mill 735 Moltonville Road Clinton, NC Sampson County to receiving waters designated as UT to Six Runs Creek, a class C, SW Water in the Cape Fear River Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, 11, III, IV, V, and VI of General Permit No. NCG060000 as attached. This certificate of coverage shall become effective , July 9, 2012. This Certificate of Coverage shall remain in effect for the duration of the General Permit. Signed this day, July 9, 2012. ORIGINAL SIGNED M KEN PICKLE for Charles Wakild, P.E.,-Director Division of Water Quality By the Authority of the Environmental Management Commission LOCATION MAP: r. . Latitude: 34°59'14.1.4" N NCG06®335 Facility Longitude:79'15'11.73' `�J County: Sampson Prestage Farms Inc. — Location ' . Stream Class: C, SW Moltonville Feed MITI Receiving Stream: UT to Six Runs Creek Not to Scale Sub -basin: 03-06-19 (Cape Feat River Basin) OVOttA Bennett, Bradley From: Lawyer, Mike Sent: Tuesday, June 19, 2012 3:41 PM To: Bennett, Bradley Cc: Henson, Belinda Subject: RE: New NOIs for Review - Prestage Farms Bradley, 1 had met with Mr. Glenn Clifton who is in charge of environmental compliance for Prestage Foods back in April in response to a flooding complaint from a neighbor at the 421 Feed Mill in Clinton. As usual, there was nothing I could do about the flooding complaint, but realized that the facility was without permit coverage so I provided Mr. Clifton a copy of the NOL He relayed that they had another feed mill facility in Moultonville. Glad to see they applied for coverage for both facilities. The completed NOI's look good to me. Thanks, Mike Michael Lawyer, CPSWQ Environmental Specialist NCDENR-Division of Water Quality Surface Water Protection Section Fayetteville Regional Office Direct: (910) 433-3329 Main: (910) 433-3300 Fax: (910) 486-0707 e-mail: mike.lawyeri2ncdenr.gov Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties unless the content is exempt by statute or other regulation. From: Bennett, Bradley Sent: Friday, June 15, 2012 4:25 PM To: Lawyer, Mike Subject: New NOIs for Review - Prestage Farms Mike, Attached are documents for two Prestage Farms Feed Mills in Sampson County (NCG060335 and NCG060336). Please take a look and let me know if you have any comments or need additional information. Unless you have concerns or need additional time for review I'll plan to issue the permits by July 15`". Thanks BB Bradley Bennett Stormwater Permitting Unit NC Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone: (919)807-6378 Fax: (919) 807-6494 Email: brafty.ben nettCcbncdenr."o Web: httg:/(portal.ncdenr.orglweb/wq/ws/su Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties. A � Division of Water Quality / Surface Water � Protection Section NCDENRNational Pollutant Discharge Elimination System NORTH Cueow" DD w OI - E—AbNMEr+T —0 NIVl1R RESOURCE!' -NCG060000 NOTICE OF INTENT FOR AGENCY USE ONLY Date Received Year Month Day Certificate of Covers e Check # Amount 39 Permit Assi ed to e National Pollutant Discharge 1=limiriaiion System application` for coverage under General Permit NCG060000: STORMWATER DISCHARGES associatedmith activities classified as: SIC (Standard Industrial Classification)'20 Food'and Kindred,Products SIC 211 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. i (Please print or type)., 1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed?: Name A-RK% ,.rc i m,,?-T-rvvtt.t+E 144 Street Address 745 M4-14iN v tt~r.e P.D. City C1111 To►J _ State N G ZIP Code "32 8 Telephone No. 2,[.Q592 - 3531 a K 5- Fax: ra 592 - /52a 2) Location of facility producing discharge: Facility Name PIZESrdL& FAK+�4 ,1�- C ►y1Dw-,L'aJYYI Lc E F'JCr-n Facility Contact otM CARR Street -Address 73 WtoLToN ire-+-E R�' City �;L� u 7orJ _ .State r-J G ZIP Code AS, County SA++ttr�So� Telephone No. 910 - 592- 353/ e:.x"r.5 Fax: 9 ro 59t-15Zo Email �2R t� preSfdGG�rr�r.[oM 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). Fttoi% d kATvW 7Arce Nrv� ;Z+ izAs`r 6PPRot.. J,5 K4t4ei. `rultw RttpN'( oµycp DL-rb4Vlc,t.V Ag, bo APfflwc, e)-± hAILe Wttuc.r- � (A copy of a county map. or USGS quad sheet with the facility clearly located must be submitted with this application.) 4) Latitude 34 * 59�f 5 n Longitude 7$' 14-1 3gr" (deg, min, sec) 5) This NPDES Permit Application applies to which of the following: ❑ New or Proposed Facility lr Existing Date operation is to begin �cI r=3oe MAY 1 0 2012 Wetlands$ Page i of 4 SWU-221.071408 fast revised 7114l08 NCG060000 KAI. 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: I. - P,. 4- 8 7) Provide a brief narrative description of the types of industrial activities and products manufactured at this facility: Ti1iS F1a¢� M1��-apJ�Ac�u+�Ss /saPRok, roaoi. dF 'Tr+e �tCO Folt PoRr PAO%%J -fo nO 40'0o -rOM;fy P.Z6jD'jCM&'/ L Y11 61rAiw PrAGNA51N6. Tots S/T' Acia RCcr-t-l'r 6moixj F,&PA TNa j2A14-RoAn Sea rvi&c>✓e,jVjLLM At+a 421 PEED mrs.c5. 8) Discharge points ! 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? u1JNnM6D �y�T_To S,x_RuNS CRAB/< (jiCy1 SOURCE ro «�flyJr FFL� SG Receiving water classification: C : S,� Is this a 303(d) listed stream? K Has a TMDL been approved for this watershed? No If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm sewer system (e.g. City of Raleigh municipal storm sewer). 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: oo Z 6 10) Does this facility have any Non -Discharge permits (ex: recycle permit)? eNo ❑ Yes If yes, list the permit numbers for all current Non -Discharge permits for this facility: i 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: S01WAtrE 'WisK ARE 145 ALL-f* Al t-og4-reo 41 -r. REDoic_e _OROS(o1 . (RASSED AJUAs -AA.fc usco ;reR IAJAnfa Grf.iK�A�e,c1. 12) Does this facility have a Stormwater Pollution Preventlon' Plan? r MIN ❑ Yes If yes, when was it implemented? . . 11 13) Are vehicle, maintenance activities occurring at,this facility? . NrNo ❑ Yes 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 Page 2 of 4 SWU-221-071408 Last revised 7114/08 NCG060000 N.O.I. 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). 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 1 am familiar with the information contained in this application and that to the best of my knowledge and belief such information is trysre"plete, �ii acpurate. Printed Nam eof. Pejson of This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to: NCDENR Page 3 of 4 SWU-221-071408 Last revised 7/14fO8 NCG060000 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. X This completed application and all supporting documents. Uf 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, (a) areas where materials are stored, (f) impervious areas, (g) site property lines. 06 Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map. Mall 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 DWO Regional Office for your area. DWQ ReaionalOffice Contact Information: Asheville Office ...... (828) 296-4500 Fayetteville Office ... (910) 433-3300 Mooresville Office ... (704) 663-1699 Raleigh Office ........ (919) 791-4200 Washington Office ...(252) 946-6481 Wilmington Office ... (910) 796-7215 Winston-Salem ...... (336) 771-5000 Central Office ......... 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[\5-T �, TPE INV # DATE REF # REMARKS INV 05081.2 05/08/12 S WTR PERMIT GROSS DISCOUNT NET 200.00 200.00 NCDENR DWO PRESTAGE FARMS, INC. CLINTON, N.C. 28329 NUMBER : 393356 4 Division of Water Quality l Surface Water Protection Section NC'DENR' 1 National Pollutant Discharge Elimination System Hann Gnaw oa,.nrh[Nr o. FllvwaMrlENi u1U HFl1MLL ttC1Ol111C[! NCG060000 NOTICE OF INTENT FOR AGENCY USE ONLY Date Received Year Montlt Da Certirim6iUCOVeTa e Check d 1 " Ainow Pcrmit Aasi tind to c Niiional 'Pollutant Discharge'Elintination System'applicaiion fdr coverage under General,Permit NCG060000: STORMWATER DISCHARGES associated: with, activities classified as: SIC (Standard.lndustrial Classification) 20 Food and,Kindred. Products SIC 21 Tobacco Products t 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. Seepage 4. :k ,.y.A (Please print or type) . 1) Mailing address of owner/operator (address to which all uermitcorresaondence will be mailed?: Name PR 5:rA&9 E4Rw.i, I,4c. {. �tet'T�NYILLE F MILS} Street Address 735 MOIL,7&0qV14'L'_;0 City CL+a.I YD0 State toe- ZIP Code 4 Telephone No. ifl8 "'592-353! xY. 5 Fax: 4{a-_— 59- - laze 2) Location of facility producing discharge:; Facility Name 'PjZeSrAd6fi FAJtVA4;.7,iG. C 6 L,`Lb N41LL.E EZW,,2 M Ib6 Facility Contact J+M cAlta Street -Address -7j5MbL-'oP ��l.L�. RD City 11i'wlro kws• sr• = State. rJ r .ZIP Code 2 29:. County_. S1%#A S0#/ Telephone No, 910 µ 542r_ 35 / Gx Fax: Q t o 592 -15Zo .Email '� CA2R r�-f�SfAaG�rw±f.t;�n� 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). FRa t? l tJ ioy YAICg raw 2+ eA5.T PPRot. w+I9.ES._"irJRN. j3l(n11'[ ONia irtlLoL7ea1VILLG AD. be ApPRox. e9.4 wi}LeSnn � t aL'Wlt c. !JTwa r61+t7'. (A copy of a county map, or USGS quad sheet with the facility clearly located must be submitted with this application.) 4) Latitude 3`Io 59' 5 n Longitude 700 14' 3�0" _ _ (deg, min, sec) 5) This NPDES Permit Application applies to which of the following: I) �@ L5 jj �'J ❑ New or Proposed Facility Date operation is to begin W T Existing MAY j p 2012 DENR . A tJ WWtlanda 3 St Page 1 of 4 Branch SWU-221-071408 Last revised 7/14108 NCGO60000 KO.I. 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: Z4.Lj �..1`F 7) Provide a brief narrative description of the types of industrial activities and products manufactured at thisfacility: TµisFawn M+44- µ AtJd ACJVJI.gS_ APPRok_ („o% ojr Tee &rra .tort oaf Ano 400o jRK9rI0d26pJCT1•e/ L 'rr 69A)w PrOW 46 IJ. , <T#I$ - 5 � re A 06 4Cte1✓4rt GRcr al J00044 -'r _RAU. o a h 90a ►y) L YwN �IyL4 ANa 421 DECO rwicas, B) Discharge points / Receiving waters: How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 7 What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater discharges end up in? tf i NA! D ,al+gu7ARy i S�>~_RdNS___CRe6!<__(JrR M 01jac __Td�i 1,Fi � SuJAn Receiving water classification: Cam$ w _ Is this a 303(d) listed -stream? _pro Has a TMDL been approved for this watershed? N o If the site stormwater discharges to a separatestorm sewer system, name the operator of the separate storm sewer -system (e.g. City of Raleigh municipal storm sewer). S) Does this facility have any other NPDES permits? ❑ No ® Yes If yes, list the permit numbers for all currentNPDES permits for this facility: NGG-Soo 256 _ 10) Does this facility have any Non -Discharge permits (ex: recycle permit)? ffrNo ' ❑ 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 t. , - ® Yes (Show any structural BMPs on the site diagram.) If yes, please briefly describe: .S 1t t. w 'f �ac.L R a-r c.a a-r✓so 41 r. snug¢ OR05,IOW . _ 6iM SSEv McZAs. p aC u se b rot win' S 12) Does this facility have a Stormwater Pollution Preventlon'Plan? Ild"N0 e,. ' .. , , ❑ Yes If yes, when was it implemented? 'rt,I', 13) Are,,vehicie,maintenance activities ,occ u rrin g,at this facility? NrNo ❑ Yes 14) 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 (less than 1000 kg. of hazardous waste generated per month) of hazardous waste? No ❑ Yes Page 2 of 4 SWu-221-07140E Cast revised 7/14/08 NCG060000 N.O.I. c) Is this facility a Large Quantity Generator (1000 kg, or more of hazardous waste generated per. month) of hazardous waste? PC No ❑ Yes d) Is hazardous waste stored in the 100-year flood plain? la 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: Wow 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 143.215.6121 (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 rutemaking proceeding or contested case under this Article; or who falsities, tampers with, or knowingly renders Inaccurate any recording or,monitoring device or method required to be operated or maintained under this Arliclo or rules of the Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine net to exceed ten thousand dollars ($10,000). 1 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 tr plate, ac urate. Printed Name of. S s si Pe on.f a ye- C/ _ i, _ ' llt�tlfffffffl�7Ai1�,(L�. , FARAN D a 61 AoDlicantl ra This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to: NCDENR Page 3 of 4 S W U •221-0714 08 Last revised 7114108 NCG060000 N.0.1. Final Checklist This application will be returned as incomplete unless all of the following items have been Included: IN] Check for $100 made payable to NCDENR. 19 This completed application and all supporting documents. 06 A site diagram showing, a1 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, (a) areas where materials are stored, (f) impervious areas, (g) site properly lines. D6 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 Not& 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 Rgglonal Office Conjact Information: Asheville Office ...... (828) 296.4500 Fayetteville Office ... (910) 433-3300 Mooresville Office ... (704) 663-1699 Raleigh Office ........ (919) 791-4200 Washington Office ...(252) 946-6481 Wilmington Office .-. (910) 796-7215 Winston-Salem ...... (336) 771-5000 Central Office ,........(919) 807-6300 Page 4 of 4 SWU-221-071408 Last revised 7114108 l � � � -` ` � �•"s d Irk � 1\ � 1 �,r• t _��so ' $1 �f . � � �� J ! � � - 'i; ''' - ' ;��'= Q' `� _ tom` . � _ ♦; / ,� - a J ! x �1 � �`� l ,� � ~ j r� � : -•r s U �f t R � �.---lj.-;�L ,f � r � r s o / 4� :~..: J, � _ � � - � � _ � ,� � I f R. J J ✓ yf !y'T - _ JJ !�_ JJ � f _ -14 Y•• S t '.; Er"+S f Sp .i �'.. < 3 } \ 1 r FC - l - . EA Jr \\\ - i _ mac. � � 's' .'f _ .. 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'1Fd�Y &, y�+kk� '.�. r Iti,F:t� r1 r 9!e"1 r'��,4 ., � �r �'. �, fr .;.0 '? J ' r°f �iR. ':•G� . + ^ ,�i� Q11 r'k'�i x Sti�r rr""f j �Fs ., ''ys _, r�,""L YJ� t�SGf , tl'j r e� ,1 J 't-� - f -, s, ; w 4� �,r k i K s �,.T'rtl� a ✓ Y y��,�'F �iw rr,} f'L y �1" ;y�i ,'`°t��: _ � �� ' � t�,9, "!� - :...;+t ! a .��� ��. �� C� �� '• - i �• e. c r r � JI �¢-w ik r tlf��i" �r fi,`. sa' L'OtATION MAP: Igo IR71 •i 1 w,w. �1 r ti . r Prestage Farms Inc — Moltonville Feed Mill r . �� ",� Yam* .ti• J, .� � � ,. °�4 r ; �- i r � � i' t�`I USGS1Map: Clinton South fir, f Latitude: 34'59'14.14" N NCG060335 Facility Longitude: 79'15'11.73" W `1` County: Sampson Prestage Farms Inc. - Location Stream Class: C, SW Moltonvllle Feed Mill Receiving Stream: UT to Six Runs Creek Sub -basin: 03-06-19 (Cape Fear River Basin) �04t�! Not to Scale r� NCDENR North Carolina Department of Environment and Natural Resources Division of Water Quality Beverly Eaves Perdue Charles Wakild, PE Dee Freeman Governor Director Secretary April 11, 2012 CERTIFIED MAIL: 7009 0820 0000 2473 8398 RETURN RECEIPT REQUESTED Prestage Farms Attn: Glenn Clifton, Environmental Compliance PO Box 438 Clinton, NC 28329 Subject: General Stormwater Permit Coverage Clinton Feed Mill Moultonville Feed Mill Sampson County Dear Mr. Clifton: Thank you for your time and assistance during my site visit at the feed mill in Clinton on April 10, 2012. As discussed, coverage under a General Stormwater Permit is required for certain industrial facilities, including feed mills, which have point source discharges of Stormwater. During the site visit, observations were made of the facility in Clinton, which has several outfalls conveying Stormwater runoff from the property. It was relayed by you that a similar facility with stormwater outfalls is located in the nearby community of Moultonville. The General Stormwater Permit that covers these types of facilities is the NCG060000. A copy of the Notice of Intent application form to obtain coverage under the NCGO60000 permit was left with you to be completed and submitted to the Stormwater Permitting Unit at the address on the form. You are asked to submit a completed form for each facility within 30 calendar days from receipt of this fetter. If you or your staff has any questions concerning this matter, please contact me at (910) 433-3329 or by e-mail at mike.lawyer@ncdenr.gov. Sincerely, Michael Lawyer, CPSWQ Environmental Specialist cc: Stormwater Permitting Unit FRO -Surface Water Protection Section Location: 225 Green Street, Suile 714, Fayetteville, North Carolina 28301 Phone, 910-433-33001 FAX: 910.486-07071 Customer Service: 1-877-623-6748 Internet: hftp,//portal.ncdenrorg/weh/wq one NhCarolina An Equal Opportunity 1 Affirmative Action Employer MaY .nly; No Insurance Coverage • , tr m For delivery Information visit our website at wviw.uSP8.COMV 00 V FFIIAL USE M M1zr Postage , ys ^u Certified Fee dRetum Recelpt Fee t-3 (Endorsement Required) q sJ� aC r J Postmark Restricted Delivery Fee (Endorsement Required) COTotal Postage & Fees =$'5� O Q' ❑ © Sent To Miiif, hpf. o.; .. _ .-.. ---------------- .......... or PC) Box No....GC c �3 PS Form :r, ■ Complete items 1, 2, and 3. Also complete Item 4 if Restricted Delivery Is desired. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach -this card to the hack of the mallplece, or on;thejfront if space permits. 1. Artic1 AAddd essed to: fir. I 1 17jL FN\T C L I FTON, A. Signature 0 Z ❑ Agent ❑ Addressee 13.Riecolved by (Prirti d Ne a) ij C. Date of Delivery s��UII� D. Is dellvery add ti f t Y s If YES, enter delivery address below: lltlo APR 13 2012 3. Service type 110 13OX 439 Xcanified Mall ❑ Express Mail C L J N 1'O'N , NC 28329 ❑ Registered )KReturn Receipt for Merchandise ❑ Insured Mall ❑ C.O.D. 4. Restricted Delivery? (Exha Fee) ❑ Yes 2. Article Number 7009 _ Q820 0003 2473 8398 (Tran sfer from service fabel}! a PS Form 3811, February 2004 Domestic Return Recelpt 1025gs-02-M-1540