NCG050289_COMPLETE FILE - HISTORICAL_20150501

STORMWATER DIVISION CODING SHEET
RESCISSIONS
PERMIT NO.
/Vl, V (mod
DOC TYPE
0 COMPLETE FILE -HISTORICAL
DATE OF
RESCISSION
❑ o�OI SOSD
YYYYMMDD

5111205 W6165 0 a ? `�
Corporations Division �� 1 ,\ n
North Carolina
Elaine F. Marshall DEPAR ! MENT OF'rHE
Secretary SECRETARY OF STATE
PO Box 29622 Raleigh, NC 27626-0622 [phone]
Filings For: Foam -tech, Inc.
Image
Date Filed
Document Id
Event
Document Type
®J
5/14/1979
000253463
Creation Filing
Articles of Incorporation
7151199i
000508800
jAmendment
Change of Address of Registered Office/Agent
�J
7/25/1991
912060063
Annual Report
Annual Report
J
7/29/1992
922110528
Annual Report
Annual Report
J
71$11993
931890411
Annual Report
Annual Report
J
10/27/1994
943000067
Annual Report
Annual Report
�J
8I3I1995
952150868
Annual Report
Annual Report
7/31/1996
962130600
Annual Report
Annual Report
©J
7/1/1997
971821019
Annual Report
Annual Report
J
9/17/1999
992505046
Amendment
Articles of Amendment
J
12/13/1999
1999 347 29038
Annual Report
Annual Report
J
1211812000
2000 353 29406
Annual Report
Annual Report
J
5/13/2002
2001 3650
Annual Report
Annual Report
J
3/4/2003
2003 013 00303
Annual Report
Annual Report
mAl
11/3/2003
2003 307 D2233
Annual Report
Annual Report
J
1/10/2005
2005 010 00473
Annual Report
Annual Report
J
1/2/2006
2006 002 01161
Annual Report
Annual Report
J
12/25/2006
2006 3590
Annual Report
Annual Report
J
212512DD8
2008 063 00631
Annual Report
Annual Report
mJ
12/15/2008
2009 006 00270
Annual Report
Annual Report
�J
12/14/2009
CA201001300864
Annual Report
Annual Report
�J
212712012
C201205500045
Destruction Filing
Articles of Dissolution
Account
Login
Register
http:/Amww.secretary.state.nc.us/searc[YCorpFiIings/4718715 111

0F WAMichael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
<!? r Alan W. Klimek, P.E. Director
Division of Water Quality
o -c
April 28, 2003
Kent Herman
Foam Tech
117 Cedar Ln Creek
Lexington, NC 27292
Subject: NPDES Stormwater Permit Renewal
Foam Tech
COC Number NCGO50289
Davidson County
Dear Permittee:
In response to your renewal application for continued coverage under general permit NCG050000, the
Division of Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This
permit is reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between the state of North Carolina and the U.S. Environmental Protection
Agency, dated December 6, 1983.
The following information is included with your permit package:
• A new Certificate of Coverage
• A copy of General Stormwater Permit NCG050000
• A copy of the Analytical Monitoring Form (DMR)
• A copy of the Qualitativel Monitoring Form
• A copy of a Technical Bulletin for the general permit
Your coverage under this general permit is not transferable except after notice to DWQ. The Division
may require modification or revocation and reissuance of the Certificate of Coverage. This permit does
not affect the legal requirements to obtain other permits which may be required by the Department of
Environment and Natural Resources, or relieve the permittee from responsibility for compliance with any
other applicable federal, state, or local law, rule, standard, ordinance, order, judgment, or decree.
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
Winston-Salem Regional Office
fiJCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1 800 623-7748

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG050000
CERTIFICATE OF COVERAGE No. NCG050289
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,
Foam Tech
is hereby authorized to discharge stormwater from a facility located at
Foam Tech
117 Cedar Ln Creek
Lexington
Davidson County
to receiving waters designated as Swearing Creek, a class C stream, in the Yadkin - Pee Dee
River Basin in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, ll, III, IV, V, and VI of General Permit No. NCG050000 as
attached.
This certificate of coverage shall become effective May 1, 2003.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 28, 2003.
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

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
Mr. Kent Herman
Foam Tech
117 Cedar Lane Creek
Lexington, North Carolina 27292
Dear Mr. Herman:
NCDENR
January 14, 2000
Subject: General Permit No. NCG050000
Foam Tech
COC NCG050289
Davidson County
In accordance with your application for discharge permit received on September I, 1999, 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 Tony Evans at telephone number
919/733-5083 ext. 584.
Sincerely,
ORIGINAL SIGNED BY
WILLIAM C.
Kerr T. Stevens
cc: Winston-Salem Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCGO50000
CERTIFICATE OF COVERAGE No. NCG050289
STORMWATER DISCHARGES
NATIONAL POLLUTAN'r 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,
Foam Tech, Inc.
is hereby authorized to discharge stormwater from a facility located at
Foam Tech, Inc.
117 Cedar Lane
Lexington. NC
Davidson County
to receiving waters designated as an unnamed tributary to Tar Creel:, Class C. in the Yadkin River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, 11, 111,
IV, V, and VI of General Permit No. NCGO50000 as attached.
This certificate of coverage shall become effective .lanuary 14, 2000.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day .lanuary 14, 2000.
ORIGINAL SIGNED BY
WILLIAM C. MILLS
Kerr'l'. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

f1a1
3. 0.00"`w I I I P80° l
0.00- W I I I D80° 16'
0.00" W 080° 45
C.O.4
•
�.., �e 1////���1 }
F`ti i\` ii � ' �• � I' a' � 1 a
f 1 ': `�'1� _ ( l /J �`-`O- f�
E _�c.� �T'�'J � � l
L ' - / i i' `� /- 15./` ``
LA
i I��
{� • Ir ���..r'��
O
•-
,r h } 1•, ^-
e - �- 7 i.� II
`����"'1�4 � tj-y%' f=�--?.! - � s
1
+ �
:x f�j'�., � r s.AZ'
-n • o' 1
••
'/.f,J/+✓� fI 1Y, Fi (] ty�x 1
�1_iF` I i° '::/ff/�I J
" •'� ,�lA�h�� �y+a--r•3�
'�: ..�\.�-,./"�+A,, 1(' n
�•�'•a�.' Ie'•�+�/' 1�,/ T 11 �••'•'`Y
�"�{...-ti � \� •'� S
�l'L. 1
't K �,-4' Ki-
_ :T .'1..Y /71yC✓\`
�'. � I • tij! l��` //
��.
_
Z
� ^31i�`
_ BM•�7k � .� r - � � C� - ..dr
5 i'. R.•.
.�
`��� �` ,�y�, t�`��: ='�
- Pik+ y;', ' \i` Y•. C) • • \!1't� iF T
;�6
-��
_� : - . ��` -' �'� I�7 ,i/t/ �J � C C
r t r!y?'"ar .. .' -/ ��i.d,�,�y 1:� - I t�`r"!
zco
_a
4r i� �'"ire-�=,
-�%' ., �,. - � .��:_ - '�;_ _
;�•�: ',. � 'n
o
2
�J4 �.;
\ `����
l
—
.,"a
_f .�.11ll,�/ ''' :+''�,_"'/�
lo.
'�,4' R rr .
.•� :r` a� :f
j� ®r`� •t„a�';ti i ',��".
1 we
�%�
�;� �`� !ram-�`-_.._��•' ��'''u
'�r z'•� + ; -:��; ' ::�
,;• �; : ":•�� �- /
Z% - i `/
i' -5I's / III
i..rk [ •� 1
z
., R,=`v ( it /%W - �,-�
[`f,. a ! `• ,L% _� `
\ r �'•:i•7{S11�t� -�� _../'�/
Z
o—
�'J/\il(�1� r{\I\+rJ\ y
�� �f- �_•ij��.,
�,% 4{ fr rf ti�=r��� ���f��1`
o
J� (il
'1 L�
/ l J
-•�tIIF' _
•7$Ci�
r, .A2-A
`Tr
� LG� 4 f�,.• ,,\
,J lV - • +•.i
'ate, i /
`
80° 17'
0.00" I 80° 16'
0.00" 80° 15,
.ou,
Name: LEXINGTON WEST Location: 0351 46' 3f :" N 080° 1,`j ..q7 "' W
Date: 12/23/99 Caption: Stream: UT Tar Creek
Scale: 1 inch equals 2000 feet Stream Class: C
River Basin #: 03-07-07
5A1
Copyright (C) 1997, Maptech, Inc.