NCS000347_COMPLIANCE_20080408

--T" STORMWATER-DIVI'SCON-CODING-SHEET-
-7
PERMIT NO,
L S000
DOC TYPE
❑ FINAL PERMIT
❑ MONITORING INFO
❑ APPLICATION
P COMPLIANCE
❑ OTHER
DOC DATE
❑ a000�0
YYYYMMDD

•
0
Michael F. Easley, Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
Terry McDaniel Site Manager
Primary Energy of NC, LLC
PO Box 1153
Roxboro, NC 27573-1153
April 8, 2008
Subject: Compliance Evaluation Inspection NPDES Permit No. NCO065081
Stormwater Inspection NPDES Permit No._NCS000347�
Primary Energy of NC, LLC
Person County
Dear Mr. McDaniel:
On March 19, 2008, Vicki Webb of the Raleigh Regional Office conducted a compliance evaluation and
stormwater inspection of the subject facility. The assistance of Ed Kell, (ORC), Frank Hayward, (maintenance
manager), Mary Barnett, (intern), and your self was appreciated as it facilitated the inspection. process. The
following observations were made:
NPDES Permit No. NCO065081
The Primary Energy of NC, LLC is permitted to operate a waste water treatment system for coal -pile runoff,
low volume waste water, and cooling tower blow down consisting of- an H-type flume, a liquid ferrous -chloride
injection system with a bubbler flow meter, metering pump, storage drums, and secondary containment, and
two concrete waste basins (in series). The plant discharges to an unnamed tributary of Mitchell Creek, a class C
water body in the Roanoke River basin.
1. Mr. Ed Kell is the ORC and at the time of the inspection there is not a BORC. Mr. Kell stated that they
lost their BORC on March 1, 2008. Please refer to Part 11, Section C, Operation and Maintenance of
Pollution Controls, number one of your permit. Please notify our office once the facility has attained
a BORC.
2. Mr. Kell is keeping all of the files well organized, which eased the file review process.
3. A review of the Discharge Monitoring Report (DMR) data for the 12-month period from February 2007
through January 2008 was performed prior to this inspection. The staff of this facility should be
commended for not having any permit limit or monitoring violations in this 12-month time period.
4. No discrepancies were noted when DMR's were compared to laboratory and operator bench data.
tuns=?a
North Carolina Division of Water Quality Raleigh Regional Office Surface Water Protection Phone [phone] Customer Service
Internet: h2o.enr.state.nc.us 1628 Mail Service Center Raleigh, NC 27699-1628 FAX [phone]
An Equal Opportunity/Affirmative Action Employer— 50% Recycledl10% Post Consumer Paper

Primary Energy of NC, LLC
NPDES NC0065081 NPDES NCS0 47
Person County
NPDES Permit No. NCS000347
The Primary Energy of NC, LLC is permitted to discharge storm water to an unnamed tributary of Mitchell
Creek, a class C water body in the Roanoke River basin.
The facility contains one storm water outfall. The facility's storm water out.fall was observed during the
inspection.
2. Facility storm water records were reviewed during the inspection. The Site plan, the storm water
management plan, and the spill prevention and response plan were presented and appeared complete.
Please refer to Part II, Section A, Storm water Pollution Prevention Plan (SP3), number seven. Annual
updates are required on your SP3 plan. I recommend that the facility start keeping all
documentation for the SP3 together to ease the review process (qualitative and analytical
monitoring and employee training).
3. The facility has all necessary secondary containments.
4. The facility should be commended for not having any spills in the last three years.
5. I recommended to Mr. Kell and Mr. Hayward that a logbook should be kept for when they test the
alarms on the oil and water separator.
The overall conditions of Primary Energy of NC, LLC is compliant with Division standards. if you have any
questions regarding the attached report or any of the findings, please contact Vicki Webb at: [phone] (or email:
v_ickimebbiMncmail.net).
Sincerely,
45�-A��e
Vicki Webb
Environmental Specialist
Cc: RRO-SWP files
Central Piles

Compliance Inspection Report
Permit: NCS000347 Effective: 05/01/02 Expiration: 04/30/07 Owner: Cogentrix Energy Inc
SOC: Effective: Expiration: Facility: Cogentrix Energy Inc -Roxboro
County: Person 162 Allie Clay Rd
Region: Raleigh
Contact Person: Gary Mickey
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Roxboro NC 27573
Title: Phone: [phone]
Certification: Phone:
Inspection Date: 03/19/2008 Entry Time: 01:17 PM Exit Time: 03:30 PM
Primary Inspector: Vicki Webb�` �4 �'�P� Phone:
Secondary Inspector(s):
Reason for Inspection: Routine
Permit Inspection Type: Stormwater Discharge, Individual
Facility Status: ■ Compliant Q Not Compliant
Question Areas:
Storm Water
(See attachment summary)
Inspection Type: Compliance Evaluation
Page: 1

permit NCS000347 , __Owner • Facility: Cogenbix Energy.lnc_..
Inspection Date: 03/19/2008 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Page: 2

y
,Permit: NCS000347 _. Owner _-Facility: Cogentrix Energy.lnc. - - - -
Inspection Date: 03/19/2008 Inspection Type: Compliance Evaluation
Stormwater Pollution Prevention Plan
Does the site have a Stormwater Pollution Prevention Plan?
# Does the Plan include a General Location (LISGS) 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: The Plam has not been updated in a few years. I told facility that they
should keep all parts of SP3 doc. together. Had to wait on facility to find records.
No spills in over 3 yrs.
Qualitative Monitoring
Has the facility conducted its Qualitative Monitoring semi-annually?
Comment:
Analytical Monitorin
Has the facility conducted its Analytical monitoring?
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
Comment:
Permit and Qutfalls
# 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?
# Has the facility evaluated all illicit (non stormwater) discharges?
Reason for Visit: Routine
Yes No NA NE
■ ❑ ❑ ❑
Yes No NA NE
■ ❑ ❑ ❑
❑ ❑ ■ ❑
Yes No NA NE
Page: 3

•
El
_.�- ---- Permit: NCS000347 —Owner--facility: Cogentrix Energy -Inc— ---- -_-- -- -- - - -- -- - — --_, - -
Inspection Data: 03/19/2008 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Comment:
Page: 4

e
W
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
September 1, 2011
Frank W. Hayward -Site Manager
Capital Power Corporation
331 Allie Clay Road
PO Box 1153
Roxboro, NC 27573-1153
Subject: Compliance Evaluation Inspection
Capital Power Corporation -Roxboro Plant
NPDES Permit No. NCS000347
Person County
Dear Mr. Hayward:
Dee Freeman
Secretary
On August 22, 2011, Thomas Ascenzo of the Raleigh Regional Office (RRO),conducted a compliance inspection
(CEI) of the subject facility. The assistance of Ed Kell, operator in charge (ORC) was appreciated as it facilitated
the inspection process.
The following observations were made:
1. The Capital Power Corporation -Roxboro Plant is permitted to discharge Stormwater to an unnamed
tributary to Mitchell Creek, a class C waterbody in the Roanoke River Basin.
2. A Review of your Stormwater Pollution Prevention Plan Manual (SP3) revealed the following:
• The plan contained a general location map (USGS) showing outfall location and drainage
+ A Narrative descriptions of practices.
• Employee training is being conducted annually and documented as required by permit.
• Stormwater Qualitative monitoring forms were filled out appropriately.
3. Analytical Monitoring conducted June 4, 2010 indicated copper & zinc was over benchmarks. Tier 1
investigation was conducted. A Second round of sampling was within benchmarks. June 2, 2010
Qualitative Monitoring was observed to be within benchmarks.
4. Employee training is being conducted as observed on computer generated forms. Training was
conducted on Jan, 2011, Please include a sheet with signatures and dates in the SP3 manual.
5. Qualitative Monitoring was conducted June 4, 2010 and on June 27, 2010 as per permit requirements.
6. Outfall #001 was observed to be dry with rusty orange colored soil noted along the outfall.
7. No spills were noted in the three year period. Please add a sheet to the stormwater pollution prevention
plan documenting absence of spill events.
None hCarolina
Naturally
North Carolina Division of Water Quality Raleigh Regional Office Surface Water Protection Phone (9t9) 791-4200 Customer Service
Internet: www.ncwaterqualily.org 1628 Mail Service Center Raleigh, INC 27699-1628 FAX [phone].623.6746
An Equal Opportunity/Affirmative Action Employer — 50% Recycled110% Post Consumer Paper

i
Capital Power Company CEI
NCS000132 Page 2 of 2
S. Include a page with alist of responsible parties including telephone numbers and contacts in the event of
,a.spill,-This information -must be updated periodically annually.
9. This office recommends that you have one main SP3 notebook to eliminate researching and securing
other books for the necessary information. This will allow for materials to be available for quick reference
by staff.
Please continue your diligence of the Capital Power Corporation- Roxboro Stormwater Pollution Prevention
Program. Should you or your staff have any questions regarding this inspection, please do not hesitate to contact
me at 919-791-4256 or you can e-mail me at tom.ascenzo(ccDncdenr.Qov.
Sincerely,
Thomas Ascenzo
Environmental Specialist
Surface Water Protection
Attachment: Compliance Inspection Reports
CC: Central Files NC0020435
Ed Kell -Capital Power Corporation
PO Box 1153, Roxboro, NC 27573
Raleigh Regional Office SWP

Compliance Inspection Report
Permit: NCS000347 Effective: 08/01/10 Expiration: 07/31/15 Owner: Cpi USA North Carolina LLC
SOC: Effective: Expiration: Facility: CPI USA North Carolina - Roxboro Plant
County: Person 331 Allie Clay Rd
Region: Raleigh
Roxboro NC 27573
Contact Person: Gary Hickey Title: Phone: [phone]B
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 08122/2011 Entry Time: 11:00 AM
Primary Inspector: tom ascenzo
Secondary Inspector(s):
Reason for Inspection: Routine
Permit Inspection Type: Stormwater Discharge, Individual
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
0 Storm Water
(See attachment summary)
Exit Time: 12:00 PM
Phone: [phone]
Inspection Type: Compliance Evaluation
Page: 1

i
Permit: NCS000347 Owner- Facility: Cpi USA North Carolina LLC
Inspection Date: 08/22/2011 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?
■
❑
❑
Cl
# 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: Create a Responsible party list of phone number contacts and emergency
spill numbers and add it to the SP3 notebook.
Add a document that indicates no spills within the year. Include it in the SP3 plan.
It was observed that employee training was being conducted, include a document in the
SP3 manual that contains dates and employee signatures.
Qualitative Monitoring
Yea
No
NA
NE
Has the facility conducted its Qualitative Monitoring semi-annually?
■
❑
❑
❑
Comment: 10/4/2010, 6/27/2011
Analytical Monitoring
Yea
No
NA
NE
Has the facility conducted its Analytical monitoring?
■
❑
❑
❑
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
0011111110
Comment: 3/11/2010, 6/27/2011- Tier 1 investigation conducted with 3/11/2010
samples. Zinc, Copper over benchmarks.
Permit and Outfalls
Yes
No
NA
NE
# Is a copy of the Permit and the Certificate of Coverage available at the site?
MOOO
# Were all outfalls observed during the inspection?
■
❑
❑
❑
# If the facility has representative outfall status, is it properly documented by the Division?
❑
❑
■
❑
Page: 3

Permit: NCS000347 Owner - Facility: Cpi USA North Carolina LLC
Inspection Date: 08/22/2011 inspection Type: Compliance Evaluation Reason for Visit: Routine
# Has the facility evaluated all illicit (non stormwater) discharges?
Comment: Outfall #001 was dry but soil had a iron orange color observed in it. Two
additional possible outfalls were identified due to recent construction.
Page: 4

i � •

REGEVE@
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) MAR � 0 2011
Calendar Year L & I 1
NCOEMR
Individual NPDES Permit No. NC% IL!JLJMaL7J or
Certificate of Coverage (COC) No. NCG❑❑❑❑❑❑
This monitoring report summary of the calendar year is due to the DWQ Regional Office no later than March I' of the following year.
Facility Name: _CPI USA NORTH CAROLINA-ROXBORO PLANT
County: _PERSON
Phone Number: (_336__j_597-4798 Total no. of SDOs monitored 20
Outfall No. _001
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑ _
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Total
Rainfall,
Inches
Parameter, units
TSS MGIL
COD MGIL
ALUMINUM
MGIL
ANTIMONY
MGIL
ARSENIC
MGIL
BERYLLIUM
MGIL
BORON MGIL
CADMIUM
MGIL
Benchmark
N/A
100
120
0.75
0.09
0.36
0.07
N/A
0.001
Date Sample
Collected,
mmiddlyy
-
-
1113i10
0.6
41
28
2.03
<0.005
<0.005
<0.0005
.026
<0.0005
SW U-264-Generic-25May2010

Additional Outfall Attachment
Outfall No. 001
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Total
Rainfall,
Inches
Parameter, (units)
CHROMIUM
MGIL
COPPER MGIL
LEAD MGIL
MERCURY
MGIL
NICKEL
MGIL
SELENIUM
MGIL
SILVER MGIL
THALLIUM
MGIL
�rBenchmark
0:007'
:, 0 03 .
111/A .
0 26
0.056 ' _
0A01:
N1A
Date Sample
Collected,
mmlddtyy
1113110
0.6
0.003
0.008
<0.005
<0.0002
<0.005
<0.005
<0.001
<0.005
IF
SWU-264-Generic-25May2010

Additional Outfall Attachment
Outfall No. QO 1
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Total
Rainfall,
Inches
Parameter, (units)
ZINC MGIL
SULFATE
MGIL
OIL S GREASE
MGIL
PH
SU
Benchmark
N/A1
0.067
500
30
6-9
Date Sample
Collected,
mmlddtyy
Mimi=
=I=
M
M
M
1113110
0.6
0.060
6
<5.0
6.5
SWU-264-Gen eric-25May2010

" I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
Signature
Date 3- a Y--/t
Mail Annual DMR Summary Reports to:
DWQ Regional Office Contact Information:
A_ SHEVILLE REGIONAL OFFICE
F_AYET_TEVILLE REGIONAL OFFICE
MOORESVILLE REGIONAL OFFICE_
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
(828) 2964500
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE
_
WASHINGTON REGIONAL OFFICE
WILMIN_GTON REGIONAL OFFICE_
3800 Barrett Drive
943 Washiington Square Mall
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINST_ON-S_ALEM REGIONAL OFFICE-
CENTRAL OFFICE
585 Waughtown Street
1617 Mail Service Center
'To preserve protect
Winston-Salem, NC 27107
Raleigh, NC 27699-1617
andenhance
[phone]
[phone]
N WhCarctnas►vate■...R
01
SW U-264-Generic-2 5 May2010

•
0
Ascenzo, Tom
From: Ascenzo, Tom .
Sent: Tuesday, August 23, 2011 9:11 AM
To: '[e-mail]'
Subject: FW: NCS000347 Carolina Power Company
Ed, can you answer Ken with the questions required. Please CC me so I know the information also.. Thanks !!! Tom
From: Pickle, Ken
Sent: Tuesday, August 23, 2011 8:23 AM
To: Ascenzo, Tom
Cc: Lowther, Brian; Bennett, Bradley
Subject: RE: NCS000347 Carolina Power Company
Hi Tom,
I've copied Brian because he was the last one of us to go through the renewal process on NCS000347,
Cogentrix/CPC/etc. (Several past names).
Our permit file here does not have a sufficient site plan to allow me to guess what the exact configuration of the new
retention ponds might be. Absent specific information on the new site configuration, the beginning perspectives would
be:
Are these stormwater-only ponds, or are they also sluicing ash water or wash water or cooling water into them?
NCS000347 would not authorize the discharge of those wastewaters.
If they are indeed stormwater-only ponds, then the next question is, "Do the discharges mix with Outfall #003
while still on the power company's property?" If so, then we still only have just one outfall, and their permit still
just covers Outfall #003. Under those physical circumstances our interpretation would be that there is really just
one place where the flow leaves the site, and therefore just one outfall.
Gray areas might exist — I mean, what if the ponds mix with Outfall #003 off site, but only 10' off site? We could
make the call that that there are three separate outfalls, but maybe we would be amenable to representative
outfall status. A visit might be helpful in amending the permit if the physical circumstances seem muddled, or if
I don't understand exactly the physical circumstances.
I'd like to defer this on to Brian, if he's available.
Brian, are you available to help Tom on this ?
Presuming that he is available, I'll defer to his scheduling with you, and accompany you all if I can. If he's not available,
you and I can arrange our schedules to suit next week.
W%
Ken Pickle
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: [e-mail]
Website: http://portal.ncdenr.org/web/wg/ws/su
** 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 regulations.**
From: Ascenzo, Tom
Sent: Tuesday, August 23, 2011 7:34 AM
To: Pickle, Ken
Subject: NCS000347 Carolina Power Company
Ken, yesterday I conducted an inspection of Carolina Power Company in Roxboro. Ed Kell who is the Environmental
Health and Safety person assisted me with the inspection.. He had a question if two retention ponds located on the site
that mix with Outfall #003 needs to be added to the permit which only has one outfall stated on it.. The ponds in
question were recently constructed after the permit was renewed. Maybe we can do a site visit together to determine
what course of action to take. Mr. Kell stated that he is going to take samples from the location regardless.. I am on
annual leave the rest of the week starting tomorrow, be back next week.. Let me know what day would be good.. Tom
Thomas 8 Ascenzo
Environmental Specialist
NC Dept. of Environment & Natural Resources
Division of Water Quality
Raleigh Regional Office
1628 Mail Service Center
Raleigh, INC 27609
919-791-4256
FAX: [phone]
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.

RMENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
`
May 26, 2010
Mr. Elton E Gibbs �� _ 7 �� ,/ 1
CPI USA North Carolina LLC �i
PO Box 1153
Roxboro, NC 27573 fiit't E1'ai� '"='..L C)FFIC%1
Subject: Draft NPDES Stormwater Permit
Permit No. NCS000347
CPI USA North Carolina - Roxboro Plant
Person County
Dear Mr. Gibbs:
Enclosed with this letter is a copy of the draft stormwater permit for your facility. Please review the draft
very carefully to ensure thorough understanding of the conditions and requirements it contains.
The draft permit contains the following significant changes from this facility's current permit:
Analytical monitoring changes-
1. Analytical monitoring parameters including 15 metals, sulfate, and oil & grease have been added to this
permit as an effort to investigate the pollution potential of stormwater discharges.
2. pH has been added to the analytical monitoring requirements.
3. All analytical monitoring has been set to semi-annually during a representative storm event as defined in
Part II Section B. The permittee must also document the total precipitation for each event. If no discharge
occurs during the sampling period, the permittee must submit a monitoring report indicating "No Flow"
within 30 days of the end of the six-month sampling period. Additionally, samples must be taken a
minimum of 60 days apart, as specified in Table 2.
4. Benchmarks for analytical monitoring have been added to this draft permit. Exceedances of benchmark
values require the permittee to increase monitoring, increase management actions, increase record
keeping, and/or install stormwater Best Management Practices (BMPs) in a tiered program. If the
sampling results are above a benchmark value, or outside of the benchmark range, for any parameter at
any outfall then the facility shall follow the Tier 1 guidelines which require a facility inspection within
two weeks and implementation of a mitigation plan within two months. If during the term of this permit,
the sampling results are above the benchmark values, or outside of the benchmark range, for any specific
parameter at a specific discharge outfall two times in a row (consecutive), then the facility shall follow the
Tier 2 guidelines which require a repetition of the steps listed for Tier 1 end also immediately institute
monthly monitoring for all parameters at every outfall where a sampling result exceeded the benchmark
value for two consecutive samples.
5. You are required to collect all of the analytical and qualitative monitoring samples during representative
storm events as defined in Part II Section B. Qualitative monitoring is required regardless of
representative outfall status.
6. You are responsible for all monitoring until the renewal permit is issued. See Footnote 1 of Tables 1, 4,
and 5.
Wetlands and stormwater Branch One
1617 Mail Service Center, Raleigh, forth Carolina 27699-1617 NorthCalolina
Location: 512 -8 7 Salisbury St. Raleigh, North Carolina r Service:
�� ur����
Phone: 919-807-fi3001 FAX: 919-8o7-6q;>41 Customer 5ervice:1 �77-fi23-67A8
Internet: www.nmaterquality,org
An Equal Opportunity 1 Attirmative Action Employer

CPI USA North Carolina LLC •
Permit No. NCS000389
7. The flow reporting requirement has been removed per DWQ revised strategy. (The total rainfall
parameter is in this permit, however.)
8. Vehicle maintenance monitoring has been revised to semi-annually in order to coincide with analytical
and qualitative monitoring. Monitoring for TPH has replaced Oil & Grease. This requirement appears in
all Individual Stormwater permits, however it only applies to facilities that do vehicle maintenance. If the
facility begins vehicle maintenance during the permitted timeframe then the requirements shall apply.
Other permit changes:
1. Additional guidance is provided about the Site Plan requirements. The site map must now identify if the
receiving stream is impaired and if it has a TMDL established. It must also describe potential pollutants
in each outfall. The map requirements are stated more explicitly. And, the site plan must contain a list of
significant spills that have occurred in the past three years and also must certify that the outfaIIs have
been inspected to ensure that they do not contain non-stormwater discharges. Additional information is
provided in Part lI Section A.
2. Additional requirements for the Stormwater Management Plan have been specified in Part II Section A.
More details regarding secondary containment are provided.
3. Additional requirements for the Stormwater Pollution Prevention Plan have been specified in Part II
Section A. The plan must also be updated annually to include a list of significant spills and to certify that
the outfalls do not contain non-stormwater discharges.
4. The facility must now implement a semi-annual Facility Inspection Program of the site's stormwater
management controls as specified in Part II Section A.
5. Information regarding the No Exposure Exclusion has been added to this draft permit. If industrial
materials and activities are not exposed to precipitation or runoff as described in 40 CFR §122.26(g), the
facility may qualify for a No Exposure Exclusion from NPDES stormwater discharge permit
requirements:— Additional information is provided in Part I Section A.
6. In addition to submitting two signed copies of DMRs to Central Files, a separate sighed Annual Summary
DMR copy must be submitted -to the local DWQ Regional Office by March 1 of each year.
Please submit any -comments to me no later than thirty (30) days following your receipt of the draft.
Comments should be sent to the address listed at the bottom of this page. If no adverse comments are
received from the public or from you, this permit will likely be issued in about two months.
If you have any questions or comments concerning this draft permit, contact me at [phone] or
brian.lowther®ncdenr.gov
cc: TRMeigh Regional -Office
Stormwater Permitting Unit
Attachments: Draft NPDIES Stormwater Permit
Sincerely,
Brian Lowther
Environmental Engineer
Stormwater Permitting Unit
2

A'T, �
NCDENR
`North Carolina Department of Environment and Natural
Division of Water Quality *•
Beverly t_a4s' Perdue
Governor
Mr. Elton E Gibbs
CPI USA North Carolina LL,C
PO Box 1153
Fayetteville, NC 28312
Dear Mr. Gibbs:
Coleen H. Sullins
Director
May 5, 2010
Subject:
Durces
Dee Freeman
Secretary
Draft NPDES Stormwater Permit
Permit No. NCS000347
CPI USA North Carolina - Roxboro Plant
Person County
Enclosed with this letter is a copy of the draft stormwater permit for your facility, Please review the draft
very carefully to ensure thorough understanding of the conditions and requirements it contains.
The draft permit contains the following significant changes from this facility's current permit:
Analytical monitoring changes:
1. Analytical monitoring parameters including 15 metals, sulfate, and oil & grease have been added to this
permit as an effort to investigate the pollution potential of stormwater discharges.
2. pH has been added to the analytical monitoring requirements.
3. All analytical monitoring has been set to semi-annually during a representative storm event as defined in
Part II Section B. The permittee must also document the total precipitation for each event. If no discharge
occurs during the sampling period, the permittee must submit a monitoring report indicating "No Flow"
within 30 days of the end of the six-month sampling period. Additionally, samples must be taken a
minimum of 60 days apart, as specified in Table 2.
4. Benchmarks for analytical monitoring have been added to this draft permit. Exceedances of benchmark
values require the permittee to increase monitoring, increase management actions, increase record
keeping, and/or install stormwater Best Management Practices (BMPs) in a tiered program. If the
sampling results are above a benchmark value, or outside of the benchmark range, for any parameter at
any outfall then the facility shall follow the Tier 1 guidelines which require a facility inspection within
two weeks grid implementation of a mitigation plan within two months. If during the term of this permit,
the sampling results are above the benchmark values, or dutside of the benchmark range, for any specific
parameter at a specific discharge outfall two times in a row (consecutive), then the facility shall follow the
Tier 2 guidelines which require a repetition of the steps listed for Tier 1 and also immediately institute
monthly monitoring for all parameters at every outfall where a sampling result exceeded the benchmark
value for two consecutive samples.
5. You are required to collect all of the analytical and qualitative monitoring samples during representative
storm events as defined in Part II Section B. Qualitative monitoring is required regardless of
representative outfall status.
6. You are responsible for aII monitoring until the renewal permit is issued. See Footnote 1 of Tables 1, 4,
and 5. 7
Wetlands and Storrnwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 NorthCarolina
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: 91M07.64941 Customer Service: 1.877.623-6748 N%tura"�1
Internet www.nowaterquality.org +' iJ
An Equal Opportunity 1 Affirmative Action Employer

CPI USA North Carolina LLC .
Permit No. NCS000389
7. The flow reporting requirement has.been removed per DWQ revised strategy. (The total rainfall
parameter is in this permit, however.)
8. Vehicle maintenance monitoring has been revised to semi-annually in order to coincide with analytical
and qualitative monitoring. Monitoring for TPH has replaced Oil & Grease. This requirement appears in
all Individual Stormwater permits, however it only applies to facilities that do vehicle maintenance. If the
facility begins vehicle maintenance during the permitted timeframe then the requirements shall apply.
Other permit changes:
1. Additional guidance is provided about the Site Plan requirements. The site map must now identify if the
receiving stream is impaired and if it has a TMDL established.. It must also describe potential pollutants
in each outfall. The map requirements are stated more explicitly. And, the site plan must contain a list of
significant spills that have occurred in the past three years and also must certify that the outfalls have
been inspected to ensure that they do not contain non-stormwater discharges. Additional information is
provided in Part II Section A.
2. Additional requirements for the Stormwater Management Plan have been specified in Part II Section A.
More details regarding secondary containment are provided.
3. Additional requirements for the Stormwater Pollution Prevention Plan have been specified in Part IT
Section A. The plan must also be updated annually to include a list of significant spills and to certify that
the outfalls do not contain non-stormwater discharges.
4. The facility must now implement a semi-annual Facility Inspection Program of the site's stormwater
management controls as specified in Part II Section A.
5. Information regarding the No Exposure Exclusion has been added to this draft permit..: mdustria'.'
materials and activities are not exposed to precipitation or runoff as described in 40 CFR §122.26(g), the
facility may qualify for a No Exposure Exclusion from NPDES stormwater discharge permit "
requirements. Additional information is provided in Part I Section A.
6. In addition to submitting two signed copies of DMRs to Central Files, a separate signed -Annual Summary
DMR copy must be submitted to the local DWQ Regional Office by March 1 of each year.
Please submit any comments to me no later than thirty (30) days following your receipt of the draft.
Comments should be sent to the address listed at the bottom of this page. If no adverse comments are
received from the public or from you, this permit will Iikely be issued in about two months.
If you have any questions or comments concerning this draft permit, contact me at [phone] or
[e-mail]
cc: Raleigh Regional Office
Stormwater Permitting Unit
Attachments: Draft NPDES Stormwater Permit
Sincerely,
�G�
Brian Lowther
Environmental Engineer
Stormwater Permitting Unit
2

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, PE Dee Freeman
Governor Director Secretary
August 2, 2012
Mr. Frank Hayward
Site Manager - Roxboro
Capital Power Corporation
P.0 Box 1153
331 Allie Clay Rd.
Roxboro, NC 27699
Subject: NPDES Compliance Evaluation Inspection
NPDES Wastewater Discharge
Permit No. NCO065081
NCS0003IW 7 NPDES Individual
Stormwater ,
Capital Power Corporation
Person County
Dear Mr. Hayward:
On June 13, 2012, Autumn Romanski with the North Carolina Division of Water Quality
conducted a Compliance Evaluation Inspection of the Capital Power Corporation Roxboro
Plant. This inspection was conducted to verify that the facility is operating in compliance with
the conditions and limitations specified in NPDES Wastewater Permit No. NCO065081.
A summary of the findings and comments noted during this inspection is provided in Section D
on Page 2 of the attached copy of the complete inspection report titled "Water Compliance
Inspection Report".
If you have any questions concerning this report, please contact me at 919-791-4247 in the
Raleigh Regional Office.
Sincerely,
t
Autumn Romanski
Environmental Program Consultant
Page 2-1

Attachments
Cc: (w/attachments) Raleigh Regional Office — bile
DWQ/Raleigh —Central Files
Wetlands, Buffers, Stormwater Compliance & Permitting Unit
Mr. Rick Hauser Mr. Ed Kell
EHS Coordinator Operator in Responsible Charge
P.O. Box 1153 P.O. Box 1153
Roxboro, NC 27573-1153 Roxboro, NC 27573-1153
Page 2-2

i-
Section D Summary of Findings /Comments
1. Permit:
Your NPDES Individual Wastewater permit became effective February 1, 2008 and expired on
May 31, 2012 and under review for renewal. The facility is not currently under a Special
Order by Consent.
The NPDES Individual Stormwater Permit NCS000347 became effective August 1, 2010 and
expires July 31, 2015. The permittee is reminded to read, understand and comply with all of
the terms and conditions contained in the permit(s). If you have questions concerning your
responsibilities, please call the Raleigh Regional Office to speak to a Division of Water
Quality Surface Water staff member.
The facility was compliant with the wastewater and stormwater requirements of the NPDES
permit(s) in effect the day of the inspection. The permittee reported reduction in use of coal
now utilizes 20% coal and 80% wood/tire debris as MeL
2. Compliance Schedules:
The permit does not have any outstanding compliance schedules for this facility.
3. Facility Site Review:
The overall condition of the plant site was satisfactory. The appearance of the facility was in
acceptable condition indicating the current housekeeping practices are good.
4. Records/Reports:
a) A review of the daily monitoring data submitted during the previous 12-month period
and a review of the permit conditions indicates the facility was in compliance with the
permit requirements and/or limitations.
The facility was issued no penalty assessments for the 12-month period.
b) The facility must designate a certified Operator -in -Responsible -Charge (ORC) having
a certification level equal to or greater than the facility classification. A Back-up ORC
must also be designated with a minimum certification level at least one level less than
the facility classification.
The facility is currently in compliance with these requirements, This facitiis
classified as a Physical Chemical 1 (PC-1) and the Operator in Responsible_ Charge.
(ORC) is Edward Kell, Jr. He holds a PC-1 _(Cert. No, 28180). A'fr. Kell indicated
Back-up ORC's are Wrikht Whitlow and Joseph Shelton. _Please .submit an updated
Page 2-3

�r
desir_ynation information (IF ORC's chaUe over, _or additional ORC's are designated
as operators — please .send information to the attention of Steve Reid at.-
1618 Mail Service Center
Raleigh NC 27699 - 1618
The ORC designation form is located here: http://gortal.ncdenr.orm/weh/wg/tacu-
downloads
The facility is currently in compliance with these requirements.
5. Self -Monitoring Program:
You are reminded that your monitoring samples must be collected, preserved, and analyzed by
appropriate procedures and methods. You should maintain records of the sampler temperature,
and a certified laboratory must calibrate the sample thermometers annually.
Your operator is reminded that he/she must keep a logbook of all operation/maintenance
activities undertaken at the facility. The logbook should include all daily process control
activities including any field measurements conducted for process control. A visitation log for
the facility must also be maintained.
The facility is currently in compliance with these requirements
ISCO composite sampler- Please ensure proper cooling of the samples_ with ice. New, clean
sample tubing was in place the day of the inMection.
6. Laboratory:
For all analytical data submitted for compliance monitoring purposes, a certified Iaboratory
must be utilized for all laboratory analysis. Additionally, if field parameter testing is
conducted, an operator certified to perform the specified field parameter analysis is also
required. The operator needs to be sure to calibrate all meters/instrumentation before each use
and retain all calibration records.
The facility is currently in compliance with these requirements and utilizes_ Meritech
certified commercial laboratory 165. The facilityholds_a current NC DWQ Laboratory
Field Parameter Certification 95458 for pH, TRQ and temperature measurements.
The Rezional Field Inspectors checklist _wasnot _ completed cisJeff Adams _of the Lab
Certification Program completed an evaluation of the facility November 29, 2011
7. Flow Measurement:
If the permit requires a flow measurement device for determining the effluent flow, the
flow measurement device must be calibrated annually.
Page 2-4

.4
0
This facility is required to monitor and report e( uent flow and the Facility is in compliance
with this re uirement.
S. Effluent/Receiving Waters:
The effluent discharge should be clear with a continuous flow with no visible changes to
the receiving waters.
The effluent discharge was clear and flow_was continuous.
9. Pretreatment:
This faciliU currently has no pretreatment permit 'and does not accept or discharge
domestic or industrial waste to a sanitary sewers stem. Pre-treatment permits are
required, if yolicable, by your NPDES Discharge Permit.
10. Solids HandlinW is osah
The facility must dispose of solids by an acceptable method such as a landfill or utilize the
services of an approved solids hauling and disposal contractor, which requires the facility
to be included under the contractor's non -discharge permit (i.e. land application). The
facility is reminded to maintain adequate records (i.e. shipment dates, quantities, etc.) of
any solids hauling and/or disposal activities.
The facility is in compliance with these requirements and reports disposal of'solid waste to
the Republic Landfill. The facility should address Coal Combustion Products management
as directed by the NC Division of Solid Waste andlor as directed by other state or federal
regulations as that apply to CC solids at this faciliM.
11. Sanitary Wastewater is connected to sanitary sewer.
12. Compliance Sampling:
No compliance sampling was conducted the day of this inspection.
13. NPDES NCS000347 Stormwater Permit:
SW Out a11001-. sampling results were_reviewed and the facility was in compliance with the
permit requirements the day of the kpeclion.
14. Operations & Maintenance:
The facility was in compliance with these requirements the day of'the inspection._
Page 2-5

14. Com liance Status:
®, Compliant
Name and Signature of Inspector:
t mn Romanski
Surface Water Protection Section
Raleigh Regional Office
❑ Non -compliant
If
Date
Neither
Page 2-6

F
Permit: NCS000347
SOC:
County: Person
Region: Raleigh
• .0 .
Compliance Inspection Report
}
Effective: 08/01/10 Expiration: 07/31/15 Owner: Cpi USA North Carolina LLC
Effective: Expiration: Facility: CPI USA North Carolina - Roxboro Plant
331 Allie Clay Rd
Contact Person: 47
6�H�v�
Directions to Facility:
System Classifications: /
Primary ORC:
Secondary ORC(s):
On -Site Re pros e ntative(s):
Related Permits:
Roxboro NC 27573
Title: Phone: [phone]
Certification: Phone:
Inspection Date: 06/12/2012 Entry Time::1 09:00 AM Exit Time: 10:45 AM
Primary Inspector: Autumn H Romanski /' Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine
Permit Inspection Type: Stormwater Discharge, Individual
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
E Storm water
(See attachment summary)
Inspection Type: Compliance Evaluation
Page: 1

Pormit: NCS000347 Owner - Facility: Cpi USA North Carolina LLC
Inspection pate: 06/12/2012 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
The permittee was in compliance with stormwater requirements the day of this inspection.
Page: 2

Permit: NCS000347 Owner - Facility: Cpi USA North Carolina LLC
Inspection Date: 06/12/2012 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:
Qualitative Monitoring Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? ■ ❑ ❑ ❑
Comment: ORC keeps excellent records,
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: Analytical Monitoring required twice per year, and the facility is in
compliance with this requirement.
EHS Manager reports data regularly to RRO.
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: NCS000347 Owner - Facility: Cpi USA North Carolina LLC
Inspection Qate: 05112/2012 Inspection Type: Compliance Evaluation Reason for Visit: Routine
# Has the facility evaluated all illicit (non stormwater) discharges? ■ 0 ❑
Comment: Two stormwater outfalls were observed by the railroad and sheet flow of
stormwater in the area by the front of the facility. Outfall 001 (SDO) is sampled for
priority pollutants(a combination of wastewater and stormwater) flows off the property to
an adjoining neighborhood (UT to Mitchell Creek). Sample results were reviewed. The
facility does an excellent job with sampling and record keeping.
Page: 4

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy. Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
ENVIRONNENTALCUALITV (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY I ONLY
Date Received
Year
I Month Da
,i�l v�o
AU6 022018
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
rER
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
N I C I S p 0 0 3 14 17
2) Facility Information:
Facility name.-
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage
N C G
CPI USA North Carolina - Roxboro Plant
CPI USA North Carolina LLC
331 Allie Clay Road
Address
Roxboro NC 27573
City • State 'Lip
To find the current legally responsible person associated with your permit, go to this website:
ltttp;//deg.nc.aov/about/divisions/eneray-mineral-land-resources/energy-mineral-land-permits/Stormwater-program
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Frank Hayward
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this pert -nit: Terry Nealy
first M1 Last
Page I of 2
5 W U-OWNERAFFILr23March2017

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
Plant Manager
Title
331 Allie Clay Road
Mailing Address
Roxboro NC 27573
City State Zip
(33(0)330_4502 -tn"%%APCA0;AA1 09!!~, uw,
'telephone E-mailAddress
(3310 330 -450R
Fax Number
5) Reason for this change:
0 Employee or management change
A result of: ❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
1 Terry Nealy , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processed.
"7-"3 0_ 1
Signatur P0 Date
PLEASE SEND THE COMPLETED FORM TO:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center '
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website
at: http://deg..nc.gov/about/divisions/energy-mineral-land-resources/stornlwater
Page 2 of 2
S WU-OWNERAFFIL`23Mar2017

�J f --

r�gpt:
� r
J�"Beverly Eaves Perdue, Govern
Dee Freeman, Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
0 I 0 1 0 1 IN
II. Permit status nEjaE to requested change.
a. Permit issued to (company name):
b. Person legally responsible for permit:
c. Facility name (discharge):
d. Facility address:
Primary Energy of North Carolina LLC aka
Cogentrix Energy
Elton E _ Gibbs _
First MI Last
General Manaeer
Title
P.O. Box 1153
Permit Holder Mailing Address
Roxboro NC 27573
City State Zip
[phone] [phone]
Phone Fax
Prima Encra of North Carolina - Roxboro Plant
331 Allie Clav Road
Address
Roxboro NC 27573
City State Zip
e. Facility contact person: Elton E. Gibbs [phone]
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
CPI USA North Carolina LLC
Elton E_ _ Gibbs _
First MI Last
General M
Title
P.O. Box 1153
Permit Holder Mailing Address
T Roxboro NC 27573
City State Zip
[phone]
Phone E-mail Address
CPI USA North Carolina - Roxboro Plant
331 Allie CIR Road
Address
Roxboro NC 27573
City State Zip
EIton E Gibbs
First MI Last
Revised 812008
[phone]

PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact:
First MI Last
Title
Mailing Address
City State Zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
.....................................................................................................................
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature
APPLICANT CERTIFICATION
Date
I, Elton E. Gibbs, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
-ld Z��& /?�iS-//.O9
Sign ture 11 Date �^
....................................
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 7/2008

K&L I GATES
ENCLOSURE MEMO
TO: Mr. Bradley Bennett
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, NC 27699-1617
DATE: December 17, 2009
K&L Gates ue
4350 Lassiter at North Hills Avenue, Suite 300
Post Office Box 17047
Raleigh, NC 27619.7047
r 919.743,7300 www.klgates,com
@rn'�3� \I
DEC 2 1 2009
RE: Notification of Name Change - North Carolina Stormwater Permits
Enclosed for filing and processing are name change notification forms for the following
stormwater permits for CPI USA North Carolina LLC:
1. Stormwater Permit Number NCS000347 (CPI USA North Carolina - Roxboro
Plant); and
2. Stormwater Permit Number NCS000348 (CPI USA North Carolina - Southport
Plant).
Please confirm receipt of the above -referenced documents. Thank you for your
assistance in this matter.
K&L Gates LLP
r
By: .. I e� -
Stanford D. Baird
cc: Christopher L. Kopecky, Esquire (with enclosures)
4839-9177-8821.01