NCG050437_COMPLETE FILE - HISTORICAL_20170425

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. I IV U& C) �5(jy'3 %
I DOC TYPE HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ L� D
YYYYMMDD

Central Files: APS _ SWP
4/25/2017
Permit Number NCGO50437 Permit Tracking Slip
Program Category Status Project Type
NPDES SW Active New Project
Permit Type Version Permit Classification
AppareVPrinbng/PaperA-eather/Rubber Stornwater Discharge COC 1.00 COC
Primary Reviewer RECEIVED ED Permit ContactAfffllation
robert.patterson
APR 2 5 &r
Coastal SWRuIe CENTRAL FILES
Permitted Flow ' DWR SECTION
Facility
Facility Name
Major/Minor Region
Hubbell Lenoir City, Inc.
'Minor Raleigh
Location Address
County
546 English Rd
Nash
Rocky Mount NC 27804
Owner
Facility Contact Affiliation
Josh Futrell
546 English Rd
Rocky Mount NC 1 27804
Owner Name Owner Type
Mark Youmans Non -Government
Owner Affiliation
Mario Youmans
3621 Industrial Paris Dr
Dates/Events Lenoir City TN 37771
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
4126/2017 3f7/2017 4/25/2017 412WO17 5/31/2018
Regulated Activities Requested /Received Events
Plastics & synthetics manufacturing RO staff report requested 3113/17
RO staff report received
Additional information requested 3/13/17
Additional information received 4121/17
Outfall
Waterbody Name Streamindex Number Current Class Subbasin

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
April 25, 2017
Mr. Mark Youmans
Hubbell Lenoir City, Inc.
3621 Industrial Park Dr.
Lenoir City, TN 37771
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
Subject: General Permit No. NCGO50000
Hubbell Lenoir City, Inc.
COC No. NCG050437
Nash County
Dear Mr. Youmans:
In accordance with your application for a discharge permit received on March 7, 2017, 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 upon approval of the
Division of Energy, Mineral and Land Resources. The Division of Energy, Mineral, and Land
Resources 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 Energy, Mineral and Land Resources, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
Per the requirements of the Tar -Pamlico Riparian Buffer Rule, all stormwater drainage to stream
buffers, from portions of this site that have been constructed after January 1, 2000, must meet diffuse
flow requirements per 15A NCAC 2B .0259. Diffuse flow requirements are described on the
Riparian Buffer Protection Program website: https://deg.nc. ov/about/divisions/water-
resources/water-resources- ermits/wastewater-branch/401-wetlands-buffer- ermits/401-riarian-
buffer-protection-program.
If you have any questions concerning this permit, please contact Robert Patterson at [phone]
or robert.oattersonancdenr.gov.
State of North Carolina I Emimnmemal Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1512 N. Salisbury St. I Raleigh, NC 27699
919 707 9200 T

Sincerely,
�;? �p
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Raleigh Regional Office
Central Files
Stormwater Permitting Program Files
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resowees
102 Mail Service Center j 512 N. Salisbury St. I Raleigh, NC 27699
919 707 9200 T

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG050000
CERTIFICATE OF COVERAGE No. NCG050437
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,
Hubbell Lenoir City, Inc.
is hereby authorized to discharge stormwater from a facility located at
Hubbell Lenoir City, Inc.
546 English Road
Rocky Mount
Nash County
to receiving waters designated as UT to Stony Creek, a class C; NSW water in the Tar -Pamlico
River Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, III, IV, V, and VI of General Permit No. NCG050000 as
attached.
This certificate of coverage shall become effective April 25, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 25, 2017.
,for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

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Division of Energy, Mineral and Land Resources
Land Quality Section
NCDENR National Pollutant Discharge Elimination System
t&MM CAMO.^
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NCGO50000
NOTICE OF INTENT
hC670 4�3 I
National Pollutant Discharge Elimination System application for coverage under General Permit
NCGO50000:
STORMWATER DISCHARGES associated with activities classified as:
SIC 23 Apparel and Other Finished Products Made from Fabrics and Similar Materials
SIC 265 Paperboard Containers and Boxes
SIC 267 Converted Paper and Paperboard Products {-
Sle 27 Printing, Publishing and Allied Industries
SIC 30 Rubber and Miscellaneous Products (except as specified below) OMqq
SIC 31 Leather and Leather Products (except as specified below) zA1l
SIC* 39 Miscellaneous Manufacturing Industries 11ENR_Lgtj,,) QIJAf_!ry
SIC' NIA Like activities deemed by DEMLR to be similar in the process and/or the exposure:ofsgW,,llfr/ C
materials, products, by-products, or waste materials
The following activities are specifically excluded from coverage under this General Permit:
SIC 301 Tires and Inner Tubes
SIC 311 Leather Tanning and Finishing
• Standard Industrial Classification Code
(Please print or type)
1) Mailing address of ownedoperator (address to which all.permit correspondence will be mailed :
Name Mark Youmans
Street Address 3621 Industrial Park Drive
City Lenoir CRY State TN ZIP Code 37771
Telephone No. _ [phone] Fax:
E-mail Address [e-mail]
2) Location of facility producing discharge:
Facility Name Hubbell Lenoir City, Inc.
Facility Contact Josh Futrell
Contact E-mail [e-mail]
Street Address 546 English Road_
City Rocky Mount ' _ State NC ZIP Code 27604
County Nash
Telephone No. 252 467-2210 _ X2pL4 ? Fax:
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). From US Highway 64, drive north on N. Winstead Ave.
Turn left (west) onto English Rd at the traffic light. The facility is approximately 0.5 mile on the right, _
(A copy of a county map or USGS quad sheet with faciidy clearly located on the map is requkEd with this application)
Page 1 of 4
5WU-220-071408 Last Revised 6/24114

NCG050000 N.O.I.
� 7 $ 51 '7 3
4) Latitude 3505849" N Longitude 77051'09" W (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
® Existing
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: 3 0 8 2
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: Hubbell utilizes three in-house processes (infection molding, roto molding and polymer concrete)
to manufacture HDPE above -grade and underground enclosures for underground utility infrastructure markets.
8) Discharge points:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 1
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Tar River via Stoney Creek and an unnamed tributary.
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate stoma
sewer system (e.g. City of Raleigh municipal storm sewer).
10) Does this facility have any other NPDES permits?
® No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
® No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
® Yes
If yes, please briefly describe: management of waste streams, secondary containment requirements for all
containers >5 gallons, use of biodegradable fluids compatible with sanitary sewer systems, good house-
keeping practices, weekly site inspections, heat treated pallets only (no pressure treated)
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
© Yes
If yes, when was it implemented? April 2016
14) Are vehicle maintenance activities occurring at this facility?
© No ❑ Yes
Page 2 of 4
SWU-220-071408 Last Revised 6/24114

NCG050000 N.O.I.
' 15) 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 (Conditionally Exempt Small Quantity Generator)
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
10 No ❑ Yes
d) 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 / disposal vendor:
Vendor address:
16) Certification:
North Carolina General Statute 143-215.6 b (1) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document tiled 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 maintainad under this Article or rules of the
[Environmental Management] Commission implementing this Artide shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten thousand dollars ($10,000).
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: John Dina
Title: a Plant_Marrager
of Applicant)
91/Y ac j
(Date gignedl
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to NCDENR.
Page 3 of 4
SWU-220-071408 Last Revised 6/24/14

NCGO50000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NCDENR
❑ This completed application and all supporting documents
❑ Copy of county map or USGS quad sheet with location of facility clearly marked on map and nearby waters
Mail the entire package to:
Stormwater and General Permits Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-Wl
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 4 of 4
SW U-220-071408 Last Revised 6124114

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NCDENR
HAZ WASTE MANAG SECTION
RALEIGH NC 27699
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ROY COOPER
Governor
Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Mr. Mark Youmans
Hubbell Lenoir City, Inc.
3621 Industrial Park Dr.
Lenoir City, TN 37771
Dear Mr. Youmans:
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
April 25, 2017
Subject: General Permit No. NCO050000
Hubbell Lenoir City, Inc.
COC No. NCG050437
Nash County
In accordance with your application for a discharge permit received on March 7, 2017, 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 upon approval of the
Division of Energy, Mineral and Land Resources. The Division of Energy, Mineral, and Land
Resources 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 Energy, Mineral and Land Resources, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
Per the requirements of the Tar -Pamlico Riparian Buffer Rule, all stormwater drainage to stream
buffers, from portions of this site that have been constructed after January 1, 2000, must meet diffuse
flow requirements per 15A NCAC 2B _0259. Diffuse flow requirements are described on the
Riparian Buffer Protection Program website: https.//dgq.nc.gov/about/divisions/water-
resources/water-resources-permits/wastewater-branch/401-wetlands-buffer-permits/401-riparian-
buffer-protection-program.
If you have any questions concerning this permit, please contact Robert Patterson at [phone]
or robert.pattersonLaMcdenngov.
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1 512 N. Salisbury St. I Raleigh, NC 27699
919 707 9200 T

e
Sincerely,
Original Signed by Robert A Patterson, PE
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Raleigh Regional Office
Central Files
Stormwater Permitting Program Files
State of North Carolina j Environmental Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1 512 N. Salisbury St. I Raleigh, NC 27699
919 707 9200 T

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG050000
CERTIFICATE OF COVERAGE No. NCG050437
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,
Hubbell Lenoir City, Inc.
is hereby authorized to discharge stormwater from a facility located at
Hubbell Lenoir City, Inc.
546 English Road
Rocky Mount
Nash County
to receiving waters designated as UT to Stony Creek, a class C; NSW water in the Tar -Pamlico
River Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, II, III, IV, V, and VI of General Permit No. NCG050000 as
attached.
This certificate of coverage shall become effective April 25, 2017.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 25, 2017.
Original Signed by Robert D. Patterson, PE
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

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Patterson, Robert D
From: Patterson, Robert D
Sent: Monday, March 13, 2017 1:49 PM
To: 'Youmans, Mark'; Carol Moser
Cc: Futrell, Josh
Subject: RE: NPDES Stormwater General Permit NCG050000
Mark— What is the offical company name as filed with the NC Dept. of the Secretary of
State? https://www.sosnc.gov/search/index/corp Ft�`bWCb- 1-P w/ yMgt'
Thanks! -Co ^A4LK aN ql,.3%i? .
Robert D. Patterson, P.E.
Stormwater Engineer
NCDEQ I DEMLR I Stormwater Permitting Program
919-807-6369 ! Robert. PattersonOD ncdgnr.eov
512 N. Salisbury St. ! Raleigh, NC 27604
1612 MSC I Raleigh, NC 27699-1612
http://portal.ncdenr.org/web/ir/stormwater
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third porties.
From: Youmans, Mark [mailto:[e-mail]]
Sent: Wednesday, March 08, 2017 1:23 PM
To: Carol Moser <[e-mail]>
Cc: Patterson, Robert D <[e-mail]>; Futrell, Josh <[e-mail]>
Subject: RE: NPDES Stormwater General Permit NCGO50000
Hi Carol, can you please help with the missing information?
Thank you,
Mark
From: Patterson, Robert D fmailto:robert.Mtterson(a ncdenr.aov]
Sent: Wednesday, March 08, 2017 1:03 PM
To: Futrell, Josh
Cc: Youmans, Mark
Subject: NPDES Stormwater General Permit NCG050000
*External E-mail alert! Use caution before clicking links/attachments*
Josh,
We received your notice of intent (application form) for coverage under the subject permit on March 7, 2017. We
cannot process it until we receive some additional information.
Pages 2 and 4 of the form were not included with what was submitted to us. Please send those missing pages at your
earliest convenience so we can process this application. You may submit it via email, regular mail, or fax (919-807-
6494).
Please let me know if you have any questions. Thanks.

Robert D. Patterson, P.E.
Stormwater Engineer
NCDEQ I DEMLR I Stormwater Permitting Program
919-807-6369 1 Robert. Patterson @ncdenr.eov
512 N. Salisbury St. I Raleigh, NC 27604
1612 MSC I Raleigh, NC 27699-1612
http://portal.ncdenr.org/web/ir/stormwater
Email correspondence to and from this address is subject to the North Carolina Public Records taw and may be disclosed to third parties.
--------------,------------------ - -------i-.---------------------------------------------------------------
Confidentiality Regtiiseinent: This communication; including any attachment(s), may contain confidential information and
is for the sole use of the intended recipient(s). If you are not the intended recipient, you are hereby notified that you have
received this communication in error and any unauthorized review, use, disclosure, dissemination, distribution or copying
of it or its contents is strictly prohibited. If you have received this communication in error, please notify the sender
immediately by telephone or e-mail and destroy all copies of this communication and any attachments.

Patterson, Robert D
From: Patterson, Robert D
Sent: Monday, March 13, 2017 2:42 PM
To: Valentine, Thad
Subject: NCG050437 - Hubbell Lenoir City, Inc.
Attachments: NOI.pdf
Thad,
Please review the attached NO[ application and let me know of any recommendations for the permit. Copy of the NOI
and map is attached.
COC # Facility Location City/County
NCGO50437 I Hubbell Lenoir City, Inc. 1546 English Rd. I Rocky Mount / Nash
Thanks so much for your help. If you need any more info, give me an email or call. If you could send me a
recommendation for the permit by 4/13/2017 so I can issue their COC, I'd greatly appreciate it.
Have a great day!
Robert D. Patterson, P.E.
Stormwater Engineer
NCDEQ I DEMLR I Stormwater Permitting Program
919-807-6369 1 Robert. [e-mail]
512 N. Salisbury St. I Raleigh, NC 27604
1612 MSC I Raleigh, NC 27699-1612
http://portal.ncdenr.orglweb/ir/stormwater
Email correspondence to and from this address is subject to the North Carolina Public Records taw and may be disclosed to third parties.

P24'PIV'5 011-t
A*&
Division of Energy, Mineral and Land Resources
Land Quality Section
NCDENR
National Pollutant Dischuge Elimination System
NCGQSOOQO
NOTICE OF INTENT
hC(r0u
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG050000:
STORMWATER DISCHARGES associated with activities classified as:
SIC 23 Apparel and Other Finished Products Made from Fabrics and Similar Materials
SIC 265 Paperboard Containers and Boxes
SIC 267 Converted Paper and Paperboard Products .�
SlC 27 Printing, Publishing and Allied Industries
SIC 30 Rubber and Miscellaneous Products (except as specified below) 'I'll D ry
SIC 31 Leather and Leather Products (except as specified below) r ��i�l
SIC 39 Miscellaneous Manufacturing Industries
SIC* NIA Like activities deemed by DEMI_R to be similar In the process and/or the exposure of raw ti
materials, products, by-products, or waste materials
The following activities are specifically excluded from coverage under this General Permit:
SIC 301 Tires and Inner Tubes
SIC 311 Leather Tanning and Finishing
Standard Indusbial Classification Code
(Please print or type)
1) Mailing address of ownerloperator (address to which a I rmit correspondence will be mailed):
Name
Street Address
city
Telephone No.
E-mall Address
Mark Youmans
3621 Industrial Park Drive
Lenoir City - _! State TN ZIP Code . 37771
(W5) 635-2144 Fax:
1mveurrans0hubbel l.com
2) Location of facility producing discharge:
Facility Name Hubbell Lenoir City, Inc.
Facility Contact Josh Futrell
Contact E-mail [e-mail]
Street Address 546 EnglishRoad _
City _ Rocky Mount • ^ _ „ State -NC--- - ZIP Code 27804
County Nash
Telephone No. 252 467-2210 _ x?flz'f ? Fax:
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). From US Highway 64. drive north on N. Winstead Ave.
Turn left (west) onto English Rd at the traffic light. The facility is approximately 0.5 mile on the right.
(A copy of a county map or U5GS quad sheet with facility eleariy located on the map is required with this appli¢atbn)
Page 1 of 4
SWU-220-071408
Last Revised fi24114

T W,
NCG05if000,N�O.,
' -. 5"58'49"`NF A
4) l atituiie Longitude.. -77. 51i69ew (degrees,-riiiriiites,�bec6ndil
hits NPDE5 Permit Application applies to whi ch of the foiib*InR •:
b New or Proposed Facifity Date operation - is io- egin
® Existing
6) Standard industrial Classification:
Provide he 4 digit Stand&a Industrial Classification Code (Sic Code),that describes the primary industrial
activit at.this;facirity `
SIC-t ode: 3 '0-. 8 T
7j 'Provide a brief narrative description of the.types of industrial activities and products mairufactureal at'
ihts facility! 'Hubbell'utilizes'three;iri-houseprocesses in'ectioht mo)ding,'roto rnoldine.and'potymer concrete)
.to.manufaciure.H&E above -grade and:uaderground,enclasures foe.underaroundLatilit►i infrastructure markets..
8) discharge points:
FibW rhady dsahirge points (ditches, pipes,.chanriels, etc.) convey storrnwater firm thieprnpertV
9) Recelving waters:
.What is the .nanie of the body or bodies of.water (creek, stream, river; Iake,.etc:)-that the facility stormwater
.disdtiarges end up lh? ' TarRiveryia stoney-Creek.arid.an'unham'ed tributary.,
If the site'stormwater discharges-io a separate storm sewersystem name the operator of the separate storm
sev✓er,system {e:g..City of Releigh.ritunicipal storm,sewer)_
,1opde's ihii-fa ility have'ariy-otherlOD'ES peirmits?'
fl'No
Yes -
If yes,'list the'permit numbers for all,cutreni NPDES permifs for"this facility:' _
1,t? Does tFiis facility have any Nbri=Dlscharge;permit5'(ez recycle perrriitsj?
® No
If yes; list the. permi 'numbers'for all,current,Nbn=Discharge perm ts"for this'facility
A. ), 6ces this aidility'.im loyan9 best'managemerit practices tat stonnwater.control?.
If yes, please briefty describe: management & waste streams; secondary.coniainrnent requirements for all.
.-containers >5 gallons, use of biodegradable fluids co�le with" hltary seJirens rs� t&6ri . gba_ od.ho_ds—i �
keeping practices,.weekty site inspecii6hs;,heat-a6ted,pallets'_only'(nb pressure treated)'
is) Does this facility have a Story; *ater Pollution Prevention Plan?.
ID:No
© Yes.
If yes, Viriien was t implemented?_ A ri12016' _
,14) Are vehicle maintenance activities'occiirring at ihls;faciliiy?` j
® No O Yes
Page 2-of 4
SW L1420-0774D8 Last Revised 6404

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'dl - No. f7 _yes
0), 'it this ficilld"i
y, a Sm ne n .-t6r (Id,than 1606.46..6f hiiardiibs wisie:6.inei;6t-ed,pqrwriiohthyof'
M"LisW'a6 sI
.
No. 'Ejy6s -(C
is"iiiis-66lity a lLite.bLfqhbtyr.benerii6r (1066'
kg.- or mowahazaradus, waste generEiWd per, month bf'
Y.
31;zgrdotai: waste?
1 `No &Y-
'e.
0)y.ou:answ6tedyes to-questions'b.-'6r'c.,please: provide the 'fiDIIowfn- f m Mibfi.
Vifiere'Jg.'m­ ie:iiiillsto
Ho'W",mi-any-
.V­:�p!je ,jt� per yyear:Narfie-gf,trahsdlposa endor-
6naRr,0ddres&-T
.N6rtWdiibftnb dp6qra.l,StatuteA,0L-215;6
Any pemo`. who kn.An glyivak@,4;!,y falses4"rt r repo o report, lafi affk&
Aoc'umenl filed criequired to bernaintafned under this Artide ors'ruieImpi6inenft wMs'db: 66 kM
Pan ly rR",aAalse:
:Si�� of a material fact in.Wnjleinikkpror eedu�g'or,00niAW&ciie under Vui.ktld Lim piii _ifffi;- or ICnowinIj
re
nde
rs
monitoring deM6 or method required 6 6e operaled.or maintained under this ArGde or iulisbi.the
jE4i6A M-6fitil Maha9e'!ne,nq',&nmIStJan Implementing IhIs Article SWI'b6 gui#ty of S'WSO miideKi6arvdr-'wt'iIch may lncfiidij Ohs not to
exoeW tan ftusindaollm (SjoODD)
Ther6by request coverage undbr,the referenced, General'Perm it. I urxierstand that'CbVer . . thi d @. ge un. ar is pprmLi
will constitute.the permit requirements y!pkMp. n1i th' aril is iififoi6ii" 11r, iWa-riner as an
for e discharg.., tlhe,'s;im6
1�dM_ dual ... ... -
permit.
W ithation,cointa m- a ro
6 1 d injfiii �Opilcqijon ind,that 1:6'thii b&sl.
Stion-61true, complete; and d6curati.
OrInt6d _Nime of JohnEi'
_�erpbn Sighing trig
Tttie - i Plbnt,MaElpger,
frt
ki)t6 of Interit inust.66�accompanied bya,c;_ick-or money f6F,$10000 i ai 6kvibli tb'NdDE4P
!022071408
e � 3- of- 4
Lesl RiMsed &2*i 4,

I
NCG050000 N.0.1.
Final Checklist
This application will be returned as Incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NCDENR
❑ This completed application and all supporting documents
❑ Copy of county map or USGS quad sheet with location of facility clearly marked on map and nearby waters
Mail the entire package to:
Stormwater and General Permits Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ......
(828) 2964500
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-Ml
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 4 of 4
SW U-220-071408 Last Revised 6124114