NCGNE0178_COMPLETE FILE - HISTORICAL_20160908

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
HISTORICAL FILE
DOC DATE
0 Ca01 CP 061 O g
YYYYMMDD

r
�A
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
NCDENRNational
Pollutant Discharge Elimination System
C�_'�`�
[MNi.O.�MDR µD NRV41 ftrlP�/�c[!
PERMIT NAMEIOWNERSHIP CHANGE FORM'
FOR AGENCY USE ONLY
Date Received
Year Month
Da
Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
Ii. Permit status prior to requested change.
a. Permit issued to (company name):
b. Person legally responsible for permit:
c. Facility name (discharge):
d. Facility address:
e. Facility contact person:
CLEMENT PAPPAS NC FNC
Pete Szelwach
First Ml Last
Plant Manacer
Title
125 FNDUSTRIAL PARK RD
Permit Holder Mailing Address
Hendersonville NC 28792
City '—State Zip
[phone] 828 697-2984
Phone Fax
WH NO.2
199 N EGEDRTON RD
Address
Hendersonville NC 28792
- City State Zip
Tracy L Wolfe 828 329-6647
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:
RECEIVED
SEP 08 2016
DENR-LAND QUALITY
STORMWATER PERMITTING
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
CLEMENT PAPPAS NC LLC
Pete Szelwach
First MI Last
Plant Manaser
Title
125 INDUSTRIAL PARK RD
Permit Holder Mailing Address
Hendersonville NC 28792
City State Zip^
_J828) 693-0711 [e-mail]
Phone E-mail Address
WH NO. 2
199 N EGEDRTON
Address
Hendersonville NC 28792
City State Zip
Tracy L Wolfe
First Ml Last
Revised Jan. 27, 2014
828 329-6647 [e-mail]
Phone E-mail Address
S

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
W. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: _
First Ml 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-Olease 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 r uired 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):
1, 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
1, Pete Szelwach, 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 an if all uire uppo information is not included, this application package will be
returned as i com e e
el,1-
S gnature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stonnwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014

—
: NORTH CARO LI NA
t Department of the Secretary of State
tt ,
i To all whom these presents shall come, Greetings:
i'Elairie F. Marshall, Secretary of State of the State of North Carolina, do hereby certify
the following and hereto attached to be a true copy of
'. ARTICLES OF ORGANIZATION
OF
CLEMENT PAPPAS NC, LLC
.,t
;l
the original of which was filed in this office -on the 22nd day of February, 2013.
,1
IN WITNESS WHEREOF, I have hereunto set my
hand and affixed my official seal at the City of
Raleigh, this 22nd day of February, 2013.
A�� •,.A 7*464.&
Sean to verify online,
�Kifi�gjic%�1(i Secretary of State
a t tY,lhiticcnif%kiL`imli%ic`glwww.ucrctarystatenO5u00eficatiage; 1ef3

ti
SOSI D: 0591854
Date Filed: 2/22/2013 3.22:00 PM
Elaine F. Marshall
North Carolina Secretary of State
C201305300900
state of North Glnroltnx
Department of the Secretary of State
AAT1CUM OF ORGANVATION
MCLUD1NG AR'1'YCIZO OF CONVEMON
pursuant to $f 57CG221, 57C-9A-01 and 57CJ9A-03 of ilia Genoml Statutes of North Carolina, the
and,rsiSAW convening business entity 40e8 hereby submit theso'Artialcs ofOrganizatlon Including Artlelas of
Convffjon for She purpose of founing a limited liability company.
11 no ndmo ofthe limited liability company is; cLe mavT Prof As Nc—u c_
The iimited liability company is balog foamed pure uAta a waverslon of anotherbuslaoss entity,
2, The mama of the owrozing business entity is ct.rrmet+T F AwAe NO, W.
and the organizatlon and fnterrarl affairs of the converting business cntity am govon A by the laws of
tho Mjjta Ur countryof WhC Mho
A plan ot'convoralon has been approved by the converting business entity as required by law.
31 The converting business entity is a e6ech one): Ov dntuastlo corpomilon; ❑foreign corporation;
foreign MAW liability compan • L] domestic limited partnership;
❑ forolga limited partnarahip; U domeatia rogistored limited liability partnership;
E] foreign limitod liability 4zrtnarshlp; or ❑ other par4iership as defined In O.S. 59-36, whether or not
formed under the lawn ,of North Carolina
4, If the limited liability company is to dissolve by a specific. date, the latest date on which the halted
liability ootnpany is to dissolve; (#'no dale for4roludon ii spac#?ed, theme shall b© no lath on the
duration of staff llmttad llabll#y camprmy.)
5.
The aamo and address of oacb person executing theca articles of organization is as follows; (State
whellrer arch person is executing thus aMclea of org;mIzatlon in tiro capacity of a membar, •organirar
or loth),
Cfal>,nlPap{se�egtlCornP�lry.ln4,eaN4nmEereilaorennhnr . •
Cast Cdnte Mc sub 200 '
The stae� addra:a and equnty of the Initial registered offma of the Urniled liability company is:
'NQmbor and Street t26 kidW&W Park Read
City, State, Zip Coda Mowhdn Hums, HC 2GY64 Comity Hvndareon
The umiling address, di,Qbr'tru /torrf slit stw d addreaar, of tbo ialtial regktorod office is:
The nano of the initial registased ageoR is; et.>oe ftet 0c
OMPORATIONjONB DWMION
',sr a911gry30Dif .
P.O.13OX 79622 lUILMGff, NC27626-0622
P

v
9. YrWpal OWN 1AWWAdon: (&rVCS OUIW a or 6)
TJ* MuIftd HaWly comM buapKWpd offim.
wmba Me tilloct US WOMO Pau"
CIW, SWA
IUM91ligaddna Vd0krewpom air tfta a0mr, of the VWtlzi offlab of tho Utotted UbjMy
9wom ht
The fimbd NW4 mWq
io. Cbcok cma of tho IbUawipv
Mdiabp4mmiaged LLO. all mamben* vine of thoir otatus to momben Bball bo =nqm of
this limited IWRW company.
(H) A1wiqar-xwmpdLLO. wLoWmpmvidodbyN.C.0,9.80otWn37C-3-20(a),ftmembmi
of this tivallad Babfltty couWasy 44 not bo magms by*Wc of tbt* status as nmtvm
11, Any OtbW pwvidm wIM do BMW liability OuTay loots to Icolude am attached.
12, Thm Wolm wdt bo Offmtm " aft IwWs a do mWot time Iv Wooffied:
'Phis ivjh�i day of.NWA" J 2013
PIM649 reopaci and Ommmy. I
— I Lm-c - - Member and 0 r9anIzer
cimmt DAVId papp"m prawAlcut
or P,4W Name 7v�d-27-04
L
CORPOUTIONSVIVMW P.O, BOX296M RALHIQBjNC276264=
Refe renceh C201305300900. Page: 3 of 3

(r \14ATkE Michael F. Easley, Governor
`O�� TOG William G. Ross Jr., Secretary
North Carolina Department of Environment and Nalural Resources
Alan W. Klimek, Y. E. Director
MAZ
Division of Water Quality
>_
Q COleen 1-1. Sullins, Deputy Director
Division of Water Quality
April 20, 2005
Blake Myles Kehoe
Clement -Pappas Coompany NC Inc
PO Box 1009
Mountain Home, NC 28758
Subject: No Exposure Certification NCGNE0178
Warehouse No. 2 - 199 Egerton Rd
Henderson County
Dear Permittee:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on July 21, 2004. We apologize for the extended period it has
taken us to get back to you on this request and we appreciate your patience as we have worked through this
process. Based on your submittal and signed certification of no exposure at the above referenced facility the
Division is granting your certification as provided for under 40 CFR 126.22(g) which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of your no exposure certification, you are obligated to maintain no
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no -
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no -exposure exclusion expires in five years (April 30, 2010). At that time you must re -certify with
the Division, or obtain NPDES permit coverage for any slormwater discharges from your facility.
Your certification of no exposure does not affect your facility's legal requirements to obtain environmental
permits that may be required under other federal, stale, or local regulations or ordinances.
If you have any questions or need further information, please contact Jonathan Diggs at (919) 733-5D83 ext.
537, or at [e-mail].
cc: Asheville Regional Office
Stormwater Permitting Unit Files
Sincerely,
for Alan W. Klimek, P.E.
Central Files — wlattachments
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
WED E UR
Customer Service
1-877-623-6748

CLEMENT-PAPPAS
July 20, 2004
North Carolina DENR
Water Quality Section
Asheville Regional Office
2090 US Highway 70
Swannanoa, NC 28778
Attn: Mr. Roy Davis
Re: Clement -Pappas Company NC, Inc.
Warehouse #2 5tormwater Permit
Dear Mr. Davis:
I am formally submitting an application for a NO EXPOSURE CERTIFICATION for Exclusion
from NPDES Storm Water Permitting for CPC NC's Storage Warehouse #2. This Is
being sent to your office at the direction of Patrick Grogan of the Moore5vllle Office of
DENR. Please route this application to the proper individual at your location.
Be advised that this facility 15 not contiguous with the property that houses the
Company's manufacturing operation.
Should you have any cjue5tlon5 or wish to discuss this matter in detail, please feel free
to contact me personally (828-C93-07 I I , Ext. 1 244) at your convenience.
Ve truly yours,
Michael A. Koral, PE
Xc: Michael P. Strickland, Clement Pappas NC
Blake Kehoe, Plant Manager
David Jones, Maintenance Manager nF
File U ti 2aa4
WAS QUALM`! SECTION
cug:Vlk LE REGIONA_ � OFFI(
P. O. Box 1009 Mountain Home, NC 28758
828-G92-1 894 828-G97-2984 (Fax)

E6A8-.
Form Approved
United States Environmental Protection Agency OMB No, 2040-0211
NPDES �
3510-11 EPA Washington, DC 20460
FORM `r► NO EXPOSURE CERTIFICATION for Exclusion from
NPDES Storm Water Permitting
Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit authorization for its storm water
discharges associated with industrial activity in the State identified in Section B under EPA's Storm Water Multi -Sector General Permit due to the existence
of a condition of no exposure.
A condition of no exposure exists at an industrial facility when all industrial materials and activities are protected by a storm resistant shelter to prevent
exposure to rain, snow, snowmelt, and/or runoff. Industrial materials or activities include, but are not limited to, material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste products. Material handling activities include the storage,
loading and unloading, transportation, or conveyance of any raw material, intermediate product, final product or waste product. A storm resistant shelter is
not required for the following industrial materials and activities:
— drums, barrels, tanks, and similar containers that are tightly sealed, provided those containers are not deteriorated and do not leak. "Sealed"
means banded or otherwise secured and without operational taps or valves;
adequately maintained vehicles used in material handling; and
— final products, other than products that would be mobilized in storm water discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In addition, the exclusion from NPDES permitting is
available on a facility -wide basis only, not for individual outfalls. If any industrial activities or materials are or will be exposed to precipitation, the facility is
not eligible for the no exposure exclusion.
By signing and submitting this No Exposure Certification form, the entity in Section A is certifying that a condition of no exposure exists at its facility or site,
and is obligated to comply with the terms and conditions of 40 CFR 122.26(g).
ALL INFORMATION MUST BE PROVIDED ON THIS FORM.
Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4.
A. Facility Operator Information
1. Name: jZI1,IGIir�E�41r.�i_[I� I IAtPIPIAIS) IClol iNN("I Ij IkSICI I I I I 12. Phone: ISIGISIGG E5400 1 ii i i
3. Mailing Address: a.Street: 171O1 1510IX1 11 1O0IgI 111aISI 1lZIb
b. City: i=41DI0 Ia I-T-IA 11 16 1 114 10 I1.i1E I I I 1 -( 1_ _ 1 1 1 I c. State: �) d. Zip Code: ;;� 19 `S 19 1 —
B. FacilitylSite Location Information
1, Facility Name:
2. a. Street Address: ILSI IELIE—IIZI1Ib11.11 IV—IUI I I I I I I I I I I i I I II I I
b. City: luip io ist i 1 AI t Ih11 Ii-i I❑ 1Mil e I 11 I I I I l I j c. County: S❑ t.1
d. State: LU e. Zip Code: S —
3. Is the facility located on Indian Lands? Yes ❑ No
4. Is this a Federal facility? Yes ❑ No
5. a. Latitude: 1_6I51Z Z Z-Z b. Longitude: ISIZ_ * 12.M 1 17-111
6. a. Was the facility or site previously covered under an NPDES storm water permit? Yes No
b. If yes, enter NPDES permit number:
7. SIC/Activity Codes: Primary: [L41 ZI Z.I�; Secondary (if applicable): I I 1 1
8. Total size of site associated with industrial activity: Z .Ofo(o acres
9. a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure exclusion? Yes No JR
b. If yes, please indicate approximately how much area was paved or roofed over. Completing this question does not disqualify you for the no exposure
exclusion. However, your permitting authority may use this information in considering whether storm water discharges from your site are likely to have
an adverse impact on water quality, in which case you could be required to obtain permit coverage.
Less than one acre ❑ One to five acres ❑ More than five acres Cl
EPA Form 3510-11 (10-99) Page 1 of 4

NPDES NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
FORM -,EPA OMB No.2040-0211
3510-11 NPDES Storm Water Permitting
C. Exposure Checklist
Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future?
(Please check either "Yes" or "No" in the appropriate box.) If you answer "Yes" to any of these questions
(1) through (11), you are not eligible for the no exposure exclusion.
Yes
No
1. Using, storing or cleaning industrial machinery or equipment, and areas where residuals from using, storing
❑
or cleaning industrial machinery or equipment remain and are exposed to storm water
2. Materials or residuals on the ground or in storm water inlets from spills/leaks
❑
3. Materials or products from past industrial activity
❑
4. Material handling equipment (except adequately maintained vehicles)
❑
5. Materials or products during loadingfunloading or transporting activities
❑
6. Materials or products stored outdoors (except final products intended for outside use (e.g., new cars] where
❑
exposure to storm water does not result in the discharge of pollutants)
7. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers
❑
8. Materials or products handled/stored on roads or railways owned or maintained by the discharger
❑
9. Waste material (except waste in covered, non -leaking containers (e.g., dumpsters))
❑
10, Application or disposal of process wastewater (unless otherwise permitted)
❑
11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated
❑
(i.e., under an air quality control permit) and evident in the storm water outflow
D. Certification Statement
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no exposure" and obtaining an
exclusion from NPDES storm water permitting.
certify under penalty of law that there are no discharges of storm water contaminated by exposure to industrial activities or materials from the industrial
facility or site identified in this document (except as allowed under 40 CFR 122.26(g)(2)).
I understand that I am obligated to submit a no exposure certification form once every Five years to the NPDES permitting authority and, if requested, to
the operator of the local municipal separate storm sewer system (MS4) into which the facility discharges (where applicable). I understand that I must
allow the NPDES permitting authority, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request. I understand that I must obtain coverage under an NPDES permit prior
to any point source discharge of storm water from the facility.
Additionally, 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 gathered and evaluated 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 fine and imprisonment for knowing violations.
Print Name: 191L IAIKIEI IKE , 114101E 11 I I I I I I 1 I I I I I I I I 1 I l I I J
Print Title: IP IL IA lk iT I IMIA Ito IA IG ir_ IRI I 1 I I I I I I I I I l _ I _ I__1 _ I
Signature:
Date: 10 17 1 z 1010 14
EPA Form 3510-11 (10-99) Page 2 of 4