NCGNE1195_COMPLETE FILE - HISTORICAL_20170824

STORMWATER DIVISION CODING SHEET
.NCG PERMITS
PERMIT NO.
NCGNE rD
DOC TYPE
[Y HISTORICAL FILE
DOC DATE
F1 � �' � � � � `/
YYYYMMDD

V,
8
amazon FULFILLMENT
August 8, 2017
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, NC 27699-1612
Re: Change of Responsible Official on No Exposure Certification for Exclusion from Industrial
Stormwater Permitting
To Whom It May Concern:
I am writing to request a change of contact information listed on the No Exposure Certification for the
Amazon.com.dedc, LLC — CLT5 facility located at 1745 Derita Road, Concord, NC 28027. Please accept
this request to remove Cory Levengood from the Responsible Authority contact and add Kevin Winston
as the Responsible Authority for the No Exposure Certification at this facility. Please find attached a
NPDES Owner Affiliation Designation Form as the request for this change. For your reference, Kevin
Winston's information is as follows:
Kevin Winston
Senior Regional Environmental Manager
Cell: [phone]
Email: winskevi amazon.com
Mailing Address:
NA Environmental Dept.
Amazon.com
P.O. Box 80842
Seattle, WA 98108
RECEIVED
AUG 2 A. 2017
DENR-LAND QUALITY
STORMWATER pEFtM1TT1NG
Please let me know if you have any questions or require any additional information.
Sincerely,
Kevin Winston
Senior Regional Environmental Manager

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C'..NCDENR
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F—Ito..E —0 Nnr — RE9 RCC
Division of Energy, Mineral and Land Resources
Land Quality Section 1 Stormwater Permitting Program
National Pollutant Discharge Elimination System (NPDES)
PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
FOR AGtiNCY LX: ONLY
Dale Received
Year
I Month
Dav
if NO CHANGE in company or facility ownership or name has occurred.
If a Name Change and/or Ownership Transfer at the facility has prompted this change, do
NOT use this form. You must fill out the Name -Ownership Change Form and provide all
necessary supporting documentation instead.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner
Affiliation") applies:
Individual Permit
N"C I S
2) Facility Information:
Facility name:
Company/Owner Organization
Facility address:
(or) Certificate of Coverage
N C' G,
Amazon. com.dedc, LLC - CLT5
Amazon.com.dedc, LLC
1745 Derita Road
Address
Concord NC 28027
City State zip
To find the current legally responsible person associated with your permit, go to this website:
http://portal.nedenr.org/web/Ir/sw-permit-contacts and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Cory Levengood
First M l Last
4) NEW OWNER AFFILIATION (Legally responsible for the permit):
Person legally responsible for this permit:
Kevin Winston
First MI Last
Senior Regional Environmental Manager
Title
P.O. Box 80842, Attn: Amazon.com, NA Environmental Dept.
A auol r, Mailing Address
p�NRI.P�RpFV011�' Seattle WA 98108
S��RMWp�E City State zip
( 925 ) 577 - 5326 winskevi(ci•?amazon.com
Telephone E-mail Address
Fax Number
SWU-OWNERAFFI L-22May2D14
Page I oft

NPDESStormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
5) Reason for this change:
A result of: El Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
What does "legally responsible person" mean?
That 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 that person above.
The certification below must be completed and signed by the permit
holder.
PERMITTEE CERTIFICATION:
I, Kevin Winston , 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. V6��
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please visit our website:
http://portal.ncdcnr.ora/web/lr/stot-mwater
ti
4
}
j SM-OWNERAFFIL-22May2014
1
Page 2 of 2

'nI ROY COOPER
` I 1
Governor
MICHAEL S. REGAN
5ecreiary
Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
May 9, 2017
Amazon. com.dedc, LLC
Attention: Mr. Lance Jones
345 Boren Avenue North
Seattle, Washington 98109
Subject: No -Exposure Certification NCGNE1195
Amazon,com,dedc, LLC
1745 Derita Road
Cabarrus, North Carolina 28027
Dear Mr, Jones,
TRACY E. DAVIS
Uirecrnr
The Division has reviewed your submittal of the No -Exposure Certification form for Exclusion from NPDES Stormwater
Permitting. Based on your submittal and signed certification of no exposure at the above referenced facility, and the inspection
dated May 2, 2017, the Division is granting your conditional exclusion from permitting as provided for under 40 CFR 122,26(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 unpermitted discharge.
You must self re -certify your No -Exposure status annually and the form can be downloaded by visiting-
http://portal.ncdenr.org/web/ir/npdes-stor ' mwater the web page for the Division of Energy, Mineral and Land Resources
Stormwater Program, The annual self re -certification does not need to be submitted to DEMLR unless requested. A copy
should be maintained in your file.
Your conditional exclusion from permitting does not affect your facility's legal requirements to obtain environmental
permits that may be required under other federal, state, or local regulations or ordinances.
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
Mooresville Regional Office � 610 East Center Ave Ste 301 1 Mooresviile, NC 28115
704 663 1699 T

Amazon.com.dede, LLC
NCGNE1195
May 9, 2017
Page 2 of 2
If you have any questions or need further information, please contact Isaiah Reed at [phone], or at
[e-mail]
Sincerely,
Zahid S. Khan, CPM, CPESC, CPSWQ
Regional Engineer
Land Quality Section
Enclosure: Inspection Report
scc:-Central-Office-Stormwater'Permitting-Program—No7,Exposure-Files"NCGNE-1 5

Compliance Inspection Report
Permit: NCGNE1195 Effective: Expiration: owner: Amazon Corn Dedc LLC
SOC: Effective: Expiration: Facility: Amazon.com.dedc, LLC - CLT5
County: Cabarrus 1745 Derita Rd
Region: Mooresville
Concord NC 28027
Contact Person: Stephanie Sparkman Title: Phone: [phone]
Directions to Facility:
take exit 4a14b off i-540 and head west on us-70, turn left on tw alexander drive, continue to 1805 tw alexander dr., the facility will be
on the right hand side.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 05/02/2017 Entry Time 02:OOPM Exit Time: 02.30PM
Primary Inspector: Isaiah L Reed Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Technical Assistance
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ® Compliant [] Not Compliant
Question Areas:
® Miscellaneous Questions
(See attachment summary)
Page: 1

F —0
Permit: NCGNE1195 Owner - Facility:Amazon Com Dedc LLC
Inspection Date: 05102/2017 Inspection Type : Technical Assistance Reason for Visit: Routine
Inspection Summary:
This site was inspected on May 2, 2017. No areas or materials were observed which could affect stormwater runoff. It is
recommended that this facility be granted the no exposure permit.
Page: 2