NCG200538_Application_20210903

iN
RFr
FOR AGENCY USE ONLY VE
NCG20 0 5 ?>i3 SEp 0 3 2021
Assigned to: CulSoVt, �3� 4 -ifc� �� DEN -LAND QUALITY
ARO FRO RO RRO WARO WIRO WSRO STORMWATER PERMITTING
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG200000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC 5093 [Scrap Metal Recycling — except as specified below] and liked activities deemed
by DEMLR to be similar in the process, or the exposure of raw materials, intermediate products, final products, by-
products, or waste materials. The following activities ore excludes' from coverage under this General Permit:
Portions of SIC 5093 [Automobile Wrecking for Scrap, and Non -Metal Scrap Recycling], and SIC 5015 [Used Motor
Vehicle Part]. You can find information on the DEMLR Storm water Program at deq.nc.gov/SW.
Directions: Print or type all entries on this application. Send the original, signed application with all required
items listed in Item (6) below to: NCDEMLR Stormwater Program, 1612 MSC, Raleigh, NC 27699-1612. The
submission of this application does not guarantee coverage under the General Permit. Prior to coverage under
this General Permit a site inspection will be conducted.
Owner/Operator (to whom all permit correspondence will be mailed):
2. Industrial Facility (facility hainF narmitfPril-
Facility name:
T Facility environmental contact:
,n S'Co++ coole
Street address:
S Ltkjzz
City: ,
ri Ck,'
State:
Zip Code:
n...
NG
�rarvz�
Parcel Identification Number (PIN):
County:
D1J<rh.
Telephone number:
Email address:
a y- y.57 - I/
4-digit SIC code:
Facility is:
Date operation is to begin or began:
New OProposed 9Existing
Latitude of entrance:
Longitude of entrance:
Brief description of the types of industrial activities and products manufactured at this facility:
S(I
If the storm ater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
N/A
Page 1 of 5

Check all activities conducted at this facility
❑ Outdoor stockpiling of materials ❑ Transport of materials by a conveyor or front-end
® Processing — cutting, grinding, crushing, baling, loader
separation, etc. ❑ Vehicle and equipment maintenance
❑ Storage of materials in above -ground tanks ❑ Vehicle or equipment washing
Material loading and unloading ❑ Vehicle and equipment fueling
3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Street address:
City:
State:
Zip Code:
Telephone number:
Email address:
i
4. Outfall(s) At least one outfall is required to be eligible for coverage.
3-4 digit identifier: Name of receiving water: Classification:
Latitude of outfall: Longitude of outfall:
Brief description of the industrial activities that drain to•this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall?
If yes, how many gallons of new motor oil are used each month when averaged oN
❑ This water is impaired.
❑ This watershed has a TMDL.
®'Yes [3 No
calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? El Yes E-11 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
All outfalls must be listed and at least one outfall is required. Additional outfalls may be added in the section
"Additional Outfalls" found on the last page of this NOI.
Page 2 of 5

Utner Facility Conditions (check all that apply and explain_accordi
❑ This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
This facility has Non -Discharge permits (e.g. recycle permit).
checked, list the permit numbers for all current Non -Discharge permits:
❑ This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
❑ This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
❑ This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
❑ This facility is a (mark all that apply)
❑ Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility
el;,.-;
.
Re aired Items (Application will be returned unless all of the following_ items have been included):
heck for $100 Trade payable to NCDEQ
g Copy of most recent Annual Report to the NC Secretary of State (if applicable)
This completed application and any supporting documentation
A site diagram showing, at a minimum, existing and proposed:
a) outline of drainage areas j
i I b) surface waters
c) stormwater management structures
d) location of stormwater outfalls corresponding to the drainage areas
e) runoff conveyance features
f) areas where industrial process materials are stored
g) impervious areas
h) site property lines
L opy of county map or USGS quad sheet with the location of the facility clearly marked
Page 3 of 5

7. Applicant Certification:
North Carolina General Statute 143-215.613 (i) provides that: Any person who knowingly makes any false statement,
representation, or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
EX I am the person responsible for the permitted industrial activity, for satisfying the requirements of this permit, and for any
f ivil or criminal penalties incurred due to violations of this permit.
®'The information submitted in this NOI is, to the best of my knowledge and belief, true, accurate, and complete based on
my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
.nformation.
0 I will abide by all conditions of the NCG200000 permit. I understand that coverage under this permit will constitute the
(rmit requirements for the discharge(s) and is enforceable in the same manner as an individual permit.
I hereby request coverage under the NCG200000 General Permit.
Printed Name of Applicant: 4D-C,yJ)V J 6• 4 CoJk
Title: Lrc sl'd e-,, ,1
Page 4 of 5

Additional Outfalls
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? El Yes r7l No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 17,71 Yes 13 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired. l
❑ This watershed has a TMDL.
Latitude of outfall:
I
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall: 1
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes 0 No I
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
J
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Page 5 of 5

rA."7,-) BUSINESS CORPORATION ANNUAL REPORT
10 2017
NAME OF BUSINESS CORPORATION: C & D Salvage Of China Grove, Inc.
SECRETARY OF STATE ID NUMBER: 0650495 STATE OF FORMATION: NC
REPORT FOR THE FISCAL YEAR END: 12/31/2020
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: The Law Office of Ralph E Stevenson III, PLLC
2. SIGNATURE OF THE NEW REGISTERED AGENT:
Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
645 LENTZ RD 645 LENTZ RD
CHINA GROVE, NC 28023 Rowan County
CHINA GROVE, NC 28023
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: SALVAGE AND RECYCLING
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS
645 Lentz Road
China Grove, NC 28023-8439
645 Lentz Road
China Grove, NC 28023-8439
6. Select one of the following if applicable. (Optional see instructions)
The company is a veteran -owned small business
The company is a service -disabled veteran -owned small business
SECTION C: OFFICERS (Enter additional officers in Section E.)
NAME: DARWIN SCOTT COOK
TITLE: President
ADDRESS:
645 LENTZ RD
CHINA GROVE, NC 28023
NAME: DARWIN SCOTT COOK
TITLE: Secretary
ADDRESS:
645 LENTZ RD
CHINA GROVE, NC 28023
NAME: CHERYL BOSS
TITLE: Vice President
ADDRESS:
645 LENTZ RD
CHINA GROVE, NC 28023
SECTION D: CERTIFICATION OF ANNUAL REPORT Section D must be completed in its entirety by a person/business
entDARWIN SCOTT COOK
8/31/2021
SIGNATURE
Form must be signed by an officer listed under Section C of this form.
DARWIN SCOTT COOK
Print or Type Name of Officer
President
DATE
Print or Type Title of Officer
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

Kovin.L., Auten, Sheriff
I ` ,�

35033'38.3"N 80°34'13.9"W
Imagery ©2021 Google, Imagery ©2021 Maxar Technologies, USDA Farm Service Agency, Map data ©2021 200 ft L- —,.. ,

• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online • Add Entity to My Email Notification List • View Filings
Print a Pre -Populated Annual Report form • Print an Amended a Annual Report form
Business Corporation
Legal Name
C & D Salvage of China Grove, Inc.
Information
Sosld: 0650495
Status: Current -Active O
Date Formed: 10/25/2002
Citizenship: Domestic
Fiscal Month: December
Annual Report Due Date: April 15th
Currentgnnual Report Status:
Registered Agent: The Law Office of Ralph E Stevenson III, PLLC
Addresses
Reg Office
645 LENTZ RD
CHINA GROVE, NC 28023
Officers
Vice President
CHERYL BOSS
645 LENTZ RD
CHINA GROVE NC 28023
Stock
Class: Common
Shares: 10000
No Par Value: Yes
Reg Mailing
645 LENTZ RD
CHINA GROVE, NC 28023
President
DARWIN SCOTT COOK
645 LENTZ RD
CHINA GROVE NC 28023
Mailing
645 Lentz Road
China Grove, NC 28023-8439
Secretary
DARWIN SCOTT COOK
645 LENTZ RD
CHINA GROVE NC 28023
Principal Office
645 Lentz Road
China Grove, NC 28023-8439