NCGNE1615_Application_20230524

RECEIV
1. Owner/Operator(to whom all permit correspondence will be mailed):
Name of legal organizational entity: Le ally responsible person (as signJAMAre ow):
+rnl C Cst LLC, WIZA 5T W O "D o L-" Colo
Street address: City: Stat Zi Code
3 O L I OW-f bQ D li�►�''f ( �$
Telephone number: Email address: I '
sT/NE 'fC-GtN
Type of Ownership:
Government
❑ County ❑ Federal ❑ Municipal ❑ State
Non-government
,X Business(If ownership is business,a copy of NCSOS report must be included with this application)
❑ Individual
2. Industrial Facility (facility requesting exclusion):
Facility name: Facility environmental co tact:
C /CCA✓)OI i�S tiZ�76IP-r
Street address: Telephone number:
w
Email address:�l�tSe.�tir vL � ( i ,e,->A�
City /aM C nt� State'(��..,/ C Zip Code
Latitudeofentrance: ,22I -037 W`
Longitude of entrance: "-79;c? qO-Z �7
Parcel Identification Number(PIN): 9I I T IJ 2
Date operation b gan: L Standard Indu trial Classification(SIC)Code:
S 2 2 4 ,S�
Brief description of t)te types oXustrial activities and products produced at this facility:
3. Consultant(if applicable): /1
Name of consultant: Consulting firm:
Street address: City: State and zip code:
Telephone number: Email address:
4. Exposure Checklists
Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future? If you
answer"Yes"to any of these items,you are not eligible for the no exposure exclusion.
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 ❑Yes XNo ❑ N/A
stormwater
Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes;;<No ❑ N/A
Materials or products from past industrial activity ❑ Yes$No ❑ N/A
Material handling equipment(except adequately maintained vehicles) ❑ YesXNo ❑ N/A
Page 3 of 6

Materials or products during loading/unloading or transporting activities ❑Yes No ❑ N/A
Materials or products stored outdoors(except final products intended for outside use[e.g., new ❑ Yes No ❑ N/A
cars]where exposure to stormwater does not result in the discharge of pollutants)
Materials contained in open,deteriorated, non-sealed',or leaking storage drums barrels,tanks, ❑YesXNo ❑ N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger ❑Yes;Z No ❑ N/A
Final products that would be mobilized in stormwater discharges(e.g.,rock salt) ❑ Yes P'No ❑ N/A
Waste material(except waste in covered,non-leaking containers(e.g.,dumpsters]) ❑ YesXNo ❑ N/A
Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes XNo ❑ N/A
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise ❑ Yes XNo ❑ N/A
regulated(i.e. under an air quality control permit)and evident in the stormwater outflow
Empty containers that previously contained materials that are not properly stored (i.e., not closed ❑yes;4 No ❑ N/A
and stored upside down to prevent precipitation accumulation)
For any exterior ASTs,as well as drums,barrels,tanks and similar containers stored outside, has ❑YesXNo ❑ N/A
the facility had any releases in the past three(3)years?
'Sealed means banded or otherwise secured and with locked or non-operational taps or valves.
Above Ground Storage Tanks(ASTs)and Secondary Containment
If you answer"No"to any of the following items,you are not eligible for the no exposure exclusion.
Are exterior ASTs or piping free of rust,damaged or weathered coating,pits,or deterioration,or 1dYes O Nol/A
evidence of leaks? J`"�,
Is secondary containment provided for all exterior ASTs?If so,is it free of any cracks,holes, or ps yes❑ No ❑ N/A
evidence of leaks,and are drain valves maintained locked shut?
Is secondary containment provided for single above ground storage containers(including drums, p Yes❑ No XN/A
barrels,etc.)with a capacity of more than 660-gallons?
Is secondary containment provided for above ground storage containers stored in close proximity
❑Yes❑ No
to each other with a combined capacity of more than 1,320 gallons? N/A
Is secondary containment provided for Title III Section 313 Superfund Amendments and ❑Yes❑ No N/A
Reauthorization Act(SARA)water priority chemicals?
Is secondary containment provided for hazardous substances designated in 40 CFR §116? ❑Yes ❑ No XN/A
Are release valves on all secondary containment structures locked? ❑Yes ❑ NoXN/A
Other information
If you answer"Yes"to any of the following items,you might not be eligible for the no exposure exclusion. A more
in-depth evaluation of the site circumstances may be required.
Are vehicles used in material handling in disrepair and/or leaking fluid? ❑ YesXNo ❑ N/A
Does this facility store used, recycled,or otherwise reclaimed pallets outside? Yes ❑ No ❑ N/A
Does this facility have coal piles on site? ❑ Yes XNo ❑ N/A
Does this facility store other fuel sources outside in piles,such as wood chips,sawdust,etc.? ❑ YesXNo ❑ N/A
Page 4 of 6

Does this facility have air emissions associated with industrial activity(e.g.,degreasing operations, ❑Yes No ❑ N/A
plating, painting,or metal finishing)?
If yes:
Describe the industrial activity:
Are those emissions permitted by an Air Quality Permit? ❑ Yes ❑ No
Please specify:
5. Other Facility Conditions (check all that apply and explain accordingly):
❑ This facility has other NPDES permits. ATM
If checked,list the permit numbers for all current NPDES permits:
❑ This facility has Non-Discharge permits(e.g.recycle permit). �/�
If checked,list the permit numbers for all current Non-Discharge permits:
❑ 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)
JxHazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility
If checked, indicate:
• Kilograms of waste generated each/month: <
• TYpe(s)ofwaste: -Pb. mbK 44 6) Aje_ k ber" vtaSt
• How material is stored: s (� 0>2 (\ � {yt q a ¢ CZkts
• Where material is stored: I V\
• Number of waste shipments per year: /L/ /'L
• Name of transport/disposal vendor: VeM1(0—
• Transport/disposal vendor EPA ID: /V7 0 �'3 ( 3 6�
• Vendor address: 2/?L& tA((Suw Roi
C ree dMo��, Ne- z 7-s2 2
❑ This facility is located on a Brownfield or SUPERFUND site.
If checked,briefly describe the site conditions:
❑ This facility is located on Native American Lands.
6. Required Items (Application will be returned unless all of the following items have been included):
C$Copy of most recent Annual Report to the NC Secretary of State(if applicable)
19 This completed application and any supporting documentation
Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 5 of 6

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). 1 hereby request exclusion from NPDES stormwater permitting.
Under penalty of law,I certify that:
L I am the person responsible for the industrial activity,for satisfying the requirements of this exclusion,and for any civil
or criminal penalties incurred due to violations of this exclusion.
I have read and understand the eligibility requirements for claiming a condition of"no exposure"and obtaining an
,yy exclusion from NPDES stormwater permitting.
yn There are no discharges of stormwater 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 maintain no exposure conditions and complete a Self-Recertification form at least
once each year and,if requested,provide this certification 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 North Carolina
Division of Energy,Mineral,and Land Resources,or MS4 operator where applicable,to perform inspections to confirm
the condition of no exposure and to make such inspection reports publicly available upon request.I understand I must
keep a copy of annual recertifications on file at the facility.
XI understand that in the event that the site no longer qualifies for a No Exposure Exclusion that I must obtain coverage
under an NPDES permit prior to any point source discharge of stormwater from the facility.
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 forgathering the
information.
Printed 020D ,
nName of Person Signing:
Title: 02 0D f C 40-4 5R/Je- Dam
Signature of Applicant Date Signed
Mail the entire package to: DEMLR—Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 6 of 6

i LIMITED LIABILITY COMPANY ANNUAL REPORT
10/2017
NAME OF LIMITED LIABILITY COMPANY: Cygnus Technologies, LLC
Fictitious Name, if any,used in North Carolina: Filing Office Use Only
SECRETARY OF STATE ID NUMBER: 1550585 STATE OF FORMATION: DE
R ❑0❑�REPORT FOR THE CALENDAR YEAR:
Changes
SECTION A:REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: CT Corporation System
2.SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS&COUNTY 4.REGISTERED AGENT OFFICE MAILING ADDRESS
160 Mine Lake Ct Ste 200 160 Mine Lake Ct Ste 200
Raleigh, NC 27615-6417 Wake Raleigh, NC 27615-6417 Wake
SECTION B:PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS:
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3.PRINCIPAL OFFICE EMAIL:
4.PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS
r
..RI
4332 Southport Supply Road SE 10770 Wateridge Circle,Ste 200
Southport,CA_28461-8583 San Diego,CA 92121-San Diego
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: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Wyatt Glynn NAME: Kevin Herde NAME: Carl Hull
TITLE: Authorized Signatory TITLE: Chief Financial Officer TITLE: President
ADDRESS: ADDRESS: ADDRESS:
10770 Wateridge Circle,Ste.200 10770 Wateridge Circle, Ste 200 10770 Wateridge Circle,Ste 200
San Diego,CA 92121 San Diego san Diego,CA 92121 San Diego San Diego, CA 92121 San Diego
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
Print or Type Name of Company Official Print or Type Title of Company Official
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF $200
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27626-0525

SECTION E: ADDITIONAL COMPANY OFFICIALS
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: Name:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:

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