NCG030693_NOI Application_20180406

Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
RCDENR
"�NM RT — N UR MENT °F NCG030000 j
ENVIRONMENT ANo N6IURAL RESOURCESOC6-hE OV33
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year Month 7 Da
Certificate of Covera e
N CG 0 3
hec ount
Penni,Assi ed to
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG030000:
STORMWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification) 335 Rolling, Drawing, and Extruding of Nonferrous Metals
SIC 3398 Metal Heat Treating
SIC 34 Fabricated Metal Products
SIC 35 Industrial and Commercial Machinery
SIC 36 Electronic and Other Electrical Equipment
SIC 37 Transportation Equipment
SIC 38 Measuring, Analyzing, and Controlling Instruments
1 ' I For questions, please contact the DEMLR Regional Office for your area. See page 4.
(Please print or type)
1) Mailing address of ownerloperator (address to which all permit correspondence will be mailed):
Name Jack Herndon
Street Address 4328 South York Hw
City Gastonia State N.C. ZIP Code 28052
Telephone No. 704 864 3032 Fax: [phone]
2) Location of facility producing discharge:
Facility Name Industrial Fabricators VC Plant
Facility Contact Jack Herndon
Street Address 4920 South York Hwv
City Gastonia State N.C. ZIP Code 28052
County Gaston
Telephone No. 704 868 9617 Fax: NIA
Email [e-mail]
3) Physical Location Information:
RECEIVED
APR 0 3 2010
DENR•LAND OUALITY
STORMWATER PERMITTING
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). Located on the corner of Hwy 321 South and Old Depot
Road
(A copy of a county map or USGS quad sheet with the facility clearly located must be submitted with this application.)
4) Latitude 350 13'33.4" N Longitude 810 11' 56.14" W
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NCG030000 N.O.I. , - '
X No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
d) Is hazardous waste stored in the 100 -year flood plain?
X No ❑ Yes If yes, include information to demonstrate protection from flooding.
e) 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:
15) Certification:
North Carolina General Statute 143-215.6113 (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; 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 maintained under this Article or rules of the Commission implementing this Article shall be guilty of a Class 2
misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000).
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:�o_ ,J
Title:Nd/!L,✓Y1Cw
of
(Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDENR
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NCG030000 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.
I� A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
(f) impervious areas, (g) site property lines.
Li' Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map.
Mail the entire package to:
Stormwater Permitting 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 coverage under the General Permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office
... [phone]
Mooresville Office
... [phone]
Raleigh Office ........
[phone]
Washington Office
...[phone]
Wilmington Office ...
[phone]
Winston-Salem ....,.
[phone]
Central Office .........
[phone]
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