NCG050444_NOI Application_20190314

Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NCG050000
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
Certificate of Covera *e
N C G 0
Check #
Amount
IoS$ _¢..lot7
Permit, i nod to
i IL a
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG050000:
STORMWATER DISCHARGES associated with activities classified as:
SIC 23 Apparel and Other Fini6hod Products Made from Fabrics and Similar MatcRl-CciVFD
SIC` 265 Paperboard. Containers and Boxes ff ��44 ii __ 44
SIC* 267 Converted Paper and Paperboard Products MAR 14 2019
SIC' 21 110itlrlg, Publishing gild Allied hiduslrles
SIC 30 Rubber and MiscellaneotlS Prodl.WtS (e..=e..pt aS Spe-Oified beloW) �ENft-LAND M Y
STORMUVMTEa PERMITTING
SIC' 31 Leather and Leather Products (except as specified below)
SIC' 39 Miscellaneous Manufacturing Industries
SIC* N/A Like activities deemed by DEMLR to be similar in the process and/or the exposure of raw
materials, products, by-products, or waste materials
The following activities are specifically excluded from coverage under this General Permit:
SIC` 301 Tires and Inner Tubes
SIC' 311 Leather Tanning and Finishing
* Standard Industrial Classification Code
(Please print or type)
1) Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name
American Phoenix, Inc - Greg Lewis, CEO
Street Address
318 Blount Street
City
Fayetteville State NC ZIP Code 28301
Telephone No.
910 484-400f Fax:
E-mail Address
[e-mail]
2) L ovation of facility producing dlschargo:
Facility Name
American Phoenix, Inc
Facility Contact
Elizabeth "Rocky" Carr
Contact E-mail
[e-mail]
Street Address
318 Blount Street
City Fayetteville State NC ZIP Code 28301
County Cumberland
Telephone No. 910 484-4007 X 24 Fax: [phone]
3) Physical Location Information:
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). 301 to Robeson, turn onto Blount, across from Highland Lumber
(A copy of a county map or USCS quad sheet with facility clearly located on the map is required with this application)
4) Latitude 35.049150 Longitude -78.884640 (degrees, minutes, seconds)
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SWU-220-071408 Last Revised 6/24/14

5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin
MA Existing
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 3 0 6 9
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: Blends rubber chemicals into appropriate recipes and weights, as called for by the customer.
8) Discharge points:
I low rriariy dlsaliarge hufrrls (dllclies, plpes, cliarrrielb, etc.) oorrvey slurrnwaler rrorn llie properly? 1
List discharge points (outfalls) that convey discharge from the site (both on -site and off -site) and location
coordinates. Attach additional sheets if necessary, or note that this information is specified on the site plan.
Stormwater Outfall No. 1
Latitude (degrees/minutes/seconds): 35.047577 N
Longitude (degrees/minutes/seconds):-78.885592 W
Stormwater Outfall No
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Pago 2 of 4
SW U-220-071408
Last Revised 6/24/14

Stormwater Outfall No.
Latitude (degrees/minutes/seconds): _
Longitude (deg rees/minutes/seconds)•
9) Receiving waters:
N
►nl
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Blounts creek
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer).
10) Does this facility have any other NPDES permits?
11 No
L Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
Yes
If yes, please briefly describe: Trained personnel - quarterly visual inspections of representative outfall discharges
and potential pollutant source areas; and an evaluation of compliance with the Multi -Sector General Permit (MSGP).
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
Yes
If yes, when was it implemented? 11/20/2018
14) Are vehicle maintenance activities occurring at this facility?
11 No ❑ Yes
15) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
❑ No 91 Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
No ❑ Yes
d) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: Non -Hazardous. SQG Hazardous - Rescorcinal (Rosnic)
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SWU-220-071408 Last Revised 6/24/14

NCG050000 N.O.I.
How is material stored: Bags & Supersacks.
Where is material stored: Warehouse.
How many disposal shipments per year: 12
Name of transport / disposal vendor: Safety-Kleen
Vendor address: 934 N 5th Street, St. Pauls NC 28384
16) Certification:
North Carolina General Statute 143-215.6 b (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
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten tl iuusar id dollars ($ 10,000).
I 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: ize 6 y ley A
Title: co 0
(Sig(�rf4p-�plicant) (Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to NCDEQ.
MAR 14 2019
MR -LAND QUALI i Y
gl"C31= MWATER PERMITTING
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SWU-220-071408 Last Revised 6/24/14

1 1111 1 • lR
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NCDEQ
❑ This completed application and all supporting documents
❑ Copy of county map or USGS quad sheet with location of facility clearly marked on map and nearby waters
Mail the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
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SWU-220-071408 Last Revised 6/24/14

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North Carolina Secretary of State Search Results
Page 1 of 1
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Business Corporation
Legal Name
American Phoenix, Inc.
Information
Sosld: 1227046
Status: Current -Active
Annual Report Status: Current
Citizenship: Foreign
Dale l7w fined. 10/24/201 1
Fiscal Month- December
State of Incorporation:
MN
Registered Agent: Carr, Elizabeth
Addresses
Reg Office
Reg Mailing
Mailing
Principal Office
318 Blount Street
318 Blount Street
5500 Wayzata Blvd., Suite 1010
5500 Wayzata Blvd., Suite 1010
Fayetteville, NC 28301
Fayetteville, NC 28301
Golden Valley, MN 55416
Golden Valley, MN 55416
Officers
Chief Operating Officer
Greg Lewis
5500 Wayzata Blvd., Suite 1010
Golden Valley MN 55416
Stock
President
Alexander Nazarenko
5500 Wayzata Blvd., Suite 1010
Golden Valley MN 55416
https://www.sosne.gov/online_services/search/Business Registration_Results 3/26/2019