NCG200503_COMPLETE FILE - HISTORICAL_20160520

STORMWATER DIVISION CODING SHEET
RESCISSIONS
PERMIT NO.
IVC 6
DOC TYPE
❑COMPLETE FILE -HISTORICAL
DATE OF
RESCISSION
❑ L-2Q
YYWMMDD

5/20/2016
Click Here To:
Corporations Division # � o� /�zto n 3
North Carolina 1
Elaine F. Marshall DEPARTMENT OF'THE
Secretary SECRETARY OF STATE
PO Box 29622 Ralelgh, NC 27626-0622 [phone] Account
Login
Register
View Document Filings File an Annual Report Amend a Previous Annual Report
Print a Pre -Populated Annual Report form
Corporate Names
Legal: Carolina Rail Service, LLC
Prev Legal: CRS Holdings, LLC
Limited Liability Company Information
S osl d:
0605238
Status:
Admin. Dissolved
Annual Report Status:
Current
Citizenship:
Domestic
Date Formed:
9/25/2001
Fiscal Month:
December
State of Incorporation:
NC
Registered Agent:
Dabbs, David W
Corporate Addresses
Mailing:
100 Terminal Road, State Port
Morehead City, NC 28557
Principal Office:
100 Terminal Road, State Port
Morehead City, NC 28557
Reg Office:
101 North Tryon Street Ste 1900
Charlotte, NC 28246
Reg Mailing:
101 North Tryon Street Ste 1900
Charlotte, NC 28246
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager: Canal Holdings, LLC
3700 Clay Pond Road; Suite 6
Myrtle Beach SC 29579
httpsJMww.sosnc.gov/SearcWprofcorp/5W7674 111

5J20/2016
Corporations Division
North Carolina
Elaine F. Marshall DEPARTMENT OF THE
Secretary SECRETARY of STATE
PO Box 29622 Raleigh, NC 27626-0622 (919)807-20D0
Filings For: Carolina Rail Service, LLC
Image
FDate Filed I
Document Id
I Event
Document Type
®
8/28/2001
212409017
Name Reservation
Application to Reserve a Corporate Name
® .
9/25/2001
212679062
ICreatiorl Filing
Articles of Organization Limited Liability
®
9/27/2001
212719024
Survivor
Articles of Merger
®
1/28/2002
220280079
Annual Report
Annual Report LLC
®
1/10/2003
2002 127 00411
Annual Report
Annual Report LLC
®
2/11/2004
2004 042 00079
Annual Report
Annual Report LLC
®
2/11/2004
12004 042 00080
Annual Report
Annual Report LLC
®
2/14/2005
2005 045 00014
Annual Report
Annual Report LLC
®
3/11/2010
C201007030721
Notice Annual Report
AQM Notice
®
8/26/2010
C201023809024
Destruction Filing
ADM Dissolution
Account
Login
Register
hops:/M(ww.sosnc.gov/Searchlfilings/5367674 1/1

OR April 22, 2015, an application for interim approval of professional compensation was filed in the
bankruptcy case of CRS Holding of America, LLC (d/b/a Creative Recycling Systems & Bargain Computer
Products) and its affiliates.
The filing was assigned docket number 279 and is described on the court's official docket as follows:
Application for Compensation and Allowance and Payment of Compensation for Services Rendered for
Hugo S deBeaubien, Other Professional, Fee: $169,555.50, Expenses: $1,391.59. For the period: August
29, 2014 through December 16, 2014 Filed by Attorney Hugo S deBeaubien (deBeaubien, Hugo)
(Entered: 04/22/2015)
CRS Holding of America, LLC (d/b/a Creative Recycling Systems & Bargain Computer Products) filed for
bankruptcy protection, or had an involuntary bankruptcy petition filed against it, on August 29, 2014. The
bankruptcy case is pending before the United States Bankruptcy Court for the Middle District of Florida.
httpalchapterl l cases.com/2015/04/27/crs-holdi ng-of-ameFica-llc-dba-creadve-recycl i ng-systems-bargain-com puter-products-bankr uptcy-nevi-fi l ing-alert-appl... 113

5/20/2016 CR5 Holding of America, LLC (d/b/a Creative Recycling Systems & Bargain Computer Products) Bankruptcy New Filing Alert: Application For Interim ...
The--.ase number for the lead bankruptcy case is 14-10142. The bankruptcy case is currently assigned to
United States Bankruptcy Judge K. Rodney May. The law firm of Shumaker, Loop & Kendrick, LLP is
acting as lead bankruptcy counsel to CRS Holding of America, LLC (d/b/a Creative Recycling Systems &
Bargain Computer Products) in the bankruptcy case.
Priced to be accessible
for. eve-ry firm.
Access'ver 3,m tlroncourt filings
CHAPTER ® DOCKETS
SHARE THIS:
f Facebook' Twitter $+Google in Linkedin .:Email
LIKE THIS:
Loading...
Related:
http:l/chapterl l cases.coml20l &O4/27/crs-holding-of-ameri ca-1 I c-dba-creative-recycling-systems-bargain com puler-products-bankruptcy-new-fi li ng-alert-appI... 213

f
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG200000
CERTIFICATE OF COVERAGE No. NCG200503
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
CRS Holding of America, LLC
is hereby authorized to discharge stormwater from a facility located at
Creative Recycling Systems of North Carolina, LLC
619 Distribution Drive
Morrisville
Wake County
to receiving waters designated as unnamed tributary to Kit Creek, a class WS-IV;NSW water in
the Cape Fear River Basin, in accordance with the effluent limitations, monitoring requirements,
and other conditions set forth in Parts I, II, I1I, IV, V, and VI of General Permit No. NCG200000
as attached.
This certificate of coverage shall become effective June 21, 2013.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 21, 2013.
ORIGINAL SIGNED B1
KEN PICKLE
for Thomas A. Reeder, Acting Director
Division of Water Quality
By the Authority of the Environmental Management Commission

NCG200503 CRS Holding of America, LLC
Creative Recycling Systems of North Carolina, LL
Map Scale 1:24, 000
Latitude: 351 52' 16" N
Longitude: 780 51' 28" W
County: Wake
Receiving Stream: UT to Kit Creek
Index No: 16-41-1-17-2-(0,7)
Stream Class: WS-IV;NSW
Sub -basin: 03-06-05 (Cape Fear River Basin)
Facility Location

_x_
j'A
'
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder
Governor Acting Director
June 21, 2013
Mr. Shaun O'Sullivan
Creative Recycling Systems
8108 Krauss Blvd
Tampa, FL 33619
Subject: General Permit No. NCG200000
John E. Skvada, III
Secretary
CRS Holding of America, LLC
Creative Recycling Systems of North Carolina
COC NCG200503
Wake County
Dear Mr. O'Sullivan:
In accordance with your application for a discharge permit received on May 20, 2013, we
are forwarding herewith the subject certificate of coverage to discharge under the subject state —
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina
General Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the
US Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except after notice to
the Division of Water Quality. The Division of Water Quality may require modification or
revocation and reissuance of the certificate of coverage.
Per the requirements of the Jordan Lake Nutrient Strategy Buffer Rule, all stormwater
drainage to stream buffers, from portions of this site that have been constructed after August 11,
2009, must be discharged through a correctly designed level spreader or another device that meets
diffuse flow requirements per 15A NCAC 2B .0267. Diffuse flow requirements are described in
Chapter 8 of the North Carolina Stormwater BMP Manual, available at:
http://portal.ncdenr.orv,/web/wq/ws/su/bmp-manual,
This permit does not affect the legal requirements to obtain other permits which may be
required by the Division of Water Quality or permits required by the Land Quality Section of the
Division of Energy, Mining and Land Resources, Coastal Area Management Act or any other
federal or local governmental permit that may be required.
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N, Salisbury St. Ralegh, North Carolina 27604
Phone: [phone] FAX [phone] l Customer Service: 1-877-623-6748
Internet www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
NorthCarolina
Natura!!rf

Mr. Shaun O'Sullivan
Creative Recycling Systems—NCG200503
June 21, 2013
If you have any questions concerning this permit, please contact Julie Ventaloro at
telephone number [phone], or at [e-mail].
Sincerely,
ORIGINk SIGNED W
KEN PICKLE
for Thomas A. Reeder
cc: Raleigh Regional Office, Danny Smith
Central Files
Stormwater Permitting Unit Files
Wake County Environmental Services, Attn: Eric Green, P.O. Box 550, Raleigh, NC
27602
Page 2 of 2

Ventaloro, Julie
From: Shaun O'Sullivan [[e-mail]]
Sent: Thursday, May 30, 2013 3:09 PM
To: Ventaloro, Julie
Subject: RE North Carolina- Stormwater Permit Application- Creative Recycling Systems
Hi Julie,
Literally within a few yards of the facility it becomes Durham County but our facility address is in Wake County.
Best Regards,
Shawn
Shaun O'Sullivan I Director of Conipliance/QFH&SMR
0-calive Recycling Systems
IT Asset Management & Recychiig
(0) 813-386-6070 x 347 I (m) 813-495-2777
CRSeRegyeling.com
CREATIVE RECYCtIMa �l+r�!1,a„i.','s.lit
GREEN
IT ASSET VANAGIMINT & MY"V40
Creative Recycling Systems, LLC.
}lead Nationai Geographic High Tech Trash
Like CRS ` Follow CRS
From: Ventaloro, Julie [[e-mail]]
Sent: Thursday, May 30, 2013 2:54 PM
To: Shaun O'Sullivan
Subject: RE: North Carolina- Stormwater Permit Application- Creative Recycling Systems
Hi Shaun,
I've got one last question for you. On the application, the facility is listed as being in Wake County. On the map, it
appears to be just across the county line, in Durham County. Can you confirm which county the facility is located in?
Thank you,
Julie
From: Shaun O'Sullivan [mailto:[e-mail]]
Sent: Thursday, May 30, 2013 12:57 PM
To: Ventaloro, Julie
Subject: RE: North Carolina- Stormwater Permit Application- Creative Recycling Systems
Ms/Mrs. Ventaloro,

Please see responses below.
1) According to the NC Secretary of State website, the state revoked the Certificate of Authority for Creative
Recycling Systems of North Carolina as of May 23, 2013. The report cites a failure to file an annual report.
Would you please send me something in writing that describes steps your company is taking to resolve this
matter?
We are submitting the Application for Certificate of Authority today along with our Annual Report. This is
something that fell through the cracks. We should be fully authorized shortly after the NC Sec. of State
receives our application and processes it accordingly.
2) We require a location map to be submitted with all permit applications. Would you please send me a map that
shows the location of the facility clearly marked on the map? It can be a county map, LISGS map, anything that
shows topographic contours.
(Please see attached)
3) Please send me a signed letter authorizing you as an agent to sign the permit application on behalf of the
corporation.
(Please see attached)
4) Lastly, can you please tell me how many discharge points (ditches, pipes, channels, etc) convey stormwater from
the property? The application for this facility lists "roof runoff' as the only discharge point. The types of
discharge points I'm looking for are areas where concentrated flow leaves the property. This can be stormwater
running off of paved or unpaved areas, or coming from ditches, pipes, or channels.
There are 3 drains in the parking lot and another 4 feet into the grass at the back of our parking lot. No
ditches or pipes visible.
If you have any further question(s), please feel free to contact me.
Thank you.
Best Regards,
Shaun
Shaun O'Sullivan I Director of Conipliarice/QEII&,SMR
Creative Recycling; systems
IT ri.9set Management & Reevelhig
(o) 81:3-:386-6070 x 347 I (m) 813-495-2777
CRSeRecycling.com
ANY,
i1f.LyN-1'
CgEATIVE gECrEIIpG lJ�!lfili..,......1
46 GREENAW-
IT ASSET MANAGE ENt 4 BECYCONO
Creative Recycling Systems, LLC.
Read National Geographic High Tech Trash
Like CRS I Follow CRS
From: Ventaloro, Juliefmailto:julie.ventaloro(@ncdenr.gov]
Sent: Thursday, May 30, 2013 11:39 AM

To: Shaun O'Sullivan
Subject: North Carolina- Stormwater Permit Application- Creative Recycling Systems
Mr. O'Sullivan,
I am following up on our earlier phone call regarding the application for coverage under North Carolina General Permit
NCG20 for the Creative Recycling Systems of North Carolina facility in Morrisville, NC. In reviewing the application,
noted a few items that need to be addressed before I can proceed with the review.
5) According to the NC Secretary of State website, the state revoked the Certificate of Authority for Creative
Recycling Systems of North Carolina as of May 23, 2013. The report cites a failure to file an annual report.
Would you please send me something in writing that describes steps your company is taking to resolve this
matter?
6) We require a location map to be submitted with all permit applications. Would you please send me a map that
shows the location of the facility clearly marked on the map? It can be a county map, USGS map, anything that
shows topographic contours.
7) Please send me a signed letter authorizing you as an agent to sign the permit application on behalf of the
corporation.
8) Lastly, can you please tell me how many discharge points (ditches, pipes, channels, etc) convey stormwater from
the property? The application for this facility lists "roof runoff' as the only discharge point. The types of
discharge points I'm looking for are areas where concentrated flow leaves the property. This can be stormwater
running off of paved or unpaved areas, or coming from ditches, pipes, or channels.
Please let me know if you have any questions.
Thank you,
Julie Ventaloro
Coordinator. Water Supply Watershed Protection Program
NC Division of Water Quality
Wetlands & Stormwater Branch
1617 Mail Service Center, Raleigh, NC 27699-1617
Phone: (gig) 807-6370 Fax: (gtg) 807-6494
Website: ht w t r 1 wat er hed nc. v
F.-rn« it correspondence to andfirom this address may he subject to the North Carolina Public Records Law and may be disclosed to third
Parties,

Ventaloro, Julie
From: Ventaloro, Julie
Sent: Thursday, May 30, 2013 2:24 PM
To: Smith, Danny
Subject: Review Request NCG200503 Creative Recycling Systems of NC
Attachments: NCG200503_CRS Holding of America_NOI.pdf
Hi Danny,
We've received an NOI for a new facility in your region:
NCG20 — Creative Recycling Systems of North Carolina in Wake County. The site discharges stormwater at (at least) one
point to an unnamed tributary to Kit Creek (Class WS-IV;NSW). The NOI is attached. Note that there is additional
information about the site within the email scanned and attached to the NOI.
Please let me know if the Raleigh Regional Office has any concerns about issuing a COC for a general permit for this
facility. Please also let me know of any potential impacts to wetlands. If we don't receive any objections, we'll issue the
COC in 30 days.
Thanks!
Julie Ventaloro
Coordinator, Water Supply Watershed Protection Program
NC Division ofWater Quality
Wetlands & Stormwat.er Branch
1617 Mail Seivice Center, Raleigh, NC 27699-r617
Phone: (gig) 807-6370 Pax: [phone]
Wehsite:littp:// atcrsuoplvwaterslied,nc.gov
E-mail correspondence to and front this address may be subject to the North Carolina Public Records Law and may he disclosed to third
part ies.
'C, �� ke. —b lain S kk 5a.5,0kc,d a-4 i

#K 1
Ventaloro, Julie
From: Shaun O'Sullivan [[e-mail]]
Sent: Thursday, May 30, 2013 12:57 PM
To: Ventaloro, Julie
Subject: RE: North Carolina- Stormwater Permit Application- Creative Recycling Systems
Attachments: Site map and authorization letter CRS-NC_SW appl._5-30-13.pdf
Ms/Mrs. Ventaloro,
Please see responses below.
1) According to the NC Secretary of State website, the state revoked the Certificate of Authority for Creative
Recycling Systems of North Carolina as of May 23, 2013. The report cites a failure to file an annual report.
Would you please send me something in writing that describes steps your company is taking to resolve this
matter?
We are submitting the Application for Certificate of Authority today along with our Annual Report. This is
something that fell through the cracks. We should be fully authorized shortly after the NC Sec. of State
receives our application and processes it accordingly.
2) We require a location map to be submitted with all permit applications. Would you please -send me a map that
shows the location of the facility clearly marked on the map? It can be a county map, USGS map, anything that
shows topographic contours.
(Please see attached)
3) Please send me a signed letter authorizing you as an agent to sign the permit application on behalf of the
corporation.
(Please see attached)
4) Lastly, can you please tell me how many discharge points (ditches, pipes, channels, etc) convey stormwater from
the property? The application for this facility lists "roof runoff' as the only discharge point. The types of
discharge points I'm looking for are areas where concentrated flow leaves the property. This can be stormwater
running off of paved or unpaved areas, or coming from ditches, pipes, or channels.
There are 3 drains in the parking lot and another 4 feet into the grass at the back of our parking lot. No
ditches or pipes visible.
If you have any further question(s), please feel free to contact me.
Thank you.
Best Regards,
Shaun
Shaun O'Sullivan I Director o1'Compliance/QE1-1&SMR
Creative Recycling S}-stuns
i'r Asset Management & Recycling
(o) 8i3-386-6070 x 347 1 W 813-495-2777

[ w
CRSeRegycling.eom
C##EATIY�G ECTtINC
11 ASSE1 11ANAGEtr#HT & MYGUNG
NV r Oil ft
GREEN
Creative Recycling Systems, LLC.
tzead National Geographic High Tech Trash
Like CRS I Follow CRS
From: Ventaloro, Julie [mailto:iulie-ventaloro( ncdenr.gov]
Sent: Thursday, May 30, 2013 11:39 AM
To: Shaun O'Sullivan
Subject: North Carolina- Stormwater Permit Application- Creative Recycling Systems
Mr. O'Sullivan,
I am following up on our earlier phone call regarding the application for coverage under North Carolina General Permit
NCG20 for the Creative Recycling Systems of North Carolina facility in Morrisville, NC. In reviewing the application, I
noted a few items that need to be addressed before I can proceed with the review.
5) According to the NC Secretary of State website, the state revoked the Certificate of Authority for Creative
Recycling Systems of North Carolina as of May 23, 2013. The report cites a failure to file an annual report.
Would you please send me something in writing that describes steps your company is taking to resolve this
matter?
6) We require a location map to be submitted with all permit applications. Would you please send me a map that
shows the location of the facility clearly marked on the map? It can be a county map, USGS map, anything that
shows topographic contours.
7) Please send me a signed letter authorizing you as an agent to sign the permit application on behalf of the
corporation.
8) Lastly, can you please tell me how many discharge points (ditches, pipes, channels, etc) convey stormwater from
the property? The application for this facility lists "roof runoff" as the only discharge point. The types of
discharge points I'm looking for are areas where concentrated flow leaves the property. This can be stormwater
running off of paved or unpaved areas, or coming from ditches, pipes, or channels.
Please let me know if you have any questions.
Thank you,
Julie Ventaloro
Coordinator, Water Supply Watershed Protection Program
NC Division of Water Quality
Wetlands & Stornwater Branch
1617 Mail Service Center, Raleigh, NC 27699-1617
Phone: (gig) 8o7-637o Fax: [phone]
Website: httR//watersunnlvwatcrshed,nc.gov
E-mail correspondence to and from this address may be subject w the North Carolina Public Records Low and may be disclosed to third
parties.

CREATIVE RECYCLING
4 ;
5/30/2013
To whom it may concern:
We the undersigned, hereby authorize Shaun O'Sullivan to act on our behalf in all
manners relating to the application for NPDES permit, including signing of all
documents relating to these matters. Any and all acts carried out by Shaun
O'Sullivan on our behalf shall have the same effect as acts of our own.
This authorization is valid until further written notice from Creative Recycling of
North Carolina, LLC.
Sincerely,
Brian Diesselhorst
Senior VP - Operations
R2 Certified
THE SCIENCE OF REUSE
RIOS Certified
8108 Krauss Blvd Suite 110
ISO 14001
Tampa, FL 33619
IS09001
813.621.2319
OSHAS 18001
800.797.2061
813.626.1248 fax
www.crserecycling.com

� { 3.1 l 5 e
1 _ r= IT'-'
.��'� ill .. �....e ��G ��� ' �i yTa�".�-. i:��r � -.:
�� 5I r~ � _ � k' 'ram' ir�{r �k� l,q,��t4 t��t�� �.. �+.- ,
�'� � �'>>+ ` �' 1'1 � �I{{ 3 f�� +ri.-�y+�l'.o�� ,� a - �f �ilm5tw l' I -

NOTICE TO REGISTERED AGENT:
Under N.C.G.S, Section 55D-30(b), it is the duty of the registered agent to forward this certificate to the business entity at the last known
address.
CorpDirect Agents, Inc.
Creative Recycling Systems of North Carolina, LLC (0869924)
150 Fayetteville Street,
Box1011
Raleigh, NC 27601
State of North Carolina
Department of the Secretary of State
CERTIFICATE OF REVOCATION
OF
CERTIFICATE OF AUTHORITY
1, Elaine F. Marshall, Secretary of State, as mandated by law, do hereby certify that the Certificate of
Authority of
Creative Recycling Systems of North Carolina, LLC
to transact business in the state of North Carolina has been revoked pursuant to the procedures set
forth in N.C.G.S. Section 57C-7-14(a)(2) for failure to file an annual report effective as of the date set
forth hereunder.
Foreign Limited Liability Company revoked under N.C.G.S. Section 57C-7-14(b) may appeal the
Secretary of State's revocation of its certificate of authority under the same procedures that a foreign
corporation may appeal the revocation of its certificate of authority pursuant to N.C.G.S. Section 55-
15-32 and Section 55-15-33.
This the 23rd day of May, 2013
Elaine F. Marshall
Secretary of State
Document I& C201314304916

w
AW
AdMbW�
NCDENR
Envinon�eHr iwo NQUR+i. Reao�nee=
Division of Water Quality
National Pollutant Discharge Elimination System
NCG200000
rOR AGENCY USE ONLY
Date Received
Year
I Month
Da
CertiEcateofCoverage
Check #
Amount
Permit Assigned to
cn aro
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit NCG200000:
STORMWATER DISCHARGES associated with activities classified as:
SIC 5093 Scrap Metal Recycling (except as specified below)
SIC* NIA Like activities deemed by DWQ 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:
• Automobile Wrecking for Scrap (SIC 5093)
• Non -Metal Scrap Recycling (SIC 5093)
• Used Motor Vehicle Parts (SIC' 5015) * Standard Industrial Classification Code\
cgs �� d� ++� os, V� n►+r ice,, L LC (p-aAn.✓ ; K j
1) Mailing address of owner/operator: (address to which all permit correspondence will ailed
Name Shaun O'Sullivany
Street Address 8108 Krauss Blvd.
City Tam mpa State FL ZIP Code 33619
Telephone No. 813-386-6070 Ext. 347 Fax: [phone]
E-mail Address [e-mail]
2) Location of facility producing discharge:
Facility Name Creative Recycling Systems of North Carolina, LLC
Facility Contact Jennifer Rivero
Contact E-mail [e-mail]
Street Address 619 Distribution Drive
City Morrisvill State NC ZIP Code 27560
County -Wake . 1 �
Telephone No. , 919-995-1772 Fax:
3) Physical Location Information:
Narrative description of how to get to.the facility (use street names, state road numbers, and distance and direction
from a roadway intersection). Take 140 to the Davis Drive exit. Turn Left onto Park Knoll Drive. Turn Right on
Distribution Drive.
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required to be submitted with
this application)
4) Latitude 35* 52' 16.3164 " Longitude -78* 51' 28.8576" (degrees, minutes,
5) This NPDES Permit Application applies to which of the following:
t9r New or Proposed Facility
Q Existing
6) Standard Industrial Classification:
Date operation is to begin 5/20/2012
MAY � 0 20 i3
a � - wA nLrrY
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial activity at
this facility:
SIC Code: 5 0 9 3
7) Provide a brief description of the types of industrial activities and products produced at this facility:
Sorting, shredding, and de -manufacturing of used electronics into intrinsic parts. CRT glass, metals, plastic, scrap.
Page 1 of 3
5WU-235-11.16.09

f -
NCG200000 N.O.I.
8) Discharge points:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? Roof run off.
Receiving water classification (if known): Unknown
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Unknown
Receiving water classification (if known): Unknown
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?
W/No
❑ 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)?
If / 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
t/ Yes
If yes, please briefly describe: Stormwater Pollution Prevention Plan
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
dYes
If yes, when was it implemented? 5/15/2013
14) Are vehicle maintenance activities occurring at this facility?
VNo
❑ Yes
15) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
VN0
D Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg, of hazardous waste generated per month) of
hazardous waste?
❑ No
VYes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
"o
❑ Yes
d) If you answered yes to questions b. or c., please provide the following information:
Page 2 of 3
SWU-235-11.16.09

y
NCG200000 N.Q.E.
Type(s) of waste: Universal Waste
How is material stored: In Gaylord boxes and steel_ containers.
Where is material stared: In a designated RCRA area.
How many disposal shipments per year: 12
Name of transport 1 disposal vendor: Li htin Resources & MCT
Vendor address:. 1007 SW 16`1' Lane. Ocala, Florida 34474; 1 East Porter Street, Cartersville, GA 30120
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 Managementj 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
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: Shaun O'Sullivan
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for $100 made payable to NC DENR
❑ This completed application and all supporting documents
❑ Copy of county map or USGS quad sheet with location of
facility clearly marked on map
Mail the entire package to: Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DWO Central Office or Regional Office for your area.
DWO 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 .........(919)
807-6300
Page 3 of 3
SW U-235-11.16.09