3428-TIRECOLL-2023 American Tire Distributors - Rural Hall SW023-0089 PARF-Data Sheet & Invoice 7-18-23

SW023-0089
P1402
PERMIT APPLICATION REVIEW FORM
Review Requested by:
Benjamin Kelly
Date Requested:
7/6/2023
Facility Name and Permit ID
American Tire Distributors — Rural Hall, 3428-TIRCOLL-2023
Applicant (Owner) Name
American Tire Distributors, Inc.
Description of Permit Request
® (1)a. New — New Facility
[This is the action the applicant
❑ (1)b. New — Substantial Amendment
is requesting in accordance with
❑ (1)c. New — Expand Waste Boundary
NCGS 130A-294(a3)
❑ (1)d. New — Substantial Amendment
❑ (2)a. Amendment — Next Phase of the Approved Facility Plan
❑ (2)b. Amendment— Renewal/Review ❑ 5YR ❑ 10YR
❑ (2)c. Amendment — Change in Ownership
❑ (3)a. Modification — Change to Approved Plans (No CHR)
❑ (3)b. Modification — Subsequent Permit to Operate (No CHR)
❑ (3)c. Modification — Five-year Limited Review
Permitted Annual Tonnage
N/A
Permit Fee
$50.00
6/22/2023
Mr. Brian Miller, VP of Operations and Sustainable Ecosystem,
Date Application Received
Contact Name, Title & Phone #
704 632-1905
Email Address
bmiller(D-atd-us.com
Company
American Tire Distributors, Inc.
250 Northstar Dr., Rural Hall, NC 27045
911 Address
Mailing Address
12200 Herbert Wayne Court
City/State/Zip
Huntersville, NC 28078
Unknown
Unknown
Parent Company
Known Subsidiaries
Other known names business
Unknown
has operated under
North Carolina
Yes ® No ❑ Unknown ❑
Known Counties of Operation
Does the applicant have a past
or current solid waste permit?
Facility Type: TP Permit #: 98-11
Did the permit applicant submit
Yes ® No ❑ Not Needed ❑
Financial Assurance cost
estimates?
Other notes
Application for new Scrap Tire Collection facility in Rural Hall, NC

Data Field
Description
Data
Site —Name
M: name given to the facility. Name can permit name, but does not
have to.
American Tire Distributors - Rural Hall
Address1
M: first line of physical address assigned by local 911 service, may
be different than mailing address.
250 Northstar Drive
Address2
M: second line of physical address, used when necessary.
City
M: city, town or locality where facility is located.
Rural Hall
State
M: two letter US postal service abbreviation for the state where the
facility is located.
NC
Zip
M: zip code for the location address.
27045
County
M: county name where facility is located.
Forsyth
Latitude
M: decimal degrees, should be between 33 and 37.
36.209264
Longitude
M: decimal degrees, should be between -75 and -85.
-80.288413
Horiz_Collection _Method
O: applies to how the coordinates were collected: 001=GPS or
002=geocode or 003=from map
3
Supplemental_Location
O: descriptive text for locating a facility when address is not
practical.
Geometric Type
M: 001=Fixed or 002=Mobile, e.g. Facility is Fixed, a septage
pumper is Mobile
1
Reference_ Point
O: description of point where coordinates were collected at the
facility, 001=front door, 002=permitted feature, 003=for mobile,
004=undefined point on facility
4
Status
M: description of the overall facility; Open or Closed.
Proposed
Owner
M: classification of the owner of the facility as either Public or
Private entities.
Private
Start Date
M: date on which the facility began to be of interest to the
program, Facility Registration Date; Facility's Original Permit Issue
Date; Facility's First Inspection Date; Program's Start Date;
Department's Creation Date (07/01/1989)
6/22/2023
Start_ Date_ Qualifier
O: description of event represented by Start —Date field, e.g.
Facility's Original Permit Issue Date.
Receipt of Permit Application
End Date
O: date on which the facility ceased to be of interest to the
program.
End_ Date_ Qualifier
O: description of event represented by End_Date field, e.g. Date
of Final Closure.
PermitlD
M: unique id number used for permit
LocationlD
M: id number used in location table to identify the facility or
environmental interest subject to this permit. This number is
assigned and is only needed if permit relates to an existing site.
Permit Name
M: Common Name used for this permit
ATD - Rural Hall Scrap Tire Collection Facility
Orig_PermitlssueDate
M: Date when first permit issued.
PermitlssueDate
M: Date MOST recent permit issued.
PermitExpDate
M: Date when current permit expires.

M: Active=Accepting/handling waste; Inactive=Not accepting
waste; Proposed=Application in-house for NEW permit;
Expired=Past Expiration date but not officially closed; Post-
Closure=Not taking waste but monitoring; Closed=Not accepting
waste and 'official' closure letter sent; Post -Closure Complete=Not
taking waste and monitoring complete; County=Non-facility within
PermitStatus
a county
Proposed
M: block of rules governing site e.g..1600, .0500, .1100, .0800,
Rule
etc.
0.1100
M: environmental monitoring required, yes is required or no is not
EnvMonitoring
required.
No
M: primary waste type handled under this permit: MSW, CD,
PrimaryWaste_Type
Indus, Tire, LCID, Medical, YW, Septage, HHW, WG
TIRE
M: primary operation when dealing with waste: LF, Trans, LandAp,
TP, Compost, MatRecovery, Incin, Hauler, WasteToEnergy,
Prim aryOperation_Type
Authorization, Notification, Collection, Detention
TIRECOLL
Owner Name
M: name of owner as appears on the permit.
American Tire Distributors, Inc.
Operator_Name
I M: name of operator/facility manager.
jAmerican Tire Distributors, Inc.

North Carolina Department of Environmental Quality
Division of Waste Management
Solid Waste Section INVOICE
NORTH CAROLINA _ Quality
Division of Waste Management To: Brian Miller, VP of Operations & Sustainable Ecosystem
Solid Waste Section American Tire Distributors, Inc.
1646 Mail Service Center 12200 Hebert Wayne Court
Raleigh, NC 27699-1646 Huntersville, NC 28078
phone: [phone]
I DESCRIPTION
Facility -Application:
American Tire Distributors - Rural Hall (New Facility)
250 Northstar Drive
Rural Hall, NC 27045
la. New Facility
Total Amount Due
Pavment Oations:
Invoice Date:
Invoice #:
AM
Date Due:
July 10, 2023
SW023-0089
$50.00
$50.00
August 09, 2023
E-check - Available online at https://deq.nc.gov/swpay
Requires bank account and routing information. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 alonq with the invoice number.
Credit Card - Available online at https://deq.nc.gov/swpay
Accepts MasterCard, Visa, and Discover cards. You will need to use the zip code in the description box and the invoice number
shown on this invoice to access your account. If a zip code is not listed, use the code: 99999 along with the invoice number.
*Convenience Fee of 2.65% added to amount invoiced.
Paper check - Make checks payable to N.C. Division of Waste Management, Solid Waste Section, include Permit Number and invoice number on
check. If you are paying by electronic transfer, include the invoice number with your electronic transfer. Please return a copy of this
invoice with your payment.
Mail paper checks to:
N.C. Division of Waste Management
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646
[G.S. 25-3-506: A $25.00 processing fee will be charged on all returned checks.]
Explanation of Invoice Amount is Based on Facility's Current Permit Application:
Pursuant to North Carolina General Statute 130A-295.8 you are required to pay fee(s) based on your solid waste management activities. The fee(s) shall
be used to support the solid waste management program. An application is deemed incomplete until all fees are received.
Solid Waste Contacts:
Billing process:
Theresa Williams [phone] - Payments, e-Payments
Sherri Stanley [phone] - Fee Amounts
Regulations and Technical Assistance:
Sherri Stanley [phone] - Landfills, Transfer Stations, Compost Facilities
Perry Sugg [phone] - Land Application Sites
More information available on the web:
North Carolina Department of Environmental Quality (DEQ) - http://deq.nc.gov/
North Carolina Solid Waste Program - http://deq.nc.gov/about/divisions/waste-management/solid-waste-section
NC DEQ:WM Solid Waste Invoice Form 1-2023