NCG050350_COMPLETE FILE - HISTORICAL_20160927

PERMIT NO.
DOC TYPE
DOC DATE
STORMWATER DIVISION CODING SHEET
NCG PERMITS
LP/HISTORICAL FILE
❑ MONITORING REPORTS
aa►�o9
YYYYMMDD

Energy Mineral &
Land Resources
ENVIRONMENTAL MALTY
.Iervey McGlothlin, Printing Manager
Imaflex USA, INC
1200 Unity Street
Thomasville, NC 27360
September 27, 2016
Subject Compliance Evaluation Inspection
Permit No NCG 050350
Imaflex USA, Inc
Davidson County
Dear Mr McGlothlin
PAT McCRORY
Covetnor
DONALD R VAN DER VAART
Secretary
TRACY DAVIS
Director
4n September 27, 2016 Glen White of the North Carolina Department of Environmental Quality,
Department of Energy, Minerals, and Land Resources met with you and Fransisco Quijano
(Assistant Printing Manager) at the facility located at 1200 Unity Street in Thomasville, to
conduct a compliance inspection per the Industrial Stormwater Permit requirements Inspection
consists of review of the Stormwater Pollution Prevention Plan, training, monitoring and spills
records as well as observation of the general condition of the site, the outfalls and any possible
exposures to downstream stormwater Your assistance with the inspection was greatly
appreciated
Permit
This facility holds. General Stormwater Permit NCG050350 to discharge stormwater from
industrial activity associated with Apparel, Printing, Leather, Rubber, & Miscellaneous
Manufacturing under the National Pollutant Discharge Elimination System (NPDES) The
permit became effective .Tune 1, 2013 and expires on May 31, 2018 A copy of the current
permit is required to be maintained with the Stormwater Pollution Prevention Plan (SPPP)
documents No issues detected at review
Records/Reports
This facility was required to develop and maintain a (Stormwater Pollution Prevention Plan)
SPPP in accordance with Part II, Section A of the permit The facility has developed a SPPP
Mr McGlothlin has updated the documents annually since he carve on in 2013 All documents
including annual training were current No deficiency found
Facility Site Review
Imaflex USA opened at this location in 2005 Printing was moved here in 2012 The process
extrudes polyethylene and prints on it Examples of products they create are mulch bags, bread
bags, hospital and specialty bags
State of North Carolina I Environmental Quality I EnLrgy Mineral and Land Resources
Winston Salem RLglon-ilOffice 1450HanesMill Road SuitL300 I Winston Salem NC 17103
336 776 9800

Imaflex has two (2) plants in Canada and one (1) in High Point, NC and one (1) new plant
coming to a new location in America The business appears to be growing and prospering
Effluent Receiving Waters
Effluent from this facility drams to North Hamby Creek, class "C" waters of the Yadkin Pee Dee
River Basin
Self -Monitoring Program
Part 11, Section C of the permit requires semi-annual qualitative monitoring No analytical
monitoring is required under current operating procedures and permit requirements Monitoring
has been performed as required The facility has four outfalls All industrial processes occur
inside and under roof and very few ,possible stormwater exposures exist The only obvious
possible exposure would be from the plastic pellets stored in large silo's outside of the facility
If a spill were to occur the pellets could easily be cleaned up without any damage to downstream
waters or property
Your assistance with this inspection was very much appreciated The facility was found to be
compliant with requirements of its industrial stormwater permit If you have questions or need
additional information, please contact Glen White at [phone]
Sincerely,
- Y �
Matthew E Gantt, P E
Regional Engineer
Land Quality Section
Winston-Salem Regional Office
Enclosures Inspection Report
cc File Copy Division of Energy, Mineral and Land Resources (WSRO)
State of North Carolina I Environmental Quality I Energy Mineral and Land Resources
Winstcn Saien Regional Office 1450 Hanes MITI Road Suite 300 1 Winston Salem NC 27I03
336 776 9800

0
Compliance Inspection Report
Permit NCGO50350 Effective 06/01/13 Expiration 05/31/18 Owner Imaflex USA Inc
SOC Effective Expiration Facility Imafiex USA Inc
County Davidson 1200 Unity St
Region Winston Salem
Thomasville NC 27360
Contact Person Macklin L Hess Title Phone [phone]
Directions to Facility
Exit #106 (Finch Farm Road) off Interstate 85 Go west on Finch Farm Road for 0 2 miles (becomes Unity Street) Go 2 3 miles Site
on left (south) at intersection with railroad
System Classifications
Primary ORC Certification Phone
Secondary ORC(s)
On Site Representatives)
Related Permits
Inspection Date 09/27/2016 EntryTime 10 00AM Exit Time 10 45AM
Primary Inspector Glen White Phone [phone]
Secondary Inspector(s)
Reason for Inspection Routine Inspection Type Compliance Evaluation
Permit Inspection Type Apparel/Pnntmg/Paper/Leather/Rubber Stormwater Discharge COC
Facility Status Compliant Not Compliant
Question Areas
Storm Water
(See attachment summary)
Page I

Permit NCGO50350 Owner Facility )maflex USA Inc
Inspection pate 09/27/2016 Inspection Type Compliance Evaluation Reason for Visit Routine
Inspection Summary
(See Compliance Letter)
Page 2

t
Pernnit NCG050350 Owner Facility Imaflex USA Inc
Inspection Date 0912712016 Inspection Type Compliance Evaluation
Reason for Visit Routine
Analytical Monitoring Yes Nq NA NE
Has the facility conducted Its Analytical monitoring? ❑ ❑ ® ❑
# Has the facility conducted its Analytical monitonng from Vehicle Maintenance areas? ❑ ❑ ® ❑
Comment No analytical) monitoring required under current facility operation nor permit requirements
Permit and Outfalls Yes No NA NE
# Is a copy of the Permit and the Certificate of Coverage available at the site? ®❑ ❑ ❑
# Were all outfails observed during the Inspection? ®❑ ❑ ❑
# If the facility has representative outfall status Is rt properly documented by the Division? ❑ ❑ E ❑
# Has the facility evacuated all Illicit (non stormwater) discharges? ®❑ ❑ ❑
Comment No deficiency noted
Qualitative Monitoring Yes No Na NE
Has the facility conducted Its Qualitative Monitoring semi annually? ® ❑ ❑ ❑
Comment Monitorint}_per permit
Stormwater Pollution Prevention Plan
Yes No NE
Does the site have a Stormwater Pollution Prevention Plan?
®❑ ❑ ❑
# Does the Plan include a General Location (USGS) map?
®❑ ❑ ❑
# Does the Plan include a Narrative Description of Practices?
®❑ ❑ ❑
# Does the Plan include a detailed site map including outfall locations and drainage areas?
®❑ ❑ ❑
# Does the Plan include a list of significant spills occurring during the past 3 years?
®❑ ❑ ❑
# Has the facility evaluated feasible alternatives to current practices?
® ❑ ❑ ❑
# Does the facility provide all necessary secondary containment?
® ❑ ❑ ❑
# Does the Plan include a l3MP summary?
®❑ ❑ ❑
# Does the Plan Include a Spill Prevention and Response Plan (SPRP)?
® ❑ ❑ ❑
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
®❑ ❑ ❑
# Does the facility provide and document Employee Training?
® ❑ ❑ ❑
# Does the Plan include a list of Responsible Party(s)?
IN ❑ ❑ ❑
# Is the Plan reviewed and updated annually?
® ❑ ❑ ❑
# Does the Plan Include a Stormwater Facility Inspection program?
® ❑ ❑ ❑
Has the Stormwater Pollution Prevention Plan been implemented?
®❑ ❑ ❑
Comment No defigency noted
Page 3

NCDENR
EuvinOr.rerrr .r�o N.m�nw Rs�neea
Division of Energy, Mineral and Land Resources
Land Quality Section 1 Stormwater Permitting Program
National Pollutant Discharge Elimination System (NPDES)
PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
Use this form if there has been
FOR AGENCY USE ONLY
Date Received
Year
Monih Day
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation
What does "legally responsible individual" mean9
The person is either
• the responsible corporate officer (for a corporation),
• the principle executive officer or ranking elected official (for a municipality, statRECI VE bhc
rj
agency), 1V�
• the general partner or proprietor (for a partnership or sole proprietorship), OCT 02 2014
• or, the duly authorized representative of one of the above
DENR LAND QUALITY
1) Enter the permit number for which this change in Legally Responsible IndivATW(M0 pEAfAj1IM4gn")
applies
Individual Permit
N I C, F S 0 1 5 1 0 1 3 1 5 1 0
2) Facility In€ormation
Facility name
Company/Owner Organization
Facility address
(or) Certificate of Coverage
N I C I G
Imaflex USA Inc
1200 Unity St
Address
Thomasville, NC 27360
City State Zip
To find the current legally responsible person associated with your permit, go to this website
hup //portal nedenr orgiwebllrlsw-permit-contacts and run the Permit Contact Summary Report
3) OLD OWNER AFFILIATION that should be removed
Previous legally responsible individual John T Hayes
rj rst M I Last
4) NEW OWNER AFFILIATION (legally responsible for the permit)
Person legally responsible for this permit
Macklin L Hess
First MI Last
SWU OWNERAFRL 25Juty2014
Pagel of 2

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
S) Reason for this change
A result of
If other please explain
. . . ... . .......
Panting Manager _
TitlL
1200 Unity St
Mailing Address
Thomasville
NC 27360
City
State Zip
[phone]
lamarr hess(ihiriaflexusa com
Telephone
E-mail Address
[phone]
Fax Number
X Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
The certification below must be completed and signed by the permit holder
PERMITTEE CERTIFICATION
1, josepb Abbandanato, attest that this application for this change in Owner Affiliation (person legally
responsible for the permit) has been reviewed and is accurate and complete to the best of my knowledge I
understand that if all re re s of this form are not completed, this change may not be processed
-- 2�
Signature Date
PLEASE SEND THE COMPLETED FORM TO
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call 919-707-9220 or visit the website at
httn //portal ncdenr or26veb/Ir/stoLm water
Page 2 of 2
SwU4YME iAFFlt.25JuiyM4

�1�gyp, �
NW
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakdd, P E
Govemor Director
March 5, 2013
Imaflex Inc
Attn Mr Dan Jones, Operations Mgr
1200 Unity Street
Thomasville, NC 27360
Subject Compliance Evaluation Inspection
Certificate of Coverage #NCGO54350
Imaflex USA Inc
Davidson County
Dear Mr Jones
John E Skvarla, III
Secretary
On February 14, 2013, Jenifer Carter, of the Division of Water Quality, performed a stormwater inspection at
Imaflex USA Incorporated, located on Unity Street in Thomasville, North Carolina You were present during the
inspection The following observations and/or permit conditions were noted during the inspection
• A Stormwater Pollution Prevention Plan (SPPP) has been developed in accordance with the permit
➢ Document any needed changes to the SPPP, or lack thereof, annually
➢ Staff training needs to be documented annually
• Vehicle maintenance is not performed onsite, so no analytical monitoring is required
• Qualitative monitoring has been conducted at all outfalls, and recorded in accordance with the permit Make sure
this monitoring is performed during a rain event, as defined in the permit
The Division greatly appreciates your efforts to maintain compliance Should you have any questions, please contact
Jenifer Carter at [phone]
Sincerely,
W Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc CWSRO-Files
John Hennessy —NPS-ACO Unit
SWP — Central Files
Nord► Carolina Division of Water Qualdy Winston-Salem Regional office
Location 585 Waughtown Street Winston Salem NC 27107
Phone (336) T71 50001 Fax [phone] ti Customer Service 1 877-623-6748
Internet http //portal nodenr orghveblwq
None Carolina
pUMMIly
An Equal Opportunity i Affirmative Action Employer

o�0F W ALI 9q BLvetly Eaves Perdue. Govemor
— Dee Freeman Secret try
VJ North Carolina Department of Environment and Natural Resources
0 .� Coleen M Sullins Director
Division of Water Quality
January 28, 2009
CERTIFIED MAIL #7008 0150 0002 7876 8263
RETURN RECEIPT REQUESTED ' 1100
i0v x 31
Mr CLLP�Bu`tler �J0 neS
Imaflex USA Inc
1200 Unity Street
Thomasville, NC 27360
Subject NOTICE OF VIOLATION and
RECOMMENDATION FOR ENFORCEMENT
Certificate of Coverage #NCG050350
Imaflex USA Inc
Davidson County
Dear Mr Butler
On January 15, 2009, Jenifer Carter, from the Winston-Salem Regional Office of the Division of Water
Quality, attempted to perform a stormwater inspection at Imaflex USA Incorporated, located on Unity
Street in Thomasville, North Carolina The site drains to Beaverdam Creek, Class WS-IV waters located
in the Yadkin -Pee Dee River Basin The site visit and file review revealed that the site is covered by
NPDES General Permit — NCGO20206
You failed to appear for the inspection as scheduled, though Mr Sammy Thomas, maintenance, walked
the perimeter of the site with me He was not prepared, however, to discuss the permit and it
requirements You later admitted on the phone that you were also not familiar with the permit You
agreed to review the permit and it's requirements, as well as guidance documents provided to you A
meeting was scheduled at the Winston-Salem Regional Office (WSRO) for January 23, 2009, to answer
questions about the permit requirements Mr Marls Myers was sent in you place, though he had not had a
chance to review the permit It was his understanding that he would probably be tasked with
understanding and implementing the permit requirements, so it was recommended that he review the
permit and online guidance, and to schedule another meeting should he still have questions
The following observations and/or permit conditions violations were noted during the inspection
• A Stormwater Pollution Prevention Plan (SPPP) has not been developed in accordance with the permit
(Part II Section A)
• Qualitative monitoring has not been conducted and recorded in accordance with the permit (Part It
Section D)
continued on reverse
(Inc
North Carolina Division of Water Quality 585 Waughtown Street Winston Salem NC 27107 Phone [phone] NQithcarolina
Customer Service 1 877 623 6748 Internet www ncwaterquality org I ax (336) 7714630 ;/VatumIllf
An Equal Opportunity/Affirmative Action Employer — 50%Recycled/10%Post Consumer Paper

Requested Response, due within 15 business days of receipt of this letter
• Please describe your failure to create a site -specific SPPP, as well as your failure to perform
qualitative monitoring
• Complete and submit an SPPP before April 1, 2009 Your permit describes what is required to be
included in the SPPP A copy of the permit and the Division's SPPP Guidance Document for
Industrial Sites can be found on the Internet at http 1lh2o enr state nc us/su/Forms— Documents htm
(see `NCG080000' for related permit info, and the guidance can be found at the bottom of the page)
• Begin qualitative monitoring immediately, using the form provided at the along with the permit It
can also be found at the abovementioned website
Thank you for your attention to this matter This Office is considering sending a recommendation for
enforcement regarding these issues Your above -mentioned response to this correspondence will be
considered in this process This office requires that the violations, as detailed above, be abated
immediately These violations and any future violations are subject to a civil penalty assessment of
up to $25,000 00 per day for each violation Should you have any questions regarding these matters,
please contact Jenifer Carter at [phone]
Sincerely,
Steve W Tedder
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc WSRO Files
John Hennessy — NPS-ACO Unit
SWP — Central Files

Michael F Easley, Governor
William G Ross Jr Secretary
North Carolina Department of Environma,nt and Natural Resources
Alan W Klimek, P E Director
Division of Water Quality
September 29, 2006
Mr Gary Olem
Imaflex USA Inc
1200 Unity Street
Thomasville, North Carolina 27360
Subject General Permit No NCG050000
Imaflex USA Inc
COC No NCG050350
Davidson County
Dear Mr Olem
In accordance with your application for a discharge permit received on June 8, 2006, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state —
NPDES general permit This permit is issued pursuant to the requirements of North Carolina General
Statute 143-215 I and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated May 9, 1994 (or as subsequently amended)
If any parts, measurement frequencies, or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual
permit application Unless such demand is made, this certificate of coverage shall be final and binding
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 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
Division of Land Resources, Coastal Area Management Act or any other federal or local governmental
permit that may be required
With respect to your question concerning adding a second, new facility to this permit, the new
facility, once completed, will have to apply for a separate permit If you have any questions concerning
this permit, please contact Bill Diuguid at telephone number [phone] ext 382
Sincerely, �.
GRbC:i NAL SIGNED BY
BRADLEY 9BNNBTT
Alan W Klimek, P E
cc Winston-Salem Regional Office
Central Files
Stormwater Permitting Unit Files)
Attachments
NNao Carolina
turally
North Carolina Division or Water Quality 1617 Mail Service Center Raleigh NC 27699 1617 Phone [phone]
Internet www ncwaterguality ore Location 512 N Salisbury St Raleigh NC 27604 Fax [phone]
An Equal opportunity/Affirmative Action Employer— 5001. Recycted/10'/o Post Consumer Paper
Customer Service
1 877-623-6748

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO NCGO50000
CERTIFICATE OF COVERAGE No NCGO50350
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,
Imaflex USA Inc
is hereby authorized to discharge stormwater from a facility located at
Imaflex USA Inc
1200 Unity Street
Thomasville
Davidson County
to receiving waters designated as Hanks Branch to Hunst Fork Creek, a class C, to the Yadkan-Pee Dee River Basin,
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1,1I, III,
IV, V and VI of General Permit No NCG050000, as attached
This Certificate of Coverage shall become effective September 29, 2006
This Certificate of Coverage shall remain in effect for the duration of the General Permit
Signed this day September 29, 2006
CnrCr.NAL-rG.Ni_D ICY
BRADLEY BENIgEI T
Alan W Klimek, P E Director
Division of Water Quality
By Authority of the Environmental Management Commission

Re [Fwd �Maflex USA Inc NOI]
Subject Re [Fwd Imaflex USA Inc NOI]
From Steve Mauney <Steve Mauney@ncmail net>
Date Fn, 30 Jun 2006 09 19 25 -0400
To Corey Basinger <Corey Basinger@ncmaii net>, Bill Diuguid@ncmail net
BILL -As the facility has a consultant working on their SWPPP I suggest we issue the COC now We
will plan to get around to them in the next 2 or 3 years for a compliance inspection Let me know if you
have any other issues on this item
Steve Mauney
NC DENR Winston-Salem Regional office
Division of Water Quality, Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27107
Voice [phone]
Main # [phone]
FAX [phone]
On 6/20/2006 9 00 AM, Corey Basinger wrote
Steve,
Please review and comment back to Bill
ThanW
Corey
-------- Original Message --------
Subject Imaflex USA Inc NOI
Date Mon, 19 Jun 2006 11 32 59 -0400
From Bill Diuguid <bill diuguid ci,ncmail net>
To Corey Basinger <Corey Basinger@ncmail net>
Corey Basinger, Winston Regional Office
Please either review the attached application yourself or pass this information on to the appropriate
person for approval In addition to the table below, I've also attached a scanned copy of the NOI for
review
COC ## Facility [Location City
NCG050350 Imaflex USA Inc 1200 Unity Street Thomasville
If you need any more info, give me a call If you could respond by 7/19/2006, I'd appreciate it, so I
can issue their COC
Thanks
of 2 9/26/2006 9 00 AM

r
r
RL [Fwd Imaflex USA Inc NO[]
William H Diuguid, AICP
Community Planner, Wetlands and Stormwater Branch
Division of Water Quality
Department of Environment and Natural Resources
1617 Mail Service Center
Raleigh North Carolina 27699-1617
Phone [phone] ex 382
Fax [phone]
Corey Basinger
Corey Basinger@NCmail net
NC DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
Fax [phone]
Steve Mauney <Steve MauneypNCmail net>
WSRO
NC DENR
2 of 2 9/26/2006 9 00 AM

Markers
Name NCG050350 - Imaflex USA, Inc
Short Name 050350
Coordinates 0350 53' 37 69" N, 0800 03' 38 71 W
Comment Imaflex USA Inc, Hanks Branch to Hunts Fork Creek to Yadkin -Pee Dee River
Basin, Davidson County Quad High Point West H1-TF-024, Sub -basin 03-07-07,
Class C,Stream 12-119-7-3-1

N }^
�&6 [Fwd •maflex USA Inc N411
Subject Re [Fwd Irnaflex USA Inc NOI]
From Steve Mauney <Steve Mauney@ncmail net>
Date Fri, 30 Jun 2006 09 19 25 -0400
To Corey Basinger <Corey Basinger@ncmail net>, Bill Diuguid@ncmail net
BILL -As the facility has a consultant working on their SWPPP I suggest we issue the COC now We
will plan to get around to them in the next 2 or 3 years for a compliance inspection Let me know if you
have any other issues on this item
Steve Mauney
NC DENR Winston-Salem Regional Office
Division of Water Quality, Water Quality Section
585 Waughtown Street
Winston-Salem, NC 27103
Voice [phone]
Main # [phone]
FAX [phone]
On 6/20/2006 9 00 AM, Corey Basinger wrote
Steve,
Please review and comment back to Bill
Thanks'
Corey
------- Original Message --------
Subject Imaflex USA Inc NOI
Date Mon, 19 Jun 2006 11 32 59 -0400
From Bill Diuguid <bill diuguidnncrnail net>
To Corey Basinger <Corey Basinger@ncmail net>
Corey Basinger, Winston Regional Office
Please either review the attached application yourself or pass this information on to the appropriate
person for approval In addition to the table below, I've also attached a scanned copy of the NOI
for review
ICOC # ,lFaciltty Location I�City
INCGO50350 Imaflex USA Inc 1200 Unity Street IlThomasville
I i
If you need any more info, give me a call If you could respond by 7/19/2006, I'd appreciate it, so I
can issue their COC
Thanks
I of 2 6/30/2006 9 54 AM

Re Twd Imaflex USA Inc NOIj
William H Diuguid, AICP
Community Planner, Wetlands and Stormwater Branch
Division of Water Quality
Department of Environment and Natural Resources
1617 Mail Service Center
Raleigh North Carolina 27699-1617
Phone [phone], ex 382
Fax [phone]
Corey Basinger
Corey Basinger@NCznail net
NC�DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
Fax [phone]
Steve Mauney <Steve Mauncy a NCrnail net>
WSRO
NC DEN
2 of 2 6/30/2006 9 54 AM

May 26, 2006
NCDINR
Division of Water Quality
Stormwater and General Permits Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Subject Notice of Intent — NPDES General Permit NCGO50000
Imat]ex USA Inc. Facility
1200 Unity Street
Thomasville, Davidson County, North Carolina
Dear Gentlemen
On behalf of Imaflex USA Inc, Blue Ridge Gea ftwal Services, Inc. prepared the attached Notice of Intent
NPDES application for coverage under General Permit No NCGO50000 Please contact the undersigned at
336-431-5454 if you have any questions concerning this application or need additional information
Sincerely,
5 � 44'1�
Jeffrey L Gerlock, L G
NC Licensed Geologist #1141
Attachments — Notice of Intent Application, Figure I - USGS Site Location Map, Check
Cc Paula Nygard, Imaflex
Blue Ridge Geological Services, Inc - 107 Oakley Court, Archdale, NC 27263 - Phone/Fax 33643 I-5454

,Nirr�L�i�ra
,A,LVT1l?,%Fj
NCQENR
mo" GaAaa.a. ovrwnor or
t ..P.~ n "L+ flaw.9 =
Division of Water Quality / Water Quahty Section
National Pollutant Discharge Elimination System
NCG050000
FOR AGENCY USE ONLY
Pate Received
Year
MmNh I
Dav
Cer ficate M Coverage
check / Amaunt
O Dp
Permit A l to
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 Finished Products Made from Fabrics and Similar Materials
SIC 265 Paperboard Containers and Boxes
SIC 267 Converted Paper and Paperboard Products
SIC 27 Printing, Publishing and Allied Industries
SIC 30 Rubber and Miscellaneous Products (except as specified below)
SIC 31 Leather and Leather Products (except as specified below)
SIC 39 Miscellaneous Manufacturing Industries
The following activities are specifically excluded from coverage under this General Permit
SIC 301 Tires and Inner Tubes
SIC 311 Leather Tanning and Finishing
1) Mailing address of ownorloperator-
!Name
Street Address
City
Telephone No
2) Location of facility producing discharge
Facility Name -T na--rfe+ v
Facility Contact
Street Address
City
County
Telephone No 331, _
3) Physical Location Information
' Standard Industrial Classification Code
(Please print or type)
'Address to which all permit correspondence will be mated
Z)taie N C- LIt- Ulue CA /, kv
Please provide a narrative description of how to get to the facility (use street names state road nuf �'bers and
distance and direction from a roadway intersection) xt' Blot; (�'n Tg"., Z)) erl.
SLE 65, &o wsf & hik1i Arm __ A,44(� O � ,m•' /be+ern�t 1XI,
(A copy of a county map or USGS quad sheet vath faafity clearly bcated on tho map Is required to be subrqdlod with t ap lcui
4) This NPDES Permit Application applies to which of the following 1,, A rift �r.sttt�
�j New or Proposed Facility Date operation is to begin 0Gf ;too
Pagel of 3
SWU-220-101701

NCGOS0000 N O 1
❑ Existing
5) Standard Industrial Classrf+cation
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code 2 - 7 3
b) Provide a brief narrative description of thgQ types pf rndus"l activities an prodgc manufa tured at
this facility S.n•i 7'�� r mays aolW_7�
7) Discharge points I Receiving waters
How many discharge points (ditches, pipes, channels, etc ) convey stormwater from the property?
What is the name of the body or bodies of water ( reek stye m, river, lake etc that the facility stormwater
discharges end up in? r a n r L_ , "!- ,�
If the site stormwater discharges to a separate stormmwer system name the operator of the parate storm
sewer system (e g City of Raleigh municipal storm sewer) a.✓� j
8) Does this facility have any other NPDES permits?
IR No
❑ Yes
If yes list the permit numbers for all current NPDES permits for this facility
9) 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 _
101 Does this facility, employ any best management practices for stormwater control?
❑ No
® Yes �/ f
If yes please txiefly describe
11) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
® Yes
If yes, when was it implemented? -z,,, pw a r c' -7,V
12) Are vehicle maintenance activrfies occurring at this facility?
® No ❑ Yes
13) Hazardous Waste
a) Is this facility a Hazardous Waste Treatment, Storage or Disposal Facility?
0 No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg of hazardous waste generated per month) of
hazardous waste?
W No ❑ Yes
Page 2 of 3
SWU-220-101701

NCG050000 N 01
c) Is this facility a Large Quantity Generator (1000 kg or more of hazardous waste generated per month) of
hazardous waste
0 No © Yes
d) If you answered yes to questions b or c , please provide the following information
Type(s) of waste
How is material stored
Where is matenal stored
Now many disposal shipments per year
Name of transport f disposal vendor-_
Vendor address-
14) Certification
North Carolina General Statute 143-215 6 b (i) provides that
Any person who knowingly makes any false statement representation or certifitabon in any appilcatron record report plan or
other dmument filed or required to be maintained under Artsele 21 or regulations of the Environmental Manageineni
Commission implementing Brat Article or who faisifies tampers with or knowingty renders inaccurate any recording or
monitoring device or method required to be operated or maamtamod under Amide 21 of regulafons of the Environmental
Managament Commission implernerittng that Article shall be guilty of a ahtsdemearror punishable by a fine not to exceed
$10 000 or by imprisonment not to exceed six months or by both (18 U S C section 1001 provides a punrslunerd by a fine of
not more man $10 000 or imprisonment not more than 5 years or both for a similar oltense )
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
i
Notice of Intent must be accompanied by a check or money order for $80 00 made payable to
NCDENR
Final Checklist
This application will be returned as incomplete unless all of the following items have been included
® Check for $80 made payable to NCDENR
! 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
5tormwater and General Permits Unit
Division of Water Quality
1617 Mail Service Center
Raleigh North Carolina 27699-1617
Page 3 of 3
5 W U-220-101701

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Site Location Map
Imanex USA Inc
REF Microsoft Tmwerver - USGS High Point West NC Quadrangle Map 1200 Unity Street
dated1969 photorevtsed 1987 Thomasville, North Carolina
Project Na 759 1 Fgure l

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Markers
Name NCGO50350 - lmaflex USA, Inc
Short Name 050350
Coordinates 0350 53' 37 69" N, 0800 03 38 71" W
Comment lmaflex USA Inc Hanks Branch to Hunts Fork Creek to Yadkin -Pee Dee River
Basin, Davidson County Quad High Point West H1-TF-024, Sub -basin 03-07-07
Class C Stream 12-119-7-3-1