NCGNE0657_COMPLETE FILE - HISTORICAL_20170213

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
1% HISTORICAL FILE
DOC DATE
❑ d a 1 3
YYYYM M DD

Energy, Mineral &
Land Resources
ENVIRONMENTAL DUALITY
Mr. Jeffrey J. Newman
Generics Bidco lI
3241 Woodpark Blvd.
Charlotte, NC 28206 o,
-&19,ect
- Dear Mr, Newman:
February 13, 2017
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
Name/Ownership Change Request
No Exposure Certification NCGNE0657
Generics Bidco I1, dba Prinston
Laboratories
Formerly Qualitest Pharmaceuticals
Mecklenburg County
The Division has reviewed your submittal of the permit name/ownership change form for the
subject No -Exposure Certification. Division personnel have reviewed and approved your
request to transfer the exclusion from NPDES stormwater permitting requirements.
Please note that by our original acceptance of the No -Exposure Certification and by our
approval of your request to transfer it, you are obligated to maintain no -exposure conditions
at your facility. If conditions change such that your facility can no longer qualify for the no -
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for
your stormwater discharge. Otherwise. the discharge becomes subject to enforcement as an
un-permitted discharge.
Annual re -certification is required, and we have enclosed one blank Annual No Exposure
Exclusion Self Re -Certification form for your use. Your certification of no exposure does
not affect your facility's legal requirements to obtain environmental permits that may be
required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sin �ti�iAL SIGNED BY
BETHANY GEORGOULIAS
for Tracy E. Davis; P.E.; CPM, Director
Division of Energy, Mineral and Land
cc: Mooresville Regional Office
Mecklenburg County DEP
Stormwater Permitting Program
Nothing Cornpares--.-
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
512 N. Salisbury Street 1 1612 Mail Service Center I Raleigh, North Carolina 27699-1612
919 707 9200

P ri nston
Labcratori—s
Dear Sir or Madam,
3241 • 3700 • 3801 Woodpark Blvd.
Charlotte, NC 28206
On January 4 2017 Generics Bidco II dba Qualitest Pharmaceuticals was purchased by Prinston Pharmaceuticals
and will now be operating as Generics Bidco II dba Prinston Laboratories. I spoke with Marcia Allocco from the
Mooresville office who was very helpful with the proper forms. Please contact me if additional information is
required.
Jeff Newman
Facilities
Prinston Laboratories, 3801 Woodpark Blvd, Charlotte, NC 28206
704.612.8867
JNewman(dPrinstonPharm.com
E
rinsfnbor,9.1 �aP
RECEIVED
JAN 25 2B17
DENR-LAND QUALITY
STORM`d,IATER PERMITTING

Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
National Pollutant Discharge Elimination System
NCDENR
PERMIT NAME/OWNERSHIP CHANGE FORM
EHVIRCNNCMT up NVSIAL IiClOUNtC!
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N; G S 10 1616 1 ' 0 I N 1C I G E-1 01 b 5 rl
11. Permit status prior to requested change. a. Permit issued to (company name): �,q
�es�- &,,rr• e, 1.5
b. Person legally responsible for permit: j ---+-krY 6rr---_
First MI - Last
Title
Permit Holder Mailing Address
City State Zip
Phone hh Fax
c. Facility name (discharge): c>tt,.xli'Fp;1 0KA,1VV,,t:�ji;14
d. Facility address: Wco 'P"" h (btu
Address
CIofl�: 0, C. 28266
City State Zip
e. Facility contact person: le- Iel I MCM�� {'1-Sly) ���- 91
First 1 MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: Change in ownership of the facility
Name change of the facility or owner
!f other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge)
e. Facility address:
f. Facility contact person:
First h4I Last
1 °+'tom -C � 4 14%
Title
e mit Holder Mailing Address
Chi, to w__ 12 (-- _ 2820
City State Zip
(?6q )677-3%r S�,
Pltone E-mail Address
32 It Q ✓
Address
- aNk laft�f= A), 6, jl
City `` State Zip
First Mt Last
Phone E-mail Address
oriel
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan, 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2 \\
Fi t MI Last
rt cs
Title
Mail' Address
N �h� 10'1 tom— . 6 � Zg-w
City State pzip
(�al 6l2 g16`7 S�ulthar�t iK;vtcovA,,rto
Permit contact:
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
Yes
No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
......................................................................................................................
The certifications below must be completed and signed by froth the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package wilt be
returned as incomplete.
Signature
APPLICANT CERTIFICATION
Date
I, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned a� incomplete.
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
. COr%_
Revised Jan. 27. 2014

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALIT'f
Division of Energy, i'lineral and Land Resources
Land Quality Section — StorniNvater Permitting
National Pollutant Discharge Elimination System
ANNUAL NO EXPOSURE EXCLUSION SELF RE -CERTIFICATION
NIQGNE0000
Do not submit this form to DEMLR unless requested.
For questions, please contact the DEMLR Regional Office for your area or the Central Office.
(Please print or type)
Facility's No Exposure Exclusion No. Date Completed (MM/DD/YYYY)
N C G N E 0 6 5 7 0 7/ O 1 1/ 2 0 6
1) Has the facility name or owner changed? ❑ Yes ® No
(if yes, please submit a separate Name/Ownership Change Form to DEMLR located at:
httl):ildeci. nc.gov/about/divisions/enerov-rn ineral-land-resources/energv-mineral-land-f)ermits/sto.rmwater-permits/npdes-
industrial-sw )
2) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable
future? (Please check either "Yes" or "No.") If you answer "Yes" to any of these items, you are not
eligible to maintain your no exposure exclusion, and must immediately apply for a permit from DEMLR.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes ® No
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes ® No
c. Materials or products from past industrial activity ❑ Yes ® No
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes ® No
e. Materials or products during loadinglunloading or transporting activities ❑ Yes ® No
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ® No
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes ® No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ® No
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes ® No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes ® No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ® No
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
1. Empty containers that previously contained materials that are not properly stored ❑ Yes ® No
(i.e., not closed and stored upside down to prevent precipitation accumulation)
Page 1 of 3
5WU-NESR-Wav2016

WRITTEN CONSENT OF THE SOLE i4IE11 BER
OF
C;FNr,RICS BIDCO 11, LLC
.IANUARY 11, 2017
i
']'he undersigned, constituting the sole mcntbet (the "Sole Member-") of Generics Bidco_II; LLC:, a
Delaware limited liability company (the "Corn am"}, hereby waives till notice of time: place or purpose
of' a meeting and consent to, approve and adopt the following resolutions pursuant -to the Defa.vare
Limited Liability Company Act and direct that this Written Consent of the Sole Member (this "Consent")
be filed with tire minutes ofthe proceedings of the Cornpany.
APPoI1-rN1ENT OF \`Ifs\ CE11.
WHEREAS. in connection with the Sole WrnbeCs acquisition of Al isstmed and outstanding
mcn7bership interests of the Company pursuant to that certain Membership Interest and AssetPurchase,
Agreement dated as of October 31. 2016 by and among. Generics International (US), Inc. (--Generics
Vintage Pharmaceuticals: L.LC and the Sole>Nlember, Generics US resigned as the sole manager! of
the Company, !
VIFIIEIZI,AS, pursuant to Section 10 of the Amended and Restated Limited Liability Company
Agreement of the Company. the Sole Member may elect one or more individuals or entities to manage the
Company;
WHEREAS, the Sole Member desires to elect Prinston Pharmaceutical Inc. as manager:ol'
the Company.
NOW, THEREFORE, BE IT RTSOLVED; that effective as of the date hereof. Pri.nston.
Phartj1aceutical lire. (the "Manager") be. and hereby is. elected as the sole manager of tfre Company to
serve until a successor is duly elected and qualified.
TRAim =VA:rtF; Ftt.INGS.
WflF.REAS, the Company desires to conduct business under a trade name and to. file tire:
appropriate applications to register the trade name with any, state, -territory•or dependency of the Unit :d
,States or anv foreign country in which it is necessary or expedient for the Cornpany to triinsactbusiness
using tr trade name. ;
,NOW. THERFFORF, BF -IT Ri° SOLVED. that fdr the purpose of authorizing tire Company io
do business under a trade name in anv'state . territory or dependency of tile: United States or any foreign
country in which it is necessary or expedient for the Company -to transact business using"a trade name, the
Sole ,\,,Iernbcr hereby autho6zes the Sole,lMernber or the Manager to make and file all applications,
cetlificates. reports and other instrurttents as may.be.required or appropriate tender the laws of such state,
territory: dependency or cauntrV. to authorize the Company to transact business under a trade,name
therein arid, whenever it is expedient for the Company to cease doing business therein tinder a trade name,
to file such. certificates. reports, and other instruments as may be required to cancel the trade name in aniv
such state.,terriiory. dependency or: country, taut if in connection With the foregoing!sny particular form cif
resolution shall be.reclutred, such resolution,shall be deemed hereby adopted, provided that a copy ofsitch
resolution shall be inserted in the minute boot: of tire Company following. this Coirsent and that the Sole
-Member is.authorized to certify: such resolution as having been adopted. by this Consent,
f
i

GrNE:I2AL RESOLUTIONS.
NOW, THEREFORE, ICE IT RESOLVED, that Sole- 1%-fember and the Manager of] the"
Company,. be and hereby is, authorized, empowered and directed to door cause to -be done any and all
such acts and things, and to -execute and deliver, or cause to be executed and delivered, all agreements,.
instruments, documents and certificates (including anv and all amendments or supplements thereto,
modifications: extensions or waivers thereof, or rePlaccrnents), in each casein the name and on behalf of
the Company. as the Sole Member or the Manager decnis necessary, appropriate or desirable to effcct the.
intent.and accomplish the purposes of these resolutions: and be it
FURTHER RESOLVED. that the execution and delivery by the Sole Member or the Manager
of any agreement. instrument. certificate or other dncttmt:nt. and the taking of Any other action in
connection with any of these resolutions: shall evidence the Sole Member's or the Manager's approval
and aulhoritys and the -approval, adoption, authorization. ratificatian and confirmation by the Sole Member
and by the Company: and be it
F'URTIIER RLSOLVED, that all agreerents. instruments, certificates .and other docum ms
executed and delivered and all other actions taken by the Sole Nlember or the Manager in connection % ith
any of the foregoing matters prior or subsequent to the date of these resolutions are approved, ad6oted;
authorized: ratified and confirmed in all respects.
ISIGtiATURE PAGE F'OLLOWSI
0
R,L;3�aaxoat7�. i

IN WITNrSS wjIrREOF; the undersigned lias.caused this Cons�iit°to be duly exectatcd.as ©t
the day and year set forth above_
SOLI: Ii'iEMMR:
PRINSTON PHARMACEUTIC =AL INC.
1
e
Bf
NameJun Du.
Title: Chie1'Executive Officer
I5y1 t�ad3�3�8,1

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor F
Di Secretary
-ram
Jeff Green, Plant Manager
ALI
RMe 19, 2010
Qualitest Pharmaceuticals, Inc. �°co
i
3241 Woodpark Blvd. �, o
Charlotte; NC 28206 -Su
U �a No Exposure Certification NCGNE0657
%i l l Qualitest Pharmaceuticals, Inc.
:�L_ NVoodpark Blvd.
_� ':Charlotte, NC 28206
Dear Mr. Green:
The.Division has reviewed your submittal of the No -Exposure Certification form for Exclusion
from -NPDES Stormwater Permitting. Based on your submittal and signed certification of no exposure
at the above referenced facility, and the site visit on 02/09/2010. the Division is granting your
conditional exclusion from permitting as provided for under 40 CFR 126.22(g), which is incorporated by
reference in North Carolina regulations_
Please note that by our acceptance of your no -exposure certification; you are obligated to
maintain no -exposure conditions at your facility. If conditions change such that your facility can no
longer qualify for no -exposure exclusion, you are obligated to immediately obtain NPDES permit
coverage for your stormwater discharge. Otherwise, the discharge becomes subject to enforcement as an
un-permitted discharge. Your conditional no -exposure exclusion expires in five years (February 19,
2015). At that time you must re -certify with the Division; or obtain NPDES permit coverage for any
stormwater discharges from your facility.
Your conditional exclusion from permitting does not affect your facility's legal requirements to
obtain environmental permits that may be required under other federal; state, or local regulations or
ordinances.
If you have any questions or need further information; please contact Mr. Samar Bou-Ghazale at
[phone].
Sincerely,
Robert B. Krebs
Surface Water Protection Regional Supervisor
CC:Stormwater Permitting Unit No -Exposure Files
Fran McPherson -Budget Office
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville. NC 28115
Phone: [phone] Fax: [phone] Customer Service: 1-877-623.674E North Carolina
Internet: www.ncwater ualit .or ; 7afllrally
. - .- .. .... ­­_ c ; oo „nlo ifiroL Pncff i cilmef naOB�

NCDENR
F,i.�n�.ewrs� Iwo �.tew caaa..a�es
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000
NO EXPOSURE CERTIFICATION
Am-fco-bov,- k mg-0
�S
FOR AGFNCY USE ONLY
Date Received
Year A4onth
bay
Ctsdficate of Coverage
Please check here if this is a renewal: ❑ RENEWAL
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit based
on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notification that your facility does not require a
permit for stormwater discharges associated with industrial activity in the State of North Carolina because
it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means all
industrial materials and activities are protected by a storm resistant shelter (with some exceptions) to
prevent exposure to rain, snow, snowmell, and/or runoff.
For permitted facilities in North Carolina, DWQ must approve your application for No
Exposure Certification before this exclusion is effective. Until you are issued a No
Exposure Certification and your NPDES permit is rescinded, your facility must continue
to abide by the terms and conditions of the current permit.
Industrial materials or activities include, but are not limited to: material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste products.
Material handling activities include the storage, loading and unloading, transportation, or conveyance of
any raw material, intermediate product, final product or waste product. A storm resistant shelter is not
required for the following industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed, provided those containers are not deteriorated and do not leak. "Sealed" means
banded or otherwise secured and with locked or non -operational taps or valves; adequately maintained
vehicles used in material handling; and final products, other than products that would be mobilized in
stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In
addition, the exclusion from NPDES permitting is available on a facility -wide basis only —not for individual
outfalls. if any industrial activities or materials are, or will be, exposed to precipitation, the facility is not
eligible for the no exposure exclusion. By signing and submitting this No Exposure Certification form, you
certify that a condition of no exposure exists at this facility or site and are obligated to comply with the
terms and conditions of 40 CFR 122.26(g).
You are required to reapply for the No Exposure Exclusion once every five 5 ears.
For questions, please contact the DWQ Regional Office for your area. (See page aAj r? i, t'
(Please print or type)
1) Mailing address of owner/operator
Name Quaiitest Pharmaceuticals. Inc.
Contact Jeff Green
Street Address 3241 Woodpark Blvd.
r.Ifu Charlotte
Telephone No 704
( r4 5 —
596-0515
, f q� O/ 60 Page 1 of 7
State Nc
Fax:
will
ZIP Code 213206
596-6237
stl�!
5WU-NE-021309 Last revised 2/1312009

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Qualitest Pharmaceuticals, Inc.
Facility Contact Jeff Green
Street Address 3241 Woodpark Blvd,
City Charlotte State NC ZIP Code 28206
County Mecklenburg
Telephone No, 704 596-0516 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). East to Woodpark Blvd. - Facility located at 3241 Wood park Road
East to Woodpark Blvd. - Facility located at 3241 Woodpark Road
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes M No
5) Is this a Federal facility? El Yes I4 No
6) Latitude 35° 16' 13.95" N Longitude 800 49' 25.82" W (deg., rain., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
14 Existing Date operation began
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? 19 Yes ❑ No
If yes, what is the NPDES Permit Number? NCGO60000Applied for
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: d S 3
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Formulating, mixing, coating of generic pharmaceutical drugs
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:
Page 2 of 7
SWu-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
Exposure Checklists (12. - 14.)
12) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable
future? (Please check either "Yes" or "No.") If you answer "Yes" to any of these items, you are not
eligible for the no exposure exclusion.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes Ri No ❑, N/A
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spillsAeaks ❑ Yes 8 No ❑ NIA
c. Materials or products from past industrial activity ❑ Yes 9 No ❑ NIA
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes 19 No ❑ N/A
e. Materials or products during loading/unloading or transporting activities ❑ Yes A No ❑ N/A
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ® No ❑ N/A
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums; barrels, tanks, ❑ Yes B No ❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ® No ❑ N/A
the discharger
1. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes A No ❑ N/A
j. Application or disposal of process wastewater (unless otherwise permitted) . ❑ Yes ® No ❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes !I No ❑ N/A
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes N No ❑ N/A
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes A No ❑ N/A
stored outside, has the facility had any releases in the past three (3) years?
13) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or ❑ Yes ❑ No R N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? if so, is it free of any ❑ Yes ❑ No ®NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
14) Secondary Containment: If you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for single above ground storage containers
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored
-in close proximity to each -other with a combined. capacity -of -more -than 1,320-
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40
CFR §116?
e. Are release valves on all secondary containment structures locked?
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator.(less than 1000 kg. of hazardous waste
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: s0fvent Waste D001, P003
How is material stored: 55 gallon closed head steel drums
Where is material stored: 90 day accumulation room - internal/contained
How many disposal shipments per year: Approximately 23
Name of transport / disposal vendor: Unitar USA / Pollution control Millington
Vendor address: 5485 Victory Lane, Millington, TIN 38053
Footnotes to Questions 14) c. & d.
❑ Yes ❑ No IN NIA
❑ Yes ❑ No B NIA
❑ Yes ❑ No I@ NIA
❑ Yes ❑ No L& NIA
❑ Yes ❑ No ® NIA
❑ Yes IN No © NIA
❑ Yes 10 No ❑ NIA
® Yes ❑ No ❑ NIA
'Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for de minimis amounts of certain substances,
and/or other qualifiers, as described in the exemptions from reporting requirements of Title III SARA 313 in 40 CFR
§372.38.
"'Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for amounts less than the Reportable Quantities
of the hazardous substances listed in 40 CFR §117.3.
Page 4 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
16) Other information: If you answer "Yes" to any of the following items, you might not be eligible for the
no exposure exclusion. A more in-depth evaluation of the site circumstances may be required.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? ❑ Yes ® No ❑ NIA
b. Does your facility have coal piles on site?
❑ Yes IN No ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes IN No ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., IN Yes ❑ No ❑ NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? l@ Yes ❑ No ❑ NIA
Please speCify: Regislered Facility in Mecklenburg County
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: �1 C 0 d a G' 6 7 8 9 2 7 Program: r, (_f7 L= 6q n 4T
Permit: jy l Program: k." 4e.- 7r}COary�
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit:. , Program:
Page 5 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
17) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no
exposure" and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that there are. no_discharges.of.stormwater contaminatedby exposure to industrial activities
or materials from the industrial facility or site identified in this document (except as allowed under 40 CFR 122.26(g)(2)).
I understand that I am obligated to submit a.no exposure certification form once every_five (5) years to the North Carolina
Division of Water Quality and, it requested, to the operator of the local municipal separate storm sewer system (MSG) into
which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief trice, accurate and complete. I am aware
that there are significant penalties for submitting false information, Including the possibility of fine and imprisonment for
knowing violations.
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: J e f- Frw L e - G--re- evi
Title: P i a %+ 01 a o a er
' iC 7 -C 7
(Signature ofAWlicant) (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 13(1) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, retard, 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 mater al 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 thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SW U-NE-02t 309 Last revised 2!13/2009

Division of Water Quality / Surface Water
1
Protection Section
National Pollutant Discharge Elimination System
Y ✓ts, �awWDEN.-W
FMY��V✓F: T 414) i4lAY �F3,::3=: S
NCG060000
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year Month
Dar
24C,
CerdScate of coveratre
Check #
1 Amount
-10 5
Pester A-ierted to
,,
National Pollutant Discharge Elimination System application for coverage under General Permit
NC G 060000:
STORMWATER DISCHARGES associated with activities classified as:
SIC (Standard Industrial Classification)'20 Food and Kindred Products
SIC 21 Tobacco Products
SIC 283 Drugs
SIC 284 Soaps, Detergents, & Cleaning Preparations; Perfumes, Cosmetics, & Other Toilet Preparations
SIC 422 Public Warehousing and Storage (except 4226)
For questions, please contact the DWO Regional Office for your area. See page 4.
1
(Please print or type)
1) Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name - Qualitest Phaimaceut}cats, Inc.
Street Address 3241 Woodpark Blvd.
City
charlotte
Telephone No.
704 596-0516
2) Location of facility producing discharge:
Facility Name
Qualitest Pharmaceuticals, Inc.
Facility Contact
Jaff Green
Street Address
3241 Woodpark Blvd.
City
Charlotte
County
Mecklenburg
Telephone No.
704 596-0516
Email
[e-mail]
3) Physical Location Information:
State NC ZIP Code 28206
Fax: .[phone]
State NC ZIP Code 28206
Fax: [phone]
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). 1-85 N to Statesville Avenue, East to Jeff Adams Drive, North to Starita Road,
East to Woodpark Blvd. - Facility located at 3241 Woodpark
(A copy of a county map or USGS quad sheet with the facility clearly located must be submitted with this application.)
4) Latitude 350 16' 13.95"N Longitude Bfla 49' 25.82- W (deg, min, sec) � �i
5) This NPDES Permit Application applies to which of the following: �
❑ New or Proposed Facility Date operation is to begin 2 6 2�09
® Existing QC�
Page 1 of 4
S W U-221-07140B
revised 7114/07

NCG060000 N.O.I.
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: A Q 3 Li----�- - - - - _ _
7) Provide a brief narrative description -of -the -types of industrial activities and -products manufactured at
this facility: Formulation, mixing, coating of generic pharmaceutical drugs
8) Discharge points 1 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 (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Tributary to Irwin creek
Receiving water classification: c
Is this a 303(d) listed stream? Yes Has a TMDL been approved for this watershed? No
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). cilyolcharlotte
9) Does this facility have any other NPDES permits?
® No.
❑ Yes
If yes, list the permit numbers for all current NPDFS permits for this facility:
10) Does this facility have any Non -Discharge permits (ex: recycle permit)?
0 No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
11) Does this facility employ any best management practices for stormwater control?
® No
❑ Yes (Show any structural BMPs on the site diagram.)
If yes, please briefly describe:
12) Does this facility have a Stormwater Pollution Prevention Plan?
® No
❑ Yes
If yes, when was it implemented?
13) Are vehicle maintenance activities occurring at this facility?
® No ❑ Yes
14) 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 ❑ Yes
Page 2 of 4
5WU-221-071406 Last revised 7114107

NCG060000 N.O.I.
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
❑ No ® Yes
d) Is hazardous waste stored in the 100-year flood plain?
® 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: solvent waste o001, F003
Flow is material stored: 55 gallon closed head steel drums
Where is material stored: 90 day accumulation room - lntemaltcontalned
Now many disposal shipments per year: Approximately 23
Name of transport i disposal vendor: Unlvar USA I Pollution control Millington
Vendor address: 5485 Victory Lane, Millington, TN 3Bo53
15) Certification:
North Carolina General Statute 143-215.613 (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report,
plan, or other document fled or required to be maintained under this Article or a rule implementing this Anicle; 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 shalt be guilty of a Class 2
misdemeanor which may include a fine not to exceed ten thousand 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: je Ff~ry L. ce Cttr-,/-ieeh
Title: - 1� F__ M1err
DCA ZP� — /0—/ 7
(Signatur o piicant) (Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable to:
NCDENR
Page 3 of 4
SWU-221-071403 Last revised 7/14107

am
:L
,-_
QUALITEST PHARMACEUTICALS
3241 WOOEPARK AVENUE
CHARLOTTE, NORTH CAROLINA
SHIELD #1030075-04
DATE : 09/28/09 1 DRAWN BY: RBS

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Latitude: 35116'16" �0006�3� sFacility
Longitude: 80049'25"
County Mecklenburg Qualitest Pharmaceutics Location
Stream Class: C Charlotte NC `w
Receiving Stream: UT to Irwin Creek
Sub -basin: 03-08-34 (Catawba Basin) NOT ICAILE®
Stream Index: 11-137-1

11200 r-Aallard Crossing Dr; Charlotte, NC 28262 to 3241 Woodpark Blvd, Charlotte, NC... Page 2 of 2
Driving directions to 3241 Woodpark Blvd, Charlotte, NC 28206
(A�
11200 Mallard Crossing Dr]
Charlotte, NC 28262
1.
Head southwest on Mallard Crossing Dr toward Wild Duck Ct�
[
0.2 mi
2.
Turn left at Harris Houston_Rd_ 4�
1.1 mi
3.
- --- � �--- - - - - -- -- -- -� _--
at University City d
�-_----_��Q
0.3 mi4.
_
_Turn _right _Blv_
Take the ramp onto I-485 N _ -- -�_
�—_2.7
mi
5.
_--_
Take the exit onto 1-85 S toward Spartanburg
_
j)
7.4 mi
_ _ _ _
Take exit 40 for Graham St
i
0.3 mi
_6.
7.
Turn left at N Graham
0.2_mi
8.
_St _ _ _ _ _ _
Turn right at the 1st cross street onto N I - 85 Sry Rd/Jeff Adams__ Dr v
_Q
_ Q
0.9 mi
9
Take the 3rd left_ onto_S_tarita Rd
0.2_mi
10.
_ _ _j
Take the 1st right onto Woodpark Blvd
0.1 mi
Destination will be on the left
Q3241
Woodpark Blvd
-
Charlotte, NC 28206
These directions are for planning purposes only. You may find that construction projects, traffic, weather, or other events may cause
conditions to differ from the map results, and you should plan your route accordingly. You must obey all signs or notices regarding your
route.
Map data 02010 , Google
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3241 woodpark road, charlotte, n...
http://maps.google.com/
2/8/2010