NCG180258_Application_20191223

NCC -t CM) 25S
FOR AGENCY USE ONLY
Date Received
Year Month Day
Division of Energy, Mineral, and Land Resources 2-AA rt. to
Land Quality Section Certificate of Covera e
e Elimination System N C ck t 8o s Amount
18 M.�C�
National Pollutant Discharge Y Check# Aun
Environmental 5€,&1 Z * ‘oO
Quality Permit Assigned to
NCG180000 S. 5Ace1G1aM01
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General ftswit
NCG180000: CE6V
STORMWATER DISCHARGES associated with activities classified as: n,�('' n
SIC*25 Furniture and Fixtures, and SIC 2434 Wood Kitchen Cabinets, w 3 � �`�
And, Like activities deemed by DEMLR to be similar in the process, or the exposur�B N ER pQCipt/Y
materials, products, by-products, or waste materials. R'14/7 ZINC
*Standard Industrial Classification Code
(Please print or type)
1) Mailing address of owner/operator(address to which official permit correspondence will be mailed):
Name
Street Address /00 `' �/11<- g�
✓�
City � IaV$ Y� /t State n ZIP Code
Telephone No. ( 6 3 C-V4 oo A //6 Fax: (1z ] G�, 5-- /333
E-mail address //
2) Location of facility producing discharg :
Facility Name cd
Facility Contact 0-2: �`'1�
Street Address /00 C4' /A J' 51A)
City ✓__ State AZ ZIP Code 2-7gro
County tYain
Telephone No. (V 2_ ) C3 s'- 449© X// Fax: ( g) 135--J333
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).
(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 Longitude (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin
Existing
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code)that describes the primary industrial
activity at this facility
SIC Code: 0 9 3
7) Provide a briefrjm�rrative description of the types of industrial activities anfl products man factured at
this facility:_ /KeCoV*--.1 /2(a</ <s5/n cr.,-d(• roc-/i4 /%1
/ ,n �.►'✓OUS rr .p.e _�
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NCG180000 N.O.I.
8) Discharge points/ Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property?
List discharge points (outfalls)that convey discharge from the site (both on-site and off-site) and location
coordinates. Attach additional sheets if necessary, or note that this information is specified on the site plan.
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No. 2-
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No. 3
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): _W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
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? (i(.a- - ,,i e_tvf
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).
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NCG180000 N.O.I.
10) Does this facility have any other water quality permits?
No
❑ Yes
If yes, list the permit numbers for all current water quality permits for this facility:
11) Does this facility have any Non-Discharge permits (ex: recycle permit ? ,/� 40.4X No
y�
( 11e
nr /�
❑ Yes Nc, I J E o s-
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
No
❑ Yes
If yes, please briefly describe:
13) Does this facility have a Stormwater Pollution Prevention Plan?
No
❑ Yes
If yes, when was it implemented?
14) Are vehicle maintenance activities occurring at this facility?
No ❑ Yes
15) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
No ❑ Yes
c) Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste generated per month)of
hazardous waste?
No ❑ Yes
d) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport/disposal vendor:
Vendor address:
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NCG180000 N.O.I.
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 Article 21 or regulations of the Environmental •
Management Commission implementing that Article, or who falsifies, tampers with or knowingly renders inaccurate
any recording or monitoring device or method required to be operated or maintained under Article 21 or regulations of
the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor 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 punishment by a fine of not more than$10,000 or imprisonment not more than 5 years,or both,for a similar
offense.)
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 o erson igni : r � CiL
qG�'/
Title: Y`t Sf
�l _ *Zi#,/2
(Signature of,;: .•1111°- i
Notice of Intent -t be accompanied by a check or money order for$100.00 made payable to:
NCDEQ.
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SWU-233-82814 Last revised 8/28/14

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Owner: CLOUDGATE INDUSTRIES LLC Acreage: 10.29
Mailing Address: 9 POPLAR FOREST RD Fire District: CITY OF TAYLORSVILLE
FAIRVIEW,NC 28730 Structure Value: 306917
Physical Address: 100 5TH AVE SW Land Value: 201450
Misc Value: 41149
Parcel ID: 0008797 Fair Market Value 549516
PIN: 3759453561 Tax Value: 549516
Deed Reference: 0614 2210 Account#: 9341485
Alexander County
assumes no legal responsibility
for the
Alexander County contained on information
n this map.

NCG180000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included.
Please do not ask us to hold an incomplete application in anticipation of a check under separate cover.
❑ Check for$100 made payable to NCDEQ
❑ This completed application, signed by the owner/operator, and all supporting documents
❑ Copy of county map or USGS quad sheet with the location of the facility clearly marked on the map
Mail the entire package to:
DEMLR- Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Please note: The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
To visit our website, go to http://portal.ncdenr.org/web/lr/storm water
DEMLR Regional Office Contact Information:
Asheville Office [phone]
Fayetteville Office [phone]
Mooresville Office [phone]
Raleigh Office [phone] ' .*\4°
ttotlisi ° -,
Washington Office ...[phone]
�"Y s
Wilmington Office [phone] '
Winston-Salem [phone] FAY °
Central Office [phone] ,
Wih ngte n
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SWU-233-82814 Last revised 8/28/14

North Carolina Secretary of State Search Results Page 1 of 2
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online •
Add Entity to My Email Notification List • View Filings • Print a Pre-Populated Annual Report form • Print
an Amended a Annual Report form
Business Corporation
Legal Name
Gateway Recycling, Inc.
Information
Sosld: 1557611
Status: Current-Active
Annual Report Status: Current
Citizenship: Domestic
Date Formed: 12/1/2016
Fiscal Month: December
Registered Agent: Lubbe, Jacob
Addresses
Mailing Principal Office Reg Office
100 5th Avenue SW 100 5th Avenue SW 9 Poplar Forest Road
Taylorsville, NC 28681 Taylorsville, NC 28681 Fairview, NC 28730-7625
Reg Mailing
9 Poplar Forest Road
Fairview, NC 28730-7625
Officers
President
Jacob D Lubbe
9 Poplar Forest Rd
Fairview NC 28730
Stock
https://www.sosnc.gov/online_services/search/Business_Registration_Results 12/27/2019

North Carolina Secretary of State Search Results Page 2 of 2
Class: Common
Shares: 10000
No Par Value: Yes
https://www.sosnc.gov/online_services/searchBusiness_Registration_Results 12/27/2019