NCG050406_COMPLETE FILE - HISTORICAL_20121022

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
Iv C� v � y0 (1,2
DOC TYPE
60' HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
0a-'�-
YYYYMMDD

BANK OF AMERICA 12534
1 CORPORATE OFFICES 32-001/1110
PO BOX 5687
. SPARTANBURG, SC 29304 ft+RRk;� 10 / 2 2 / 2 012
Exopack �";rr. y
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PAY TO THE ORDER OF NC DENR -
ONE HUNDRED AND 00/100++++++++++t*.*++++++++_+fir,+t,*;+++*+++++++++++*+++
k,�.:r�'� fir'; °., ��`p��p'� DOLLARS
NC DENR
DIVISION OF WATER QUALITY `
1617 MAIL SERVICE CENTER maw: � ;; ? .���• � y
MEMO RALEIGH NC 27699-1641
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NCDENR National Pollutant Discharge Elimination System
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NCG050000
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
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National Pollutant Discharge Elimination System application for coverage under General Permit
NCGO50000:
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
SIC'
NIA
Like activities deemed by DWQ to be similar in the process andlor the exposure of raw
materials, products, by-products, or waste materials
The following activities are specifically excluded from coverage under this General Permit:
SIC 301 Tires and Inner Tubes l
SIC* 311 Leather Tanning and Finishing
�y_ (N{
Standard Industrial Classification Code
(Please print or type)
1) Mailing address of w erlo erat r (address to which all permit correspondence will be mailed)
Name Exopack,Thomasvllle
Street Address 1308 Blair Street
City Thomasville StateNC ZIP Code 27360
Telephone No. [phone] Fax: [phone]
E-mail Address [e-mail]
2) Location of facility producing discharge: IDENR
Facility Name Exopack, ThomasvilleFacility Contact Jerry QuesinberryCT 6 LOiZ
Contact E-mail [e-mail] Address 1308 Blair Street . WF,TF�lALITY
City Thomasville StateNC ZIP Code 27360 s j& s:�;;�,ate_�tiaY
County Davidson
Telephone No. [phone] 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). 1-85 South to Old Thomasville Rd exit. Turn left on
Old Thomasville Rd. Facility is 1.8 miles on right. Near intersection of Unity St. and Blair St.
Page 1 of 4
SWU-220-071408 Last Revised 7/14/2008

NCGOS0000 N.O.I.
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required with this application)
4) Latitude 36 deg 53 min 44.2062 sec_ Longitude 80 deg 3 min 31.194 sec (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin
X 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: 2673
Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: The facility extrudes plastic film which is then printed and converted into bag
7) Discharge points:
Mow many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 2
8) 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? Drains to holding basins on outfall 1 and 2. Eventually draining into unnamed creek, a
tributary of the Yadkin River.. /14ld-rs IcV jCK , 03 _oq. 07 • JSf,. -z,.,1d,c 1 2 -119-7 3
Gt,T To -.-I ' C_ LA ss C J
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). City of Thomasville out -fall to parking lot surface.
9) Does this facility have any other NPDES permits?
X No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
10) Does this facility have any Non -Discharge permits (ex: recycle permits)?
X 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
X Yes
If yes, please briefly describe: All materials are stored under cover or inside buildings, no floor drains are in
building,
12) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
X Yes
1f yes, when was it implemented?November 17,2003
13) Are vehicle maintenance activities occurring at this facility?
X No ❑ Yes
Page 2 of 4
SWU-220-071408 Last Revised 7/14/2008

NCG050000 N.O.I.
14) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
X No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
❑ No X Yes
d) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:Waste Water Based Ink, Solvent & Solvent Based inks, Waste Adhesives
How is material stored:Totes and steel drums, in a covered, walled area, with concrete floor and diked all around.
Where is material stored:West side of building
How many disposal shipments per year:Approx 15 shipments per year
Name of transport / disposal vendor: Southeastern Chemical and Solvent Company
Vendor address:755 Industrial Road Sumter,SC 29151
15) 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 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).
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: %JeorrLA
Title: E14'-) G." SKh',U)AAIv MenJi6 >`
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(SVature of ptic nt) (Date Sighed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to NCDENR.
Page 3 of 4
SWU-220-071408 Last Revised 7/14/2008

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Copyright (C) 1998, Maptech, Inc,

NCG050000 N.O.I.
Final Checklist
This application will be retumed as incomplete unless all of the following items have been included:
X Check for $100 made payable to NCDENR
X This completed application and all supporting documents
X Copy of county map or USGS quad sheet with location of facility clearly marked on map and nearby waters
Mail the entire package to:
Stormwater and General Permits 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 DWQ Central Office or Regional Office for your area.
DWQ_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 ......... [phone]
Page 4 of 4
SWU-220-071408 Last Revised 7/1412008

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