NCG050452_Application_20201218

1.166-0r-0o�rZ
FOR AGENCY USE ONLY
Date Received
Year Month Day
Division of Energy, Mineral and Land Resources Zak t t
Land Quality Section Certificate ofCoverage
National Pollutant Discharge Elimination System tvICheck# 5lo►mount ��
b � Check# Amount
Environmental 24(05110(563 tot
Quality NCG050000 Permit Assigned to
NOTICE OF INTENT
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG050000:STORMWATER DISCHARGES associated with activities classified as: RECEIVED
SIC' 23 Apparel and Other Finished Products Made from Fabrics and Similar Materials DEC 18 2020
SIC' 265 Paperboard Containers and Boxes
SIC' 267 Converted Paper and Paperboard Products DENR-LAND QUALITY
SIC' 27 Printing, Publishing and Allied Industries STORMWATER PERMITTING
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* N/A Like activities deemed by DEMLR to be similar in the process and/or 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
SIC' 311 Leather Tanning and Finishing
*Standard Industrial Classification Code
(Please print or type)
1) Mailing address of owner/operator(address to which all permit correspondence will be mailed):
Name Richard Jager
Street Address 3725 Faith Road
City Salisbury State NC ZIP Code 28146
Telephone No. 336 517-9085 Fax: n/a
E-mail Address [e-mail]
2) Location of faciiity producing discharge:
Facility Name Intertape Polymer Corp.
Facility Contact Richard Jager
Contact E-mail [e-mail]
Street Address 3725 Faith Road
City Salisbury State NC ZIP Code 28146
County Rowan
Telephone No. 336 517-9085 Fax: n/a
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). From Raleigh: I 26W to 14',5BL S and I-85S to US-52 S in Salisbury. Exit 76
from I-85S
(A copy of a county map or USGS quad sheet with facility clearly located on the map is required with this application)
4) Latitude 35°35'43.08"N Longitude -80°27'46.72"W (degrees, minutes, seconds)
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5) This NPDES Permit Application applies to which of the following :
❑ New or Proposed Facility Date operation is to begin _
I 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: 2 7 5 9
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: Plastic lumber wrap is manufactured at this location.The industrial activities associated exposed to stormwater include
parking lots,the material receiving area,the finished product staging area,and facility waste disposal practices.
8) Discharge points:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 1
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. 1
Latitude (degrees/minutes/seconds): Same as Facility N
Longitude (degrees/minutes/seconds): Same as Facility 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
Stormwater Outfall No.
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
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NCG050000 N.O.I.
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? Tributary of Crane Creek
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).
10) Does this facility have any other NPDES permits?
• No
❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
e No
❑ Yes
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: Good housekeeping,inside storage of ink,covering of materials stored outside other than final product
(Lumber Wrap)and pre-printed wrap which is for outside use anyway.
13) Does this facility have a Stormwater Pollution Prevention Plan?
❑ No
Pi Yes
If yes, when was it implemented? December 2020
14) Are vehicle maintenance activities occurring at this facility?
PI 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?
I 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: n/a
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How is material stored: n/a
Where is material stored: n/a
How many disposal shipments per year: n/a
Name of transport/disposal vendor: n/a
Vendor address: n/a
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 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: Richard Jager
Title: Operations Manager
Z�z
(Signet of ppllc t (Da e Si ne 0
d)
Notice of Intent must be accompanied by a check or money order for$100.00 made payable to NCDEQ.
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Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
❑ Check for$100 made payable to NCDEQ
❑ This completed application and all supporting documents
❑ Copy of county map or USGS quad sheet with location of facility clearly marked on map and nearby waters
Mail the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
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.
DEMLR Regional Office Contact Information:
Asheville Office [phone] ton-Sake r�
Fayetteville Office [phone] ,71- ` t4tal gh ;
Mooresville Office [phone] �. w+ tit`. 0 4 p
Raleigh Office [phone] l �
Washington Office ...[phone] L, la ,„..
Wilmington Office [phone]
Winston-Salem [phone]
l �w
Central Office [phone]
�1 wll ngton
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North Carolina Secretary of State Search Results Page 1 of 1
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Business Corporation
Legal Name
Intertape Polymer Corp.
Information
Sosld: 0279798
Status: Multiple 0
Date Formed: 12/17/1990
Citizenship: Foreign
State of Incorporation: VA
Fiscal Month: December
Annual Report Due Date: April 15th
Registered Agent: Secretary of State
Addresses
Mailing Principal Office
110 E Montee De Liese Montreal, Quebec 110 E Montee De Liese Montreal, Quebec
Canada, XX 00000-0000 Saint Laurent, CA H4T 1N4
Reg Office Reg Mailing
2 South Salisbury Street 2 South Salisbury Street
Raleigh, NC 27601 Raleigh, NC 27601
Officers
Stock
Class: 99 SEE CERT
Shares: 0
Par Value 0
https://www.sosnc.gov/online_services/search/Business_Registration_Results 12/22/2020