NCGNE1271_Rescission Request_20210125

• FOR AGENCY USE ONLY N f .11 -
Division of Energy, Mineral & Land Resources Date Received Land Quality Section/Stormwater Permitting Program Year Month oay
Ervirurrmenfaal National Pollutant Discharge Elimination System
Quality RESCISSION REQUEST FORM
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N C S N C I G
N I E 1 1 2 7 1
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name Amazon.com.dedc LLC- UNC1
Facility Contact Debora Sanches
Street Address P.O. Box 80842
City Seattle State WA ZIP Code 98108
County _ King E-mail Address
Telephone No. 510-541-5774 dbrsnch @amazon com
Fax:
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
® Facility closed or is closing on 12/31/2020 All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
❑ Facility sold to on . If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
❑ Other:
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complete and accurate. n
Signature
_Debora Sanches
Print or type name of person signing above
Please return this completed rescission request form to:
Revised 20187an10
Date - 1 5 /2/
Business Environmental Leader
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612

Energy, Mhwal
and LandResources
ENVIRONMENTAL QUALITY
June 01, 2018
Amazon.com.dedc, LLC
Attention: Derek Jones
Attention: Lance Jones
345 Boren Avenue North
Seattle, Washington 98109
Subject: No -Exposure Certification NCGNE1271
Amazon.com.dedc, LLC — UNC1
300 Dalton Avenue
Charlotte, North Carolina 28206
Dear Mr. Jones,
le
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
WILLIAM E. (TOBY) VINSON, JR.
Interim Director
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 inspection dated May 31, 2018, the Division is granting your conditional exclusion
from permitting as provided for under 40 CFR 122.26(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 a No -
Exposure exclusion, you are obligated to immediately obtain NPDES pen -nit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an unpermitted discharge.
You must self re -certify your No -Exposure status annually and the form can be downloaded by visiting:
http://portal.ncdenr.org/web/lr/npdes-stormwater the web page for the Division of Energy, Mineral and Land
Resources Stormwater Program. The annual self re -certification does not need to be submitted to DEMLR
unless requested. A copy should be maintained in your file.
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.
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
Mooresville Regional office 1 610 East Center Ave Ste 301 1 Mooresville, NC 28113
704 663 1699 T

Amazon.com.dedc, LLC
NCGNE1271
June 01, 2018
Page 2 of 2
If you have any questions or need further information, please contact Angela Lee at [phone], or
at angela.leet'&.ncdenr.,ov.
Sincerely,
Zahid S. Khan, CPM, CPESC, CPSW Q
Regional Engineer
Land Quality Section
Enclosure: Inspection Report
cc: Annette Lucas, Stormwater Permitting Program, No- Exposure Files NCGNE1271

11
Com. aliance Inspection Report
Permit: NCGNE1271 Effective: Expiration: Owner: Amazon Com Dedc LLC
SOC: Effective: Expiration: Facility: Amazon.com.dedc, LLC - UNC1
County: Mecklenburg 300 Dalton Ave
Region: Mooresville
Charlotte NC 28206
Contact Person: Israel Burch Title: Phone: [phone]
Directions to Facility:
take exit 3 B off hwy 277 on w 12th st and continue until it ends at n graham st (it 49) and turn right, in 1/4 mile turn right onto dalton
avenue, in another 114 mile the facility is on your left.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(a):
On -Site Representative(s):
Related Permits:
Inspection Date: 05/31/2018 Entry Time: 11:30AM Exit Time: 12:00PM
Primary Inspector: Angela Y Lee Phone. [phone]
Secondary lnspector(s):
Reason for Inspection: Other Inspection Type: Technical Assistance
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ❑ Compliant ® Not Compliant
Question Areas:
X Miscellaneous Questions 11 Misc
(See attachment summary)
Page: 1

Permit: NCGNE1271 Owner- Facility: Amazon Cam Oedc LLC
Inspection Date: 05/31/2018 inspection
Type, Technical Assistance Reason for VIsR: Other
Inspection Summary:
The site was inspected due to a request for a No Exposure certification. Per the inspection, it is found that the site qualifies
for the No Exposure Certification.
Page: 2

permit NCGNE1271 Owner - Facility: AmazOnCOMDedcLLC
Inspection Date: 05/31/2018 Inspection Type: Technical Assistance Reason for Visit Other
Misc
Is the facility compliant?
Comment:
Yet No NA NE
❑❑❑■
Page: 3

DocuSign Envelope ID: 1858B8CA-147E-4240.AEF1-F5314722AF6C
PRIME NOW LLC JAN 2s
DELEGATION OF AUTHORITY
(Boese, Nickens, Wilson, Vijaykumar, Sanches) A
I, Scott Lescher, being the duly elected, qualified and acting Vice President and Secretary of Prime Now
LLC (the "Company"), and having been authorized by resolutions duly adopted by the Board of the
Company, do hereby sub -delegate my authority as follows:
DELEGATION OF AUTHORITY
1. Effective September 10, 2020, authority is hereby delegated to Michael Boese, Amber Nickens,
Paul Wilson, Vimal Vijaykumar, and Debora Sanches ("Authorized Representatives") to act on
behalf of the Company and in its name and place to execute and file environmental and permitting
applications, and related documents with government authorities. This Delegation of Authority
shall not include any authority to commit spend on behalf of the Company.
SUBDELEGATION
2. The Authorized Representatives are not authorized to subdelegate the authority granted to them
in this delegation.
TERM OF DELEGATION
3. The authority delegated hereby shall terminate upon the earlier of: (i) when revoked by the
Company, the undersigned, any successor in responsibility to the undersigned, or any person to
whom the undersigned reports; or (ii) immediately upon the cessation of the Authorized
Representative's employment by Amazon.com, Inc. ("Amazon"), the Company, and Amazon's
affiliates.
4. The authority delegated herein shall remain in full force and effect until terminated in accordance
with Section 3 of this Delegation of Authority regardless of the appointment status of the
undersigned with the Company.
DATED: September 10, 2020
rsocuSigned by:
ce{ (,c.sc�t it
Scott Lescher
Vice President, and Secretary