NCG060416_Application_20210204

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Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
Environmental NCG060000
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NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
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National Pollutant Discharge Elimination System application for coverage under General Permit -
NCG060000:
STORMWATER DISCHARGES associated with activities classified as:
Fat)
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 DEMLR Regional Office for your area. See page 4.
Do Not use this NOI for renewals.
(Please print or type)
1) Mailing address of owner/operator (address to which all permit correspondence will be mailed):
Name Kimbra Parker, Safety Manager
Street Address 18200 Highway 41 North
City Evansville State IN ZIP Code 47725
Telephone No. 812 4990609 Fax:
2) Location of facility producing discharge:
Facility Name
Facility Contact
Facility Address
Facility City
Facility County
Telephone No.
Email
Ameriqual Aseptic
Jeff Rummage
131 Wright Way
Troy State NC ZIP Code 27371
Montgomery
910 8600007 Fax:
[e-mail]
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). Just of NC-24/NC-27 and intersection of Wright Way
(A copy of a county map or USGS quad sheet with the facility clearly located must be submitted with this application.)
4) Latitude
Longitude,
5) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility
❑✓ Existing
(deg, min, sec)
Date operation is to begin
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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: 2 0 3 2
7) Activities
a) Provide a brief narrative description of the types of industrial activities and products manufactured
at this facility: Production of low acid aseptic alternative and protein beverages.
b) Check all activities occurring at this facility:
❑ use or process meats ❑ use or process animal fats/byproducts
8) Discharge points / Receiving waters:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 1 ddib..l fBv1ewnee°
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Smith Branch to Rocky Creek
Receiving water classification: c
Is this a 303(d) listed stream? no 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).
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.
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. only
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Stormwater Outfall No. only
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
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NCG060000 N.O.I.
9) Does this facility have any other NPDES permits?
11 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 permit)?
11 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?
11 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?
11 No
❑ Yes
If yes, when was it implemented?
13) Are vehicle maintenance activities occurring at this facility?
❑ No 0 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?
0 No ❑ Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
11 No ❑ Yes
d) Is hazardous waste stored in the 100-year flood plain?
INNo ❑ 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:
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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NCG060000 N.O.I.
15) Certification:
North Carolina General Statute 143-215.6E (1) 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 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: Kimbra Parker
Title: Safety Manager
2/1/2021
(Signatur6 of Applicant) (Date Signed)
This Notice of Intent must be accompanied by a check or money order for $100.00, made payable
to: NCDEQ. Do not send the check or money order separately.
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NCG060000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
El Check for $100 made payable to NCDEQ. Must be included with this application (not sent separately).
This completed application and all supporting documents.
❑ A site diagram showing, at a minimum, (existing or proposed):
(a) outline of drainage areas, (b) stormwater management structures, (c) location of stormwater outfalls
corresponding to the drainage areas, (d) runoff conveyance features, (e) areas where materials are stored,
/ loaded, and unloaded, (f) impervious areas, (g) site property lines.
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
Note
The submission of this document does not guarantee coverage under the General Permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR 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]
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SWU-221 Last revised 6/24/14

North Carolina Secretary of State Search Results Page 1 of 1
• 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
Limited Liability Company
Legal Name
Ameriqual Aseptic, LLC
Information
Sosld: 1860851
Status: Current -Active O
Date Formed: 6/27/2019
Citizenship: Foreign
State of Incorporation: DE
Annual Report Due Date: April 15th
Registered Agent: NC Corporate Connection, Inc.
Addresses
Reg Office
176 Mine Lake Court, Ste. 100
Raleigh, NC 27615
Principal Office
18200 Highway 41 N
Evansville, IN 47725
Company Officials
Reg Mailing Mailing
176 Mine Lake Court, Ste. 100 18200 Highway 41 N
Raleigh, NC 27615 Evansville, IN 47725
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Chief Executive Officer Manager President
Jon Geisler Sandra Rasche Dennis Straub
18200 Highway 41 N 18200 Highway 41 N 18200 Highway 41 N
Evansville IN 47725 Evansville IN 47725 Evansville IN 47725
https://www.sosnc.gov/online_services/search/Business_Registration_Results 2/8/2021