NCG060422_Application_20210913

FOR AGENCY USE ONLY
NCG06 0 L�?_
Assigned to: CuftiOr+,%+lid
ARO FRO MRO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG060000 Notice of Intent
This General Permit covers STORMWA TER DISCHARGES associated with activities under the following Standard
industrial Classifications: SIC 20[Food and Kindred Products], SIC21 [Tobacco Products], SIC 283 [Drugs], SIC284
[Soaps, Detergents, & Cleaning Preparations; Perfumes, Cosmetics, & Other Toilet Preparations], SIC 422 [Public
Warehousing and Storage — except for 4226]. You can find information on the DEMLR Stormwater Program at
deq.nc.gov/SW.
Directions: Print or type all entries on this application. Send the original, signed application with all required
items listed in Item (6) below to: NCDEMLR Stormwater Program,1612 MSC, Raleigh, NC 27699-1612. The
submission of this application does not guarantee coverage under the General Permit. Prior to coverage under
this General Permit a site inspection will be conducted.
1. Owner/Operator (to whom all permit correspondence will be mailed):
Name of legal organizational entity: F4 ► -&
Legally responsible person as signed in Item (7) below:
Amazon.com Services LLC - NA Environmental Department
Debora Sanches
Street address:
City:
Fwst)ate:
Zip Code:
PO BOX 80842
Seattle
198108
Telephone number:
Email address:
206-266-1036
[e-mail]
Type of Ownership:
Government
E]County [3Federal OVlunicipal MState
Non -government
[Z]Business (If ownership is business, a copy of NCSOS report must be included with this application)
01ndividual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
Amazon.com Services LLC - CLT6
James Mills
Street address:
City:
State:
INC
Zip Code:
128134
12220 Carolina Logistics Drive
Pineville
Parcel Identification Number (PIN):
County:
205-18-111
Mecklenburg
Telephone number:
Email address:
[phone]
[e-mail]
4-digit SIC code:
1
Facility is:
Date operation is to begin or began:
109/2612021
4225
O New ElProposed ElExisting
Latitude of entrance:
Longitude of entrance:
35.105332
- 80.915338
Brief description of the types of industrial activities and products manufactured at this facility:
General Warehousing facility engaged in the handling, storage, and transportation of merchandise.
This facility processes meat: E3Yes [Z] No
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
❑ N/A City of Charlotte
Page 1 of 5

3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Evan O'Brien
Environmental Resources Management (ERM)
Street address:
City:
State:
Zip Code:
345 Woodcliff Drive, 2nd Floor
Fairport
INY
114450
Telephone number:
Email address:
[phone]
[e-mail]
4. Outfall(s) At least one outfall is required to be eligible for coverage.
3-4 digit identifier:
Name of receiving water:
Classification:
El This water is impaired.
1
001
Sugar Creek
C
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35.099526
-80.912608
Brief description of the industrial activities that drain to this outfall:
Material loading and unloading, shipping and receiving
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? Pl Yes 171 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Less than 55 gallons
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? El Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? n Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? El Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
All outfalls must be listed and at least one outfall is required. Additional outfalls may be added in the section
"Additional Outfalls" found on the last page of this NOL
Page 2 of 5

5. Other Facility Conditions (check all that apply and explain accordingly):
❑ This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
0 This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
Indoor storage, covered dumpsters, inspections, housekeeping, training, preventative maintenance,offsite detention ponds.
0 This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
September 26th, 2021
0 This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
❑ This facility is a (mark all that apply)
0 Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility
If checked, indicate:
Kilograms of waste generated each month:
Type(s) of waste:
Less than 1000 kg
Broken consumer flammable and corrosive products
How material is stored:
Where material is stored:
55 gallon poly drums or 55 gallon steel drums depending on waste
A secured hazardous waste storage area on spill containment pallets inside the warehouse
Number of waste shipments per year:
Name of transport/disposal vendor:
Varies and based entirely on the receiving of damaged products
US Ecology
Transport/disposal vendor EPA ID:
Vendor address:
NCTF00000067
101 S. Capitol Blvd, Suite 1000, Boise, Idaho 83702
❑ This facility is located on a Brownfield or Superfund site
If checked, briefly describe the site conditions
6. Required Items (Application will be returned unless all of the following items have been included):
0 Check for $100 made payable to NCDEQ
0 Copy of most recent Annual Report to the NC Secretary of State
0 This completed application and any supporting documentation
0 A site diagram showing, at a minimum, existing and proposed:
a) outline of drainage areas
b) surface waters
c) stormwater management structures
d) location of stormwater outfalls corresponding to the drainage areas
e) runoff conveyance features
f) areas where industrial process materials are stored
g) impervious areas
h) site property lines
0 Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 3 of 5

7. Applicant Certification:
North Carolina General Statute 143-215.68 (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 ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that:
0 1 am the person responsible for the permitted industrial activity, for satisfying the requirements of this permit, and for any
civil or criminal penalties incurred due to violations of this permit.
0 The information submitted in this N01 is, to the best of my knowledge and belief, true, accurate, and complete based on
my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information.
I] I will abide by all conditions of the NCG060000 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.
IZI I hereby request coverage under the NCGO60000 General Permit.
Printed Name of Applicant: Debora Sanches
Title: Business Environmental Leader
(Signature of Applicant)
(Date Signed]
Mail the entire package to: DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4 of 5

Additional Outfalls
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall•
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? Yes 0 No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Page 5 of 5

` LIMITED LIABILITY COMPANY ANNUAL REPORT
10/2017
NAME OF LIMITED LIABILITY COMPANY: AntaZon.corn Services LL
Filing Office Use Only
SECRETARY OF STATE ID NUMBER: 1938649 STATE OF FORMATION: DE E - Filed Annual
REPORT FOR THE CALENDAR YEAR: 2021 Report
1938649
SECTION A: REGISTERED AGENT'S INFORMATION Changes
1. NAME OF REGISTERED AGENT: Corporation Service Company
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
2626 Glenwood Ave Ste 550
2626 Glenwood Ave Ste 550
Raleigh, NC 27608 Wake County Raleigh, NC 27608
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Fulfillment Center and customer Service holding company
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS
410 Terry Ave N 410 Terry Ave N
Seattle, WA 98109 Seattle, WA 98109
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: MICHAEL D. DEAL NAME: NAME:
TITLE: Manager TITLE: TITLE:
ADDRESS:
410 TERRY AVE N
ADDRESS:
ADDRESS:
SEATTLE, WA 98109
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a persontbusiness entity.
MICHAEL D. DEAL 4/2/2021
SIGNATURE DATE
Form must be signed by a Company Official listed under Section C of This form.
MICHAEL D. DEAL Manager
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

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