NCG060423_Application_20210913

FOR AGENCY USE ONLY SEP 012021
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Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG060000 Notice of Intent
This General Permit covers STORMWATER 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:
Legally responsible person as signed in Item (7) below:
Amazon.com Services LLC Det"4cf, J 9f'`
Paul Wilson
Street address:
City:
State:
Zip Code:
PO Box 80842
Seattle
IWA
198108
Telephone number:
Email address:
951-445-7785
[e-mail]
Type of Ownership:
Government
OCounty OFederal OVlunicipal 177IState
Non -government
MBusiness (If ownership is business, a copy of NCSOS report must be included with this application)
0 Individual
2. Industrial Facility (facility being nermitteri)-
Facility name:
Facility environmental contact:
Amazon.com Services LLC — DLT8
Leslie Harris
Street address:
City:
State:
Zip Code:
9817 Old Statesville Rd
Charlotte
INC
128269
Parcel Identification Number (PIN):
County:
02527108, 02503112
Mecklenburg
Telephone number:
Email address:
941-962-1049
[e-mail]
4-digit SIC code:
Facility is:
Date operation is to begin or began:
4225
0 New OProposed ElExisting
9/29/2021
Latitude of entrance:
Longitude of entrance:
35.354778
-80.823050
Brief description of the types of industrial activities and products manufactured at this facility:
Facility serves as a distribution warehouse of consumer goods.
This facility processes meat: II Yes ED No
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
El N/A
Page 1 of 5

3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Parker Cliatt
ERM
Street address:
City:
State:
Zip Code:
300 W Summit Ave, Suite 330
Charlotte
INC
128203
Telephone number:
Email address:
980-297-7273
[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:
❑ This water is impaired.
001
unnamed tributary of Dixon Branch
C
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35.358318
-80.826603
Brief description of the industrial activities that drain to this outfall:
loading/unloading of goods for warehousing; vehicle and equipment fueling, storage, maintenance, and cleaning
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? F-71 Yes n 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? Il 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 El 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 El 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 NOI.
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:
121 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 loading areas, covered dumpsters, inspections, good housekeeping, preventative maintenance, spill prevention, training, detention basin
Q This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
9/29/2021
1:1 This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
Ell 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
Spilled/broken consumer products for retail sale. Waste types vary: typicallyflammables and corrosives.
How material is stored:
Where material is stored:
55 gallon poly drums or 55 gallon steel drums depending on the waste
Secured hazardous waste storage area on spill containment pallets inside warehouse
Number of waste shipments per year:
Name of transport/disposal vendor:
Varies and is 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):
El Check for $100 made payable to NCDEQ
El Copy of most recent Annual Report to the NC Secretary of State
0 This completed application and any supporting documentation
El 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
ED 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 143-215.613 (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 I 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.
ID The information submitted in this NOI 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.
El 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.
ID I hereby request coverage under the NCG060000 General Permit.
Printed Name of Applicant: Paul Wilson
Title: NA Environmental Leader —Last Mile
'i
(Signat re of Applicant) (Date Sig ed)
Mail the entire package to: DEMLR —Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4of5

Additional Outfalls
3-4 digit identifier:
Name of receiving water:
Classification:
710, is water is impaired.
is 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? D 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

r � �` '� LIMITED LIABILITY COMPANY ANNUAL REPORT
roi2ot7
NAME OF LIMITED LIABILITY COMPANY: Amazon.Com Services LLC
SECRETARY OF STATE ID NUMBER: 1938649 STATE OF FORMATION: DE
REPORT FOR THE CALENDAR YEAR: 7n71
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Corporation Service Company
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual
Report
1938649
Changes
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, INC 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
Seattle, WA 98109
410 Terry Ave N
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
TITLE: Manager
ADDRESS:
410 TERRY AVE N
SEATTLE, WA 98109
NAME: NAME:
TITLE: TITLE:
ADDRESS:
ADDRESS:
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business 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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Tod Staiger
To: Parker Cliatt
Subject RE: NC Stormwater NCG060000 Notice of Intent - DLT8
From: McCoy, Suzanne <suzanne.mccoy ncdenr F-ov>
Sent: Wednesday, September 1, 20213:13 PM
To: Parker Cliatt <Parker.Cliatt erm com>
Cc: paulrwil < [e-mail]>
Subject: NC Stormwater NCG060000 Notice of Intent - DLT8
+.Ku i iuiv: i nis email originated from outside of the organization. Do not click links or open attachments unless you recognize the
sender and know the content is safe.
Good afternoon,
I received the Notice of Intent for the Amazon.com facility located at 9817 Old Statesville Rd Charlotte 28269.
However the $100 application fee was not included.
Please let me know the check number to be watching for.
I will hold this application until the check arrives.
Thank you for your attention to this issue.
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
North Carolina Department of Environmental Quality
Physical: 512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
Mailing: 1612 Mail Service Center, Raleigh, NC 27699-1612
Email: Suzanne.mccoy(a�ncdenrgov
Phone: [phone]
Website: http:/Jdeg.nc eov/aboutJdivisionsJenery mineral land resourceslstormwater
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Before printing this email, please consider your budget and the environment.
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your