NCG030725_NOI_20220217

FOR AGENCY USE ONLY
NCG03 Q I I- S
Assigned to:
ARO FRO RO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG030000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC 335 [Rolling, Drawing, and Extruding of Nonferrous Metals], SIC 3398 [Metal Heat
Treating], SIC34 [Fabricated Metal Products], SIC35 [Industrial and Commercial Machinery], SIC 36[Electronk
and Other Electrical Equipment], SIC 37[Transportation Equipment], and SIC 38 [Measuring, Analyzing, and
Controlling Instruments]. 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:
General Motors LLC
Ronald Kennedy
Street address:
City:
State:
Zip Code:
4540 Fortune Avenue
Concord
NC
28027
Telephone number:
Email address:
810-853-8921
[e-mail]
TypeOwnership:
� )
W�
ROOM)
Government
OCounty ©Federal E3Municipal OState
�EB i Q �P2
Non -government
13 Business (If ownership is business, a copy of NCSOS report
must be inumowbutfOation)
I' Individual
STORMWATPR PERMITTING
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
General Motors Plant 9
Cynette Cavaliere
Street address:
City:
State:
Zip Code:
4540 Fortune Avenue
Concord
NC
28027
Parcel Identification Number (P(N):
County:
Cabarrus
Telephone number:
Email address:
585-747-2279
[e-mail]
4-digit SIC code:
Facility is:
Date operation is to begin or began:
3711
© New 0 Proposed El Existing
4/1/2021
Latitude of entrance:
Longitude of entrance:
35025'40.4"N
80039'04.6"W
Brief description of the types of industrial activities and products manufactured at this facility:
Vehicle assembly including fueling and equipment washing.
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
O N/A
Page 1 of 5

3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Street address:
City:
State:
Zip Code:
Telephone number:
Email address:
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
Irish Buffalo Creek
C
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35°25'40.6"
80°38'55.9"
Brief description of the industrial activities that drain to this outfall:
Fuel Filling, Vehicle Storage
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:
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:
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:
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:
All outfalls must be listed and at least one outfall is required. Additional outfalls may be added in the section
"Additional Outfalis" found on the last page of this NOI.
Page 2 of 5

S. 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:
O This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
Storm Pond, Aboveground Diesel Tank Fuel Fill Procedures, Aboveground Tank Management Procedures
❑ This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
To be developed
❑ This facility stores hazardous waste in the 100-year floociplain.
If checked, describe how the area is protected from flooding:
O 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 100 kg
misc automotive fluids
How material is stored:
Where material is stored:
drums
building interior
Number of waste shipments per year:
Name of transport/disposal vendor:
estimating 1 drum every other year
to be determined
Transport/disposal vendor EPA ID:
Vendor address:
to be determined
n/a
❑ 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 (if applicable)
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
O 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 143-215.6E (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:
O 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.
I7 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.
O I will abide by all conditions of the NCG030000 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.
O I hereby request coverage under the NCG030000 General Permit.
Printed Name of Applicant: Ronald Kennedy
Title: Sr.
ad ,6 g j,u,cy14 / -/� - '� ?-
(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:
3-4 digit identifier:
Name of receiving water:
Classification:
❑ This water is impaired.
❑ This watershed has a TMDL
Latitude of outfali:
Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
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:
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:
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:
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:
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:
Page 5 of 5

0�r r j-7 � LIMITED LIABILITY COMPANY ANNUAL REPORT
v
��.
mrzov
NAME OF LIMITED LIABILITY COMPANY. General Motors LLC:
SECRETARY OF STATE ID NUMBER: 1120318 STATE OF FORMATION: DE
REPORT FOR THE CALENDAR YEAR: 2021
SECTION A:
1. NAME OF REGISTERED AGENT: Corporation Service Company
2. SIGNATURE OF THE NEW REGISTERED AGENT:
- Filed Annual
120318
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
E
2626
Glenwood Avenue,
2626
Glenwood Avenue„ Suite 550
Raleigh,
NC 27608 Wake County
Raleigh,
NC 27608
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Manufacture and Sales Of motor vehicles
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
300 Renaissance Center
Detroit, MI 48265
5. PRINCIPAL OFFICE MAILING ADDRESS
300 Renaissance Center
Detroit, MI 48265
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: Mark L Reuss
NAME: Paul Jacobson
WNT1l14
TITLE: Manager TITLE: Manager TITLE:
ADDRESS:
ADDRESS:
300 Renaissance Center 300 Renaissance Center
Detroit, MI 48265
Detroit, MI 48265
ADDRESS:
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Mark L Reuss 4/11/2021
SIGNATURE
Form must be signed by a Company Official listed under Section C of This form.
Mark L Reuss 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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