NCG081015_NOI_20220217

FOR AGENCY USE ONLY
NCG081 D 15
Assigned to:.__._.A. C/fivON
ARO FRO MRO RRO WARO WiRO (WSR
RECEIVED
Division of Energy, Mineral, and Land Resources Land Quality Seep;
National Pollutant Discharge Elimination System �tttii 2022
NCGO80000 Notice of Intent AMNAND WMI y
3��R�RMf1'FiP10
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC 40 [Railroad Transportation], SIC 42 [Local and Suburban Transit and Interurban
Highway Passenger Transportation], SIC 42 [Motor Freight Transportation and Warehousing — except for SIC
4221-4225], SIC 43 [United States Postal Services], SIC 5171 [Petroleum Bulk Stations and Terminals — when total
petroleum site storage capacity is less than 1 million gallons]. The following activities are also included: other
industrial actives where the vehicle maintenance area(s) ore the only area requiring permitting; stormwater
discharges from oil water separators and/or from secondary containment structures associated with petroleum
storage facilities with less than 1 million gallons of total petroleum site storage capacity. 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:
MGX Equipment Services
Keith Poff
Street address:
City:
State:
Zip Lode:
3760 North Liberty Street
Winston Salem
NC
27105
Telephone number:
Email address:
336.582.7400
[e-mail]
Type of Ownership:
Government
OCounty OFederal OMunicipal OState
Non -government
OBusiness (If ownership is business, a copy of NCSOS report must be included with this application)
Individual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
MGX Equipment Services
Michelle Russell
Street address:
City:
State:
Zip Code:
3760 North Liberty Street
Winston Salem
NC
27105
Parcel Identification Number (PIN):
County:
6837-61-5110
Forsyth
Telephone number:
Email address:
336.582.7400
[e-mail]
4-digit SIC code:
Facility is:
Date operation is to begin or began:
7353
1 E3 New 13 Proposed O Existing
10/1/2021
Latitude of entrance:
Longitude of entrance:
36.1368944
80.2302805
Page 1 of 5

Brief description of the types of industrial activities and products manufactured at this facility:
Construction equipment and crane parts, service, rental, and sale.
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the M54:
❑ N/A City of Winston Salem
3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Ben Conlon
Ramboll
Street address:
City:
State:
Zip Code:
5050 Lincoln Drive, Suite 440, 4th Floor
Edina
MN
55436
Telephone number:
Email address:
507-995-3508
[e-mail]
4. Outfall(s) At least one outfall is required to be eligible for coverage.
3-4 digit identifier:
1
Name of receiving water:
Classification:
❑ This water is impaired.
001
Bowen Branch/Brushy Creek
C
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
36.1370722
80.2313889
Brief description of the industrial activities that drain to this outfall:
Vehicle maintenance, fueling
Do Vehicle Maintenance Activities occur in the drainage area of this outfall?
E]Yes ®No
If yes, how many gallons of new motor oil.areused7eicch month when-averiged'over the calendaryear?
200 gallons
a Y�
3-4 digit identifier:
Name of receiving water:
Classification:. ,..
❑This water is impair'ed,x
❑ This watershed has'a TMDL
Latitude of outfall: ----
longitude of outfall: `
Brief desciiption'of the industrial activities that drain"to this outfall: '
Do Vehicle Maihtenance Activities occur in the'drainagearea'of this outfall? - © Yes ® 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 [3 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 Outfalle 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:
❑ This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
Loading and unloading procedures, visual observation, good housekeeping, employee training
❑ This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
In progress
❑ 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)
❑ Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility—
r.-- If checked, indicate: -
Kilograms of waste generated eac_h.month:
Type(s) of waste:
How material is stored:,*
Where material is stored:
x
Number of -waste shipments'per-yeari -"
Name of transport/disposal vendor:
e
Transport/disposal vendor EPA ID:
Vendor address: s
❑ This facility is located on a Brownfield or Superfund site 0" r
If checked, briefly describe the site conditions
6. Required Items (Application will be returned unless all of the following items have been included):
17
Check for $100 made payable to NCDEQ
O
Copy of most recent Annual Report to the NC Secretary of State
El This completed application and any supporting documentation
O
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:
El 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.
El 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 NCGO80000 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.
El I hereby request coverage under the NCGO80000 General Permit.
Printed Name of Applicant: Keith Poff
Title: Region Vice President MGX Equipment Services, Inc
1 /25/2022
(Signature of Applicant) - k,n _ (Date Signed)
Mail the entire package to: DEMLR Stormwater Program
-Department of Environmental Quality ` €
F 1612 Mail Service Center =l_
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? ❑ Yes ❑ 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 ❑ 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:-'- " "-ELongiltude
ion:— "-
❑ This water is impaired.
t'f
-❑This watershed'ha'sa:TMDL.
Latitude of outfall .,.,, r �' - -
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 ❑ 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 ❑ 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? Dyes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Page 5 of 5

State of North Carolina
Department of the Secretary of State
SOSID: 2270081
Date Filed: 9/16/2021 10:21:00 AM
Elaine F. Marsha&
North Carolina Secretary of State
C2021256 00118
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR LIMITED LIABILITY COMPANY
Pursuant to §57D-7-03 of the General Statutes of North Carolina, the undersigned limited liability company hereby applies for a
Certificate of Authority to transact business in the State of North Carolina, and for that purpose submits the following:
1. The name of the limited liability company is MGX Equipment Services, LLC
and if the limited liability company name is unavailable for use in the State of North Carolina, the name the limited
liability company wishes to use is
2. The state or country under whose laws the limited liability company was formed is Delaware, USA
3. Principal office information (Select either a or b.)
a. 9 The limited liability company has a principal office.
The principal office telephone number: 414-760-4600
The street address and county of the principal office of the limited liability company is:
Number and Street: 11270 W. Park Place, Suite 1000
City: Milwaukee
State: W 1 Zip Code: 53224 County:
Milwaukee
The mailing address, if different from the street address, of the principal office of the corporation is:
Number and Street:
City:
State:_ Zip
b. ❑ The limited liability company does not have a principal office.
County:
4. The name of the registered agent in the State of North Carolina is: Corporation Service Company
5. The street address and county of the registered agent's office in the State of North Carolina is:
Number andStreet:2626 Glenwood Avenue, Suite 550
City: Raleigh State: NC
Zipcode:27608 County: Wake
6. The North Carolina mailing address, if different from the street address, of the registered agent's office in the State of North
Carolina is:
Number and
State: NC
Zip Code: County:
BUSINESS REGISTRATION DIVISION P.O. BOX 29622 RALEIGH, NC 27626-0622
(Revised July 2017) (Form L-09)

APPLICATION FOR CERTIFICATE OF AUTHORITY
Page 2
7. The names, titles, and usual business addresses of the current company officials of the limited liability company are:
(use attachment if necessary) (This document must be signed by a person listed in item 7.)
Name and Title Business Address
Aaron H. Ravenscroft 11270 W. Park Place, Suite 1000, Milwaukee, WI 53224
Thomas L. Doerr, Jr. 11270 W. Park Place, Suite 1000, Milwaukee, WI 53224
Leslie L. Middleton 11270 W. Park Place, Suite 1000, Milwaukee, W153224
David J. Antoniuk 11270 W. Park Place, Suite 1000, Milwaukee, WI 53224
8. Attached is a certificate of existence (or document of similar import), duly authenticated by the secretary of state or other official
having custody of limited liability company records in the state or country of formation. The Certificate of Existence must be
less than six months old. A photocopy of the certification cannot be accepted.
9. If the limited liability company is required to use a fictitious name in order to transact business in this State, a copy of the
resolution of its managers adopting tile fictitiou
10. (Optional): Please provide a business e-mail add Privacy Redaction
The Secretary of State's Office will e-mail the business automatically at the address provided above at no cost w en a ocumen
is fled. The e-mail provided will not be viewable on the website. For more information on why this service is offered, please see
the instructions for this document.
11. This application will be effective upon filing, unless a delayed date and/or time is specified:
This the 9thdayof September 2021
X vipmen(Services, LLC
`\Name of Limit Liability Company
Signature of pany Official
Thomas L. Doerr, Jr.NP & Secretary
Tvpe or print Name and Title
Notes:
1. Filing fee is $250. This document must be filed with the Secretary of State.
BUSINESS REGISTRATION DIVISION P.O. BOX 29622 RALEIGH, NC 27626-0622
(Revised July 2017) (Form L-09)

Delaware Pagel
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY "MGX EQUIPMENT SERVICES, LLC" IS DULY
FORMED UNDER THE LAWS OF THE STATE OF DELAWARE AND IS IN GOOD
STANDING AND HAS A LEGAL EXISTENCE SO FAR AS THE RECORDS OF THIS
OFFICE SHOW, AS OF THE TENTH DAY OF SEPTEMBER, A.D. 2021.
AND I DO HEREBY FURTHER CERTIFY THAT THE SAID "MGX EQUIPMENT
SERVICES, LLC" WAS FORMED ON THE EIGHTEENTH DAY OF MARCH, A.D.
2021.
AND I DO HEREBY FURTHER CERTIFY THAT THE ANNUAL TAXES HAVE BEEN
ASSESSED TO DATE.
5561509 8300 '/�''y
SR# 20213216427 """"�
You may verify this certificate online at corp.delaware.gov/authver.shtml
"�qQ T—
V11"r ". awM.3nn a Sbb
Authentication:204129914
Date: 09-10-21

K. MAP(.1to s.b)
SITE LOCATION
MGX EQUIPMENT SERVICES
0 l.m 2.00B 3760 NORTH LIBERTY STREET
1 i Feel WINSTON-SALEM, FORSYTH, NORTH CAROLINA
FIGURE 1
RAMBOLL US CONSULTING, INC.
A BAMBOU COMPANY

PROPERTY BOUNDARY (APPROXIMATE) SITE LAYOUT FIGURE 2
------- UNDERGROUND STORM WATER PIPING
0 STORM WATER INLET
—� STORM WATER FLOW DIRECTION RAMBOLL US CONSULTING, INC.
® IMPERVIOUS AREA ARna+eaUWMPa
EQUIPMENT AND PARTS STORAGE AREA MGX EQUIPMENT SERVICES
0 60 $760 NORTH LIBERTY STREET
I Fe. WINSTON-SALEM, FORSYiH, NORTH CAROLINA