NCG060430_Application_20220512

FOR AGENCY USE ONLY
NCG06 ID 4 3 Q d /
Assigned to: ClY 80A
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Division of Energy, Mineral, and Land Resources Land Quality S�-LAND QUALITY
National Pollutant Discharge Elimination System ATERPLtkldlI ZING
NCG060000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classfcations: SIC20 [Food and Kindred Products], SIC21 [Tobacco Products], SIC283 [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 assigned in Item (7) below:
Amazon.com Services LLC
Paul Wilson
Street address:
City:
State:
Zip Code:
PO Box 80842
Seattle
WA
98108
Telephone number:
Email address:
[phone]
[e-mail]
Type of Ownership:
Government
❑County ❑Federal DAunicipal ❑State
Non -government
E Business (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:
Amazon.com Services LLC - SNC3
Paul Wilson
Street address:
City:
State:
Zip Code:
125 National Way
Durham
NC
27703
Parcel Identification Number (PIN):
County:
226305
Durham
Telephone number:
Email address:
[phone]
[e-mail]
4-digit SIC code:
Facility is:
1
Date operation is to begin or began:
4225
❑ New Il Proposed ❑ Existing
13 July 2022
Latitude of entrance:
Longitude of entrance:
35.90746830243775
-78.84447057344138
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: ❑ Yes El No
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
❑+ N/A
Page 1 of 5

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3, CDnadtant.(if uviicable).
Name of consultant:
Consulting firm:
Parker Cliatt
ERM
Street address:
City:
State:
Zip Code:
300 W Summit Ave #330
Charlotte
NC
28208
Telephone number:
Email address:
704-5.41,8345
parker.cliattQamazon.cam
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
ISfirrup Iron Creek
C;NSW
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35.909564
-78.841300
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? ❑ Yes ❑ 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.
1
002
5tirrup Iron Creek
C;NSW
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35.907355
-78.842504
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? 1] Yes ❑ 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: "Jame 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 outtall:
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?
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

I DSher.FwAIU C=di>Kions.(S,hea-all .xhdY-AWY -and -explain ,accordlna)yl:
❑ 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 durrpsters, Inspections, housekeeping, training, preventative maintenance, two on -site detention ponds(one of which is shared with another property).
0 This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked„please list the date the SWPPP was implemented:
July 13, 2022
❑ 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)
O Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
O 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 drurns depending on waste
A a led hazardous waste s sage area on spni ix,r jmsent palww insba as waretou
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
1101 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 followine 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
❑ 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

T .AppJkatntCRrtifllsat'KWz
North Carolina General Statute 143-215.68 (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 .. , shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000).
Underpenalty 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.
17 The information submitted in this NO] 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 hyall conditiortsof the N00600OOpermit. 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 NCGO60000 General Permit.
Printed Name of Applicant: Paul Wilson
Title: North America Environmental Leader - Last Mile
& V 96t-
(Signs ure of Applicant) (Date Sign )
Mail the entire package to: DEMLR —Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 4 of 5

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LIMITED LIABILITY COMPANY ANNUAL REPORT
10IM17
NAME OF LIMITED LIABILITY COMPANY: Amazon.COr11 Services LLC
REZAR) DF:STA711FJ});i±1UMBER Tga8644 STATE'OF FORMATION: DE
REPORT FOR THE CALENDAR YEAR: 2021
SECTION A:
1. NAME"OF REGISTERED AGENT: -Corporation Seryice�COTnpany
2. SIGNATURE OF THE NEW REGISTERED AGENT:
-filed"Annual
1938649
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS $ COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
.2526 Glerwood.AusSte-550
2626"Glen.WoodAve5te550,
Raleigh, NC 27608 Wake County Raleigh, NC 27608
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: ,Fulfiliment-Center-and•.cUStemeFSery-ice-.holdingp 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- 4.1.0 Tery...AveN-
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: WGHAELD,.DEAL NAME:
TITLE: Manager TITLE:
ADDRESS:
410 TERRY AVE N
SFCTTLE i,WA'98TU9
ADDRESS:
NAME:
TITLE:
ADDRESS:
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
MICHAEL D. DEAL
SIGNATURE
Form must be signed by a Company Official fisted under Section C of This form.
4/2/2021
MICHAEL D. DEAL Manager
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronicaliv.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 276260525