NCG050456_Application_20220523

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FOR AGENCY USE/ ONLY
NCG05 fj!LS 1,
Assigned to: %_ e 0
ARO FRO MRO RO ARO WIRO WSRO
RECEIVED
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Division of Energy, Mineral, and Land Resources Land Quality SENb9tormwaterProW m
National Pollutant Discharge Elimination System
NCG050000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC 23 [Apparel and Other Finished Products Made from Fabrics and Similar Materials],
SIC265 [Paperboard Containers and Boxes], SIC 267 [Converted Paper and Paperboard Products], SIC 27 [Printing,
Publishing and Allied Industries], SIC 30 [Rubber and Miscellaneous Products — except as specified below], SIC 31
[Leather and Leather Products — except as specified below], and SIC 39 [Miscellaneous Manufacturing Industries],
and other like activities deemed by DEMLR to be similar in the process and/or the exposure of raw materials,
products, by-products, or waste materials. SIC 301 [Tires and Inner Tubes] and SIC 311 [Leather Tanning and
Finishing] are specifically excluded from coverage under this General Permit. 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:
Essentra Packaging U.S. Inc.
Paul Jagielski
Street address:
City:
State:
Zip Code:
1000 CCC Drive
Clayton
NC
27520
Telephone number:
Email address:
919-763-1562
Paul,[e-mail]
Type of Ownership:
Government
)3County C3Federal 13Municipal OState
Non -government
MBusiness (If ownership is business, a copy of NCSOS report
must be included with this application)
I3 Individual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
Essentra Packaging
Ines Garda
Street address:
City:
State:
Zip Code:
1000 CCC Drive
Clayton
INC
27520
Parcel Identification Number (PIN):
County:
OSE9902BE
Johnston
Telephone number:
Email address:
919-820-2239
[e-mail]
4-digit SIC code:
Facility is:
1
Date operation is to begin or began:
2752
0 New 0 Proposed 0 Existing
1984
Latitude of entrance:
Longitude of entrance:
35.6719151
-78.4949069
Page 1 of 5

.a
Brief description of the types of industrial activities and products manufactured at this facility:
Essentra manufactures, prints, and creates cartons, leaflets, labels, printed primary packaging, and tapes for healthcare products.
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
O N/A
3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Lindsay Fletcher, PE
Kleinfelder
Street address:
City:
State:
Zip code:
9009 Perimeter Woods Drive, Suite E
Charlotte
NC
28216
Telephone number:
Email address:
713-299-0304
tetcher@ ldeinfeldeccom
4. Outfail(s) (at least one outfall is required to be eligible for coverage):
3-4 digit identifier:
Name of receiving water:
Classification:
E3 This water is impaired.
SD01
I Little Creek
C; NSV 1
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
35.673
78.495
Brief description of the industrial activities that drain to this outfall:
Manufacturing building, paved parking areas, outdoor waste storage area, dust collector, loading and unloading areas
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑Yes M 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? O Yes O 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? O Yes O 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 N01.
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:
❑ This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
O This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
The SWPPP is being developed in parallel to the submittal of the NOI
❑ This facility stores hazardous waste in the 300-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:
000 kg/month
Waste inks and glues, petroleum distillates, ethers, universal waste
How material is stored:
Where material is stored:
Drums
Covered outdoor waste storage area
Number of waste shipments per year:
Name of transport/disposal vendor:
Transport/disposal vendor EPA ID:
Vendor address:
GAR00007879
6140 Purdue Drive Atlanta, GA 30336
❑ 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
O Copy of most recent Annual Report to the NC Secretary of State
O 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
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:
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.
O 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.
I will abide by all conditions of the NCG050000 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 NCG050000 General Permit.
Printed Name of Applicant: Paul Jagielski
Title: Plant Director
,`' � 17. rnAq. 2022
(Signature ofApplicant) (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

Source: USGSTopo was obtained from ESRI Basemap. Back Drop W Project Boundary
represents 7.5 Minute Quadrangle sheet for Clayton. North Carolina.
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VN: 4/18/2022
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Project Location Map
Essentra Packaging U.S. Inc.
1000 CCC Drive
Clayton, NC 27520
FIGURE
1

n` `1' BUSINESS CORPORATION ANNUAL REPORT
uenon
NAME OF BUSINESS CORPORATION: ESSentra Packaging U.S. Inc.
SECRETARY OF STATE ID NUMBER: 1454206 STATE OF FORMATION: DE
REPORT FOR THE FISCAL YEAR END: 12/31 /2021 AMENDING DOC ID
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Capitol Corporate Services, Inc.
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
1454206
CA202207303630
3/14/2022 01:15
❑X Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
120 Penmarc Drive
Raleigh, NC 27603-2400 Wake County
SECTION B:
120 Penmarc Drive, Suite 118
Raleigh, NC 27603-2400
1. DESCRIPTION OF NATURE OF BUSINESS: Commercial printing
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] x 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS
Two Westbrook Corporate Center, Suite 200 Two Westbrook Corporate Center, Suite 200
Westchester, IL 60154-5718 Westchester, IL 60154-5718
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: OFFICERS (Enter additional officers in Section E.)
NAME: Kamal Taneja NAME: ,Jacob Fitzgerald NAME: Emma Reid
TITLE: President TITLE: Vice President TITLE: Secretary
ADDRESS: ADDRESS: ADDRESS:
Two Westbrook Corporate Center, Suite 200, Two Westbrook Corporate Center, Suite 200 Two Westbrook Corporate Center, Suite 200
Westchester, IL 60154 Westchester, IL 60154 Westchester, IL 60154
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
entity.
Emma Reid 3/14/2022
SIGNATURE
Form must be signed by an officer listed under Section C of this form.
Emma Reid
Print or Type Name of Officer
DATE
Secretary
Print or Type Title of Officer
!6
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 2762"525

SECTION E: ADDITIONAL OFFICERS
NAME: Kamal Tagjea NAME:
TITLE: Treasurer TITLE:
ADDRESS: Two Westbrook Corporate Center ADDRESS:
Suite 200
Westchester. IL 60154
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