NCG081020_Application_20220531

FOR AGENCY USE ONLY
NCG081Ll0 a� Assigned to:
ARO FRO MRO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resour
National Pollutant Discharge Elimii
NCG080000 Notice of Int
cor�-'e)OAI
This General Permit covers STORMWATER DISCHARGES associated with
Industrial Classifications: SIC40 [Railroad Transportation], SIC41[Local
Highway Passenger Transportation], SIC 42 (Motor Freight Transportatio
4221-42151, SIC 43 [United States Postal Services], SIC S171 [Petroleum 6
petroleum site storage capacity is less than 1 million gallons]. The followi
industrial actives where the vehicle maintenance areas] are the only arec
discharges from oil water separators and/or from secondary containment
storage facilities with less than I million gallons of total petroleum site stc, yu capacity.
on the DEMLR Stormwater Program at deq.nc.gov/SW
You can find information
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:
Fastenal Company
Bobby Petrella
Street address:
City:
State:
Zip Code:
4110 Premier Drive, Suite 102
High Point
NC
27265
Telephone number:
Email address:
336 888-3015
Bpetrell fastenal.com
Type of Ownership:
Government
17County ®Federal E3Municipal E3State
Non -government
13 Business (If ownership is business, a copy of NCSOS report
must be included with this application)
131ndividual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
Fastenal Company N-Hub)
Alex Doss
Street address:
City:
State:
Zip Code:
4110 Premier Drive, Suite 102
High Point
NC
27265
Parcel Identification Number (PIN):
County:
Guilford
Telephone number:
Email address:
336 888-3043
[e-mail]
4-digit SIC code:
Facility is:
Date operation is to begin or began:
4225
0 New 13 Proposed 13Existing
July 1st, 2004
Latitude of entrance:
Longitude of entrance:
36` 2' 20.15" N
79" 57' 17.18"W
Page 1 of S k" qY . j i 2(12t'
DEMA tormwatet Pm9lai

Brief description of the types of industrial activities and products manufactured at this facility:
Warehousing and distribution center with some minor maintenance activities (stud cutting, chain sling assembly, and power tool repair).
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
❑ N/A
3. Consultant fif aoolicable):
Name of consultant:
Consulting firm:
CJ Begalke
US Compliance
Street address:
City:
State:
Zip Code:
520 Third Street, #100
Excelsior
MN
55343
Telephone number:
Email address:
952-567-5629
[e-mail]
4. Outfall(s) At least one outfall is required to be eligible for coverage.
3-4 digit identifier:
Name of receiving water:
I Classification:
❑ This water is impaired.
001
Unnamed Tributary of East Fork Deep River
I WS-IV
1 ❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
3602'10.88"N
79°5724.68"W
Brief description of the industrial activities that drain to this outfall:
No industrial activities but potential pollution sources include: Scrap wood dumpster, Compactor, Pallets, Obsolete EquipmenuRacking, Loading/Unloading areas.
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.,
1
002 _
Unnamed Tributary of Fast Fork Deep River
WS-IV
❑ This watershed has a TMDL
Latitude of outfail:
Longitude of outfall:
36"2'13.94"N -
79"57'17"W -
Briefdescriptiohofthe industrial activities that drain tothis outfall: ' '
No industrial activities but potential pollution sources include: Obsolete EquipmentlRacking, Totes/Drums, Loading/Unloading areas.
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0 Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
0, only maintenance activity here is truck washing, but all water from washing is container by third party vendor.
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

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:
NCGNE1131, this is a No Exposure and will be terminated when General Permit Coverage is obtained
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
Inspections aM deanirg performed around gm fedlity, especially around a0 potential sources of MUinJon. Regular maintenance Neas to emu dumpsiam and Corr m are in mrkrg onler.
El 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:
Date of this NO[ Submission
❑ 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
If checked, indicate: ---
Kilograms of waste generated each month: -
Type(s) of waste:
<220 Ibs - -
Waste flammable liquids, hazardous waste liquid, used bulbs
How material is stored:
Where material is stored:
In closed containers
Inside the facility
Number of waste shipment's per year: -
Name of-transport/disposal vendor:
Varies
Safety-Kleen Systems Inc.
Transport/disposal vendor EPA ID:
Vendor address:
KYD053348108
37000 Lagrange Road, Smithville,KY
❑ 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):
❑' Check for $100 made payable to NCDEQ
❑+ Copy of most recent Annual Report to the NC Secretary of State
0 This completed application and any supporting documentation
I7 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
El 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 ($50,000).
Under penalty of law, I certify that:
51 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.
III] 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 NCG090000 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.
® 1 hereby request coverage under the NCG080000 General Permit.
Printed Name ofApplicant:b�BBY Ealmec-A
7js�e� os a ac,�
(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:
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 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 ❑ 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? ❑ Yes ❑ No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
Page 5 of 5

®rlBUSINESS CORPORATION ANNUAL REPORT
uvmu
NAME OF BUSINESS CORPORATION: Fastenal Company
0288765 Fling `a U. Only
SECRETARY OF STATE ID NUMBER: STATE OF FORMATION: MN E - Filed Annual Report
0288765
REPORT FOR THE FISCAL YEAR END: 12/31/2021 CA202211900224
412=022 08:00
SECTION A: REGISTERED AGENT'S INFORMATION ❑K Changes
1. NAME OF REGISTERED AGENT: Corporation Service Company
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS 8 COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
2626 Glenwood Ave Ste 550
2626 Glenwood Ave Ste 550
Raleigh, NC 27608 Wake County Raleigh, NC 27608
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Distribution of Industrial and construction supply materials and related services within the U.S.A.
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
2001 Theurer Blvd.
Winona, MN 55987
5. PRINCIPAL OFFICE MAILING ADDRESS
2001 Theurer Blvd.
Winona, MN 55987
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: Holden Lewis
TITLE: Chief Financial Officer
ADDRESS:
2001 Theurer Blvd.
Winona, MN 55987
NAME: Daniel Florness
TITLE: President
ADDRESS:
2001 Theurer Blvd.
Winona, MN 55987
NAME: Sheryl Lisowski
TITLE: Treasurer
ADDRESS:
2001 Theurer Blvd.
Winona, MN 55987
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
anti
SLryl Lisowski 4/29/2022
SIGNATURE
Form must be signed by an officer laced underSeclion C of this farm.
DATE
Sheryl Lisowski Treasurer
Print or Type Name of Officer Print or Type Tale of Officer
This Annual Report has been filed electronically.
MAIL TO: Secietary of State, Business Registration Division, Post Office Box 29525. Raleigh, NC 27626-0525

SITE MAP
Fastenal Company (N-Hub)
4110 Premier Drive, Suite 102
High Point, NC 27265
y
MAP LEGEND
`F�F f.Ti
Drainage Features
I
Sampling Loranon
Outfall
_
® =Storrs Drain
.L
=Flow Direction
rr .i
— — =Property Line
impervious Surface
k
Potential Sources of Pollution
1: Scrap Wood Dumpster
M.
2: Trash CnmpaRars
3: Pallets
* 1 ^•
4: Obsolete Equipment/Racking
S: Loading/Unloading Area
6: Totes/Dorms
1: Truck Washing (water contained)
a
I •.�y
" 9
Ij)
'
m
Will M'Or 13.2"N
May,
IoNkuAe: 79'S7'20.9"W
2022
OY$
Y+
CNMIII�f

STORM WATER POLLUTION PREVENTION PLAN IMPAIRED WATERS & SURFACE WATERS MAP
Fastenal Company (N-Hub)
4110 Premier Drive, Suite 102
Hi hPoint NC27265
MAP LEGEND
Feaanes
k = Facility Location
�1 = East Fork of the Deep River
TMDL For: Fecal Coliform and
Turbidity
a . = Wetlands
as
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is
A
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assail_
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Latitude: 36'02'13.2-N May
�a Loon[Nude: 79- ST 20.9- W 2022
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Map provided by NC DEQ rapalred Waters &TMOL Map'. h"ps// dnr.Maps.arcg om/apps/webappvlewer/Index. html7J=e9be64746W1091dgb4cDb77edace6bd 0 NS CNMPIIANCE

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