NCG050459_Application_20220831

Appendix J
FOR AGENCY USE ONLY
NCG05 -b t'5.q
Assigned to: SO
RECEIVED
AUG 312022
ARO FRO MRO WARO WIRO WSRO DENR-LANDQUAL Y
STORMi"/AI ER PERMITTING
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NC6050000 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 SIC39 [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:
Cambia Manufacturing Company
Shailesh Bambardekar
Street address:
City:
State:
Zip Code:
5801 Skylab Road
Huntington Beach
CA
92647
Telephone number: -^
Email address: .,V,k ,
714-230-4219
[e-mail]
Type of Ownership:
Government
OCounty ❑Federal OMunicipal ❑State
Non -government
❑Business (If ownership is business, a copy of NCSOS report
must be included with this application)
ElI ndividual
2. Industrial Facility (facility being permitted):
Facility name:
Facility environmental contact:
Cambia Manufacturing
Alex Talamantes
Street address:
City:
State:
Zip Code:
1268 West Holt Street
Mebane
NC
27302
Parcel Identification Number (PIN):
County:
9815242044
Alamance
Telephone number:
Email address:
919-568-8530
[e-mail]
4-digit SIC code:
Facility is: i
Date operation is to begin or began:
3089
1 El New ❑Proposed MExisting
1/1/2016
Latitude of entrance:
Longitude of entrance:
36.096219 N
-79.29726° W
Page 1 of 5

Brief description of the types of industrial activities and products manufactured at this facility:
Cambro Manufacturing manufactures molded plastic products utilized in food service operations worldwide.
If the stormwater discharges to a municipal separate storm sewer system (MS4), name the operator of the MS4:
9 N/A
3. Consultant (if applicable):
Name of consultant:
Consulting firm:
n/a
n/a
Street address:
City:
State:
Zip code:
n/a
n/a
n/a
n/a
Telephone number:
Email address:
n/a
I n/a
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
Moadams Creek (Latham Lake)
WS-V, NSW
❑ This watershed has a TMDL.
Latitude of outfall:
Longitude of outfall:
36.093791 N
-79.298003 W
Brief description of the industrial activities that drain to this outfall:
Plastic product manufacturing
Do Vehicle Maintenance Activities occur m 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 c butfall: -
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? E3 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:
<2
Brief description of the industrial activities that drain to this outfall:
Ecofio Inc.
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes E3 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

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:
Storm water retention basin collects all runoff from facility. Retention basin has single discharge outfall.
Z This facility has a Stormwater Pollution Prevention Plan (SWPPP).
If checked, please list the date the SWPPP was implemented:
SWPPP is complete and will be implemented by 10/1/2022
❑ This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
0 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:
< 100
Aerosol cans, Universal Waste ,l
How material is stored:
Where material is stored:
Enclosed containers located inside facility
/
Inside facility in Maintenance Dept. Area
Number of_waste shipments per year:
Name of transport/disposal vendor:
< 2 41
Ecoflo Inc.
Transport/disposal vendor EPA ID:
Vendor address: "
NCD980842132
12750 Patterson St., Greensboro, NC 27407
❑ 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):
Z Check for $100 made payable to NCDE4
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
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.
O I will abide by all conditions of the NCGO50000 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 NCG050000 General Permit.
Printed Name of Applicant: Shailesh Bambardekar
Title: Vice President, Manufacturing
(Signature ofApplicant)
Mail the entire package to: DEMLR—Stormwater Program
(Date Signed)
Department of Environmental Quality
1612 Mail Service Center AMW
z Ralei h NC 27699-1612
g
DePartmunl ul I i",l oality
Page 4 of 5

6��Y BUSINESS CORPORATION ANNUAL REPORT
� . oP
102017
NAME OF BUSINESS CORPORATION: Caimblro Manufacturing Company
SECRETARY OF STATE ID NUMBER: 1375870 STATE OF FORMATION: CA
REPORT FOR THE FISCAL YEAR END: 12/31 /2020
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Steele, C. Thomas
2. SIGNATURE OF THE NEW REGISTERED AGENT:
- Filed Annual Report
612021 02:02
�X Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
1694 Westbrook Avenue
Burlington, NC 27215 Alamance County
SECTION B: PRINCIPAL OFFICE INFORMATION
Post Office Box 2290
Burlington, NC 27216
1. DESCRIPTION OF NATURE OF BUSINESS: Plastic foodservice equipment manufacturing
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
5. PRINCIPAL OFFICE MAILING ADDRESS
5801 Skylab Road 5801 Skylab Road
Huntington Beach, CA 92647 Huntington Beach, CA 92647
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:
Argyle Campbell
NAME:
Charles William Jarvis
NAME:
Greg Fischer
TITLE:
President
TITLE:
Secretary
TITLE:
Senior Vice President
ADDRESS:
ADDRESS:
ADDRESS:
5801 Skylab Road 5801 Skylab Road 5801 Skylab Road
Huntington Beach, CA 92647 Huntington Beach, CA 92647 Huntington Beach, CA 92647
SECTION D: CERTIFICATION OF ANNUAL REPORT, Section D must be completed in its entirety by a person/business
entityrgyle Campbell A SIGNATURE
Pon must be signed by an officer listed under Section C of this form.
3/16/2021
DATE
Argyle Campbell President
Print or Type Name of Officer Print or Type We of Officer
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525. Raleigh, NC 2762M525

SECTION E: ADDITIONAL OFFICERS
NAME: Leigh GotsmaD NAME: NAME:
TITLE: Chief Financial Officer TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
5801 Skylab Road
Huntington Beach, CA 92647
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
NAME:
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NAME:
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NAME:
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Name:
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TITLE:
ADDRESS:

Property Boundary 23 Acres
Outfall 001
To Moadams Creek
(Latham Lake) H �Stgrn]•ureter.•:•;
Retention:POndRiprt
I
'Rock Forebay
Eros •'Bafrfe(s'
Erosion Control m Esiosio T
Eron Contit I
O
k1
F--
STORM WATER Sl' MAP
CAMBRO MANUFACTURING CO.
1268 W. Holt Street
Mebane, NC 27302
By: C. Barth Date: 7-13-2022
Rail Spur
F— —� Plastic P II Offloading Area —�
Si O
00
CAMBRO MANUFACTURING COMPANY
1268 W. Holt Street
Mebane, NC 27302
f
Area \
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