NCG050468_Application_20230508

RECEIVED
FOR AGENCY USE ONLY MAY 0 g 2023
NCGO5 Q �
Assigned to: �, 7EMLR-Stonwater Prograrr,
ARO FRO MRO RR ARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
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],SIC267[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.SIC301[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 atdeq.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:
Protolabs Kenny Capps
Street address: City: State: Zip Code:
3700 Pleasant Grove Church Rd. Morrisville NC 27560
Telephone number: Email address:
984.439.7046 [e-mail]
Type of Ownership:
Government
13County 131'ederal OMunicipal [3State
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:
Protolabs Scott Anderson
Street address: City: State: Zip Code:
3700 Pleasant Grove Church Rd. Morrisville NC 27560
Parcel Identification Number(PIN): County:
0757399007 Wake
Telephone number: Email address:
984.439.7046 [e-mail]
4-digit SIC code: Facility is: Date operation is to begin or began:
3089 1 0 New 13 Proposed 0 Existing Oct 2016
Latitude of entrance: Longitude of entrance:
35.889978 -78.818667
Page 1 of s

Brief description of the types of industrial activities and products manufactured at this facility:
31D Printed Plastic Parts(Nylon and Epoxy)
If the stormwater discharges to a municipal separate storm sewer system(MS4),name the operator of the MS4:
El N/A
3. Consultant(if applicable):
Name of consultant: Consulting firm:
Street address: City: State: Zip code:
Telephone number: Email address:
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 jErier Creek QNSW ❑This watershed has a TMDL.
Latitude of outfall: Longitude of outfall:
35.891197 -78.817937
Brief description of the industrial activities that drain to this outfall:
Transferring solvents in outdoor containment pit.Occasional pallet storage.
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 13Yes 0 No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year?
N/A
3-4 digit identifier: Name of receiving water: Classification: ❑This water is impaired.
002 1 Lake Crabtree QNSW ❑This watershed has a TMDL.
Latitude of outfall: Longitude of outfall:
35.843 78.804
Brief description of the industrial activities that drain to this outfall:
Same as above-Previous outfall leads here .
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? 0Yes 0 No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year?
N/A
3-4 digit identifier: Name of receiving water: Classification: ❑This water is impaired.
N/A 1 1 ❑This watershed has a TMDL
Latitude of outfall: Longitude of outfall:
12
Brief description of the industrial activities that drain to this outfall:
Hazmat Environmental Services
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? Dyes O No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year?
N/A
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:
N/A
❑This facility has Non-Discharge permits(e.g. recycle permit).
If checked,list the permit numbers for all current Non-Discharge permits:
N/A
❑This facility uses best management practices or structural stormwater control measures.
If checked,briefly describe the practices/measures and show on site diagram:
N/A
❑This facility has a Stormwater Pollution Prevention Plan(SWPPP).
If checked, please list the date the SWPPP was implemented:
Working on currently
❑This facility stores hazardous waste in the 100-year floodplain.
If checked,describe how the area is protected from flooding:
Not in floodplain
0 This facility is a(mark all that apply)
O 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:
450 Flammable solvents(D001)
How material is stored: Where material is stored:
In 55 gal drums Shipping/Waste Area
Number of waste shipments per year: Name of transport/disposal vendor:
12 - Hazmat Environmental Services
Transport/disposal vendor EPA ID: Vendor address: "
NCDO48461370 1221 Dalton Avenue Charlotte,NC 28206
❑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 -m Ajo-rco S PARAT —CHECI<41ZOSZ6
0 Copy of most recent Annual Report to the NC Secretary of State
0 This completed application and any supporting documentation
0 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 143-215.613(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($50,000).
Unor penalty of law, I certify that:
el am the person responsible for the permitted industrial activity,for satisfying the requirements of this permit,and for any
5wil or criminal penalties incurred due to violations of this permit.
2-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.
will abide by all conditions of the NCG050000 permit.I understand that coverage under this permit will constitute the
ermit requirements for the discharge(s)and is enforceable in the same manner as an individual permit.
hereby request coverage under the NCG050000 General Permit.
Printed Name of Applicant: Kenny Capps
Title: Director of Manufacturing Operations-3DP
i�
4/10/2023
(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? E3 Yes E3 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 E3 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 0 No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year?
Page 5 of 5

Pic 1—Containment pit—Solvent tanks
580 Gals of Isopropyl
1160 Gals of PLM-402 Sub
2200 Gal containment pit
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BUSINESS CORPORATION ANNUAL REPORT
11613D]]
NAME OF BUSINESS CORPORATION: Proto Labs,Inc.
1377260 mg ca Use Only
SECRETARY OF STATE ID NUMBER: STATE OF FORMATION: MN E-Filed Annual Report
1377260
REPORT FOR THE FISCAL YEAR END: 12/31/2021 CA202210411653
4/14/2022 02:46
SECTION A: REGISTERED AGENT'S INFORMATION FX� Changes
1. NAME OF REGISTERED AGENT: CT Corporation System
2.SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS&COUNTY 4.REGISTERED AGENT OFFICE MAILING ADDRESS
160 Mine Lake Ct Ste 200 160 Mine Lake Ct Ste 200
Raleigh, NC 27615 Wake County Raleigh, NC 27615
SECTION B: PRINCIPAL OFFICE INFORMATION
1.DESCRIPTION OF NATURE OF BUSINESS: Manufacturing
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
5540 Pioneer Creek Drive 5540 Pioneer Creek Drive
Maple Plain,MN 55359 Maple Plain,MN 55359
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: Robert Bodor NAME: NAME:
TITLE: President TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
5540 Pioneer Creek DR
Maple Plain,MN 55359-9003
SECTION D: CERTIFICATION OF ANNUAL REPORT Section D must be completed in its entirety by a person/business
entity
Kobert Bodor 4/14/2022
SIGNATURE DATE
Form must be signed by an officer listed under Section C of this form.
Robert Bodor President
Print or Type Name of Officer Print or Type Title of Officer
This Annual Report has been filed electronically.
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NO 27626-0525