NCG081043_Application_20230615

'CEIVED
FOR AGENCY USE ONLY
NCGO8 1 0* 3 JUN 14 2023
Assigned to: Q- CotstC
ARO FRO MRO RRO WARO WIRO SRO % R-StOrmwaterPrpgram
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG080000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities under the following Standard
Industrial Classifications: SIC40[Railroad Transportation],SIC 41[Local and Suburban Transit and Interurban
Highway Passenger Transportation],SIC 42 jMotor Freight Transportation and Warehousing—except for SIC
4211-4225],SIC 43[United States Postal Services],SIC S171[Petroleum Bulk Stations and Terminals—when total
petroleum site storage capacity is less than 1 million gallons]. The following activities are also included:other
industrial actives where the vehicle maintenance areas)are the only area requiring permitting;stormwater
discharges from oil water separators and/or from secondary containment structures associated with petroleum
storage facilities with less than 1 million gallons of total petroleum site storage capacity. 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,1622 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:
Terra Nova Solutions, LLC Byron Bellman
Street address: City: State: Zip Code:
Telephone number: Email address:
TN [e-mail]
Type of Ownership:
Government
❑County ❑Federal ❑Municipal El State
Non-government
M 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:
Terra Nova Soluttons -Thom2sville Byron Bellman
Street address: City: State: Zip Code:
Parcel Identification Number(PIN): County:
6787-01-39-2339 Davidson
Telephone number Email address:
bbellman tnsolutions.co
4-digit SIC code: Facility is: Date operation is to begin or began:
❑New ❑Proposed !]Existing 11/3/2021
Latitude of entrance: Longitude of entrance:
o r u o i n
Page 1 of 5

I
fdescriptionrothetypesofindustrial'activitiesand`products'manufactured-at this facility:lidification ofnon-hazardo t liaa�d waste and waste water tre
e stormwater discharges to a municipal separate storm sewer system(MS4),name the operator of the M54:
El N/A
3. Consultant(if applicable):
Name of consultant: Consulting firm:
Alessandra Braswell Geosyntec Consultants of NC, P.C.
Street address: City: stare: Zip Code:
314 Walnut Street Suite 200 Wi in NC 28401
Telephone number: Email address:
abraswel[Omeosyntec,com
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.
0 North a CreeK IClassC 0 Thiswatershed hasaTMDL.
Latitude of outfall: Longitude of outfall:
350 53' 9.657" - 0° 4' 9 "
Brief description of the industrial activities that drain to this outfall:
-Solidifffication of nQn-hazardoustruck
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑Yes I]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.
1 ❑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:SOther FaCIIWC6nlditio05 check all'that apply an d 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:
0 This facility uses best management practices or structural stormwater control measures.
If checked, briefly describe the practices/measures and show on site diagram:
lomrted soil berms are used to mana a on site storm water flow.
0 This facility has a Stormwater Pollution Prevention Plan(SWPPP).
If checked, please list the date the SWPPP was implemented:
A ril2023
❑This facility stores hazardous waste in the 100-year floodplain.
If checked,describe how the area is protected from flooding:
f ❑This facility is a(mark all that apply)
j ❑ Hazardous Waste Generation Facility
11 ❑ 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:
---- How materialisstored:—— -Wherematerial isstored: - - - - ---
Number of waste shipments per year: Name of transport/disposal vendor:
Transport/disposal vendor EPA ID: _ Vendor address:
❑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):
O Check for$100 made payable to NCDEQ
D Copy of most recent Annual Report to the NC Secretary of State
O This completed application and any supporting documentation
ff 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 stormwateroutfalls 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

ApplicanYCertificationi—
North Carolina General Statute 143-215.68(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:
I7 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.
l7 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.
0 I will abide by all conditions of the NCGO80000 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.
0 I hereby request coverage under the NCGO80000 General Permit.
Printed Name of Applicant:Byron Bellman
Title: Director of Health &Safety
(Sigg to pplicant) (Date Signed)
- Mail"the entire package fo- DEfv1LR-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.
f ❑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 El No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year?
i
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 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.
13 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

Annual-Report to the--NC
Secretary of State

SOSID:2296407
Date Filed:4/13/2023 3:25:00 PM
-- Elaine F.Marshall
-- - --- - - North-Carolina-Secretary-of-State-- - -
State of.North Carolina C2023 094 08297
Department of the Secretary of State
APPLICATION FOR CERTIFICATE OF AUTHORITY FOLLOWING
ADMINISTRATIVE REVOCATION OF A LIMITED LIABILITY COMPANY
I'ursnant m�37D-7-31(0 ofllieNmth Carolina Genend Statum the undersigned limited liability company hereby
SnbnsitS this-Applicutioit for Certificate of Atphorily Pollntving Adminislmtive Rcrocation.
1, Company Name
(a) The name ofthe limited liability cmtipany as it appears on(heNorth Carolina Bu3imm Registry is:
Hazmat Emergency Response and Remediation, LLC
Xmmal Emeipancy Respwae arm Raree.otlan,Lle
(b). The name ofltie limited liability cornp;mgcursntly in its home slate is:
(c) I fthe nonrcafthe limited liability company liwq been changed in the hame state since the adaunislnuive
rcvocalion:
lSm it,airucvions for additional docunreadatimr neededforprocaming,
• Ifdte company's name is unavailable for use in the State ol'Norlh Carolina,the home the limited liability
company wilLuse in North Carolina is:
2. llic North Carolina SOSIDN: 2296407
3. 'nit elkeliw date ofdteudministrativeievoclionofthe applicant limited liability wmpany: 03/24/2023
4. Choose the statement� satisfiing the grounds for administrative revocation
Thc grounds for theadministrmivc revocation orthe eppliam limited liability compony havebecn climhtated It
(choose all dint apply)
El providing the acquired annual repro and applicable filing fce,including updated Registered Agent/OlTice
designation
El All patillies.Pas,or other paymcmi;due to the dxpnnmem of the Secretary of Stale have been paid
❑1nuntraimories propounded by the Department of the Secretary of State haw been arssnend and provided
❑Ilia grounds for the administrative rewcmion orthe applicant limited Itubility company did not exist..
(On u separate'she:t.insert brief planation aryour claim)
3.. Attached am:
(a) Certiaeale,of Existence(or document of similar"ilnpart)duly.ntalteptiatefl by the Secretary of Stale or tither
official having custody orbusfness.registration records in the state or country ororgmsirhron. Tire Cenificate of
Fyistence mina be an orleinal and lass ilmn.r7.s mmi old
(b) One(1)Annual Report with current information signed by a Cmpany ofreia)listed on the annual report.if
applicable.
6. Enclosedisafccnf.$450•asmggtuindby(i57D-1-22ofihe Nonli Camlim GencmlSwmlm
phis is the SCA _ day of rtCC, .20 23 Hazmat Emergency Response and Remediation,LLC
(Njammee of.4pplic/tan Limited Liobilifv/Companv/
lSiR+mhae)
Michael L. Cauthen ,CFO
njye or Prim Aware and'Title/
'NOTES:
I. Ilia tiling fee Ibr thisApplication.is$450(Animal Report$200 and Application$250)
2. This application must be filed with the Secretory ofState.
BUSINESS REGISTRATION DIVISION P.0.BOX 29622 RALEIGH.NC 27626-0622
(.lanuaip f5,1020) (Form L-09A)

tit I v
Delaware Page 1
The First State
I, JEFFREY W. BULLOCK, SECRETARY Or STATE OF z7w STATE OF
DELAWARE, DO inmEBY CERTIFY ,BAmT EMERGENCY RESPONSE AND
REdEDIATION, LLC" IS DDZY 80RMED UNDER TBE LAWS OF THE STATE OF
DELAWARE AND IS IN GOOD STANDING AND HAS A LEGAL EXISTENCE SO FAR
AS THE RECORDS OF THIS OFFICE SHOW, AS OF THE THIRD RAY OF APRIL,
A.D. 2023.
AND I DO HERESY EVRTMM CERTIFY THAT THE SAID r'HAZMT EMERGENCY
RESPONSE AND REdEDIATION, LLC" WAS FORMED ON THE TWENTY-FIFTR DAY
OF OCTOBER, A.D. 2021.
AND I DO HEREBY FORTHER CERTIFY THAT THE AmuAL TAXES HAVE BEEN
PAID TO DATE.
ACA :. iRR!ywa101rJ.lM!Ury vACvly�'- .
6332519 8300 $ Authentication:203064271
SR#20231270345 Date:04-03-23
You may verify this certificate online at corp.delaware.gov/authver.shtml

. • LIMITED LIABILITY-COMPANYANNUALREPOR7
Nk OF UMITED UABIUTV COMPANY: HaZMgLEMMML-VftsbonseenifIRemodation LLC
Fidtitbns Name,ifanq,nseA in North Csropna:
SEdRETARY OF STATEJO.NUMBEit 2290407 STATE OF FORMATION:,Ell.
REPORT FOR THE CALENDAR YEAR' 20M
aEcnbN A:REGISTERRD AGEMM IMFORUAIM.
1.NAME OF REGISTOWAGENT: URS Agents,LLC
I ,
Z SIGNATURE OFTHE NEW REGISTERED AGENT: KanaOm Mdwp,Assi.Secretary
SIGNAUMMEMIMS1:01OEM TO THE APPOWMENr
-3.REGISTERFAAGENT OFFICE STREETADDRESS&COUNTY 4.REGL91EREDAIIENTAFFlCEMAILMOADDRESS
I !
176 Mine Lakeeoerrste 106 176 Nrme Lake cour S_te 1 OD
Ratelgh,NE27615 wake Ralelgh•NC 27_615 1
SECTION S:PRINCIM OFFICE INFORMATION
1.DESCRNM=OFf7ATUREOFSUSINESS; servicoa and waft
2.PRINCIPAL OFFICE NOW NUMM: f910165$.M -;1.FRINCIPALOFF CE Privacy Redaction
— — 4.PRINCIPAL OFFICE STREETAODRESS S.PRINCIPAL OFFI LWLING ADDRESS
303 South Mauitsby Street 303 South Maul y Street
1Nhitevllle,NC28472 Columbus Whitevi0e,NC2 W72 Columbus
I
&Select one otthePollowingifepplic WLjOpSonalswinstruaftna) t
The aanpany js a vwAren-owned smog fioshtess i
❑ The ceWp ny.Js a serYk G-A5btrtivetMn- MW emaA business j
-SECTION O:COMPANY OFFICIALS{Enteraddi=W ccmpanyvrabls In Seel E) '
I
NAME: Chris Valerian NAME, Sdan Timmy I NAME: Mlclmel Cauthen
7171-M CEO TRLE: Sypotbpere0orls I Tam CFO
I
ADDRESS 01 E.WngOeld Road 'ADDRESS: 201&WngReld ftd ; ADDRESS: 901 ESpdnglield,Road
Rl9hPolnGN027263 M0Po1nt NC27263 LOgh Point NC V263
I
I '
SE0710MN D:4ERRFICATION OF ANNUAL REPORT. eemon D'muat be.eaaptated In Aa RDIpN by a palswtlbltsldesa entity:
0410312D23
aIGNATURe DATE
PameaWlrilvwara COD�oryONdlOCld�mCB&MIImCalTk.fdgd
Midwel lGuihan Chief Finandal 0119
T"210r dc7""oat w
SUBMIT THIS ANNUAL REP TRO WITH THE REQUIRED FILING F a OF$200
MA6TOcaaaatrryoRef0.'i,eaw..aea�aRa,toere.eo<�uramaggncn I
I
I

- -- -� - -- ---- Figures

a 2 /
Acreage
Site Area: 7.86 p .f
Area exposed to �0 e� o ,,,r•
Industrial Activity:4.99 8' Site ,r
has r`
Tote Storage Area
o�
v Frac Tank
y�ow4
Solid,frcatmn Ama Rlant Trash Water Treatment ma �� v
i
Office 43� _
1
Oil-Water Separator.
yi►'. �ti Frac Tank
Air Stripper
Solid Waste 7 ¢a
Cumpstef AOL Inc.
Temporary Hazar�o. _ � o
WasieStorage.Trad � \ � �
Metal Recycling
Roil-Off
8 At -
w
Ouffa11001 8�
Lat:35"53'9.657" !�
Long:-80"4'9.21" r e
Area exposed to
Industrial Activity:4.99 j
r Trinity Street
ram' u
o zoo
eel
Legend
-- SpillKit Stonnwater Collection Area Site Map
Culvert Plant Trash/Water Treatment Area
Cutfalls Tote Storage Area 809 Blair Street
StonnwaterDitch Parking and Storage/LaydownArea Thomasville, North Carolina 27360
—► Stormwater Flowlines Solidification Area
Imported Soil Berms ® Relict Concrete Pipes
— Topographic Contour Impervious Surfaces Geosyntec D
Temporary Hazardous Waste Storage Site Boundary
Notes. COnst ltlnts
1.Aerial imagery obtained through ESRI online database. Figure
2.Parcel boundary information provided by NC One Map GIS website. N Geosyntec Consultants of NC,P.C.
3.Site is composed of Davidson County PIN No,6787-01-39-2339. 1
4.Building and road labels sourced from Google Maps. II'f¢y11.
5.Site features locations are based on observations made from Geosyntec
personnel during 18 October 2022 site visit Wilmington,NC January 2023
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