NC0002305_More Information (Received)_20231201

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCD058520016 NC0002305 Lear Corporation OMB No.2040-0004
SECTION 11.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
11.1 In Column 1 below,mark the sections of Form 1 that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note
that not all applicants are required to provide attachments.
Column 1 Column 2
❑✓ Section 1:Activities Requiring an NPDES Permit 0 w/attachments
0 Section 2:Name,Mailing Address,and Location ❑ w/attachments
❑✓ Section 3:SIC Codes 0 w/attachments
O Section 4:Operator Information ❑ w/attachments
O Section 5:Indian Land ❑ w/attachments
❑✓ Section 6:Existing Environmental Permits ❑ w/attachments
a) ❑✓ Section 7:Map ❑ matopographic ❑ w/additional attachments
o ❑✓ Section 8:Nature of Business ❑ w/attachments
❑✓ Section 9:Cooling Water Intake Structures ❑ w/attachments
❑✓ Section 10:Variance Requests ❑ w/attachments
❑✓ Section 11:Checklist and Certification Statement 0 w/attachments
11.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted. Based on my inquiry of the person or persons who manage the system,or those persons
directly responsible for gathering the information,the information submitted is,to the best of my knowledge and
belief,true,accurate,and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Michael Cothran Plant Manager
Signature Date signed
rite , ,. f f/a7/aoa3
Click to go back to the beginning of Form
EPA Form 3510-1(revised 3-19) Pace 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCD058520016 NC0002305 Lear Corporation OMB No.2040-0004
SECTION 12.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
12.1 In Column 1 below,mark the sections of Form 2C that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note
that not all applicants are required to complete all sections or provide attachments.
Column 1 Column 2
❑ Section 1:Outfall Location ✓❑ wl attachments
❑✓ Section 2:Line Drawing ✓❑ w/line drawing ❑ w/additional attachments
im Section 3:Average Flows and w/list of each user of
Treatment ❑ w/attachments ❑ privately owned treatment
works
❑✓ Section 4:Intermittent Flows ❑ w/attachments
❑✓ Section 5:Production ❑ w/attachments
w/optional additional
ESection 6:Improvements ❑ w/attachments ❑ sheets describing any
additional pollution control
plans
w/request for a waiver and wl explanation for identical
❑ supporting information ❑ outfalls
PP 9
❑ w/small business exemption w/other attachments
request El
in ❑ Section 7:Effluent and Intake ❑✓ w/Table A ❑✓ w/Table B
Characteristics
0
❑✓ w/Table C ❑✓ w/Table D
❑ w/analytical results as an
❑ w/Table E attachment
✓❑ Section 8:Used or Manufactured ❑ w/attachments
�, Toxics
❑ Section 9:Biological Toxicity ❑ w/attachments
Tests
U
✓❑ Section 10:Contract Analyses ❑ w/attachments
✓❑ Section 11:Additional Information ❑ w/attachments
171 Section 12:Checklist and
Certification Statement ❑ w/attachments
12.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly
responsible for gathering the information,the information submitted is,to the best of my knowledge and belief,true,
accurate,and complete.I am aware that there are significant penalties for submitting false information,including the
possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Michael Cothran Plant Manager
Signature Date signed
-Mitt ,, FPO
I t lao3
EPA Form 3510-2C(Revised 3-19) Page 7