NCGNE1662_Application_20240122

Nc6NE / ((2,
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):
kanr At L C
Mailing address: qty; State Zip Code
ilY �hr Dim WC, NC xro3
Telephone number. Email address:
11 - Do a
Type of Ownership:
Government
❑County ❑Federal ❑Municipal ❑State
Non-government
VBusiness(If ownership is business,a copy of NCSOS report must be included with this application)
❑Individual
2. Industrial Facility(facility requesting exclusion):
Facility nam Facility environmental contact:
e:
rA
Street address: Telephone number:
( t
Email ad(iress:
K l,an Ise..
City County State Zip Code
l al,104 I Gos4onNOA6 Car6jjI3jje IV031
Latitude of entrance: 3S•31 o5 9 fo
Longitude of entrance:
Parcel Identification Number(PIN):
0 fo 1 J,
3
Date operation began: a Standard Industrial Classification(SIC)Code:
l
Brief description of the types of industrial activities and products produced at this facility.,
h
3. Consultant(if applicable):
Name of consultant: consufting firm:
Street address: city: State and zip code:
Telephone number: Email address:
4. Exposure Checklists
Are any of the following materials or activities exposed to precipitation,now or in the foreseeable future?If you
answer"Yes"to any of these items,you are not eligible for the no exposure exclusion.
Using,storing,or cleaning industrial machinery or equipment,and areas where residuals from
using,storing,or cleaning industrial machinery or equipment remain and are exposed to ❑Yes WNo❑N/A
stormwater
Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑Yes No❑N/A
Materials or products from past industrial activity ❑Yes EiNo❑N/A
Material handling equipment(except adequately maintained vehicles) ❑Yes iYNo❑N/A
Page 2 of 5

Materials or products during loading/unloading or transporting activities ❑Yes JNo❑N/A
Materials or products stored outdoors(except final products intended for outside use[e.g.,new ❑Yes 60 No❑N/A
cars]where exposure to stormwater does not result In the discharge of pollutants)
Materials contained in open,deteriorated,neon-sealedk,or leaking storage drums barrels,tanks, ❑Yes Ci'�b❑N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger ❑Yes LKNo❑N/A
Final products that would be mobilized in stormwater discharges(e.g.,rock salt) ❑Yes❑No GA/A
Waste material(except waste In covered,non-leaking containers[e.g.,dumpstersi) ❑Yes C`No❑N/A
Application or disposal of process wastewater(unless otherwise permitted) ❑Yes No❑N/A
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise ❑Yes�")4o C�W/A
regulated(i.e.under an air quality control permit)and evident In the stormwater outflow
Empty containers that previously contained materials that are not properly stored(i.e.,not closed ❑Yes❑No OdN/A
and stored upside down to prevent precipitation accumulation)
For any exterior ASTs,as well as drums,barrels,tanks and similar containers stored outside,has ❑Yes❑No f9�NJA
the facility had any releases in the past three(3)years?
'Sealed means banded or otherwise secured and with locked or non-operational taps or valves.
Above Ground Storage Tanks(ASTs)and Secondary Containment
If you answer"No"to any of the following items,you are not eligible for the no exposure exclusion.
Are exterior ASTs or piping free of rust,damaged or weathered coating,pits,or deterioration,or �,�❑No❑N/A
evidence of leaks?
Is secondary containment provided for all exterior ASTs?If so,Is it free of any cracks,holes,or �,�❑No❑N/A
evidence of leaks,and are drain valves maintained locked shut?
Is secondary containment provided for single above ground storage containers(including drums, �,�,,//
barrels,etc.)with a capacity of more than 660-gallons? ❑Yes❑No iN/A
is secondary containment provided for above ground storage containers stored in close proximity ❑Yes❑No�N/A
to each other with a combined capacity of more than 1,320 gallons?
Is secondary containment provided for Title III Section 313 Superfund Amendments and ��O No❑N/A
Reauthorization Act(SARA)water priority chemicals?
ls secondary containment provided for hazardous substances designated in 40 CFR§116? eyes❑No❑N/A
Are release valves on all secondary containment structures locked? IrYes❑No❑N/A
Other information
If you answer"Yes"to any of the following items,you might not be eligible for the no exposure exclusion.A more
in-depth evaluation of the site circumstances may be required.
Are vehicles used in material handling in disrepair and/or leaking fluid? ❑Yes ffNo❑N/A
Does this facility store used,recycled,or otherwise reclaimed pallets outside? ❑Yes No❑N/A
Does this facility have coal piles on site? ❑Yes 4o❑N/A
Does this facility store other fuel sources outside in piles,such as wood chips,sawdust,etc.? ❑Y No❑N/A
Page 3 of 5

Does this facility have air emissions associated with industrial activity(e.g.,degreasing operations, ❑Yes It6 No❑ N/A
plating,painting,or metal finishing)?
If yes:
Describe the industrial activity;
Are those emissions permitted by an Air Quality Permit? ❑Yes ❑No
Please specify:
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: poTLo N p D[- S # N Goo lu (2`1
U This facility has Non-Discharge permits(e.g.recycle permit).
If checked,list the permit numbers for all current Non-Discharge permits:
❑This facility stores hazardous waste in the 100-year floodplam.
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:
• How material is stored:
• Where material is stored:
• 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:
❑This facility is located on Native American Lands.
6. Required Items (Application will be returned unless all of the following items have been included):
GI�Check for$250 made payable to NCDEQ
Copy of most recent Annual Report to the NC Secretary of State(if applicable)
This completed application and any supporting documentation
opy of county map or USGS quad sheet with the location of the facility clearly marked
Page 4 of 5

I
7. Applicant Certification
North Carolina General Statute 143-215.611(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 misdemeanorwhich may include a fine not
to exceed ten thousand dollars($10,000).1 hereby request excluslon from NPDES stormwater permitting.
Under penalty of law,I certify that:
G/ I am the person responsible for the industrial activity,for satisfying the requirements of this exclusion,and for any civil
or criminal penalties incurred due to violations of this exclusion.
l� I have read and understand the eligibility requirements for claiming a condition of"no exposure and obtaining an
exclusion from NPDES stormwater permitting.
There are no discharges of stormwater contaminated by exposure to industrial activities or materials from the industrial
facility or site identified in this document(except as allowed under40 CFR 122.26(g)(2)).
I understand that I am obligated to maintain no exposure conditions and complete a Self-Recertification form at least
once each year and,if requested,provide this certification to the operator of the local municipal separate storm sewer
system(MS4)into which the facillty discharges(where applicable).I understand that I must allow the North Carolina
Division of Energy,Mineral,and Land Resources,or MS4 operator where applicable,to perform Inspections to confirm
the condition of no exposure and to make such inspection reports publicly available upon request I understand I must
keep a copy of annual recertification on file at the facility.
1 understand that in the event that the site no longer qualifies for a No.Exposure Exclusion that I must obtain coverage
J under an NPDES permit prior to any point source discharge of stormwater from the facility.
kQ 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 forgathering the
information.
Printed Name of Person Signing:
Title: *�
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 5 of 5

�-� NORTH CAROLINA
�� Department of the Secretary of State
To all whom these presents shall come,Greetings:
I,ELAINE F. MARSHALL, Secretary of State of the State of North Carolina, do hereby
certify the following and hereto attached to be a true copy of
APPLICATION FOR CERTIFICATE OF AUTHORITY
OF
HANS KISSLE COMPANY,LLC
the original of which was filed in this office on the 18th day of May,2022.
IN WrINESS WHEREOF,I have hereunto set my
hand and affixed my official seal at the City of
Raleigh,this 18th day of May,2022.
� /
Scan to verify online.
Certification#C202213702588-1 Reference#C202213702588.1 Page: 1 of 5 Secretary of State
verify this ceditieate online at ht4wJ/anvw.some gov/verification

SOSID:2a16616
Date Filed:5/18/2022 7:38:00 AM
Elaine F.Marshall
State ofNorth Carolina Worth Catalina secretary orstate
Department of the Secretary of State C2022 137 02588
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR LIMITED LIABILITY COMPANY
Pursuant to§57D-7.03 of the General Statutes of North Carolina,the undersigned limited liability company hereby applies for a
Ceiiifrcate of Authority to t ansect business in[tic state of North Carolina,and for that purpose submits the following:
I. The name of the limited liability company is Hans Kissle Company, LLC
and if the limited liability company name is unavailable for use In the State of North Carolina,the now the limited
liability company wishes to use is
2. The state or country under whose laws the lin»led liability company was formed is Delaware
3. Principal office information: (Select either or b)
a. ❑The limited liability company has a principal office.
The principal office telephone number. [phone]
The street address and county of the principal office of the limited liability company is:
Number and street: 9 Creek Brook Drive
City, Haverhill State:.MA Zip Code:0 1832 County, Essex
Tite mailing address,!f different from the street address,of the principal office of the corporation is:
Number and Street:
City: __ Stata� Zip Cade: County:
b. ❑The limited liability company does net have a principal office.
4. The name of the registered agent iu the State of North Carolina is: Corporation Service Company
S. The street address and county of the r4dered agent's office in the State of North Carolina it:
Number and Street;2626 Glenwood Ave., Ste, 550
City:Raleigh State: NC zip code:27608 County: Wake
6. The North Carolina mailing address,trdlWerentfront the street address,of the registered agent's office in the State of North
Carolina is:
Number and Street:
City: _Stale. NC Zip Code: County:
BUSINESS REGISTRATION DIVISION P.O.BOX 29622 RALEIGH,NC 27626-0622
(Revised Jnly 2017)
(Fount 409)
Certification#C202213702588-1 Reference#C202213702588-Page:2 of 5

APPLICATION FOR CERTIFICATE OF AUTHORITY
Page 2
7. ThE rwiva,ti6F.i,aG.'.nnuni uuiiLc:sddu'�i5ni3 oflii6 Gir(cr,G con,j:nuy uiiluias Offce limitbtl liebitiiy mmpanyare;
(use artachwenr(fneeessmy)(Heir docantentoust be signed by person listed it ifem 7.)
Nmie mid 77rie RusinecsAdd++e¢
Scott Moffitt-Chief Executive Officer 8 Clear Brook pr., Haverhill, MA 01832
See attached list for Managers.
8. Attached is a cedificate ofexistpnce(ordocurnew of similar import),duty authenticated by the scarduryal'statcorotherofficial
havingeustodyofHatited liability companyreeordsIn ilia state orcountryofformation. The Certificate ofSxtstence must bo
less Nran six months old. A nhotoeem of the certification cannot trepeuated.
9. If ilia iitti:c d liability corapany Is.equked Muse andAieus name In oiler io tianswi b'ashim lit ufis State,a oupy of(he
resolution of its managers adopting the fictitlous name is attached.
10.(Optional):Please provide a business e-mail address:
The Secretary of State's Office will e-mail the business automatically at the address provided above at no cost when a document
be tiled. The e-mail provided will not he vkwahle on the webshe. For more httbtmation on why Ibis service is offered,please see
the instructions forthis document.
It.Tbis appilcaiion will be eMmIive upon film unless a delayed date amllor!fine is specified:
ThisthojdayofMay .2022
Hans Kissle Company, LLC
Mew ofLfneffed Lla filly tpaety
tahae ofCompat y O�'!d
owrr Karat coo
Type or Print Monte and Ndell
Notes:
1. Filing fee is$250. This document must be filed with the Secretary of Stine.
BUSINESS REGISTRATION DIVISION P.O.BOX 29622 RALBIGII,NC 27626-0622
(RevisrdJnh,1017) (porn)1-09)
Certification#CM2137 02 5 8 9-1 Referenced C202213702588-Page:3 of 5

ATTACHMENT TO APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR
HANS KISSLE COMPANY,LLC
7. The names and business address of the managers of the limited liability company are:
Yoshihiro Yathhamura
9 Creek Brook DF NO
Haverhill,MA 01832
Masatoshi Hidaka
9 Creek Brook: NI've
Haverhill,MA 01832
Totnoharu Kure
9 Creek Brook Dl-ode
Haverhill,MA 01832
Rene Ouimet
9 Creek Brook N2u1
Haverhill,MA 01832
Nobuyoshi Fujiwara
9 Creek Brook DtZvtQ
Haverhill,MA 01832
WRD(US)463346970
Certification#C202213702SWI Reference#C2022i37025S&Page:4 of 5
i

Delaware Pagel
The First State
I, JEFFREY W. BUZWCK, SECRETARY OF STATE OF THE STATE OF
DELANARE, DO HEREBY CERTIFY "HAWS RZSSLE COMPANY, LLC" IS DULY
FORMED UNDER THE LAWS OF THE STATE OF DELAWARE AND ZS TN GOOD
STANDING AND HAS A LEGAL EXISTENCE SO FAR AS THE RECORDS OF THIS
OFFZCE SHOW, AS OF THE SEVENTEENTH DAY OF MAY, A.D. 2022.
AND Z DO RERSBY FURTHER CERTIFY TRAT THE SAZD nHANS EZSSLE
COMPANY, LLC" WAS FORMED ON THE THIRTY—FIRST DAY OF OCTOBER, A.D.
2004.
AND Z DO HEREBY FURTHER CERTIFY THAT THE ANNUAL TAXES HAVE BEEN
PAID TO DATE.
°Q� nnmx. bcs. .wwma rm
u fn
3874793 8300 ' Authentication:203448530
SR#20222045982 Date:05-17-22
You may verlfythls certificate online at mrpAelawam gov/authvecshtml
Certification#C2022137025MI Referenceff C202213702588•Page:5 of 5

CIVIL PLANS
FOR
PROJECT HORNET - HANS KISSLE
SOUTHEAST FACILITY
L GY
GENERAL RAN NOTES PROJECT INFORMATION
— MfOJELI N"E
_ __� PRo.IECT Raercr-NI�N xaelE samsisr ErcAm
., .. GROJELimORE55 ��AYY
— _ 5111I➢0.ECREEN PMMHnv �m���Nu
.__. OntUS.NC SWY
VMLFL O
IMfE rr nnw+r+
emu• UNO IOT
mum
SEQUENCE OF CONSTRUCTION 21W}p55p[ T NE
asnlRaEo.Es"`n CIVIL EN6NfEEIR
LOPER
nISSLEfAMVMv.ue
_ 9 CREFII B11OON DRNE
LE
� ..- W,VEN¢LIMOt6y
COMACT VFNW YOMEI SVGROiO_ PIbNE:91>I51}pMl
_ �_ ENML:YNg1MH�NmLwp.mm
�_ OESfJER �-•`••s DYFRnHO F550CNTE5,LLC
noenna.rot wNvaRT mAL - -_
ESQ vu.WTENANCE 1"� '� f` = PROJECT HORNET
BORROW AND WASTE AREAS CML COVER SHEET

General Notes Project Hornet Device Legend
.; —,�
5118 Apple Creek Parkway, Dallas, NC 28034 n
o
Cable & Wire Legend """""
pYW�jp, *LIFE AA r1rrrYY YYtgNFMYW
wimarmexa�_=r.__
Building information — Sheet Index Vicinity Map Applicable Codes
rY+xwr ar.w rant2018 NC FIRE PREVENTION CODE = _
�.' 018 NC BUILDING CODE
awrMm
FW P1"c 13 NFPA 72
YwIlYt hw�w.Ml.iw.YwaYY_w.lw.w.p.w._w.nwf�l^TMMI'1Y ��._y�
wOm�YMYWMIAWI�L5Y4Yw1V BwIY01YhN8YpY9lMCkM.MIwYtl Y.rYw .� 'Y I•)•'+,`_•'..
Nw..lw.wr.wTY�YrM�MY �YYMY♦Ylw�. '
GwYw.YT44Y+w�MYYM.Iwww YYFY�Yn.I'rYarOY.Yrr �'
".wO.YM�W wW sw_.
OAaAw I ��
1 PROJECT HORNET
f,- a�nacamrr
i IP
Device 10 Nomenclatur '
COVER SREEf
—�Px-Nx =
XXcd

PD ,a
Ao
C�^'nuniry
4 ��
l� 4oa VB: Poole"1010" a
ccom--any;Inc.
00 LC -z0ole%'HN
a EO
GavonCcuntyQ� , , 8 -
Snnn-Clib
Dallas Park
Ao
A 9
- APPLECREEK
-a VILLAGE
C _
L
-asc __�cl ___JC-:Q _
cy O r
w�
I�
+s 5 e
a¢ tics gie