NCG130116_Application_20240610

61V`044lI (Nerej m))6r N"S 0003�a
FOR AGENCY USE ONLY �CF�
NCG13Q1_L
Assigned to: Ctrs
ARO FRO (M0 RRO WARD WIRO WSRO Lti
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Division of Energy, Mineral, and Land Resources Land Quality Section 1pr
National Pollutant Discharge Elimination System
NCG130000 Notice of Intent
This General Permit covers STORMWATER DISCHARGES associated with activities classified as:the wholesale
trade of non-metal waste and scrap(hereafter referred to as the non-metal waste recycling industry)a Portion of
Standard Industrial Classification Code(SIC)5093 and like activities deemed by DEMLR to be similar in the process
and/or the exposure of raw materials,products, by-products, or waste materials.
The following activities are specifically excluded from coverage under this General Permit:facilities primarily
engaged in the wholesale trade of metal waste&scrap, iron&steel scrap, and nonferrous metal scrap;facilities
primarily engaged in waste oil recycling;and facilities primarily engaged in automobile wrecking scrap. 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 or anizational entity: Legally responsible person as signed in Item,(7) below:
Heritage-Crysgtal Clean ,LLC Anita Decina
Street address: City: State: Zip code:
2000 Center Drive, Suite East C300 Hoffman Estates IL 60192
Telephone number: Email address:
847-783-5924 [e-mail]
Type of Ownership:
Government
❑ County ❑Federal ❑ Municipal ❑State
Non-government
IN Business(If ownership is business,a copy of NCSOS report must be included with this application)
❑ Individual
2. Industrial Facility(facility being permitted):
Faacility nam : Facility en. ironmental contact:
rieritage-Cgrystal Clean, LLC Charlotte Wastewater reat Fac�ity Rebekah Schulenberg-Corp./Greg Tayl r-Facility
Street address: City: State: Zip Code:
2115 Speedrail Court Concord NC 28025
Parcel Identification Number(PIN): County:
5518 912345 0000 Cabarrus County
Telephone number: Email address:
847-873-6942 [e-mail]
4-digit SIC code: Facility is: Date operation is to begin or began:
r5093 ❑ New ❑ Proposed Existing currently permitted under individual permit NCS00 90
ude of entrance: Longitude of entrance:
°20'17"N 80°36'48"W
Page 1 of 5

r,and
Brief description of the types of industrial activities and products manufactured at this facility no$-haurdousdw�stewa er oWroc ss�iii�serv;ces
for public and private seam clients.Used oil and oily water mixtures are transported to the farliTy by wdu and stored in a ove groun s orage ism n is
disposal
If the stormwater discharges to a municipal separate storm sewer system(MS4),name the operator of the MS4:
13 N/A
3. Consultant(if applicable):
Name of'consultant: Consulting firm:
Not Applicable
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 Coddle Creek Class C ❑This watershed has a TMDL.
Latitude of outfall: Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Parking of trucks,outside storage of used oil, oily water,and water treatment chemicals.
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes IN No
If yes,how many gallons of new motor oil are bidd each'month when averaged'overthe calendar year?
-4 digit identifier: ,Name of receiving water:. Classification: ❑This water is impaired.
❑This watershed has a T
Latitude -all: Longitude.of outfall:
Brief description of tlw stria)activities that drain to this outfall:
Do Vehicle Maintenance Activities oc in the drainage area of this outfall? El Yes El No
If yes,how many gallons of new motor oil a sed each month when average erthe calendar year?
3-4 digit identifier: Name of receiving water: a ' ication: ❑ This water is impaired.
NA ❑ This watershed has a TMDL.
Latitude of outfall: Longitude of
Brief description of the industr' ctivities that drain to this outfall:
Do Vehicle Maint nce Activities occur in the drainage area of this outfall? ❑ Yes ❑ No
If yes,how ny 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 NO1.
Page 2 of 5

5. Other Facility Conditions-(check all fh aapply enn explain accordingly):
❑This fadcility has other NPDES permits.
If ch ke ibct i yig permit nu permi��le��'un�erparisiPiaivich permit and we would like to switch to general.
❑This facility has Non-Discharge permits(e.g.recycle permit).
If checked,list the permit numbers for all current Non-Discharge permits:
We have an l W P permit: NCO036269 Oil Handling Permit: NCR000137299 we have an oil water separator-the bil collected
This facility uses best management practices or structural stormwater control measures.from the separator is sent for oil rech mation.
Pc�iec�Ced b{ieflydescribe.theeprac�ices/cmiasuresjnd�howoFsite iia r m: Water is sent throghughtreatment.
ac o ouf s ora a areas is�n s con a on nmen . aznwa er co ec m the co tainment is run throu our sit
I t
c]This facility has a Stormwater Pollution Prevention Plan(SWPPP). �'
If checked,please list the date the SWPPP was implemented:
❑This facility stores hazardous waste in the 100-year floodplain.
If checked,describe how the area is protected from flooding:
❑ This facility is a(mark all that apply)
❑ Hazardous waste Generation Facility We are a 10-Day transfer facility for hazardous waste.
❑ Hazardous Waste Treatment Facility All hazardous waste remains on trailers and moves
❑ Hazardous Waste Storage Facility
on to next location.
ElHazardous Waste Disposal Facility,. µ4tl
If checked,indicate: NA
Kilograms of waste generated each month: Type(s)of waste: °-
How material is stored^' Where material is stored:
Number of waste shipments:peryear:" 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):
Check for$120 made payable to NCDEQ
Copy of most recent Annual Report to the NC Secretary of State
This completed application and any supporting documentation
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
IN 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 143-215.6B(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:
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.
The information submitted in this NO[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.
C I will abide by all conditions of the NOS130000 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.
I hereby request coverage under the NCG130000 General Permit. _
Printed Name of Applicant: Anita Decina
Title: Vice President,Operational, Safety&Environmental Excellence
(Signature of Applicant) - (Date Signed) -„
Mail the entire,pa4a'g to: DEMLR—Stormwater Program
Department'6f Environmental Quality
1612 Mail Service Center
Raleigh,NC'27699-1612-
Page 4 of 5

AdditionaWutfalls—NA—we onlrhave-outfall—O 1.
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 iie impaired.
❑:This watershed has a TMDL.
Latitude of outfall: Longitude'of outfall:
4
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the-drainage area of this outfall?.. ❑Ye's ❑ No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year? V
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?
Page 5 of 5

Permit No. NCS000390
SECTION C: LOCATION MAP
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Latitude:35"20'17"N NCS000390
Longitude:80'36'48"W Heritage Crystal Clean,LLC Facility
County:Cabarrus 2115 Speedrail Court Location -
Stream Class:C Concord,NC 28025 - -
Receiving Stream:Coddle Creek L Sub-basin:03-07-11 (Yadkin Pee-Dee Basin) V•Ot t t
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B Heritage Crystal Clean, LLC
A Concord,North Carolina
a • Storm Water Outfall Concord Pretreatment Permit Renewal
❑ Sump Location Facility Layout
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Storm Water Drainage
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RIP RAP Cabarrus County,NC
.� C Drawn: CAL Checked: ABS
esri ASSOCIATE$
a o 100 . . Date: 12/15/2022 Approvetl: ABS
No; :� No. Figure 3
Imagery:Vivid Maxar 4/28/2022,ESRI Fret HE2401-19628-01 g
12/15/2022 8:38:56 AM

'i ' LIMITED LIABILITY COMPANY ANNUAL REPORT
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NAME OF LIMITED LIABILITY COMPANY: HERITAGE-CRYSTAL CLEAN, LLC
Filing Office Use only
SECRETARY OF STATE ID NUMBER: 0510840 STATE OF FORMATION: IN E-Filed Annual Report
0510840
CA202408701836
REPORT FOR THE CALENDAR YEAR: 2024 3127/2024 10A5
SECTION A: REGISTERED AGENT'S INFORMATION 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 27 61 5-641 7 Wake County Raleigh,NC 2 761 5-641 7
SECTION B:PRINCIPAL OFFICE INFORMATION
1.DESCRIPTION OF NATURE OF BUSINESS: Hazardous Waste Collection
2.PRINCIPAL OFFICE PHONE NUMBER: [phone] 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction
4.PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
2000 Center Drive,Suite East C300, 2000 Center Drive,Suite East C300,
Hoffman Estates, IL 60192 Hoffman Estates,IL 60192
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:COMPANY OFFICIALS(Enter additional company officials in Section E.)
NAME: Mark DeVlta NAME: Heritage-Crystal Clean, InC NAME: Anita Decina
TITLE: Member TITLE: Member TITLE: Vice President
ADDRESS: ADDRESS: ADDRESS:
2000 Center Drive,Suite East C300, 2000 Center Drive,Suite East C300, 2000 Center Drive,Suite East C300,
Hoffman Estates, IL 60192 Hoffman Estates,IL 60192 Hoffman Estates,IL 60192
SECTION D:CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety,by a personibusiness entity.
Marta DeVlta 3/27/2024
SIGNATURE DATE
Form must be signed by a Company Official fisted under Section C of This form.
Marls DeVita Member
Print or Type Name of Company Official Print or Type Title of company official
This Annual Report has been filed electronically.
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 276260525