NCG050434_COMPLETE FILE - HISTORICAL_20161202

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/VC�iC�OSOI�LI
DOC TYPE
q HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ d�Dlb Ia.o-�
YYYYMMDD

ya
Energy. Mineral
and Land Resources
ENVIRONMENTAL QUALITY
R'ECEIVED
FEB 2 81.fl17
Land FINRLDEWR
Mooresville Section
sville Reglonal
D Ice
Mr. Rick Carneil
Director, Environmental, Health, & Safety
Intertape Polymer Corp.
1091 Carolina Pines Drive
Blythewood, SC 29016
Dear Mr. Carnell:
December 2, 2016
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
secretary
TRACY DAVIS
Dtrectnr
Subject: General Permit No. NCG050000
Intertape Polymer Corp.
COC No. NCG050434
Cabarrus County
In accordance with your application for a discharge permit received on November 3, 2016, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state —
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General
Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval of the
Division of Energy, Mineral and Land Resources. The Division of Energy, Mineral and Land
Resources may require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by
the Division of Energy, Mineral and Land Resources, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
If you have any questions concerning this permit, please contact Julie Ventaloro at telephone number
[phone] or by email julie.ventalorognedenr.4ov.
Sincerely,
mr-
;)1 s1;?'1N'P.L v "4C''D t3
BETHANY OEOIRGOIJUAS
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Zahid Khan
Central Files
Stormwater Permitting Program Files
State of Noah Carolina I Environmental Quality I Energy, Mineral and Land Resources
1612 Mail Service Center { 512 North Salisbury Street � Raleigh, NC 27699-1612
919 707 9200 T

.1
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG050000
CERTIFICATE OF COVERAGE No. NCG050434
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Intertape Polymer Corp. n
is hereby authorized to discharge stormwater from a facility located at FC
FB2
Intertape Polymer Corp. j'? e4
13722 Bill McGee Road �O°�S� Pra�rF
Midland �i�/� �ZR
Cabarrus County
to receiving waters designated as Muddy Creek, a class C water in the Yadkin River Basin, in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth
in Parts I, II, III, and IV of General Permit No. NCGO50000 as attached.
This certificate of coverage shall become effective December 2, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 2, 2016.
0Riv1,(yAL SiGNED 5Y
BETHANY GEORGOUL1AS
for Tracy E. Davis, P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

NCGO50434
N
W E
S
Map Scale 1: 24, 000
Intertape Polymer Corp.
Latitude: 350 13' 48" N
Longitude: 8011 31' 07" W
County: Cabarrus
Receiving Stream: Muddy Creek
Index No: 13-17-16
Stream Class: C
Sub -basin: 03-07-12 (Yadkin River Basin)
Facility Location

• Central Files: APS _ SWP
12/2/2016
Permit Number NCO050434 Permit Tracking Slip
Program Category
Status Project Type
NPDES SW
in review New Project
Permit Type
Version Permit Clasaification
AppareUPrinting/PaperA-eathedRubber Stormwater Discharge COC
COC
/y
Primary Reviewer
R E -
RECEIVED
E I` E D
Permit Contact Affiliation
julie.ventalom
\\ 1•� �•i
C V C
Coastal SwRuia
DEC j
Permitted Flow
CENTRAL FILES
DVV SEji'iop,
Facility
Facility Name
MajorlMinor Region
Intertape Polymer Corporation
Minor Mooresville
Location Address
county
13722 Bill McGee Rd
Cabarrus
Facility Contact Affiliation
Midland NC 28107
Jason Brauch
100 Paramount Or
Owner
Sarasota FL 34232
Owner Name
Owner Type
intertape Polymer Corporation
Non -Government
Owner Affiliation
Shawn Nelson
100 Paramount Or
OateslEvents
Sarasota FL 34232
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Issue
Effective
Expiration
10121/2016
1-%y/y0/b
i�i�z•�b
5�311b°tg
Regulated Activities
Requested !Received Events
Paper products manufacture
RO staff report requested
11/21/16
RO staff report received
11/30/16
Outfall 001
Waterbody Name Streamtndex Number Current Class Subbasin
Muddy Creek 13-17-16 C 03-07-12

Energy, Mineral
and Land Resources
ENVIRONMENTAL OVALITY
December 2, 2016
Mr. Rick Carrell
Director, Environmental, Health, & Safety
Intertape Polymer Corp.
1091 Carolina Pines Drive
Blythewood, SC 29016
PAT MCCRORY
Govemor
DONALD R. VAN DER VAART
Secretary
TRACY DAVIS
Director
Subject: General Permit No, NCGO50000
Intertape Polymer Corp.
COC No. NCGO50434
Cabarrus County
Dear Mr. Carnell:
In accordance with your application for a discharge permit received on November 3, 2016, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state --
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General
Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval of the
Division of Energy, Mineral and Land Resources. The Division of Energy, Mineral and Land
Resources may require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by
the Division of Energy, Mineral and Land Resources, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
If you have any questions concerning this permit, please contact Julie Ventaloro at telephone number
[phone] or by email [e-mail].
Sincerely,
i
for Tracy E. Davis, P.E., CP , Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Zahid Khan
Central Files
Stormwater Permitting Program Files
State of North Carolina I En%ironmental Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1 512 North Salisbury Street j Raleigh, NC 27699-1612
919 707 9200 T

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG050000
CERTIFICATE OF COVERAGE No. NCG050434
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Intertape Polymer Corp.
is hereby authorized to discharge stormwater from a facility located at
Intertape Polymer Corp.
13722 Bill McGee Road
Midland
Cabarrus County
to receiving waters designated as Muddy Creek, a class C water in the Yadkin River Basin, in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth
in Parts I, 1I, III, and IV of General Permit No. NCG050000 as attached.
This certificate of coverage shall become effective December 2, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 2, 2016.
for Tracy E. Davis,-P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

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NCGO50434
N
W E
Map Scale 1:24,000
Intertape Polymer Corp.
Latitude: 350 13 48 N
Longitude: 800 31' 07" W
County: Cabarrus
Receiving Stream: Muddy Creek
Index No: 13-17-16
Stream Class: C
Sub -basin: 03-07-12 (Yadkin River Basin)
Facility Location

Division of Energy, Mineral and Land Resources
Land Quality Section
NCDENR National Pollutant Discharge Elimination System
.D�o
NCG050000
NOTICE OF INTENT
lei
�L'fiF•1c�Calll�,'
National Pollutant Discharge Elimination System application for coverage under General Permit
NCGO50000:
STORMWATER DISCHARGES associated with activities classified as:
SIC' 23 Apparel and Other Finished Products Made from Fabrics and Similar Materials
SIC" 265 Paperboard Containers and Boxes
SIC" 267 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)
SIC' 39 Miscellaneous Manufacturing Industries
SIC* NIA 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:
SIC' 301 Tires and Inner Tubes
SIC' 311 Leather Tanning and Finishing
" Standard Industrial Classification Code
(Please print or type)
Qww7
1) Mailing address of ownerloperator (address to which all permit corresponder6ce will be mailed:
Name Rick Carrell, Director Environmental. Health, & Safety
Street Address 1091 Carolina Pines Drive
City Blythewood State SC ZIP Code 29016_ _
Telephone No. 803-476-1527 Fax:
E-mail Address rcarnell[a?itape.com
2) Location of facility producing discharge:
Facility Name Intertape Polymer Corp.
Facility Contact Jason Brauch
Contact E-mail ibrauch(7a.itaae.com
Street Address 13722 Bill McGee Road
City Midland State NC ZIP Code 28107
County Cabarrus
Telephone No. 920-540-0668 Fax:
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). The facility will be located less than one mile west of
Page 1 of 4
5WU-220-071408 Last Revised 6124114

NCGO50000 N.Q.I.
downtown Midland on Bill McGee Road. From the intersection of NC-24EINC-27E and US 601, head south
on US 601 for approximately 2 miles to Wallace Road. Turn right on Wallace Road and travel approximately
0.2 miles to Bill McGee Road, Turn right on Bill McGee Road and the facility will be located at 13722 Bill
McGee Road. See attached map.
(A copy of a county map or Uses quad sheet with facility clearly located on the map is required with this application)
4) Latitude 35°13'48" Longitude 80°31'07" (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following:
0 New or Proposed Facility Date operation is to begin 02/01 /2017
❑ Existing
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2672
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: The facility will manufacture water -activated tape. The facility will consist of a glue mixing system,
laminator, printing press tape slitting, and auxillary operations for the production of tape S label materials.
8) Discharge points:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 2
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Muddy Creek
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer). NIA
10) Does this facility have any other NPDES permits?
❑ No
0 Yes
If yes, list the permit numbers for all current NPDES permits for this facility: SW3160501, Construction Storm
Water General Permit #NCG010000 Proiect ID: CABAR-2016-090
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
0 No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
0 Yes
If yes, please briefly describe: U on completion of construction there will be two sand filters for storm water runoff.
Storm water associated with industrial activity at the site will be directed to one of the two sand filters prior to
discharging from the site. Outfall 01 is the discharge from the East Sand Filter, while Outfall 02 is the discharge from
the West Sand Filter. _ - -
13) Does this facility have a Stormwater Pollution Prevention Plan?
Page 2 of 4
SWU-220-071408 Last Revised 6/24/14

NCGO50000 N.O.I.
❑ No
Q Yes
If yes, when was it implemented? The facility is in the process of developing a Storm Water Pollution Prevention Plan
and it will be finalized Prior to startup and implemented upon startup of the facility.
14) Are vehicle maintenance activities occurring at this facility?
Q No ❑ Yes
15) Hazardous Waste: NOTE: The facility has not started operating vet. It is anticipated that the facility will be a
CESQG.
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
0 No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
❑ No 0 Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
0 No ❑ Yes
d) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: TBD
How is material stored: TBD
Where is material stored: TBD
How many disposal shipments per year: TBD
Name of transport / disposal vendor: TBD
Vendor address: TBD
16) Certification:
North Carolina General Statute 143-215.6 b (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; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten thousand dollars ($10,000).
I hereby request coverage under the referenced General 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 certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Nameof Person Signing: Ri' C K CA M_ A) II
Title- _ ! /I 57 -
of Applicant)
/0/46
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to NCDENR.
Page 3of4
SWU-220-071408 Last Revised 6/24/14

NCG050000 N.Q.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
Q Check for $100 made payable to NCDENR
Q This completed application and all supporting documents
Q Copy of county map or USGS quad sheet with location of facility clearly marked on map and nearby waters
Mail the entire package to:
Stormwater and General Permits Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ......
(828) 2964500
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
(919) 7914200
Washington Office ...(252)
946-6481
Wilmington Office...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 4 of 4
SWU-220-071408 Last Revised 6124/14

TM
r • • intertape polymer groupTM
November 1, 2016
Stormwater and General Permits Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, NC 27699-1612
Re: Notice of Intent NCG050000
IPG Midlands, NC facility
Dear Sirs:
4�NR.1,.AND P�RM�n1NG
STORMWA��R
Intertape Polymer Group, IPG, is building a greenfield plant site in Midlands NC. We anticipate
starting the plant in March 2017. The plant will be subject to the requirements of the National
Pollutant Discharge Elimination System General Permit NCG050000. Attached are the
following items to apply for coverage under the General Permit:
• Check for $100 payable to NCDNER
• Completed NOI Application and supporting documents
• Coy of USGS quad sheet showing location of the IPG facility
Please advise if you have any questions or require further information to issue the general permit.
My number is ($03)476-1527 and email address is [e-mail]
Sincerely,
Rick Carrell
Director EH&S

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MIDLAND, NORTH CAROLINA
PROJECT NO, 235081.80
patewaod Pfaza One, Suite 300 FIGURE 1
30 Patewood Drive FILE NO. SAeLm X160412=d
G;ono: 86 26 M30 SITE LOCATION MAP
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Pharrs: 884, 28 i.fN130
GATE: APRIL 2016

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U J Yun Wept OH
Check Date 10/07/16 412
9600152544
PAY ONE HUNDRED AND001100AMOUNT $*******1(0.(0
VOW AM 180 Days
Pa�@ 1M r� pi..1�16ncyEWLS
TO THE NC DEFT ENVIRONMENT & NATURAL RESOURCES
ORDER
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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
GENERAL PERMIT NO. NCG050000
CERTIFICATE OF COVERAGE No. NCG050434
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Intertape Polymer Corp.
is hereby authorized to discharge stormwater from a facility located at
Intertape Polymer Corp.
13722 Bill McGee Road
Midland
Cabarrus County
to receiving waters designated as Muddy Creek, a class C water in the Yadkin River Basin, in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth
in Parts 1, II, III, and IV of General Permit No. NCG050000 as attached.
This certificate of coverage shall become effective December 2, 2016.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day December 2, 2016.
OR21iNAL SIGINED 5Y
BETHANY GEORGOULIAS
for Tracy E. Davis, P.E., CPM
Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

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NCGO50434
N
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Map Scale 124, 000
Intertape Polymer Corp.
Latitude: 350 13' 48" N
Longitude: 800 31'07" W
County: Cabarrus
Receiving Stream: Muddy Creek,
Index No: 13-17-16
Stream Class: C
Sub -basin: 03-07-12 (Yadkin River Basin)
�r�
0
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Facility Location

Energy, Mineral
and land Resources
ENVIRONMENTAL QUALITY
December 2, 2016
Mr. Rick Carnell
Director, Environmental, Health, & Safety
Intertape Polymer Corp.
1091 Carolina Pines Drive
Blythewood, SC 29016
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
Secrelan
TRACY DAVIS
Direclor
Subject: General Permit No. NCG050000
lntertape Polymer Corp.
COC No. NCG050434
Cabarrus County
Dear Mr. Carrell:
In accordance with your application for a discharge permit received on November 3, 2016, we are
forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state —
NPDES general permit. This permit is issued pursuant to the requirements of North Carolina General
Statute 143-215.1 and the Memorandum of Agreement between North Carolina and the US
Environmental Protection Agency dated October 15, 2007 (or as subsequently amended).
Please take notice that this certificate of coverage is not transferable except upon approval of the
Division of Energy, Mineral and Land Resources. The Division of Energy, Mineral and Land
Resources may require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by
the Division of Energy, Mineral and Land Resources, the Coastal Area Management Act, or any other
federal or local government permit that may be required.
If you have any questions concerning this permit, please contact Julie Ventaloro at telephone number
[phone] or by email [e-mail].
Sincerely,
0RiGINAL SION' ED IS
EETHANY GEORGOJ! 1AS
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville Regional Office, Zahid Khan
Central Files
Stormwater Permitting Program Files
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
1612 Mail Service Center 1 512 North Salisbury Street I Raleigh, SIC 27699-1612
919 707 9200 T

Ventaloro, Julie
From: Khan, Zahid
Sent: Wednesday, November 30, 2016 12:33 PM
To: Ventaloro, Julie
Subject: FW: Intertape NCG050934
Attachments: jm-11302016-001. pdf
Follow Up Flag: Follow up
Flag Status: Flagged
Please see E-mail by James. Thanks
From: Moore, James
Sent: Wednesday, November 30, 2016 12:26 PM
To: Khan, Zahid <[e-mail]>; Ventaloro, Julie <[e-mail]>
Subject: Intertape NCG050934
The facility is currently under construction and is expected to start up in April 2017. Baes on my knowledge of the
process / industrial activity, coverage under NCG050000 is required. Please proceed with coverage.
James Moore MRO
Correspondence to and from this a mail address may be subject to the NC Public records law and can be viewed by third
parties.

AyT
• Division of Energy, Mineral and Land Resources
Land Quality Section
RWENRNational Pollutant Discharge Elimination Systern
M�OF
NCG050000
NOTICE OF INTENT
FOR AGENCY USE ONLY
©C•7Ce3fi�L�I��kJC�Li'
National Pollutant Discharge Elimination System application for coverage under General Permit
NCG050000:
STORMWATER DISCHARGES associated with activities classified as:
SIC` 23 Apparel and Other Finished Products Made from Fabrics and Similar Materials
SIC" 265 Paperboard Containers and Boxes
SIC" 267 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 specked below)
SIC` 39 Miscellaneous Manufacturing Industries
SIC' NIA 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:
SIC' 301 Tires and Inner Tubes
SIC" 311 Leather Tanning and Finishing
" Standard Industrial Classification Code
(Please print or type)
1) Mailing address of ownerloperator (address
Name
Street Address
City
Telephone No.
E-mail Address
Rick Carnell. Director Environmental. Health, & Safety
1091 Carolina Pines Drive
Owwt
mce wni oe maiiea
�mfer ,0e Pokyywr
Blythewood State SC ZIP Code 29016
803-476-1527 Fax:
rcarnellAitaQe.com
2) Location of facility producing discharge:
Facility Name
Interta a Polymer Corp.
Facility Contact
Jason Brauch
Contact E-mail
ibrauch cDitaoe.com
Street Address
13722 Bill McGee Road
City
Midland State NC ZIP Code 28107
County
Cabarrus -
Telephone No.
920-540-0668 Fax:
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway, intersection). The facility will be located less than one mile west of
Page 1 of 4
SWu-220-071408
Last Revised 6124114

NCG050000 N.O.I.
downtown Midland on Bill McGee Road. From the intersection of NC-24EINC-27E and US 601, head south
on US 601 for approximately_2. miles to Wallace Road. Turn right on Wallace Road and travel approximately
0.2 miles to Bill McGee Road. Turn right on Bill McGee Road and the facility will be located at 13722 Bill
McGee Road. See attached map.
(A copy of a county map or USGS quad sheet with faciiity clearly located on the map is required with this application)
4) Latitude 35013'48" Longitude 80°31'07" (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following:
0 New or Proposed Facility Date operation is to begin 02101/2017
❑ Existing
6) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2672
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: The facility will manufacture water -activated tape. The facility will consist of a glue mixing system,
laminator, printing press, tape slitting, and auxiliary operations for the production of tape & label materials.
8) Discharge points:
How many discharge points (ditches, pipes, channels, etc.) convey stormwater from the property? 2
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
discharges end up in? Muddy Creek
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer). NIA
10) Does this facility have any other NPDES permits?
❑ No
Q Yes
If yes, list the permit numbers for all current NPDES permits for this facility: SW 3160501 . Construction Storm
Water General Permit #NCG010000 Proiect ID: CABAR-201E-090
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
Q No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
0 Yes
If yes, please briefly describe: Upon completion of construction, there will be two sand filters for storm water runoff.
Storm water associated with industrial activily at the site will be directed to one of the two sand filters prior to
dischargingdischaLging from the site. Outfall 01 is the discharge from the East Sand Filter, while Outfall 02 is the discharge from
the West Sand Filter.
13) Does this facility have a Stormwater Pollution Prevention Plan?
Page 2 of 4
SWU-220-071408 Last Revised 6124114

-NCG050000 N.O.I.
❑ No
Q Yes
If yes, when was it implemented? The facility is in the process of developing a Storm Water Pollution Prevention Plan
and it will be finalized prior to startup and implemented upon startup of the facility.
14) Are vehicle maintenance activities occurring at this facility?
QQ No ❑ Yes
15) Hazardous Waste: NOTE: The facility has not started operating vet. It is anticipated that the facility will be a
CES G.
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
0 No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
❑ No RI Yes
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
a No ❑ Yes
d) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: TBD
How is material stored: TBD
Where is material stored: TBD
How many disposal shipments per year: TBD
Name of transport 1 disposal vendor: TBD
Vendor address: TBD
16) Certification:
North Carolina General Statute 143-215.6 b (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: or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article: or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Artide shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten thousand dollars ($10,000).
hereby request coverage under the referenced General 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 certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name�qf Person Signing: R Tl CA r A) II
Title: _ 7i i o .0,47o F L>F
of Applicant)
III,
(Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to NCDENR.
Page 3 of 4
SWU-22"71408 Last Revised W24I14

NCGO50000 N.O.I.
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
Q Check for $100 made payable to NCDENR
Q This completed application and all supporting documents
Q Copy of county map or USGS quad sheet with location of facility clearly marked on map and nearby waters
Mail the entire package to:
Stormwater and General Permits Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DEMLR Central Office or Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 4 of 4
SWU-220-071408 Last Revised 6/24/14

TM
" • • intertape polymer groupTM
November 1, 2016
Stormwater and General Permits Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, NC 27699-1612
Re: Notice of Intent NCG050000
IPG Midlands, NC facility
Dear Sirs:
gov
DENWAR PE M T14G
STORM
Intertape Polymer Group, IPG, is building a greenfield plant site in Midlands NC. We anticipate
starting the plant in March 2017. The plant will be subject to the requirements of the National
Pollutant Discharge Elimination System General Permit NCG050000. Attached are the
following items to apply for coverage under the General Permit:
• Check for $100 payable to NCDNER
• Completed NOI Application and supporting documents
• Coy of USGS quad sheet showing location of the IPG facility
Please advise if you have any questions or require further information to issue the general permit.
My number is [phone] and email address is rcamell ita e.com
Sincerely,
Rick Carrell
Director EH&S

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C REPROOUCED OR COPIED IN
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Division of Energy, Mineral and Land Resonrces
A ) -
Land Quality Section
NCDENR National Pollutant Discharge Elimination System
"�Owh�o,CF
NCGO50000
NOTICE OF INTENT
National Pollutant Discharge Elimination System applicaition for coverage under General Permit
NCG050©00:
STORMWATER DISCHARGES associated with aaMtles classified as:
SIC' 23 ;Apparel and Other Finished Products Made from Fabrics and Similar Materials
SIC' 265 Paperboard Containers and Boxes.
SIC' 297 Converted Paper ard'Paperboard'Products
Sltr' 27 Printing, Publishing and Allied Industries
SIC 30 Rubber and Miscellaneous Products (except as specified ied below)
SIC` 31 Leather and Leather Products (except as specified below)
SIC" 39 Miscellaneous Manufacturing Industries
SIC" NIA Like activities deemed by DEMLR to:be similar in the process and/or the exposure of raw
materials, produds, by-products; or waste materials.
The following activities are specifically excluded from coverage under this General Permit:
SIC' 301 Tires and Inner Tubes
SIC' 311 Leather Tanning and Finishing
Standard Inch al ClassiflcsUan Code
(Please print or type) O&Wf A4W
1) Mailing address of ownerloperator (address to which all Permitoorresponds7ilegewill be mailed):
Name Dick Camell, Director Environmental. Health. & Safety xh f+rr ' �kyy'rl' j�
Street Address 1091 Carolina Pines Drive
City Blythewood State SC ZIP Code 29016
Telephone No,. 803-476-1527
E-mail-Address rearnWI(Mitape.com
2) Location of facility producing discharge:
Fadifty Name Intertape Polymer Caro.
Facility Contact Jason Brauah
Contact E-mail ibrau�citaoe.com -
Street Address 13722 Bill McGee Road
City Midland State NC ZIP Code 28107
County Ca rrus
Telephone No. 920-5404M8 Fax:
3) Physical Location Information:
Please provide a narrative description of how to get to the facility (use street names, static rbad numbers, and
distance and dir6bti6rl from a roadway'intiarsection): The fad will lye -located less than one mile west aF
_swLH220-0714M
Page 1 of 4
Last Revised 6124/14

NCG050000°N.O.I.
downtown Midland_g_nBIII_McGee Road. From the intersection of NC-24 C-27E and US 601�head sauth
on US B01 for approximately 2 miles to Wallace Road. Turn right on Wallace Road and travel approximately
0.2 miles to Bill McGee Road. TumAaht on Bill McGee Road and the facility will be located at 13722 Bill
McGee Road. See attached mag.
(A copy or a county map or USGS quad sheet with fadHty dawV bcated an the map Is requkW wits► this emotion)
4) Latitude 35°13'4W' Longitude __Q(°311Oi' (degrees, minutes, seconds)
5) This NPDES Permit Application applies to which of the following :
Q New or Proposed Facillty Date operation is to begin 02/0112017
❑ Existing
6) Standard industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2672
7) Provide a brief narrative description of the types of industrial activities and products manufactured at
this facility: The facft will mant/facture water -activated tape. The faca wE11 consist of a glue mbdna systern.
laminator, printi Press. taps sfitt_i_n_gLand auxiliary operations for the production of tape & label materials.
8) Discharge.polyds:
How many discharge points (ditches, Pipes, channels; etc.) convey stormvkmter from the property? 2
9) Receiving waters:
What is the name of the body or bodies of water (creek, stream, river, lake, etc) that the facility stormwater
discharges and up In? Muddy Creek
if the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer}. NIA
10) Does this`#acility have anyother NPDES"permits?
❑ No
® Yes
If yes, list the permit numbers,for all current NPDES permits for this fadlfty. SW3160501: Construction Storm
Water Cameral Permit #NCG010000 Protect ID: CABAR-201M90
11) Does this facility have any Non -Discharge permits (ax: recycle permits)?
Q No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
12) Does this facility employ any best management practices for stormwater control?
❑ No
0 Yes
if yes, please briefly describe: Upon comoletion of construction, there will be tLm sand Titers for stoma water runoff.
Storm water associated with industrial activity at the site will be directed to one of the two sand filters prior to
discharging from the sir e. Outfall 01 is the discharge from the East Sand Filter, while Cutfall 02 is the discharge from
The t Sand Filter.
13) Does this facility have a Stormwater Pollution Prevention Plan?
swu-22647t a
Page 2 of 4
Lest Revised Sd24M 4

NCGO50000 N.O.I.
❑ No
Q Yes
If yes, when was it Implemented? The facility is in the process of developing: a Storm Water Pollution Prevenjign Plan
and It will be finalized prior to startup and implemented upon startup of the facility.
14) Are vehleis Maintenance acdvitles occurring at this facility?
0 No ❑ Yes
15) Hazardous Waste: NOTE: The facility has not started operatinsr vet. It is anticipated that the facility will be a
CE_ SQG.
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
® No ❑ Yes
b) Is this fadlity a Small Quantity Generator (less than 1 Q00 kg. of hazardous waste generated per month) of
hazardous waste?
❑ No H Yes
c) is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
® No ❑ Yes
d) If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: TBD
How Is material stared: TBD
Where is material stored: TBD
How many disposal shipments per year. TBD
Name of transport 1 disposal vendor: TBD
Vendor address: TBD
16) Certification:
North CaroUna General. Statute 143-215.6 b (i) prcMdes that:
Any person who y mares any tatse statamant reoreseniff9on, or owl6w9on In arty appitca&m. record, repwt. plan, or other
docwment tiled or required to be mahrtah>ed urder this Mlle or a rule Implementiing thts Artme; or who Mmmingly makes a false
stater. ant of a material fad In a _rulemakfng praceedfng or contested rase wider this Artidde: or who felsiftes, tampers wih or kwbVty
r+endem #naccruate any reoording or mordtodng dew or metliod requirad to be operated or rnahrtained cinder this Article or odes of the
J> nvlronmeY tal Managemenq Commisslon Implemerptng tt" Article shall be guilty ate Class 2 misdemeanar whfcri may include a ttna not to
exceed tort thousand dollars ($10,000�
I hereby request coverage under the referenced General Permit. I understand that coverage under this permit
wili constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
1 tertEfy that i am'familiar with the information contained In this application and that to the best of my.
knowledge and belief such information is true; complete,.arvd accurate.
c>) Printed Name Person Signing: R r C 9 - (-�A r A)
rrr&l 11 f h *,44hok AOF—._ .49,
of
(Dafe Slgrrer!}
Notice of Intent must be accompanied by a check or money order far $100.00`'made payable to NC,DENR.
Stl U-22t1 IUM
Page 3 of 4 _.
Last Revtsad f8r MU

NCG050000 N.O.I.
Final Checklist
This:appllcation will.be returned:as:incomplete:uniess:all:of.the.following items have:been Included: '
Rf Check for $100 made payable to NCDENR
EZ This completed application and all supporting documents
0 Copy of county map or USGS quad sheet with location of facility clearly marked on map and nearby waters
Mall the entire package to.
Stormwater and General Permits Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27899-1612
Note
The submission of this document does not guarantee the Issuance of an NPDES permit+
For questions, please contact the DFMLR Central Office or Regional Office for your area.
DEIVILR Realonal Office Contact Information:
Asheville Office ......
(828) 296AWD
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946.6481
Wilmington Office .._
[phone]
Winston-5alem ._....
[phone]
Central Office .........(919)
807-6300
Page:4 of 4
SWU-220-071408 Last Revised W2" 4114 .

4, ,
f':r ✓,i4t
J::•: ' inertape polymer groupTM
f�
November 1, 2016
Stormwater and General Permits Unit Program
Division of EnmW, Mineral and Land.Resources
1612 Mail Service Center
Raleigh, NC 27699-1612
Re: Notice of Intent NCG050000
IPG Midlands, NC facility
Dear Sirs:
Gov o $ Fors
p�N�R P � tNG
Intertape Polymer Group, IPG, is building a greenfield plant site in Midlands NC. We anticipate
starting the plant in March 2017. The plant will be subject to the requirements of the National
Pollutant Discharge Elimination System General Permit NCG050000. Attached are the
following items to apply for coverage under the General Permit:
Check for $100 payable to NCDNER
Completed NOI Application and supporting documents
• Coy of USGS quad sheet showing location of the IPG facility
Please advise if you have any -'questions or regimes further information to issue the.general permit.
My number is [phone] and email address.isscarnell(r_.�iWe.com
Sincerely,
Rick Carrell
Director EH&5

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