NCG060105_Email re Updates_20210622

McCoy, Suzanne
From: David Schaefer <[e-mail]>
Sent: Monday, June 21, 2021 4:57 PM
To: McCoy, Suzanne
Subject: [External] NCG060105 Glaxosmithkline Zebulon, NC changes and questions regarding
six -step process for e-DMRs
Attachments: NPDES SW eDMR Owner Verification.pdf, NPDES SW Permit Summary Report.pdf,
NPDES SW eDMR Owner Verification Signed GSK Zebulon NCG060105.pdf,-
NCG060105 Signed e-DMR Registration Form GSK Zebulon.pdf
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Hi Suzanne,
Going through Step 1 Data verification I have noticed updates needed.
eDMR Owner Verification Form —attached. Need following changes:
- Owner/Permittee Address — 1011 North Arendell Avenue, Zebulon, NC 27597
- Responsible Official — Laurie Braxton
- Resp. Official Title — Site Director
Stormwater Permit Summary Report — attached.
- Owner Affiliation name — I have filled out Owner Designation/Affiliation Form. Signed, scanned copy is
attached to email — I will also send physical copy to Stormwater Program, attn: Suzanne McCoy, 1612 MSC,
Raleigh, NC 276990-1612.
- Outfalls Major Updates
o Outfall 008 — New Description — MDPI East/Southeast Storm Drains
o Outfall 008 — New location - Lat: 35.828967 Long: - 78.331917
o New Outfall 012 — Description: Post C Roadway Outfall —
■ Location Lat: 35.83255 Long:-78.332117
■ 100% Stormwater
■ Same feed stream as all other outfalls (Neuse, Little River)
- Outfalls location updates — currently in our SPPP (they are close to your files, but I did do these myself and
would prefer to align with SPPP).
o Outfall 001 - Lat: 35.832458 Long:-78.333217
o Outfall 002 - Lat: 35.834163 Long:-78.329526
o Outfall 003 - Lat: 35.834082 Long:-78.327802
o Outfall 004 - Lat: 35.833212 Long:-78.330523
o Outfall 005 - Lat: 35.831290 Long:-78.327296
o Outfall 006 - Lat: 35.830724 Long:-78.323902
o Outfall 007 - Lat: 35.831746 Long:-78.328110
o Outfall 009 - Lat: 35.829761 Long:-78.331805
o Outfall 010 - Lat: 35.831561 Long:-78.333165
o Outfall 011 - Lat: 35.830925 Long:-78.333052
- Outfall Question — While all are correct, we do have a representative outfall (005). For e-DMR can you
confirm I will only be entering data for our one representative outfall?
E-Reporting Registration Form — attached.
1

I have completed the E-Reporting Registration form and had signed by our Owner Affiliation Contract and
myself (as Facility Administrator). I will also send physical copy to Stormwater Program, attn: Suzanne
McCoy, 1612 MSC, Raleigh, NC 276990-1612
Please let me know if any more info is needed to complete these first steps. From what I can tell, I now await you to set
up our account so I can designate data entry folks including myself.
Thanks,
David Schaefer, CHMM
EHS Engineer
Safety
Manufacturing
GSK
1011 N Arendell Ave
Zebulon, NC 27597
Email david.x.schaefera-gsk.com
Tel [phone]
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NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for your permit as of 6/21/2021.
Permit Number: NCG060105 Permit Status: Expired
Permit Type: Food/Tobacco/Soaps/Cosmetics/Public Warehousing Stormwater Discharge COC
Facility Name: Glaxosmithkline - Zebulon
Facility Addressl: 1011 N Arendell Ave
Facility Address2:
City, State & Zip: Zebulon, NC 27597
Owner Information Details:
MUST submit a Change of Name/Ownership form to DEMLR to make any changes to this Owner information.
(Click Here for "Change of Name/Ownershiv"Form)
Owner Name: Glaxosmithkline
Owner Type: Non -Government Owner Type Group: Organization
*** Legally Responsible for Permit ***
(Responsible corporate officer/principle executive officer or ranking elected official/general partner or proprietor;
or any other person with delegated signatory authority from the legally responsible person.)
Owner Affiliation: Troy D Webb Title:
Addressl: 1011 N Arendell Ave
Address2:
City, State & Zip: Zebulon, NC 27597
Work Phone: [phone] Fax:
Email Address: [e-mail]
*** Permit Annual Fee Billing ***
Billing Month: March
Invoice Number Invoice Date Invoice Due Date Invoice Amount Invoice Status
Owner Contact Person(s)
Contact Name Title Address Phone Fax Email
Facility Contact Person(s)
Contact Name Title Address Phone Fax Email
Jim Kenny 1011 N Arendell Ave, Raleigh, NC 27697 919-404-6812 james.t.kenny@gsk.
com
Permit Contact Person(s)
Contact Name Title Address Phone Fax Email
David Schaefer 1011 N Arendell Ave, Zebulon, NC 27597 919-269-1966 david.x.schaefer@gs
6/21/2021 Page 1

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the followinu information in our Permit Database for vour permit as of 6/21/2021.
Permit Billing Contact(s)
Contact Name Title
David Schaefer
Address Phone Fax
1011 N Arendell Ave, Zebulon, NC 27597 919-269-1966
Email
david.x.schaefer@gs
k.com
Person(s) with Delegated Signatory Authority
Type Contact Name Title
Permit David Schaefer
Address
1011 N Arendell Ave, Zebulon,
NC 27597
Phone Fax
919-269-1966
Email
david.x.schaefer@gsk.c
om
Permit Jim Kenny
1011 N Arendell Ave, Raleigh,
NC 27697
919-404-6812
[e-mail]
Person(s) with Electronic Signature Authority
Type Contact Name Title
Address
Phone Fax
Email
Outfalls
6/21/2021 Page 2

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for vour Dermit as of 6/21/2021.
Outfall #: 001
Outfall Description: MDPI retention pond and overflow pipe
Outfall Lattitude:
35.832220 Outfall Longitude:-78.333060
Represented by Outfall:
% Stormwater:
100 % Industrial:
Stream Waterbody
Basin
Waterbody Name
Index Number Classification
Neuse
Little River (Tarpleys Pond)
27-57-(8.5) WS-V;NSW
Outfall #: 002
Outfall Description: Admin Parkin lot/road outfall
Outfall Lattitude:
35.834170 Outfall Longitude:-78.329440
Represented by Outfall:
% Stormwater:
100 % Industrial:
Stream Waterbody
Basin
Waterbody Name
Index Number Classification
Neuse
Little River (Tarpleys Pond)
27-57-(8.5) WS-V;NSW
Outfall #: 003
Outfall Description: Admin roadways outfall
Outfall Lattitude:
35.833890 Outfall Longitude:-78.327780
Represented by Outfall:
% Stormwater:
100 % Industrial:
Stream Waterbody
Basin
Waterbody Name
Index Number Classification
Neuse
Little River (Tarpleys Pond)
27-57-(8.5) WS-V;NSW
Outfall #: 004
Outfall Description: Contractor lot/roadway outfall
Outfall Lattitude:
35.833060 Outfall Longitude:-78.330280
Represented by Outfall:
Stormwater:
100 % Industrial:
Stream Waterbody
Basin
Waterbody Name
Index Number Classification
Neuse
Little River (Tarpleys Pond)
27-57-(8.5) WS-V;NSW
Outfall #: 005
Outfall Description: Representative Outfall
Outfall Lattitude:
35.831110 Outfall Longitude:-78.327220
Represented by Outfall:
Stormwater:
100 % Industrial:
Stream Waterbody
Basin
Waterbody Name
Index Number Classification
Neuse
Little River (Tarpleys Pond)
27-57-(8.5) WS-V;NSW
6/21/2021 Page 3

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for vour Dermit as of 6/21/2021.
Outfall #: 006
Outfall Description: Post B outfall
Outfall Lattitude:
35.830560 Outfall Longitude:
-78.323890
Represented by Outfall:
% Stormwater:
100 % Industrial:
Stream Waterbody
Basin
Waterbody Name
Index Number Classification
Neuse
Little River (Tarpleys Pond)
27-57-(8.5) WS-V;NSW
Outfall #: 007
Outfall Description: Bldg 15 outfall
Outfall Lattitude:
35.831670 Outfall Longitude:
-78.328060
Represented by Outfall:
Stormwater:
100 % Industrial:
Stream Waterbody
Basin
Waterbody Name
Index Number Classification
Neuse
Little River (Tarpleys Pond)
27-57-(8.5) WS-V;NSW
Outfall #: 008
Outfall Description: MDPI energy center outfall
Outfall Lattitude:
35.829720 Outfall Longitude:
-78.330830
Represented by Outfall:
Stormwater:
100 % Industrial:
Stream Waterbody
Basin
Waterbody Name
Index Number Classification
Neuse
Little River (Tarpleys Pond)
27-57-(8.5) WS-V;NSW
Outfall #: 009
Outfall Description: MDPI rear building
outfall
Outfall Lattitude:
35.829720 Outfall Longitude:
-78.331670
Represented by Outfall:
Stormwater:
100 % Industrial:
Stream Waterbody
Basin
Waterbody Name
Index Number Classification
Neuse
Little River (Tarpleys Pond)
27-57-(8.5) WS-V;NSW
Outfall #: 010
Outfall Description: MDPI waste shed outfall
Outfall Lattitude:
35.831390 Outfall Longitude:
-78.333060
Represented by Outfall:
% Stormwater:
100 % Industrial:
Stream Waterbody
Basin
Waterbody Name
Index Number Classification
Neuse
Little River (Tarpleys Pond)
27-57-(8.5) WS-V;NSW
6/21/2021 Page 4

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for your permit as of 6/21/2021.
OutFall #: 011 OutFall Description: MDPI west outfall
OutFall Lattitude: 35.830830 OutFall Longitude:-78.333060 Represented by OutFall:
% Stormwater: 100 % Industrial:
Stream Waterbody
Basin Waterbody Name Index Number Classification
Neuse Little River (Tarpleys Pond) 27-57-(8.5) WS-V;NSW
6/21/2021 Page 5

eDMR Owner Verification Report
Permit No.: NCG060105
Owner/Permittee
Owner/Permittee
Address:
Responsible Official
Resp. Official Title:
Facility Name :
Facility Address:
Version: 6.00
Glaxosmithkline
Five Moore Dr
Research Triangle Park, NC 27709
Troy D.Webb
Glaxosmithkline - Zebulon
1011 N Arendell Ave
Zebulon, NC 27597
Registered for eDMR? : No
Permt Status: Expired
Page # : 1
Date : 6/21 /2021

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
ENVIRONMENTAL OUALITV (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
N I C I S
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(01) Certificate of Coverage or No Exposure
N I C I G 10 16 10 11 0 15
Glaxosmithkline
Glaxosmithkline
1011 North Arendell Avenue
Address
Zebulon NC 27597
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
littps:Hdeg.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/npdes-industrial-
rp ograrn and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual:
Troy
First
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit:
D Webb
Mr Last
Laurie B Braxton
First MI Last
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S WU-OWNERAFFIL4Nov2019

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
Site Director
Title
1011 North Arendell Avenue
Mailing Address
Zebulon NC 27597
City State Zip
(919 ) 3065464 [e-mail]
Telephone E-mail Address
( )
Fax Number
5) Reason for this change:
❑✓ Employee or management change
A result of: ❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
1, David Schaefer , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processe .
21 June 2021
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website
at: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
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S WU-O W N ERAFFI L-4Nov2019