~ RECEIVED lLlb/1.> St:J....t-v NCCW GP Appendix 5 APPENDIXS Suggested Notice of Intent Format UNITED STATES ENVIRONMENTAL PROTECTION AGENCY- REGION 1 FIVE POST OFFICE SQUARE SUITE 100 BOSTON, MASSACHUSETTS 02109-3912 Request for General Permit Authorization to Discharge Noncontact cooling Water Notice ofIntent (NOI) to be covered by the General Permit Noncontact Cooling Water General Permit (NCCWGP) NPDES General Permits No. MAG250000 and NHG250000 A. Facility Information 1. Indicated applicable General Permit for discharge: MAG250000 181 NHG250000 D 2. Facility Information/Location: Facility Name Jen-Coal Inc. dba Prolamina Street/POBox 132 North Elm Street City Westfield State Massachusetts Zip Code 01085 Latitude 42° 07' 56" Longitude 72° 44 ' 39" Type ofBusiness Manufacturing - specialty extrusion coating for flexible packagjng applications. SIC Codes(s) 2671: Coated & Laminated Packaging; NAICS 322221: Coated & Laminated Packaging Paper 3. Facility Mailing address (if different from Location Address): Facility Name Prolamina Street/POBox PO Box 274 City Westfield State Massachusetts Zip Code 01086-0274 4. Facility Owner: Name Dave Hopkins - President ofUS Operations E-mail
[email protected] Street/POBox------------ City----------- Smte _ _ ________________ Zip Code ____ Contact Person Tel Owner is (check one): Federal __State __Tribal _____ Private X Other (describe)--------------------------- 5. Facility Operator (if different from above): Legal Name Brian Caraker- Plant Manager at facility E-mail bcaraker@prolam ina.com