NCGNE0654_COMPLETE FILE - HISTORICAL_20100909

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNEbI.OSy
DOC TYPE
�1 HISTORICAL FILE
DOC DATE
❑ JOID 090
YYYYMMDD

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Paves Perdue Coleen H. Sullins
Governor Director
September 9, 2010
Nature's Earth Pellets NC, LLC
Attn: Cliff Bragg
16900 Aberdeen Road
Laurinburg, NC 28352
Subject: No -Exposure Certification NCGNED654
Nature's Earth Pellets NC, LLC
Scotland County
Dear Mr. Bragg:
Dee Freeman
Secretary
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES Stormwater
Permitting form. Based on your submittal and signed certification of no exposure at the above referenced facility, as well
as observations made during a site visit conducted by Mike Lawyer with the Fayetteville Regional Office on September 7,
2010, the Division is granting your conditional exclusion from permitting as provided for under 40 CFR 126.22(g), which is
incorporated by reference in North Carolina regulations.
Please note that by our acceptance of your No -Exposure Certification, you are obligated to maintain no -exposure
conditions at your facility. If conditions change such that your facility can no longer qualify for no -exposure exclusion, you
are obligated to immediately obtain NPDES permit coverage for your stormwater discharge. Otherwise, the discharge
becomes subject to enforcement as an un-permitted discharge. You must self re -certify annually using the enclosed form,
or obtain NPDES permit coverage for any stormwater discharges from your facility. The annual self re -certification does
not need to be submitted to DWQ unless requested. '
Your conditional exclusion from permitting does not affect your facility's legal requirements to obtain environmental
permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact Mike Lawyer at [phone].
Sincerely,
Nic-" 1
for Coleen H. Sullins
Enclosures
cc: FRO -Surface Water Protection
Stormwater Permitting Unit, No -Exposure Files
Location: 225 Green Street, Suite 714, Fayetteville, North Carolina 28301
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterauality.oro
An Equal Opportunity 4 Affirmative Action Employer
NorthCa-rolina
Naturally

No -Exposure Self Re -Certification Information:
You are obligated to maintain no -exposure" conditions at your facility. If conditions change such that
your facility can no longer qualify for a no -exposure exclusion, you are obligated to immediately obtain
NPDES permit coverage for your stormwater discharge. Otherwise, the discharge becomes subject to
enforcement as an un-permitted discharge. State statute provides for fines of up to $25,000 per day for
un-permitted discharges.
Your conditional no -exposure exclusion must be self re -certified at least annually as follows:
- Complete the re -certification at a minimum of once per year using the included Self Re -
Certification Form.
(additional copies can be downloaded from http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-5 )
- Maintain a record of re -certifications on file at the facility. Do not submit the re -certification to
DWQ unless requested. If requested, submit a copy of the re -certification to the Division and/or
the municipality in which the facility is located.
-During an inspection by DWO or local government, provide the re -certifications immediately
upon request.
- Notify the Division of any changes in ownership, significant facility and/or activity changes, or if
the facility can no longer maintain no -exposure.
-Allow the NPDES permitting authority or, if discharging into a municipal separate storm sewer
system, the operator of the system, to: (1) inspect the facility; and (2) make such inspection reports
publicly available upon request.
* "No exposure" means that all industrial materials and activities are protected by a storm resistant shelter to
prevent exposure to rain, snow, snowmelt, and/or runoff. Industrial materials or activities include, but are not
limited to, material handling equipment or activities, industrial machinery, raw materials, intermediate
products, by-products, final products, or waste products. Material handling activities include the storage,
loading and unloading, transportation, or conveyance of any raw material, intermediate product, final product
or waste product. (40 CFR 122.26(g))
Information and forms related No -Exposure Certifications can be accessed on the website at:
http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-5
Rev. 30Aug201 0

4
t�
NC®EN R
cAnau"
t:—RONMENT AND Na URARESW CE5
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Ellininatlon System
ANNUAL NO EXPOSURE EXCLUSION SI---LI: Rl-CERTIFICATION
NCGNE0000
Do not submit this form to DWQ unless requested.
For questions, please contact the DWQ Regional Office for your area or the Central Office.
(Please print or type)
Facility's No Exposure Exclusion No. Date Completed (MM/DD/YYYY)
N I C I G N I E I I I
1) Has the facility name or owner changed? ❑ Yes ❑ No
(if yes, please submit a separate Name/Ownership Change Form to DWQ located at
http:/Iportal.ncdenr.org/web/wglws/su/npdessw#Application_Forms NPDES)
2) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable
future? (Please check either "Yes" or "No.") If you answer "Yes" to any of these items, you are not
eligible to maintain your no exposure exclusion, and must immediately apply for a permit from DWQ.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes [:]No
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes ❑ No
c. Materials or products from past industrial activity ❑ Yes ❑ No
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes [:]No
e. Materials or products during loading/unloading or transporting activities ❑ Yes ❑ No
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes [:]No
use [e.g., new cars] where exposure to stormwater does not result in the discharge
Of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, [:]Yes [:]No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ❑ No
the discharger
i. Waste material (except waste in covered, non4eaking containers [e.g., dumpsters]) ❑ Yes ❑ No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes ❑ No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ❑ No
otherwise 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 ❑ Yes ❑ No
(i.e., not closed and stored upside down to prevent precipitation accumulation)
Page 1 of 3
SWU-NESR-29JO2010

NCGNE0000 No Exposure Self Re -Certification
r
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes ❑ No
stored outside, has the facility had any releases in the past three (3) years?
3) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible to maintain your no exposure exclusion, and must immediately apply for a permit from DWQ.
a. Are exterior ASTs and piping free of rust, damaged or weathered coating, pits, or [:]Yes[:] No ❑ NIA
. deterioration, or evidence of leaks?
Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑Yes❑ No ❑ NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
4) Secondary Containment: If you answer "No" to any of the following items, you are not eligible to
maintain your no exposure exclusion, and must immediately apply for a permit from DWQ.
Is secondary containment provided for all single above ground storage
containers (including drums, barrels, etc.) with a capacity of more than 660-
gallons?
b. Is secondary containment provided for above ground storage containers stored
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund
Amendments and Reauthorization Act (SARA) water priority chemicals*?
Is secondary containment provided for hazardous substances" designated in 40
CFR §116?
e. Are release valves on all secondary containment structures locked?
Footnotes to Questions 4) c. & d.
[:]Yes[:] No ❑ NIA
❑Yes❑ No ❑ NIA
❑Yes❑ No ❑ NIA
[:]Yes[—] No ❑ NIA
[:]Yes[:] No ❑ NIA
'Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require secondary containment.
However, some exceptions may be made for de minimis amounts of certain substances, and/or other qualifiers, as described in the
exemptions from reporting requirements of Title III SARA 313 in 40 CFR §372.3&
""Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require secondary containment.
However, some exceptions may be made for amounts less than the Reportable Quantities of the hazardous substances listed in 40 CFR
§117.3.
5) Other information: If you answer "Yes" to any of the following items, and the answer if different from
how it was answered when originally applying, you might not be eligible to maintain your no exposure
exclusion. Please contact the Division if this is the case.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside?
b. Does your facility have coal piles on site?
c. Does your facility store other fuel sources outside in piles, such as wood chips,
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
If you answered yes to d., are those emissions permitted by an Air Quality Permit?
Please specify:
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes ❑No
❑ Yes ❑ No
❑Yes❑ No❑NIA
Page 2of3
SWU-NESR-29Ju12010

r
4 NCGNE0000 No Exposure Self Re -Certification
6) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no
exposure" and obtaining/maintaining an exclusion from NPDES storlmwater permitting.
I certify under penalty of law that 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 under 40 CFR 122.26(g)(2)).
I understand that I am obligated to annually self re -certify No Exposure and, if requested, submit this re -certification to
DWQ or the operator of the local municipal separate storm sewer system (MS4) into which the facility discharges (where
applicable), I understand that I must allow the North Carolina Division of Water Quality, or MS4 operator where the
discharge is into the local MS4, to perform inspections to confirm the condition of no exposure and to make such
inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information provided. Based on my
inquiry of the person orpersons who manage the system, or those persons directly responsible for gathering the
information, the information provided is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for providing false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this document and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing:
Title:
(Signature)
(Date Signed)
Please note: The Regional Office may inspect your facility at any time in the future for
compliance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 B(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; 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),
This completed form must be kept on file at the facility for at least 5 years. Do not submit this
form to DWQ unless requested.
Page 3 of 3
SWU-NESR-29J02010

Lawyer, Mike
From: Lawyer, Mike
Sent: Friday, October 30, 2009 11:32 AM
To: '[e-mail]'; '[e-mail]'
Cc: Henson, Belinda
Subject: No Exposure application for Laurinburg facility
Gentlemen,
I conducted a site visit on 10/27/09 where I met with Mr. Ralph Allen to go over the application for No Exposure
Certification (NEC). I was mistakenly under the impression that submittal of the application implied that all construction
at the facility had been completed and operations had begun. As a result of my site visit, it was obvious that this is not
the case. Until all products and materials exposed to stormwater, including construction debris, are removed or housed
indoors we are unable to issue the NEC. According to Mr. Allen, construction should be completed and operations begun
sometime in December of this year. I will place your NEC application on hold and plan to revisit the site in January or
February of 2010.Once we can confirm that all facility operations, products, materials, etc. are conducted or stored in a
manner that has no potential for stormwater runoff pollution we can then issue a No Exposure Certification. I will plan
to make contact and schedule another site visit after the first of the new year.
If you have any questions or concerns between now and then, please contact me.
Thanks,
Mike
Michael Lawyer
Environmental Specialist
NCDENR-Division of Water Quality
Surface Water Protection Section
Fayetteville Regional Office
Direct: [phone]
Main: [phone]
Fax: [phone]
e-mail: [e-mail] (please note that my e-mail address has changed)
*E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.

F�o
�/S v
NCDENR
Fr�roVrFVT u+n N.cl.rw. ruso.�.rn
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000
NO EXPOSURE CERTIFICATION
FOR AGENCY USE ONLY
Date Received
Year Month Day
Cenificate of Coverage
a renbwal:; El'
0
x
National Pollutant Discharge Elimination System application for exclusion from a Stormwa_ ter P- i1 basia
on NO EXPOSURE::
!GID it f V
Submission of this No Exposure Certification constitutes notification that your facility does not re aP
permit for stormwater discharges associated with industrial activity in the State of North Carolin E ause.
it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility mea all
industrial materials and activities are protected by a storm resistant shelter (with some exceptions) to
prevent exposure to rain, snow, snowmelt, and/or runoff.
For permitted facilities in North Carolina, DWQ must approve your application for No
Exposure Certification before this exclusion is effective. Until you are issued.a No
Exposure Certification and your NPDES permit is rescinded, your facility must continue
to abide by the terms and conditions of the current permit.
Industrial materials or activities include, but are not limited to: material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste products.
Material handling activities include the storage, loading and unloading, transportation, or conveyance of
any raw material, intermediate product, final product or wait product. A storm resistant shelter is not
required for the following industrial materials and activitle - ar ,is, barrels, tanks, and similar containers
that are tightly sealed, provided those containers are not d6w.crated and do not leak. "Sealed" means
banded or otherwise secured and with locked or non -operational taps or valves; adequately maintained
vehicles used in material handling; and final products, other than products that would be mobilized in
stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In
addition, the exclusion from NPDES permitting is available on a facility -wide basis only —not for individual
outfalls. If any industrial activities or materials are, or will be, exposed to precipitation, the facility is not
eligible for the no exposure exclusion. By signing and submitting this No Exposure Certification form, you
certify that a condition of no exposure exists at this facility or site and are obligated to comply with the
terms and conditions of 40 CFR 122.26(g).
You are required to reapply for the No Exposure Exclusion once every five (5) years.
I
For questions, please contact the DWQ Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of owner/operator (address to which all certification correspondence will be mailed):
Name 447-OR6 s 6*At 72V LC�S AIC 4-
Contact
Street Address 16 Yo 0
City Z�RIAJBuRe— State •4-1 a ZIP Code z- ej?,r- z
Telephone No. / 0 2 9/ -c o V-1 Fax: 9/O Z
® d —�
Page 1 of 7 ti,!
SWU-NE-021309 DVS 0 Last revised 2/13/2009

1 LAV C r--A"
ys
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Z,x ��ws �

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name
Allgrt.W f
�ff,4T �c�Ge.�T.S
NC _ e.4.0
Facility Contact
CL.•11�1C aeofw-a-
Street Address
/690o r
EM
Oe d • _
City
C.4NRIV. pVJQ
G
State A.-� C ZIP Code Z Z
County
-Cc O i'c- .44000
Telephone No.
IO 291
-00 y-1
Fax: /O 2
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). _S CA.) COA iJC5W OF SDI ✓W D �O
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes "o
5) Is this a Federal facility? //❑.. -Yes N
6) Latitude O'KG"T. Xongitude "�Z7 �1!'�8 de
J7g., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
Iff-INew or Proposed Facility Date operation is to begin joh:P/OQ
❑ Existing Date operation began
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE jl
B) Was this facility or site ever covered under an NPDES Stormwater Permit? �YYes ❑ No
If yes, what is the NPDES Permit Number? Ater 6- OSrOOO O AW �iE.i2iyl.u�rO 406- 2-
9) Standard Industrial Classification: 8Y P 'v/�S /V,Zo1v'6-er
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial o w�ctR 1
activity at this facility IJ
SIC Code: Z- %f 7 I
10) Provide a brief description of the types of industrial activities and products produced at this facility:
ARC-6f✓C RLOYIP0,4 4 &APO P JAI 104),C c-OSE D TR JCK 210VA70 454)P
C vr1►PR&srED i•y iro WOOD
11) Does this facility have any Non -Discharge permits (ex; recycle permits)?
R(No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SWU-NE-021309 Last revised 2/13/2009

" 0

NCGNE0000 No Exposure Certification
Exposure Checklists (12. - 14.)
12) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable
future? (Please check either "Yes" or "No.") If you answer "Yes" to any of these items, you are not
eligible for the no exposure exclusion.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes i(No ❑ NIA
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks
c. Materials or products from past industrial activity
d. Material handling equipment (except adequately maintained vehidles)
e. Materials or products during loading/unloading or transporting activities
f. Materials or products stored outdoors (except final products intended for outside
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks,
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by
the discharger
❑ Yes of No ❑ NIA
❑ Yes /No ❑ N/A
ElYes M/No ❑ NIA
❑ Yes dNo ❑ N/A
❑ Yes of No ❑ NIA
❑ Yes VNo ❑ N/A
❑ Yes I/No ❑ N/A
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes M No ❑ N/A
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes M No ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes W No ❑ NIA
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow qc�;.
I. Empty containers that previously contained materials that are not properly stored ❑ Yes i iVo ❑ NIA
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers Q Yes Rf No ❑NIA
stored outside, has the facility had any releases in the past three (3) years?
13) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion. //
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or ❑ Yes ❑ No P/N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it tree of any ❑ Yes ❑ No n/N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
14) Secondary Containment: If you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for single above ground storage containers
{ fes
❑ No W /A
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
A
b. Is secondary containment provided for above ground storage containers stored
❑ Yes
❑ No 5^
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
/
c. Is secondary containment provided for Title III Section 313 Superfund
❑ Yes
❑ No Z NIA
Amendments and Reauthorization Act (SARA) water priority chemicals'?
//
d. Is secondary containment provided for hazardous substances— designated in 40
© Yes
1-1NoC�'N/A
CFR §116?
e. Are release valves on all secondary containment structures locked?
❑ Yes
❑ No wllwA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes ar/No ❑ NIA
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes MI/No ❑ NIA
generated per month) of hazardous waste? /
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ID Yes Mf No ❑ NIA
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
Footnotes to Ouestions 14) c. & d.
"Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for de minimis amounts of certain substances,
and/or other qualifiers, as described in the exemptions from reporting requirements of Title III SARA 313 in 40 CFR
§372.38.
"Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for amounts less than the Reportable Quantities
of the hazardous substances listed in 40 CFR §117.3.
Page 4 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
16) 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.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? ❑ Yes Ia No ❑ NIA
b. Does your facility have coal piles on site? ❑ Yes VNo ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes Lf No ❑ NIA
sawdust, etc.? ,,
d. Does your facility have air emissions associated with its industrial activity (e.g., VYeNIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: A /w74 t&Pvs>p 437W 4 wv%llp
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? WYes ❑ No ❑ NIA
Please specify:
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Page 5 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
17) Certification:
i certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no
exposure" and obtaining an exclusion from NPDES stormwater permitting.
1 certify under penalty of law that 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 under 40 CFR 122.26(g)(2)).
I understand that I am obligated to submit a no exposure certification form once every five (5) years to the North Carolina
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system (MS4) into
which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make sudh inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
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 of Person Signing: K,F^i ro,-47 ofi"
Title: e*f4oV-4afNG Idfim!FetBaFiP
(Signature of Applicant) (Date Signed)
Please note_ This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 B(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; 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).
There is currently no fee for a No Exposure Exclusion
Page 6 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
W This completed application and all supporting documentation.
R"' A map with the location of the facility clearly marked.
❑ If this is a renewal, indicated current NCGNE number in Question 7.
❑ If the site currently has an NPDES Stormwater Permit, be.sure to indicate the permit number in Question 8.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office
...[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 7 of 7
5WU-NE-021309 Last revised 2/13/2009

Map of 16900 Aberdeen Rd Laurinburg, NC by MapQuest
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Map of 16900 Aberdeen Rd Laurinburg, NC by MapQuest ' Page 1 of 1
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Directions and maps are informatlonel only We make no warranties on the accuracyof their content road conditions or route usabhtyor expe6Lbusness You assume all risk of use, MapQuest and its
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