NCGNE0974_COMPLETE FILE - HISTORICAL_20170321

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE 09 7�
DOC TYPE
T2f HISTORICAL FILE
DOC DATE
Oo? �O �� o 3 a�
YYYYMMDD
i

Energy, Mineral &
Land Resources
ENVIRONMENTAL QUALITY
Mr. Glen Wilkinson
Huvepharma, Inc.
525 Westpark Drive
Suite #230
Peachtree City, GA 30269
Dear Mr. Wilkinson:
March 21, 2017
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
Subject: Name/Ownership Change Request
No Exposure Certification NCGNE0974
Huvepharma, Inc.
Formerly Zoetis, LLC
Scotland County
The Division has reviewed your submittal of the permit name/ownership change form for the
subject No -Exposure Certification. Division personnel have reviewed and approved your
request to transfer the exclusion from NPDES stormwater permitting requirements.
Please note that by our original acceptance of the No -Exposure Certification and by our
approval of your request to transfer it, you are obligated to maintain no -exposure conditions
at your facility. If conditions change such that your facility can no longer qualify for the 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.
Annual re -certification is required, and we have enclosed one blank Annual No Exposure
Exclusion Self Re-Certif cation form for your use. Your certification of no exposure 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 the Stormwater
Permitting Program at [phone].
Sincerely,
�c
for racy E. Davis, P. PM, Director
Division of Energy, Mineral and Land
cc: Fayetteville Regional Office
Stormwater Permitting Program
Nothing Compares--._,
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
512 N. Salisbury Street 1 1612 Mail Service Center I Raleigh. North Carolina 27699-1612
919 707 9200

00
A�
Division of Energy, Mineral & Land Resources
!'
Land Quality Section/Stormwater Permitting
NdMma
National Pollutant Discharge Elimination System
r1o+++. Gno,.s Pe.xm-e.* of
PERMIT NAME/OWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
II. Permit status pric►r to requested change.
a. Permit issued to (company name): 20 e4� L LC
b. Person legally responsible for pennit
ID d :
FF8 2 .3 2D17� N
c. Facility name (discharge):
d. Facility address:
e. Facility contact person:
First I/ N41 Last
Si 7'G /✓ l ✓�� r/za E—
r2.2 30�
Title
Sk tj wa (?A ear X�04
Permit Holder
-----M___ax rpK--
Mailing A dress
- - 'Ale�- zs'3G/
City
( %/D ) h'o
State Zip
- 519 q(gad) Yyy- 8� yz
Phone
Fax
� k H-t C cl 5 Ar rr o✓ t
Address
City
State Zip
First 1 M I I Last
Phone
III. Please provide the following for the requested change (revised Permit).
a. Request for cliange is a result of: Change in ownership of the facility
❑ Name change of the facility or owner
bother please explain:
b. Permit issued to (company name): �G- k rmei .�H �-
c. Person legally responsible forpertnit: G K i/A;rrSoK
p First M1 Last
Title
Permit Holder Mailing Address
46?
State Zip
(776)`% aqleq. wr1lcfH-,.ow �Liuv�P�iarr+9..+s
Phone U E-mail Address CC5
d. Facility name (discharge): l7udG�lGca ✓mom 1K�
C. Facility address: 6C S W4_ Ck"jeL Kd_l
Ad ress
City State Zip
7 f. Facility contact person: /�j�V4"aV4 �M& & mher-
First M I Last
Phone E-mail Address k4
IV. Permit contact information (if different from the person legally responsible for the pennit)
Revised Jan. 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Pennit contact: Pla Vkl(r'G( rj, /tie GC-c-er
First MI Last
Title
' kAO1107
�G4y
,'Mail' dre�s�
City state Zip
Phone E-mail Address
V.
Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
Yes
❑ No (please explain)
VI Required Items: TH[S APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Pen -nit holder prior to ownership change):
I, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are riot
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature
APPLICANT CERTIFICATION
oc.P to � � S �•p,s:.i�ur �
Date
I , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature
ate
PLEASE SEND T14E COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stornwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Remised Jan. 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact:
First M1 " last
Title
its-•
Mail'
a
City , - State Zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership onname change?
Yes. .
❑ No (please explain)
Vl Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed.
or a bill of sale) is reguired for an ownership change request. Articles of incorporation arc
not sufficient for an ownership change.
............................................................................................................... 0......
The certiftcntions below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
I ERMITTEE CERTIFICATION (Pennit holder prior to ownership change):
1. on 5 • attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge..] understand that Wall required parts of this application arc not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete. ,
Uj
�o ehf`
Signature _.. Date
APPLICANT CERTIFICATION
1, _ . attest that this application for a namelowncrship change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts ofthis application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature
Date
PLEASE SEND TI I COMPLETE APPLICATION PACKAGE TO:
Division of Encrgy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Rartsed Jan. 21, 2a 14

NPDES PERMIT NAMEJOWNERSHIP CHANGE FORM
Page 2of2
Permit contact: Gal f9w rsi !�!- /�P Lmh-er
Firsi M1 Las1 r
Title
Mail' dr�
�it �0
City Slate Zip
� 1
Phone E-nwit Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
this ownership or name change"
Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is r aired for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
......................................................................................................................
Thecertifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicants Certification is sufficient.
PERM ITTEE CERTIFICATION (Permit holder prior to ownership change):
I,. attest that this application fora name/ownership change bus been reviewed and is accurate and
complete to the best of my knowledge. 1 understand that if all required parts of this application are not
completed and that if all requir>rd supporting information is not included, this application package will be
returned as incomplete.
Signature Date_
APPLICANT CERTIFICATION
1, _ , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
return c mplcic.
Signature Dat
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting, Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
ReiSed Jan, 27. 2014

l �f llllll�llll I� llll! ll�l �111 I1Ill �11I11��f � f f�i �llll �I111I�I� lull f �n �fll
Doc ID: 002435960006 Type: CRP
Recorded: 02,t"j203g at 02123 PN
Fee Amt: $5,221.00 page 1 of 5:6
Revenue Tax: $5,195.00
Scotland county, NC
L Page Pratt III Register of Deeds
File# 2016-00000393
BK 1496 PG2os-213
Prepared by:
C. Palmer Pillans, T"sq.
Butler Snow LLP
150 P Avennc South, Suitc 1600
Nashville, TN 37201
After recording return to:
C. Palmer Pillars, Esq.
Butler Snow LLP
150 P Avenue South, Suite 1600
Nashville, 7N 37201
Excise Tax $5,195.00
SPECIAL, WARRANTY DEED
NORTH. CAROLINA
SCOTLAND COUNTY
THIS DEED made as of the 12"' day of February, 2016, by and between Zoetis LLC, a
Delaware limited liability company ("Grantor'), whose address is 100 Campus Drive, Florham
Park, New Jersey 07932 and Havepharma, Inc., a Delaware corporation ("Grantee") whose
address is 525 Westpark Dive, Suite 230, Peachtree City; GA 30269. The designation Grantor
and Grantee, as used herein, shall include said parties, their heirs, successors and assigns, and
shall include singular, plural, masculine, feminine or neuter, as required by context.
This is not the personal residence of Grantor.

WIT NESSETI-1:
That the Grantor, for a valuable consideration paid by the Grantee, the receipt of which is
hereby acknowledged, has and by these presents does grant, bargain, sell and convey unto the
Grantee in fee simple, all that certain lot or parcel of land situated in Scotland County, North
Carolina and more particularly described as follows:
See Exhibit A attached hereto and incorporated herein by this reference.
Together with the Grantor's interest in all improvements thereon, known as and
numbered 22300 Skyway Church Road, Maxton, North Carolina 28364 USA and
all of Grantor's rights, title and interests, if any, in and to all abutting roads and
rights of way and all reversionary rights therein, and in and to all appurtenant
easements, if any.
The property hereinabove described is commonly referred to as:
Map/Parcel ID Number: 0102520100402.
The property hereinabove described was acquired by Grantor by instrument
recorded in Book 1464, Page 55, Scotland County, North Carolina Registry.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land, the Grantor's interest in
the improvements thereon and all privileges and appurtenances thereto belonging to the Grantee
in fee simple.
And the Grantor covenants with the Grantee, that Grantor has done nothing to impair
such title as Grantor received, and Grantor will warrant and defend the title against the lawful
claims of all persons claiming by, under or through Grantor, subject to the exceptions hereinafter
stated.
Title to the property hereinabove described is subject to the exceptions set forth on
Exhibit B attached hereto and incorporated herein by this reference.
[SIGNATURE PAGE FOLLOWS]
2

IN WITNESS WHEREOF, the Grantor has caused this instrument to be duly executed as
of the day and year first above written.
Zoetis LLC,/a Delaware limited liability company
By: '�fZc.� IV67G-'-----
Name: -wi •n kJalaen
Title: &(-eforw
STATE OF KIP-0 JeV5-e4
4
COUNTY OF H ow-ri'5
Personally appeared before me, "bfenjaam. JQ�VIJ�C%I , a Notary Public in and for
said County and State, the within named &41ft ime N . ELWA with whom i am personally
acquainted, or proved to me on the basis of satisfactory evidence, and who, upon oath,
acknowledged himself/herself to be the E e4av of Zoetis LLC, a Delaware
li ted liability company, the within named Barg inor, and that he/she as such
��e�c ._-,�, being authorized so to do, executed the foregoing instrument for the
purposes the �i n co twined, by signing the name of the limited liability company by
himseIf/herseif as to
Witness my hand, at office, this day of February, 2016.
Notary Public
�"
My commission expires:
rJlll ��� r •
-43RENDA L.
t•IIIiI Iti,l
NOTA ly PUBLIC OF NEW JERK
I.D. # 2356734
My Comniisslon Expires 315i2017-

EXHIBIT A
Legal Description of the North Carolina Property
LYING AND BEING SITUATE IN SCOTLAND COUNTY, NORTH CAROLINA, AND
BEING MORE PARTICULARLY DESCRIBED AS FOLLOWS:
BEING ALL OF PARCEL 2, CONTAINING 57.890 TOTAL ACRES, MORE OR LESS, AS
SHOWN, LOCATED AND DESCRIBED ON THAT CERTA IN PLAT ENTITLED
"SURVEY FOR SCOTLAND COUNTY CHAMBER OF COMMERCE," DATED JUNE 4,
2002, AND LAST REVISED NOVEMBER 20, 2002, PREPARED BY J.C. WAMPLER
ENGINEERING, INC., WHICH PLAT IS RECORDED IN THE SCOTLAND COUNTY
REGISTRY IN MAP BOOK 10, AT PAGE 160, AND BEING MORE PARTICULARLY
DESCRIBED ACCORDING TO SAID PLAT AS FOLLOWS:
BEGINNING AT A RAILROAD SPIKE WHICH MARKS THE POINT OF INTERSECTION
OF THE CENTERLINE OF THE 60-FOOT RIGHT-OF-WAY OF S.R. NO. 1435 (ALSO
KNOWN AS SKYWAY CHURCH ROAD) WITI-I THE CENTERLINE OF THE 60-FOOT
RIGHT-OF-WAY OF S.R. NO. 1407 (ALSO KNOWN AS AIRBASE ROAD) AND
RUNNING THENCE FROM SAID POINT OF BEGINNING AS AND WITH THE
CENTERLINE OF THE RIGHT -OF WAY OF S.R. 1407 THE FOLLOWING COURSES AND
DISTANCES: SOUTH 38 DEGREES 31 MINUTES 37 SECONDS EAST 227.30 FEET TO A
RAILROAD SPIKE, A POINT OF CURVATURE; THENCE ALONG THE ARC OF A
CURVE TO THE RIGHT HAVING A RADIUS OF 2,042.02 FEET, A CHORD BEARING OF
SOUTH 32 DEGREES 32 MINUTES 52 SECONDS EAST AND A CHORD DISTANCE OF
425.42 FEET TO A RAILROAD SPIKE; THENCE SOUTH 25 DEGREES 15 MINUTES 29
SECONDS EAST 51.84 FEET TO A PK NAIL; THENCE SOUTH 22 DEGREES 58
MINUTES 48 SECONDS EAST 100.02 FEET TO A PK NAIL; THENCE SOUTH 20
DEGREES 05 MINUTES 12 SECONDS EAST 100.07 FEET TO A PK NAIL; THENCE
SOUTH 17 DEGREES 18 MINUTES 49 SECONDS EAST 100.00 FEET TO A PK NAIL, -
THENCE SOUTH 15 DEGREES 46 MINUTES 19 SECONDS EAST 423.54 FEET TO A PK
NAIL; THENCE, LEAVING THE CENTERLINE OF THE RIGHT-OF-WAY OF S.R. NO.
1407, AND RUNNING AS AND WITH THE NORTHERN LINE OF THE CARROLLS
REALTY PROPERTY (AS DESCRIBED IN BOOK 430, AT PAGE 58, SCOTLAND
COUNTY REGISTRY) SOUTH 72 DEGREES 24 MINUTES 16 SECONDS WEST 37.00
FEET TO A CONCRETE MONUMENT IN THE WESTERN LINE OF S.R. NO. 1407;
THENCE CONTINUING WITH THE CARROLLS REALTY LINE SOUTH 72 DEGREES 26
MINUTES 10 SECONDS WEST 535.65 FEET TO A CONCRETE MONUMENT; THENCE
CONTINUING WITH THE CARROLLS REALTY LINE SOUTH 33 DEGREES 05
MINUTES 00 SECONDS WEST 537.87 FEET TO A CONCRETE MONUMENT; THENCE
AS AND WITH THE EASTERN LINE OF THE LAURINBURG-MAX'rON AIRPORT
COMMISSION PROPERTY NORTH 51 DEGREES 13 MINUTES 04 SECONDS WEST
1,759.18 FEET TO AN IRON STAKE; THENCE CONTINUING WITH THE LAURINBURG-
MAXTON AIRPORT COMMISSION LINE NORTH 51 DEGREES 17 MINUTES 29
SECONDS WEST 485.50 FEET TO A CONCRETE MONUMENT IN THE SOUTHERN
RIGHT-OF-WAY LINE OF S.R. NO. 1435; THENCE NORTH 51 DEGREES 12 MINUTES 02

SECONDS WEST 37.83 FEET TO A PK NAIL IN THE CENTERLINE AT S.R. NO.� 1435,
WHICH PK NAIL IS LOCATED NORTH 76 DEGREES 51 MINUTES 34 SECONDS EAST
39.69 FEET FROM A PK NAIL MARKING THE POINT OF INTERSECTION OF THE
CENTERLINE OF THE 60-FOOT RIGHT-OF-WAY OF S.R. NO. 1435 WITH TI-IE
CENTERLINE OF THE 60-FOOT RIGHT -AT -WAY OF S.R. NO. 1497 (ALSO KNOWN AS
HICKMAN ROAD); THENCE AS AND WITH THE CENTERLINE OF S.R. NO. 1435
NORTH 76 DEGREES 54 MINUTES 58 SECONDS EAST 1,205.87 FEET TO A PK NAIL;
THENCE, LEAVING THE CENTERLI-NE OF S.R. NO. 1435 SOUTH 13 DEGREES 05
MINUTES 02 SECONDS EAST, PASSING OVER AN IRON STAKE INTHE SOUTHERN
LINE OF S.R. NO. 1435 AT A DISTANCE OF 30.00 FEET, FOR A TOTAL, DISTANCE- OF
240.67 FEET TO AN IRON STAKE; THENCE NORTH 76 DEGREES 54 MINUTES 58
SECONDS EAST IS1.00 FEET TO AN IRON STAKE; THENCE NORT14 13 DEGREES 05
MINUTES 02 SF.,CONDS WEST, PASSING OVER AN IRON STAKE IN THE SOUTHERN
LINE OF S.R. NO. 1435 AT A DISTANCE; OF 210.67 FEET, FOR A TOTAL DISTANCE OF
240.67 FEET TO A PK NAIL IN THE CENTERLINE OF S.R. NO. 1435; AND THENCE AS
AND WITH THE CENTERLINE OF S.R. NO. 1435 NORTH 76 DEGREES 54 MINUTES 58
SECONDS EAST 675.00 FEET TO THE BEGINNING, CONTAINING 57.890 ACRES,
MORE OR LESS.

EXHIBIT B
Permitted Exceptions
1. Taxes or assessments for the year 2016, and subsequent years, not yet due or payable.
2. Any right, easement, setback, interest, claim, encroachment, encumbrance, violation,
variations or other adverse circumstance affecting the Title disclosed by plat(s) recorded
in Plat Book 10, Page 160.
3. Easement(s) to Carolina Power & Light Company recorded in Book 3J, page 115 and
Book 10, page 735.
4. Restrictions set forth in Deed recorded in Book 5R, page 482.
5. Communications Systems Right -of -Way in favor of Time Warner Entertainment -
AdvancefNewhouse Partnership recorded in Book 1138, page 94.
6. Title to any portion of the Land lying within the right of way of Skyway Church Road
(NCSR 91435), Airbase Road (NCSR ##1407) and Hickman Road (NCSR #1497).

Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
Energy, Mineral NCGN E0000
and Land Resources
ENVIRONMENTAL QUALITY
National Pollutant Discharge Elimination System application for exclusion from a
on NO EXPOSURE:
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
Certificate ofCovera e
ermik bA
Submission of this No Exposure Certification constitutes notification that your facility does not re
permit for stormwater discharges associated with industrial activity in the State of North Carolina becaus
it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means 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, DEMLR 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 waste product. A storm resistant shelter is not
required for the following industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed, provided those containers are not deteriorated 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).
If approved, your conditional No Exposure Exclusion has no expiration date
BUT MUST BE self re -certified at least annually.
Please look for information about re -certification under the No Exposure section on this page:
https:lldeg. nc.gov/about/divisions/energy-mineral-I_and-resources/energy-mineral-land-permitslstormwater-
For questions, please contact the DEMLR 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 mailedl:
Name Huvepharma, Inc.
Contact Barbara McCumber
Street Address
City
Telephone No.
22300 Skyway Church Road
Maxton
910-506-2650
State NC� ZIP Code 28364
Fax: [phone]
Page 1 of 7
RWI I-Nf;r;NF I act ravisari q/7Ronin

NCGNEOOOO No Exposure Certification
2) Location of facility producing discharge:
Facility Name
Huvepharma, Inc.
Facility Contact
Barbara McCumber
Street Address
22300 Skyway Church Road
City
Maxton
County
Scotland
Telephone No.
910-506-2650
3) Physical location information:
State . NC _ ZIP Code 28364
Fax: [phone]
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). From Interstate 74, exit 191, near Maxton, NC go
north on NC-71 to Airbase Rd. Turn left onto Airbase Rd., take it to Skyway Church Rd. Turn left onto
Skyway Church Rd. and go west about 0.1 miles. Facility will be on the left.
(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 X No
5) Is this a Federal facility? ❑ Yes X No
6) Latitude 34.774 Longitude-79.350 (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
0 New or Proposed Facility Date operation is to begin
D Existing Date operation began
X Renewal of existing No Exposure Certification Certification No.: NCGNE 0974
8) Was this facility or site ever covered under an NPDES Stormwater Permit? 0 Yes X No
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2 8 3 6
10) Provide a brief description of the types of industrial activities and products produced at this facility:
This manufacturing facility produces poultry vaccine for poultry farmers.
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
X No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
swi "('.(;NF I act ravispri qt?R/?OIF;

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 X 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 ❑ Yes X No ❑ NIA
c. Materials or products from past industrial activity . ❑ Yes X No ❑ NIA
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes X No ❑ NIA
e. Materials or products during loading/unloading or transporting activities ❑ Yes X No ❑ NIA
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes X No ❑ NIA
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, ❑ Yes X No ❑ NIA
tanks, and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained ❑ Yes X No ❑ NIA
by the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., ❑ Yes X No ❑ N/A
dumpsters])
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes X No ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents ❑ Yes X No ❑ N/A
not otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes X No ❑ N/A
(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 ❑ Yes X No ❑ N/A
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 X Yes ❑ No ❑ NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any X Yes ❑ No ❑ N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked
shut?
14) Secondary Containment: If you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion.
Page 3 of 7
GWI1-Nr.f,NF I a;t ravigo-d WAom6

NCGNE0000 No Exposure Certification
a. is secondary containment provided for 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*?
d. Is secondary containment provided for hazardous substances** designated in
40 CFR §116?
e. Are release valves on all secondary containment structures locked?
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous
waste generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
waste:
Type(s) of
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal
vendor:
Vendor address:
Footnotes to Questions 14) c. & d.
X Yes F) No ❑ NIA
X Yes ❑ No ❑ NIA
X Yes ❑ No ❑ NIA
X Yes 0 No ❑ NIA
❑ Yes ❑ No X NIA
❑ Yes X No ❑ NIA
❑ Yes X No ❑ NIA
❑ Yes X 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
§372.38.
**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.
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.
Page 4 of 7
Sw11-Nr:C;NF I Act rpviCwS w98/9n1A

NCGNE0000 No Exposure Certification
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? ❑ Yes X No © NIA
b. Does your facility have coal piles on site?
Ej Yes X No ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips,
❑ Yes X No ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
❑ Yes X No ❑ NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality
❑ Yes ❑ No X NIA
Permit? 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: Industrial User Pretreatment # 007, Program: Industrial Pretreatment
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5 of 7
swi I_N(-('NF I act rnvicarl gosl?n1Fi

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.
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 1 22.26(g)(2)).
I understand that I am obligated to maintain no exposure conditions and complete a Self -Recertification form at least once
each year, and if requested, provide this certification 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
Energy, Mineral, and Land Resources, 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. I understand I
must keep a copy of annual re -certifications on file at the facility.
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 Sig
Title: lot Cc, yr t
(Signature of Applicant)
G
a/ FGk goi7
(Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the NCDEQ
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
SWI I_NC:r;NF I act ravicari W?A1201R

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
2( This completed application and all supporting documentation.
Ed' A map with the location of the facility clearly marked.
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 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 a No Exposure Exclusion.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR 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)
707-9220
Page 7 of 7
SWI I-Nr;C;NF I aei ravicarl QOR/2016

Driving Directions from Maxton, North Carolina to 22300 Skyway Church Rd, Maxton,... Page 1 of 2
Notes
mapq uest'
Trip to:
22300 Skyway Church Rd
Maxton, NC 28364-6412
2.96 miles 15 minutes
0? Maxton, NC
1. Start out going southeast on W Dr Martin Luther King Jr Dr I US-74-BR 1 W
0.07 ME
Saunders St toward NC-1301 S Patterson St. IAao
0.07 Mi Total
`
7 i
2. Take the 1st left onto NC-71 1 N Patterson St. Continue to follow NC-71. t_1ap
1.7 Mi
Guaranty Bank Is on the for,
1.5 Mi Total
If you are on E Dr Martin Luther King Jr Dr and reach Middle St youve gone a little
too far
3. Turn slight left onto NC-1307. klao
0.2 MI
NC-1307 is just past Gospel Dr
2.0 Mi Total
♦
4. NC-1307 becomes Alrbase Rd. MaD
. 0.9 Mi
1
2.9 Mi 'Total
L
5. Turn left onto Skyway Church Rd. Mai
0.01 Mi
!(you reach Hickman Rd you've gone about 0.4 mites too far
3.0 Mi Total
®
6.22300 SKYWAY CHURCH RD Is on the left. Mao
If you reach Hickman Rd you've gone about 0.3 miles too fa.
22300 Skyway Church Rd, Maxton, NC 28364-641 2
http://ww,.v.mapquest.com/print?a=app.core.al eeOb0340aab6b4aeOa9cae 10/24/2013

LPIWA
A, Z-A
Az=
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
May 22, 2015
Zoetis, LLC
Attn: William Sehi, Director/Site Leader
22300 Skyway Church Road _
Maxton, NC 28364
Subject: No Exposure Certification NCGNE0974
Zoetis, LLC (formerly Embrex Poultry Health, LLC)
Scotland County
Dear Mr. Sehi:
Donald R. van der Vaart
Secretary
The Division of Energy, Mineral and Land Resources (DEMLR) has received your letter and supporting
documentation regarding the transfer of ownership of the subject facility located at 22300 Skyway Church
Road, Maxton, Scotland County, NC. Based on your submittal, we are hereby revising the previously granted
conditional exclusion from permitting as provided for under 40 CFR 122.26(g), which is incorporated by
reference in North Carolina regulations, to accurately reflect your new company and/or facility name. .
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 the
No Exposure Certification, 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 DEMLR 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, please contact Mike Lawyer at [phone] or mike. [e-mail].
Sincerely,
for Tracy E. Davis, PE, CPM, Director
Enclosure
RECOVED
cc: FRO - Land Quality Section, Stormwater Files (w/o enclosure) 2015
Stormwater Permitting Program, No Exposure Files (w/o enclosure) .1,j
DENR-LAID QUALITY
Division of Energy, Mineral and Land Resources
STORMWATER PERMITTING
Land Quality Section
Fayetteville Regional Office, 225 Green Street - Suite 714, Fayetteville, North Carolina 28301
Phone: [phone] l FAX: [phone] / Internet: http://p2nal.ncdenr,orgMeb/Irl
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycled 110% Post Consumer Paper

Zoetis Global Manufacturing and SulT 910-844-5566 FAV
22300 Skyway Church Road F 910-844-8642
Maxton. NC 28364
O
Zoetis, LLC 40 t
Y�+Y �
22300 Skyway Church Road
Maxton, NC 28364
April 30, 2015
Stormwater Permitting Unit Program RECEIVED
Division of Energy, Mineral and Land Resources MAY 0 4 2015
1612 Mail Service Center
Raleigh, North Carolina 27699-1612 OENR-LAND QUALITY
STORMWATER PERMITTING
MAY 1 1 2015
Stormwater Permitting Unit:
Embrex Poultry Health, LLC is a wholly -owned subsidiary of Zoetis Inc- and holder of the No Exposure
Certification Permit # NCGNE0974. The purpose of this letter is to notify you that in connection with an
internal reorganization of certain Zoetis Inc. assets, on or about April 27, 2015 (the "Transfer Date") an
asset transfer will occur whereby the ownership of certain manufacturing and research and
development assets at Embrex Poultry Health, LLC, including Permit # NCGNE0974, will transfer from
Embrex Poultry Health, LLC to Zoetis LLC. Zoetis LLC will be responsible for permit compliance on and
after April 27, 2015. Zoetis LLC acknowledges and understands the terms and condition of Permit #
NCGNE0974 and will abide by all conditions and requirements thereof. We therefore request that you
revise your records to reflect Zoetis LLC as the permit holder of record as of April 27, 2015. Attached is
an updated application for your review/approval to replace the one currently held under Permit
NCGNE0974.
There will be no operational or personnel changes as a result of this permit transfer. The facility address
remains the same. William Sehi will remain the contact for this permit and can be reached at (910) 506-
5194. Please contact me if you have any questions. Thank you for your attention to this matter.
Sincerely,
A444,4 _,�L
William Sehi,
Director/Site Leader
Zoetis Global Manufacturing and Supply - Laurinburg/Maxton

SOS1D: 1278920
Date Filed: 4/21/2015 1:00:00 PM
Effective: 4/26/2015
Elaine F. Marshall
North Carolina Secretary of State
C2015 111 00148
State of North Carolina
Department of the Secretary of State
ARTICLES OF MERGER
Pursuant to North Carolina General Statute Sections 55-11-05(a), 55A-11-09(d), 55A-t 1-04, 57D-9-42,
59-73.32(a) and 59-1072(a), as applicable, the undersigned entity does hereby submit the following
Articles of Merger as the surviving business entity in a merger between two or more business entities.
1. The name of the surviving entity is Zoetis LLC a (check one)
❑ corporatioN 13 nonprofit corporation, 0 professional corporation, ® limited liability company,
❑ limited partnership, ❑ partnership, ❑ limited liability partnership organized under the laws of
Delaware (state or country).
2. 'C'he address of the surviving entity is:
Street Address 100 Campus Drive
CityFlorham Park
State New Jersey Zip Code 07932 County Morris County
(a) (Complete only if the sun,iving business entity is a foreign business entity that is not authorized to
transact business or conduct offairs in North Carolina) The mailing address of the surviving
foreign business entity is:
Street Address 100 Campus Drive
State New Jersey
Zip Code07932
City Florham Park
County Morris County
The Surviving foreign business entity will file a statement of any subsequent change in its mailing
address with the North Carolina Secretary of State.
3. For each merging entity: (if more than one, complete on separate sheet and attach)
The name of the merged entity is Embrex Poultry Health, LLC , a (check one)
❑ corporation, ❑ nonprofit corporation, 13 professional corporation, ® limited liability company,
❑ limited partnership, ❑ partnership, 0 limited liability partnership organized under the laws of
North Carolina (state or country).
The mailing address of each merging entity is: (if more than one, complete on separate sheet tmd
attach)
Street Address 22300 Skyway Church Road City Maxion
State North Carolina
Zip Code28364 County Robeson County
4. If the surviving business entity is a domgstic business entity, the text of each amendment, if any, to
the Articles of Incorporation, Articles of Organization, or Certificate of Limited Partnership within
the Plan of Merger is attached.
CORPORATIONS DIVISION P. O. BOX 29622 RALE10H, NC 27626-0622
(Revised January 20)4) (Form RF 1 S)
.13

S. A Plan of Merger has been duly approved in the manner required by law by each of the business
entities participating in the merger. r
6, These articles will be effective upon filing unless a delayed date and/or time is specified
This the -2 day of 20
Zoetis LLC
Nam of Entity
wr' a
Si tore �i!��
7)W or Print Name and Title
NOTF,S:
1. Piling fix is S50 fix ror-profit cntit s.
2. Filing fee is S25 for Non-profit entities,
3. This document muse be filod with the sccmtmy of state. CCnifiCRte(s) of Merge rerun be registered pursuant to the requirements or
W.C.a.S. section 47-18.1
CORPORATIONS 13iVISION F. O. PDX M22 RALEIGH, NC 27626-0622
(Revised January 2014) (Farrar BF !s)

State of Delaware
Secretary of State
Division of Corporations
Delivered 06:36 PM 0412012015
FILED 06:43 PM 0412012015
SRV 150536616 - 5114638 FILE
CERTIFICATE OF MERGER
OF
EMBREX POULTRY HEALTH, LLC
INTO
ZOETIS LLC
Pursuant to Section 18-209 of the Limited Liability
Company Act of the State of Delaware
FIRST: The name and jurisdiction of formation or organization and domicile of each of
the constituent entities is: EMBREX POULTRY HEALTH, LLC ("EMBREX"), which was
organized as and is a North Carolina limited liability company, and ZOETIS LLC, which was
organized as and is a Delaware limited liability company (the "Company").
SECOND: The constituent entities have entered into an Agreement of Merger, dated as of
April 20, 2015 (the "Merger Agreement"), providing for the merger of EMBREX with and into
the Company pursuant to Section 18-209 of the Limited Liability Company Act of the State of
Delaware (the "DLLCA") and Section 57D-9-40 of the North Carolina Limited Liability
Company Act (the "NCLLCA"). The Merger Agreement has been approved and executed in
accordance with Sections 18-204 and 18-209 of the DLLCA.
THIRD: The Company shall be the surviving entity of the merger (the "Surviving
Company").
FOURTH: The Merger Agreement is on fife at the offices of the Surviving Company at
100 Campus Drive, Florham Park, NJ 07932. A copy of the Merger Agreement will be furnished
by the Surviving Company, on request and without cost, to any member of either constituent
entity.
FIFTH: This Certificate of Merger shall be effective as of April 26, 2015.

IN WITNESS WHEREOF, the Surviving Company has caused this Certificate of Merger
to be signed this -o16Nay of &Yi 1 , 2015.
ZOETIS LLC
By: ✓;
Name: N •4i e/nN'-2 4. 4k t ck +,�
Title: SeexC+4AI
(SIGNATURE PAGE TO MERGER CERTIFICATE)
1 168345• N YCS R03A - MS W

NCDENR
Nonni Cw oum^ OeruerM o.
ENNRpn MEIlT —0 NQ — RcSp Es
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NO EXPOSURE CERTIFICATION
!rwa enel: RENEWAL
NCGNE0000
FOR AGENCY USE: ONLY
Cate Received
Year
Month
Dav
Certificate o1' over
RECEIVED
MAY 0 4 2015
Please cb6chkFh&& (YVMIM� is a
8TORMWATER PERMITTING
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit based
on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notification that your facility does not require a
permit for stormwater discharges associated with industrial activity in the State of North Carolina because
it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means 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, DEMLR 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 waste product. A storm resistant shelter is not
required for the following industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed, provided those containers are not deteriorated 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. Ir
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 922.26(g).
You are required to reapply for the No Exposure Exclusion once every five (5) years.
For questions, please contact the DEMLR 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
Contact
Street Address
City
Zoetis LLC
William D. Sehi
22300 Skyway Church Road
Maxton
Page 1 of 7
State NC ZIP Code 28364
SWU-NE-021309 Last revised 6124114

NCGNE0000 No Exposure Certification
2)
Telephone No. 910-506-5194
Location of facility producing discharge:
Facility Name
Zoetis LLC
Facility Contact
William D. Sehi
Street Address
22300 Skyway Church Road
City
Maxton
County
Scotland
Telephone No.
910-506-5194
3) Physical location information:
Fax: [phone]
State NC_ ZIP Code 28364
Fax: [phone]
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). ^From Interstate 74, exit 191, near Maxton, NC go
north on NC-71 to Airbase Road. Turn left on Airbase Road, take it to Skyway Church Road. Turn left
on Skyway church Road and go west about 0.1 miles. The Zoetis LLC facility will be on the left.
(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 ® No
5) Is this a Federal facility? ❑ Yes ® No
6) Latitude 34.774 Longitude-79.350 (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
❑ Existing Date operation began 2005
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE 0974
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes ® No
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2 8 3 6
10) Provide a brief description of the types of industrial activities and products produced at this facility:
_The manufacturing site produces poultry vaccine for poultry farmers.
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
® No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2of7
SWU-NE-021309 Last revised 6/24114

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 ®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 ❑ Yes ® No ❑ NIA
c. Materials or products from past industrial activity ❑ Yes ®No ❑ NIA
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes ®No ❑ NIA
e. Materials or products during loading/unloading or transporting activities ❑ Yes ®No ❑ NIA
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ®No ❑ N/A
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 ❑ NIA
and similar containers
h. Materials or products handledlstored on roads or railways owned or maintained by ❑ Yes NNo ❑ N/A
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes ®No ❑ NIA
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes ®No ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ®No ❑ NIA
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
1. Empty containers that previously contained materials that are not properly stored ❑ Yes ®No ❑ 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 ❑ Yes ®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 ❑ NIA
deterioration, or evidence of leaks?
b. 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?
Page 3of7
SWU-NE-021309 Lest revised 6124114

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
(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?
G. Is secondary containment provided for Title III Section 313 Superfund
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40
CFR §116?
e. Are release valves on all secondary containment structures locked?
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
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 1 disposal vendor:
Vendor address:
Footnotes to Questions 14) c. & d.
®Yes ❑ No ❑ NIA
®Yes ❑ No ❑ NIA
®Yes ❑ No ❑ NIA
®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
§372.38.
'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 6124114

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 ®No ❑ NIA
b. Does your facility have coal piles on site? ❑ Yes ®No ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes ®No 0 NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ❑ Yes ®No © NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? ❑ Yes ®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 S of 7
SWU-NE-021309 Last revised 6124/14

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.
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 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 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 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
Title: Director/Team Lea(
(Signature of Applicant)
William Sehi
30
(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 anytime 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 fled 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 6124/14

r
NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
❑ This completed application and all supporting documentation.
❑ 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 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 a No Exposure Exclusion.
For questions, please contact the DEMLR 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 7 of 7
SWU-NE-021309 Last revised 6124114

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
Tracy E. Davis, PE, CPM Land Quality Section Pat McCrory, Governor
Director John E. Skvarla, III, Secretary
November 21, 2013
William Sehi
Embrex Poultry Health, LLC n
22300 Skyway Church Road tg@
Maxton, NC 28364
Subject: No Exposure Certification NCGNE0974 DEC U 3' 2013
Embrex Poultry Health LLC
Scotland County DENR- WATER UJNJT'
WETLANDS AND STORMWATER 5RANG
Dear Mr. Sehi:
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 by Diane Adams and Mike Lawyer with the Fayetteville Regional Office on November
13, 2013, the Division is granting your conditional exclusion from permitting as provided for under 40 CFR
122.26(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 the No Exposure
Certification, 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 DEMLR 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 Diane Adams at [phone].
Sincerely,
forTracy E. Davis, PE, CPM
Enclosure
cc: FRO — Land Quality Section, Stormwater Files (w/o enclosure)
Stormwater Permitting Program, No Exposure Files (w/o enclosure)
Fayetteville Regional Office 225 Green Street, Suite 714, Fayetteville, North Carolina 28301-5095 One
Phone: [phone] FAX: [phone] Internet: http://portal'.ncdenr.org/web/Ir/land-quality NOrthCar0lina
An Equal Opportunity Affirmative Action Employer Awmall

D
1&6 Lowyer
FQ0
October 31. 2013
AT`-N. Bradley Bennett
NCDENR Division of Water Quality
Stormwater Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
' 1 +
NOV 6 2013
4
i
aY
SUBJECT. No Exposure Certification for Exclusion from NPDES Stormwater Permitting
Mr. Bennett:
Please find completed form NCGNEOOOO .,Vo L.vposure Certi lcationjbr Exclusion regarding
NPDES Stormwater Permitting for the Ioetis facility located in Laurinburg, North Carolina. If
you have any questions regarding this certification, please E-Mail me dan.ho%vefu;zoetis.com or
telephone me at [phone].
Sincerely.
t § @
D
Daniel R. Howe OCT 3 0 j
"Technical Manager EH&S
n u�t . nua Q.
Enclosure

Division of Water Quality / Surface Water Protection
NCDENRNational Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NCGNEO000
NO EXPOSURE CERTIFICATION
r-OR AGENCY USE ONLY
Date Received
Year
Munth
Day
O
U
Q
Certificate of coverage
NIEZIKIE101
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit based
on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notification that your facility does not require a
permit for stormwater discharges associated with industrial activity in the State of North Carolina because
it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means 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, DWO 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 waste product. A storm resistant shelter is not
required for the following industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed, provided those containers are not deteriorated 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
storm water 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).
For questions, please contact the DWO 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 Embrex Poultry Health LLC
Contact William Sehi�V ZQ�3 v
Street Address 22300 Skyway Church Road ,
City Maxton State NC ZIP Code 28364
Telephone No. 919 314-2180 Fax: [phone]
Email [e-mail] n���/% f�
D ��L1�L5 n
U
Page o(7 OCT T 3 �? 2013
SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Embrex Poutry Health LLC
Facility Contact William Sehi
Facility Street Address 22300 Skyway Church Road
City Maxton State NC ZIP Code 28364
County Scotland
Telephone No. 919 314 - 218 0 Fax: [phone]
Email [e-mail]
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). From Interstate 74, Exit 191 near Maxton, NC, go North on NC-71
to NC-1307. Take NC-1309 to Skyway Church Road, Take left, 22300 about .1 mile west on left. See attached map.
(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 X No
5) Is this a Federal facility? ❑ Yes M No
S) Latitude 34 . 774 Longitude -79. 350 (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
1& Existing Date operation began 2005
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes M No
If yes, what is the NPDES Permit Number? N A
9) Standard Industrial Classification:
Provide the 4 digit Standard_ Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2 8 3 6
10) Provide a brief description of the types of industrial activities and products produced at this facility:
The manufacturing site produces poultry vaccines for poultry farmers.
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
IN No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility: N/A
Page 2 of 7
SwU-NE-12Au92010

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 ® 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 X) No
c. Materials or products from past industrial activity ❑ Yes IN No
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes 2D 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 M 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 M No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes N No
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes ® No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes X No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes 0 No
otherwise regulated (i.e., under an air quality.control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes N No
(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 ❑ Yes Z) No
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 and piping free of rust, damaged or weathered coating, pits, or tiff Yes ❑ No ❑ N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any M Yes ❑ No ❑ N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SW U-NE-12Aug2010

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 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`?
d. Is secondary containment provided for hazardous substances" designated in 40
CFR §116?
e. Are release valves on all secondary containment structures locked?
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
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 Questions 14) c. & d.
M Yes ❑ No ❑ NIA
IN Yes ❑ No ❑ NIA
SI Yes ❑ No ❑ NIA
® Yes ❑ No ❑ NIA
❑ Yes ❑ No M NIA
❑ Yes ® No
❑ Yes M No
❑ Yes ® No
'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
SW U-N E-12Aug2010

NCGNE0000 No Exposure Certification
- 1 6) 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 M No
b. Does your facility have coal piles on site? ❑ Yes 20 No
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes ® No
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ❑ Yes M No
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? ❑ Yes M 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
5 W U-N E-12Aug2010

NCGNE0000 No Exposure Certification
17) Certification:
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.
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 the 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 paint 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: Wi 11 iam Sehi
Title: Director, Team,( Leader
L) L) 0 C-H
(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 tine
not to exceed ten thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SW U-NE-12Aug2010

NCGNE0000 No Exposure Certification
Final Checklist
_ - _ - _Thisapplication-should include the following items:
❑ This completed application and all supporting documentation.
❑ A map with the location of the facility clearly marked.
❑ 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 ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 7 of 7
SW U-N E-12Aug2010

Driving Directions from Maxton, North Carolina to 22300 Skyway Church Rd, Maxton,— Page 1 of 2
bo mapquest
Trip to: Y
22300 Skyway Church Rd
Maxton, NC 28364-6412
2.96 miles f 5 minutes
Q? Maxton, NC
Notes
1. Start out going southeast on W Dr Martin Luther King Jr Dr 1 US-74-BR 1 W 0.07 Mi
Saunders St toward NC-130 1 S Patterson St. Map 0.07 Mi Total
2. Take the 1st left onto NC-71 t N Patterson St. Continue to follow NC-71. Map 1.7 Mi
\� 1 Guaranty Bank is on the left 1.8 Mi Total
If you are on E Dr Martin Luther King Jr Dr and reach Middle St you've gone a little
too far
3. Turn slight left onto NC-1307. Map 0.2 Mi
NC-1307 is just past Gospel Dr 2.0 Mi Total
At 4. NC-1307 becomes Airbase Rd. Map 0.9 Mi
2.9 Mi Total
5. Turn left onto Skyway Church Rd. Map 0.01 Mi
If you reach Hickman Rd you've gone about 0.4 miles too far 3.0 Mi Total
6. 22300 SKYWAY CHURCH RD is on the left. Map
If you reach Hickman Rd you've gone about 0.3 mites too far
22300 Skyway Church Rd, Maxton, NC 28364-6412
http://www.mapquest.com/print?a=app.core.aI eeOb0340aab6b4aeOa9cae 10/24/2013

Driving Directions from Maxton, North Carolina to 22300 Skyway Church Rd, Maxton, ... Page 2 of 2
• F
Total Travel Estimate: 2.96 miles - about 5 minutes
BOOK TRAVEL with mapquest• [phone]
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Q2013 MapQuest, Inc. Use of directions and maps is subject to the MapQuest Terms of Use. We make no guarantee of the accuracy of
their content, road conditions or route usability. You assume all risk of use. View Terms of Use
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