NCGNE0975_COMPLETE FILE - HISTORICAL_20190313

STORM WATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE 09�
DOC TYPE
El HISTORICAL FILE
DOC DATE
❑ 03 13
YYYYMMOD

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
March 13, 2019
Dixon Quick Coupling
Attention: Mr. Jason Morgan
2925 Chief Court
Dallas, North Carolina 28034
Subject: No -Exposure Certification NCGNE0975
Dixon Quick Coupling
2925 Chief Court
Dallas, North Carolina 28034
Gaston County
Dear ;vir. Morgan:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Interim Director
The Division has reviewed your submittal of the No- Exposure- Certification form for Exclusion from NPDES
Stormwater Permitting. Based on your submittal and signed certification of no exposure at the above referenced facility,
and the inspection dated March 7, 2019, 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 a No -Exposure exclusion,
you are obligated to immediately obtain NPDES permit coverage for your storrnwater discharge. Otherwise, the discharge
becomes subject to enforcement as an unpermitted discharge.
You must self re -certify your No -Exposure status annually and the form can be downloaded by -visiting:
htip:;,'/pL)rt,il.ticdeiij-.org/�veb/Ir/npdes-stormtivater the web page for the Division of Energy, Mineral and Land Resources
Stormwater Program. The annual self re -certification does not need to be submitted to DEMLR unless requested. A copy
should be maintained in your file.
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 Holliday Keen at 1704) 663-1699, or at
Sincerely,
Zahid S. Khan, CPA CPESC, CPSWQ
Regional Engineer
Land Quality Section _
Enclosed: Inspection report
Annette Lucas, Stormwater Permitting Program, No -Exposure File NCGNE0975

Permit: NCGNE0975
SOC:
County: Gaston
Region: Mooresville
Contact Person: Scott Clark
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Compliance Inspection Report
Effective: Expiration: owner: Dixon Quick Coupling
Effective: Expiration: Facility: Dixon Quick Coupling
2925 Chief Ct
Inspection Date: 03107/2019
Primary Inspector: Holliday Keen
Secondary Inspector(s):
Dallas NC 28034
Title: Phone: [phone]
Certification: Phone:
Entry Time: 06'OOPM Exit Time: 06:15PM
Phone:
Reason for Inspection: Other Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ® Compliant ❑ Not Compliant
Question Areas:
® Miscellaneous Questions
(See attachment summary)
r
Page 1 of 3

Permit NCGNE0975 Owner - Facility: Dixon Quick Coupling
Inspection Date: 03/0712019 Inspection Type : Compiiance Evaluation Reason for Visit: Other
Inspection Summary
This inspection was conducted in response to a request for a No Exposure Certification received by our office February 18,
2019. Upon inspection I found that all activities and materials are contained indoors and there was no potential to impact
stormwater at the time of inspection. Please continue to maintain all outdoor areas in such a manner that will not impact
stormwater running off of the property. I recommend that this facility be granted a No Exposure Certification under
NCGNE0975. If you have any questions, please contact our office at 704-235-2148 or by email at
Holliday,[e-mail].
Page 2 of 3

Permit: NCGNE0975 Owner - Facility: Dixon Quick Coupling
Inspection Date: 0310712019 Inspection Type : Compliance Evaluation Reason for Visit: Other
Page 3 of 3

%0
Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
March 13, 2019
Dixon Quick Coupling
Attention: Mr. Jason Morgan
2925 Chief Court
Dallas, North Carolina 28034
Subject: No -Exposure Certification NCGNE0975
Dixon Quick Coupling
2925 Chief Court
Dallas; North Carolina 28034
Gaston County
Dear Mr. Morgan:
ROY COOPER
Governor
MICHAEL S. REGAN
Secrefary
S. DANIEL SMITH
Interim Director
RECT IT7`)
MAR 21 ZU19 1NrVks
DENR-LAND QUALITY
STORMWATER PERPr1fiT1NG
The Division has reviewed your submittal of the No -Exposure Certification form for Exclusion from NPDES
Stormwater Permitting. Based on your submittal and signed certification of no exposure at the above referenced facility,
and the inspection dated March 7, 2019, 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 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 unpermitted discharge.
. You must self re -certify your No -Exposure status annually and the form can be downloaded by visiting:
http:,'iportal.ncde€i€-.or�,l.vebi`lr/npdes-storm%vater the web page for the Division of Energy, Mineral and Land Resources
Stormwater Program. The annual self re -certification does not need to be submitted to DEMLR unless requested_ A copy
should be maintained in your file.
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 Holliday Keen at ('7 04) 663-1699, or at
HelIIday.r.LTov,
Sincerely, r f
J.
Zahid S. Khan, CPM, CPESC, CPSWQ
Regional Engineer
Land Quality Section
Enclosed: Inspection report
Annette Lucas, Stormwater Permitting Program, No -Exposure File NCGNE0975

Permit: NCG3NE0975
SOC:
County: Gaston
Region: Mooresville
Contact Person: Scott Clark
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Rep rose ntative(s):
Related Permits:
Compliance Inspection Report
Effective: Expiration: owner: Dixon Quick Coupling
Effective: Expiration: Facility: Dixon Quick Coupling
2925 Chief Ct
Dallas NC 28034
Title: Phone: [phone]
Inspection Date: 03/0712019
Primary Inspector: Halliday Keen
Secondary Inspector(s):
Certification: Phone:
EntryTime: 06-00PM Exit Time: 06:15PM
Phone:
Reason for Inspection: Other Inspection Type: Cornpliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: Compliant Not Compliant
Question Areas:
Miscellaneous Questions
(See attachment summary)
Page 1 of 3

+ - t
Permit: NCGNE0975 owner -Facility: Dixon Quick Coupling
Inspection Date: 03/07/2019 Inspection Type : Compliance Evaluation Reason for Visit: Other
Inspection Summary
This inspection was conducted in response to a request for a No Exposure Certification received by our office February 18,
2019. Upon inspection I found that all activities and materials are contained indoors and there was no potential to impact
stormwater at the time of inspection. Please continue to maintain all outdoor areas in such a manner that will not impact
stormwater ruching off of the property. I recommend that this facility be granted a No Exposure Certification under
NCGNE0975. If you have any questions, please contact our office at 704-235-2148 or by email at
[e-mail].
Page 2 of 3

0
Permit: MCGNE0975 Owner - Facility; Dixon Quick Coupling c
Inspection Date: 03/07/2019 Inspection Type : Compliance Evaluation Reason for Visit: Other
Page 3 of 3

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
March 12, 2019
Dixon Quick Coupling
Attention: Mr. Jason Morgan
2925 Chief Court
Dallas, North Carolina 28034
Subject: No -Exposure Certification NCGNE1-32Tr
Dixon Quick Coupling berl
2925 Chief Court
Dallas, North Carolina 28034
Gaston County
Dear Mr. Morgan:
ROY COOPER
Gavemnr
MICHAEL S. REGAN
Secrelary
S. DANIEL SMITH
(nlerim Director
MAR 21 2019
DENR-I-AND QUALITY
STORMWATER PERM11TING
The Division has reviewed your submittal of the No -Exposure Certification form for Exclusion from NPDES
Stormwater Permitting. Based on your submittal and signed certification of no exposure at the above referenced facility,
and the inspection dated March 7, 2019, 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 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 unpermitted discharge.
You must self re -certify your No -Exposure status annually and the form can be downloaded by visiting:
http://portal.ncdent-.orJweb/Ir/npdes-stormxvater the web page for the Division of Energy, Mineral and Land Resources
Stormwater Program.- The annual self re -certification does not need to be submitted to DEMLR unless requested. A copy
should be maintained in your file.
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 Holliday Keen at [phone], or at
flail ida�:. Kee�3:°ir. n�cienr.r*c�v. -
S incerely,
James Moore
Assistant Regional Engineer
Land Quality Section
Enclosed: Inspection report
Annette Lucas, Stormwater Permitting Program

Permit: NCGNE0975
SOC:
County: Gaston
Region: Mooresville
Contact Person: Scott Clark
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Compliance Inspection Report
Effective: Expiration: Owner: Dixon Quick Coupling
Effective: Expiration: Facility: Dixon Quick Coupling
2925 ChiefOt
Dallas NC 28034
Title: Phone: [phone]
Inspection Date: 03/07/2019
Primary Inspector: Holliday Keen
Secondary Inspector(s):
Certification: Phone:
Entry Time: 06:OOPM Exit Time: 06:15PM
Phone:
Reason for Inspection: Other Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ® Compliant Not Compliant
Question Areas:
Miscellaneous Questions
(See attachment summary)
Pagel of 3

Permit: NCGNE0975 Owner - Facility: Dixon Quick Coupling
Inspection Date: 0310712019 Inspection Type : Compliance Evaluation Reason for Visit: Other
Inspection Summary:
This inspection was conducted in response to a request for a No Exposure Certification received by our office January 17,
2019. Upon inspection I found that all activities and materials are contained indoors and there was no potential to impact
stormwater at the time of inspection. Please continue to maintain all outdoor areas in such a manner that will not impact
stormwater funning off of the property. I-recommendthat this facility be granted a No Exposure Certification under
NCGNE0975 If you have any questions, please contact our office at 704-235-2148 or by email at
Holliday. Keen@NC DENR.gov.
Page 2 of 3

Permit: NCGNE0975 Owner - Facility: Oixon Quick Coupling
Inspection Date: 03/0712019 Inspection Type : Compliance Evaluation Reason for Visit: Other
Page 3 of 3

0AIG ,
Environmental
Quality
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
FOR AGENCY USE ONLY
Datc Received
Year
Month
Day
Certificate of Coverage
NC NE
k0D
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000 'Nit �I�h��iVtW2f0�' %F✓
j'u. QPf I-NNga
r,r
: � I NHf
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. 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 422.26(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:
httpsaldeg.nc gov/aboutidivisions/energy-mineral-land-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 ownerloperator (address to which all certification correspondence will be mailed):
Name . i X 0f1 Qu t' C K C.ouP j; n
Contact q Y all
Street Address S C_hiQf Coon
City L)a(IaS State IVC. ZIP Code
Telephone No. 9 0L-1 33 -`i1`)S Uf31? Fax: 90L1 �3w- l�'-�fl
Page 1 of 7
SWU-NCGNE Last revised 912812016

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name 0 , )Co(\ QuticV-- COLA
Facility Contact
Street Address
City
County
Telephone No.
��so� 1'}'lor9ar.
9 9 o. c ck, � rotor f
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). (AS a,'I i Soc+t. +JQ_ fide C GrFz r Pi -a-, 61-Ja 0-KI {
+o o,d Gc:s;o, Coile.je, Co,+;nue_s+(C;S& 0nfio6(oto^;c Tec_,voio�4 Pk,/V. G3 O.ii rn;ltt turn �;S�f
(A copy of a map with the facility clearly located on it should be included with the certification application.) o�+o (,c,;e I Cf.
4) Is the facility located on Native American Lands?❑ Yes ®No i~ cC� G+i 0^ le-4.
5) Is this a Federal facility? ❑ Yes ® No
6) Latitude J5 ° ill 1�`?„ Iv Longitude gla 12' 00,3°{ /(deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
© New or Proposed Facility
® Existing
Date operation is to begin
Date operation began May g o 1 3
0 Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ® Yes 13 No
If yes, what is the NPDES Permit Number? MCG 03000 0
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: 3 Ifn 1 d-
10) Provide a brief description of the types of industrial activities and products produced at this facility:
CNC a..d jcre,­ MSct.inZ produd`S. AsJer,bl� hy��lr_c�l;c _Pnt��.s+��
r_oU101:��S sf-;�1tJI �fti , 4,,4 A(uA,;n�r,
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 2 of 7
SWU-NCGNE Last revised 9/28/2016

NCGNE0000 No Exposure Certification
ExAosure 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 p No ❑ NIA
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes ® No D 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 07 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 M No 0 NIA
tanks, and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained ❑ Yes ® No ❑ NIA
by the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., 0 Yes m No ❑ NIA
dumpsters])
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes 0 No 0 NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents © Yes ® No ❑ NIA
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 m No p 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 133 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 M NIA
deterioration, or evidence of leaks? ,
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes CI No a NIA
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
SWU-NCGNE Last revised 9/28/2016

NCGNE0000 No Exposure Certification
a. Is secondary containment provided for single above ground storage containers ❑ Yes ❑ No ® NIA
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored ® Yes p No ❑ NIA
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 0 No ❑ NIA
Amendments and Reauthorization Act (SARA) water griority chemicals*?
d. Is secondary containment provided for hazardous substances** designated in 02 Yes ❑ No ❑ NIA
40 CFR §116?
e. Are release valves on all secondary containment structures locked? [3 Yes t7 No m NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑Yes ® No ❑ NIA
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous ❑ Yes ® No t7 NIA
waste generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg, or more of hazardous waste M Yes ® 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 Questions 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.
**dote 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
SWU-NCGNE Last revised 9/28/2016

NCGNE0000 No Exposure Certification
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside?
b. Does your facility have coal piles on site?
c. floes 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:
e. If you answered yes to d., are those emissions permitted by an Air Quality
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: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
© Yes ® No 13 NIA
p Yes 0 No 17 NIA
p Yes ® No p NIA
® Yes 0 No © NIA
17 Yes 0 No ® NIA
Page 5 of 7
SWU-NCGNE Last revised 912812016

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 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.
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: �a S on 14 o r 9 of \
Title: Fq c, i -f ana t n cr e Stti e/vti Lor
&:r-- 1- 11-I - I I
(5 nature of Applicant) (Date Signed)
Please note: Misapplication 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
5WU-NCGNE Last revised 912812016

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 the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8.
Mail the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
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)
707-9220
Page 7 of 7
SWU-NCGNE Last revised 9/2812016

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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 the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8.
Mail the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
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 ........
(919) 7914200
Washington Office ...[phone]
Wilmington Office
... [phone]
Winston-Salem ......
[phone]
Central Office .........(919)
707-9220
a
Page 7 of 7
SWU-NCGNE Last revised 9/2812016

I
y
Division of.Energy, Mineral and Land Resources
Land Quality Section
�'-''�-'"�"`�"-° ^r^'"�Natiuudl'Pullut�ttil'Discharge'Elituititttiutt'Systetn '"`""-�'
FOR AGENCY USE ONLY
Dais Rc=ivcd
. Y... Mom..
aay
__certifretc QfCuvcra
NICI ITRITEt
NO EXPOSURE CERTIFICATION for: Exclusion -
Environmental; NCGNE0000 fiS
i1bMW�ioJ.gr Qu¢liry,
mf 'f'�N3ifi
National Pollutant Discharge Elimination System application for exclusion frorrli'a'StorrAWA!fef'Permit based
on No EXPOSUR�:
Submission of'this No Exposure. Certification constltuies: notification that your facility d6es.no0equire a
permit for stormwater discharges associated with industrial activity in the State of'North°Carolina because
it qualifies for a no exposure exclusion. Acondition of no: exposure at on, industrial facility, means all
industrial materials and activities are protected by a sto►`m.resistarit,sheiter elwith.sodie exceptions) to
prevent exposure. torain,.snow, snowmelt, and/or runoff.
For permitted_ facilities. in North_ Carolina, ,DEMLP_,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: ma#eriai'handling equipment oractivities,
industrial machinery; raw materials, intermediate: products, by-products, final products, or wasto 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 reslstant'shelter is hot
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-operationaltaps 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•exclusfon from NPDES permitting is available on a facilhy-'wide basis only not for individual
outfails. 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 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..
s:llcli= :nc: oVlatioutldivisionslener -mineral-Eand-resourceslene - =mineral -land= erm{t'slstorm
For questions, pleasecontact the DEMLR'Regional Wiice:foryour_area., (See page 6)
(Please print or type)
1 j Mailing address of'ownerloperator (address to which all certification correspondence will be mailed):
Name Qui'CK Cot-te rk. j
Contact oso^ 01o111,.°I ck .
Street Address �1_4'as C_ ,0_-F C 0L,4r
City _ p o-t lt-S - _ State. IV C ZIP' Code. `d 3.4
Telephone No. O Ll I'S is. �f 19 Fax: 90H 13 if - .1 20
Page 1 of 7
SWU-NCGNE Last revised g12812016

a
NCGNE0000 No Exposure Certification
2) Location of facility producing discharger
Facility Name D V i ovN Qv, c CUB¢ �'^5
Facility Contact
Street Address
City
County
Telephone No:
3) Physical location information:
rqa1­1
zbiaie tv q.Lit' L;ooe.
Please provide a narrative description of how to get to the facility (use.sfreet names; state road numbers, and
distance and direction from a roadway intamectfon), (AS_ g t SOV+L, -(r,Q t�Q C Gr-;e r 8Q,cr4, 641LA e-K
�Owa.d Gc:s}a,, Coilele, Co-:+inun. S+rz;skf 0,\1_oQ0_f0^;< Tec(UrioioSy Pxuy'. Go ©.�S_^►;l t -rGrr'^ r;5'��
(A copy'of a map with the facility clearlylocated on it'should be included with the certification application.) 0r;fo cj_e� Cf.
4) Is the facility located on Native;American Lands?17Yes N No FgC;1JS oar
5) is this a Federal facility? ,,E2Yes M No
6) Latitude 35 0 18' 12-1 N Longitude $t 0 {2, 003"W(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
® Existing Date operation. began I Y i a} go 13
© Renewal of�existing No Exposure Certification Certification No.: NCGNE
8) Was this faculty or site. ever covered undeuan PDES Stormwater Permit? ® Yes o,No
If yes, what is the NPDES Permit Number?HCG D3000 0
9) Standard Industrial Classification:
Provide the 4-digit Standard' industrial Classification Code (SIC Code) that describes the primary industdaf
activity at this facility �t
SIC Coder 3 . q d-
10) Provide a brief description of the types of industrial activities and products produced at this facillty:
Cn1C'A„d P(OJLAC_-�y, Asme,bit, (An.<ttt
Am —IL - M1+Gl,k_n2_ Pot+; Avmr br-if, 5-h cf. ff"�+�iUI �E�i , 4R�{ A cti/�+%��/►'t
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 2 of 7
SWU-NCGNE Last revised 912812016

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
p Yes ® No O'NiA
c. Materials or products from past industrial activity,
p Yes ® No 0 NIA
d. Material handling equipment (except adequately maintained vehicles)
©Yes 0 No 0 NIA
e. Materials or products during loadinglunloading or transporting activities
0 Yes ®No © NIA
f. Materials or products stored outdoors (except final products intended for outside 0 Yes 0 No 0 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, in Yes ® No © NIA
tanks, and similar containers
h. Materials or products handledlstored on roads or railways owned or maintained © Yes ® No © NIA
by the discharger
is Waste material (except waste in covered, non -leaking containers [e.g., © Yes IN No © NIA
dumpsters])
j. Application or disposal of: process wastewater (unless otherwise permitted) 0 Yes M No n NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents © Yes ® No © NIA
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 0 Yes ® No 0 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 M No 0 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 M NIA
deterioration, or evidence of leaks?
b. is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No a 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
SWU-NCGNE Last revised'9/2812016

NCGNE0000 No Exposure Certification
a. Is secondary containment provided for single above ground storage containers
E3 Yes © No ® N/A
(including drums, barrels, etc_) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored
® Yes El No [3 N/A
in close proximity to, each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment. provided for Title,Ill S_ecUon 313 Superfund
IS Yes in No © NIA
Amendments and Reauthorization Act (SARA) water priority chemicals`?
d. Is secondary containment provided for hazardous substances*" designated in
a Yes ®.No ©. NIA
40 CFR §116?
e. Are release valves on all secondary containment structures locked?
E3 Yes in No A NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? 0Yes a No EI NIA
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous a Yes a No M NIA
waste generated per month) of hazardous waste?
c. is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste IM1 Yes ® No © NIA
generated per month) of hazardous waste?
If you answered yes to,questions b. or c., ple_ase 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.
*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
§37238.
**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
SM644CGNE Last revised 912812016

NCGNE0000 No Exposure Certification
a. Does your facility store used, recycled, of 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'viwith its industrial activity (e.g.,
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? Please specify.
f. Please list any other environmental program permifs, (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
p Yes ® No © NIA.
Q Yes ® No © NIA
©Yes ® No B N/A
© Yes ® No ©. N/A
❑ Yes © No ® NIA
SWU-NCGNE
Last revised 912812016

NCGNEo000 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'NPOES 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 sfte identified in this document (except as allowed under40 CFR 122.26(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: app licable). 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. Wnderstand t
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
-art 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 tha
information, the information submitted is to the best of myknowtedge.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 fariiiliar 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: Or\. / 1 Q r -) as -\
Title: Fac 1J;et a,d M�:,�e��.,ce supe•v,so,r
_dA, no-
(S4.nature of Applicant) (Date Signed)
Please note: This application for the No Exposure Exclusion Is subject to approval by the NCDEQ
Regional Office prior fo 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 rulemak€ng proceeding of 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-NCGNE Last revised 9i2aQ016

r.-
NCGNE0000 No EXposure.Certifidation
Final.Checklist-
......,.�-z:�.--.v,�.•4r.".:�+�.r�r:�-�_;t-._-a.,. 4�?�r:�s!:-�.�.'"�-���.cea.,»a._:y�.y..�:�«�..s-�r-_x+a-�r=r.:w�......w�-�w,�.�r�o-�.�,:rtt �._..:...�.w.:s,,.,RUk.•_s_;r_«.�,.�.---c. •-----'�--'
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 the site currently'has an.NPDES StorrhWater Permit,be-sure to, indicate the permit -number in Question 8.
Mail the entire package.to:
DEMLR - Stormwater Program
Dept -of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612 -
Note
The submission of this .documerit does not guarantee'the:issuance-of a No Exposure. Exclusion.
For questions, please contact. the DEMLR Regional'Offlce 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... (910) 796-721.5
Winston-Salem ...... [phone].
Central Office .........[phone]
Page 7of7
SWU-NCGNE Last revised 912612016

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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 the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8.
Mall the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
16i 2 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
,i. [phone]
Winston-Salem ...... [phone]
Central Office .........(919)
707-9220
Page of 7
SWU-NCGNE Last revised 2/28/2016

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