NCGNE1084_COMPLETE FILE - HISTORICAL_20150921

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE I O�
DOC TYPE
❑HISTORICAL FILE
DOC DATE
❑ V/V I� �/'7 � I
YYYYMMDD
w

Is
North Carolina Department of Environmental Quality
Pat McCrory
Governor
Donald R. van der Vaart
Secretary
September 21, 2015
Nordson Xaloy
Attention: Mr. Chuck Lackey
1291 19Th Street Lane NW
Hickory, North Carolina 28601
Subject: No -Exposure CertificationNCGNE1084
Nordson Xaloy
1291 19th Street Lane NW
Hickory, North Carolina 28601
Catawba County
Dear Mr. Xaloy:
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
September 17, 2015, 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:llpgrtal.ncdenr.org/web/Ir/npdes-stormwater 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.
Division of Energy, Mineral, and Land Resources
Land Quality Section - Mooresville Regional Office
610 East Center Avenue, Suite 301, Mooresville, North Carolina 28115
Telephone: [phone]I FAX: [phone] • Internet: http://portal,ncdenr.org/webllrfand-quality
An Equal Opportunity / Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

IL
No -Exposure Certification :1
Nordson Xaloy
Page 2
If you have any questions or need further information, please contact Mr. Samar Bou-
Ghazale at [phone], or at [e-mail].
Sincerely,
Zahid S. Khan, CPM, CPESC, CPSWQ
Regional Engineer
Land Quality Section
Enclosure: Inspection Report
cctiBradiey--B'er)nett^Stormwater Permitting Program, No- Exposure Files NCGNE 1084

Compliance Inspection Report
Permit: NCGNE1084 Effective: Expiration: Owner: NordsonXaloy
SOC: Effective: Expiration: Facility: Nordson Xaloy
County: Catawba 1291 19th St Ln Nw
Region: Mooresville
Hickory NC 28601
Contact Person: Chuck Lackey Title: . Phone: [phone]
Directions to Facility:
321 N from 1-40, at 5th traffic light, go left on Clement Blvd 200 yards, 19th St Ln on right.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 09/17/2015 Entry Time: 01:10PM
Primary Inspector: Samar E Bou Ghazale
Secondary Inspector(s):
Exit Time: 01:30PM
Phone: [phone] Ext.2199
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 ® Misc
(See attachment summary)
Page: 1

Permit NCGNE1084 Owner - Facility: Nordson Xaloy
Inspection Date: 09/17/2015 Inspection Type : Compliance Evaluation Reason for Visit: Other
Inspection Summary:
No exposure from stormwater is to be granted based on inspection Dated September 17, 2015.
Page: 2

tr
Permit NCGNE1084 Owner - Facility: Nordson Xaloy
Inspection Date: 09/17/2015 Inspection Type : Compliance Evaluation Reason for Visit: other
Misc
Yes No NA NE
Is the facility compliant? ® ❑ ❑ ❑
Comment: Facility applied for no exi2osure status. No exposure -is to be ranted based on field condition.
Page: 3

North Carolina Department of Environmental Quality
Pat McCrory
Governor
Nordson Xaloy
Attention: Mr. Chuck Lackey
1291 19Th Street Lane NW
Hickory, North Carolina 28601
Dear Mr. Xaloy:
Donald R. van der Vaart
Secretary
September 21, 2015
Subject: No -Exposure Certification NCGNE1084
Nordson Xaloy
1291 19th Street Lane NW
Hickory, North Carolina 28601
Catawba County
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
September 17, 2015, 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:I/portal.ncdenr.org/web/Ir/nDdes-stormwater 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.
Division of Energy, Mineral, and Land Resources
Land Quality Section - Mooresville Regional Office
610 East Center Avenue, Suite 301, Mooresville, North Carolina 28115
Telephone: [phone] FAX: [phone] •Internet: httpalportal.ncdenr.orglwebflrlland-quality
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

No -Exposure Certification �6
Nordson Xaloy
Page 2
If you have any questions or need further information, please contact Mr. Samar Bou-
Ghazale at [phone], or at [e-mail].
Sincerely,
Zahid S. Khan, CPM, CPESC, CPSWQ
Regional Engineer
Land Quality Section
Enclosure: Inspection Report
cc: Bradley Bennett, Stormwater Permitting Program, No- Exposure Files NCGNE 1084

Compliance Inspection Report
Permit: NCGNE1084 Effective: Expiration: Owner: Nordson Xaloy
SOC: Effective: Expiration: Facility: Nordson Xaloy
County: Catawba 1291 19th St Ln Nw
Region: Mooresville
Hickory NC 28601
Contact Person: Chuck Lackey Title: .
Directions to Facility:
321 N from I-40, at 5th traffic light, go left on Clement Blvd 200 yards, 19th St Ln on right.
SystemClassifications:
Primary ORC: Certification:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 09/17/2015 Entry Time: 01:10PM
Primary Inspector: Samar E Bou Ghazale
Secondary Inspector(s):
Exit Time: 01:30PM
Reason for inspection: Other Inspection Type
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ® Compliant ❑ Not Compliant
Question Areas:
® Miscellaneous Questions ® Misc
(See attachment summary)
Phone: [phone]
Phone:
Phone: [phone] Ext.2199
Compliance Evaluation
Page: 1

1
f
Permit: NCGNE1084 Owner - Facility: Nordson XWoy
Inspection Date: 09117/2015 Inspection Type : Compliance Evaluation Reason for Visit: Other
Inspection Summary:
No exposure from stormwater is to be granted based on inspection Dated September 17, 2015.
Page. 2

permit.. NCGNE1084 Owner - Facility: Nordson Xaloy
Inspection Date: 09117/2015 Inspection Type : Compliance Evaluation Reason for Visit: Other
Misc
Yes No NA_NE
is the facility compliant? N O ❑ ❑
Comment: Facility applied for no exposure status. No exposure is to be granted based on field condition.
Page: 3

V
114
h ision of Ener-N, 1•[ineral and Land Resources
AWSMUNWERWOM'A a .,
e Land Qualify, Section
NM NW-2 %1X
al Pollutant Discharge Elimination System
N� ActPOSURE CERTIFICATION for Exclusion
�G�,PGdf� F �OiS` lnf r`� Pk)
National Polfictft"Discharge Eliminatrrygg
em application exclusion fr6m
on NO EXPOS t R Z 12D15 1 r
FOR AGENCI' USEOXL1'
Date Received
Year Month Dat
Certificate of Co,•erag;:_ ,
Stormv$ajbrmyn i f, "I d
Submission of this No Exposure Certification constltifii_�&ttflcation 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 122.26(g).
if approved, your conditional no -exposure exclusion must be self re -certified at least annually.
Please see information here: httD:I/DOrtal.ncdenr,ora/%?vebflr/nDdes
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 nn ���� ',A, ,w,rr
Contact Cam! LLOX LACA
Street Address i 791 1ri ST u.] AIU1
City H 1 C1:.0 Q State � ZIP Code Z&0 ,
Telephone No. Z 3 — Cl gF 9` Fax: Z 7--
Page 1 of 7
SUVI1-NCY,NF I ;it ravicarl 51.soni5

t
NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name A10 K4254N-
Facility Contact
Street Address
City
County
Telephone No.
izyl /9t .5TLkN44f -
3) Physical location information:
Please provide a narrative description of how to get to the facility (use street names state road nurers, and ,
distance and direction fromw a roa ay intersection). 3Z / AXVM 1- . AT 5 F IC.
'" 6 Zoo - If M VIAI OP1 Z16177
(A copy ot a map with the facility clearly located on it should be includ d with the certification application.)
4) Is the facility located on Native American Lands? 0 Yes No 1 V 55� 0 fJ' � T I 7
5) Is this a Federal facility? ❑ Yes �No 0 1 �� S 5, 1
6) Latitude _ J S"(41;1 A Longitude $I 'Cl Z (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
t' Existing Date operation began g Z/ z o0 /
0 Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ 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: 3 S 9 LJ
10) Provide a brief description of the types of industrial activities and products produced at this facility:
ni4Nv.rr�cmeiV6- �.S�t e,3CL a� f'l�'!-STICS �xrnvs-Im
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
;4,No
0 Yes
If yes; list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SM)-Nr,GNF I asi rPvicar! F/SI�f] 15

t
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 p< 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 0,No ❑ NIA
c. Materials or products from past industrial activity
❑ Yes
)4No
❑ NIA
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
XNo
❑ NIA
e. Materials or products during loading/unloading or transporting activities
❑ Yes
XNo
❑ NIA
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes
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, tanks,
❑ Yes
XNo
❑ NIA
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by
❑ Yes
1,XNo
❑ NIA
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes
XNo
❑ NIA
j. Application or disposal of process wastewater (unless otherwise permitted)
❑ Yes
9,No
❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes f No ❑ NIA
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 ;(,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 ;K 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 )d 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 3 of 7
SWI1-NrGW= I act rPviced 515/7nI

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?
c. Is secondary containment provided for Title I[] 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 (100D 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: W05% PAPNT
How is material stored: !W Seep COAMIL eIC
Where is material stored: J IAS I bC - BV 1 LL-I 0 C-
How many disposal shipments per year: ti
Name of transport / disposal vendor:
Vendor address:
Footnotes to Questions 14) c. & d.
❑ Yes ❑ No P�,N/A
❑ Yes ❑ No XNIA
© Yes, ❑ No )4NIA
❑ Yes ❑ No X NIA
0 Yes ❑ No .NIA
❑ Yes 9�,No © NIA
;!4 Yes ❑ No © NIA
❑ Yes )K.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
SM I-Nf-:r;NF Fr,/5/9015

NCGNEOOOO No Exposure Certification
1 of 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 othemlise reclaimed pallets outside? ,' Yes M No ❑ NIA
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 vvith its industrial activity (e.g.,
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: �"011GH VP FAINT �oarN
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 appilcation (such as Hazardous Waste Permits, etc.):
Permit:
, Program:
Permit:
Program:
Permit:
Program:
Permit:
Program. -
Perm it:
Program:
Permit:
Program:
Permit:
Program:
❑ Yes )_�No ❑ NIA
Ll Yes ); No 0 NIA
AYes � 1 No ❑ NIA
❑ Yes ANo ❑ NIA
Page S of 7
RWIf-NC CyAIF 1 act r�vicprl l5/7il1ri

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.
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 N e� of Person Signing: CJ L"�T -- L'J"`r7
Title: (m %4- Y IaL 4rr-
6
(Signature of Applicant) 40, (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
!North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement; representation. or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article: or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article: or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10.000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SWI I-N((,NF I act ravisari 51517n15

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.
El 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
M09.0som- XAL01
Page 7 of 7
SWII-NC:f;NF I act ravi�;arl .1V.Ygn1s

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