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HomeMy WebLinkAboutNCGNE0997_COMPLETE FILE - HISTORICAL_20190122STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. NCGNE DOC TYPE HISTORICAL FILE DOC DATE ❑ c�� (� % a YYYYMMDD STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. NCG29 DOC TYPE ❑ HISTORICAL FILE DOC DATE ❑ YYYYMMDD _P*oS l r N-&- NCG qq 7j— Division of Energy, Mineral and Land Resources Land Quality Section National Pollutant Discharge Elimination System NO EXPOSURE CERTIFICATION for Exclusion FOR AGFNCY I1SI ONLY' Ww Rcccu.d Year Momh De, Cendieme or Co,mgp Energy Mineral NCGNE®OOO and Lund 2esou, (-es N� r 1=_ 1 V E D f hblRLund e GI cesALJ" Y7 pF' i.,I National Pollutant Discharge Elimination System application for exclusion from a StormwaterlPermit based on NO EXPOSURE: N}h�-LAND QUALITY CTrn..,...-- Submission of this No Exposure Certification constitutes notification that 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 Until you are issued a No Exposure Certification and your NPDES permit is rescinded, your facility must continue to abide by the terms and conditions of the current permit.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 individua! 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, yoe; certify that a condition of no exposure exists at this facility or site and are obligated to comply with the terms and conditions o/ 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 Order the No Exoosure section on this page https://deg. nc. gov/about/d ivisions/energy-minerai-lard-resources/energy-riiineral-land-permits/stormwa,Le__ 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 Waste Industries LLC. Contact John Pfleger Street Address 3301 Benson Drive__ _ _ _ City Raleigh --_ Stare. tiro __ ZIP Code 27609 Telephone No. 919-877-7523 Fax:919-325-3018_ Page 1 or 7 NCGNE0000 No Exposure Certification 2) Location of facility producing discharge: Facility Name Waste Industries LLC, Wilmington Facility Contact Street Address City County Telephone No. Shawn Haines 3618 Hwy 421 N Wilmington 910-762-7563 3) Physical location information: State NC ZIP Code 28401 Fax: 910-762-6880 Please provide a narrative description of how to get to the !ac lity (use street names, state road numbers, and distance and direction from a roadway intersection) Francis Peter Fensel Hwy 421 N approximately 0.5 miles past Hwy 140 on right. (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, 17, 36.98 Longitude -77 58. '2.03 _ (deg., min., seconds) 7) This NPDES No Exposure Exclusion application applies to which of the following: G New or Proposed Facility Date operation is to begin X Existing Date operation began October 1998 ❑ Renewal of existing No Exposure Certificatior Certification No. NCGNE000 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:4212 10) Provide a brief description of the types of industrial activities and products produced at this facility: Vehicle maintenance washing fueling and parking. Storage of empty waste containers. Office space for administration and operations. 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-Discha. ge permits for this facility: Pang 2 of 7 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 ❑ N/A 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 ❑ N/A c. Materials or products from past industrial activity ❑ Yes X No G N/A d. Material handling equipment (except adequately maintained vehicles) ❑ Yes X No G N/A e Materials or products during loading/unloading or transporting activities ❑ Yes X No ❑ N/A I. Materials or products stored outdoors (except finai products intended for outside ❑ Yes X 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, C Yes X No ❑ N/A tanks, and similar containers In. Materials or products handled/stored on roads or railways owned or maintained ❑ Yes X No ❑ N/A by the discharger I. Waste material (except waste in covered, non -leaking containers [e.g., ❑ Yes X No ❑ NIA dumpsters]) I. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes ❑ No X NiA k. Particulate matter or visible deposits of residuals from roof stacks and/or vents O Yes ❑ No X 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 :7 No 0 N/A 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? pnnp 3 n: NCGNEOOOO 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 0 Yes ❑ No X NIA (including drums, barrels, etc.) with a capacity of more than 660-gallons? b. Is secondary containment provided for above ground storage containers stored X Yes ❑ 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 ❑ No X N/A Amendments and Reauthorization Act (SARA) water priority chemicals'? d. Is secondary containment provided for hazardous substances" designated in 0 Yes ❑ No X N/A 40 CFR §116? e. Are release valves on all secondary containment structures !ocked7 ❑ Yes ❑ No X NIA 15) Hazardous Waste: a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? G Yes X No ❑ N/A b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous X Yes ❑ No ❑ N/A waste generated per month) of hazardous waste? c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes X No ❑ N/A generated per month) of hazardous waste? If you answered yes to questions b. or c., please provide the following information: Type(s) of waste: Used petroleum products, solvents, and Kleen How is material stored: Flammables locker. 55 gallon drums AST Where is material stored: Shop How many disposal shipments per year: Every other month Name of transport / disposal vendor: Noble Oil & Safety Vendor address: Noble 5617 Clyde Rhyme Dr. Sanford NC 27330 Safety Kleen: 934 N. 5'h St. St. Pauls NC 28384 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. "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 Paue 4 of 7 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 X No ❑ N/A b. Does your facility have coal piles on site? ❑ Yes X No ❑ N/A c. Does your facility store other fuel sources outside in piles, such as wood chips. ❑ Yes X No sawdust. etc.? N/A d Does your facility have air emissions associated with its industrial activity (e g., ❑ Yes X No G degreasing operations, plating, painting and metal finishing)? If so, describe the N/A industrial activity: e. If you answered yes to d., are those emissions permitted by an. Ai; Duality ❑ Yes C No X Permit? Please specify: N/A f. Please list any other environmental program permits (federal. state, etc.) not specified earlier in this application (such as Hazardous Waste Permits, etc.). Permit: SW8880213 Program Stormwaier Management Permit: Program Permit: _ Program: Permit: _. P'o,,rair. Permit: Program. Permit: Program Permit: Program Pade 5 of -1 NCGNE0000 No Exposure Certification 17) Certification: I certify under penalty of law that 1 have read and understand the eligibility requirements for claiming a condition of "no exposure" and obtaining an exclusion from NPDES stormwaler permitting. I certify under penalty of law that there are no discharges of stormwaler 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 repots 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 _tonnwater 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 fills application and that to the best of my knowledge and belief such information is true, complete, and accurate. Printed Name of Person Title: General Manaaet (Signature of ZZL- - (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 meiho(I required to be operated or maintained under this Article or rules of the (Environmental Management) Commission Implementing this At icle 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. _I Pane fi cf 7 NCGNE0000 No Exposure Certification Final Checklist This application should include the following items: X This completed application and all supporting documentation. X A map with the location of the facility clearly marked. NSA 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 ...... (828) 296-4500 Fayetteville Office ... (910) 433-3300 Mooresville Office ... (704) 663-1699 Raleigh Office ........ (919) 791-4200 Washington Office ...(252) 946-6481 Wilmington Office ... (910) 796-7215 Winston-Salem ...... (336) 776-9800 Central Office .........(919) 707-9220 Page 7 of 7 SWI I-Nr.r:NF I act rPuicarl R/9A/90'IF ,lap of' 615 Us Fli_hwav 421 N. Wilmington, NC 284n1_om0 _ of ng Maps Page 1 of I 3618 Us Highway 421 N, Wilmington, NC 28401-9020 http://%Yw%%,.bing.com/maps" 5l4r2011 Division or Water Quality / Surface Water Protection w r"In NCDENRNational Pollutant Discharge Elimination System NO EXPOSURE CERTIFICATION for Exclusion �ivrc�xe[+wn Nrtwu. Rroo.ncrr. NCGNE000(1 USEONLY Umc R,,o,, l)lump 1);rtN EFOR01?NCY F NO EXPOSURE CERTIFICATION 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, snowmelf and/or runoff. For permitted facilities in North Carolina, DWQ must approve your application for No Exposure Certification before this exclusion is effective. Until you are issued a No Exposure Certification and your NPDES permit is rescinded, your facility must continue to abide by the terms and conditions of the current permit. Industrial materials or activities include, but are not limited to: material handling equipment or activities, industrial machinery, raw materials, intermediate products, by-products, final products, or waste products. Material handling activities include the storage, loading and unloading, transportation, or conveyance of any raw material, intermediate product, final product or 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). 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 mailedl: Name Waste Industries LLC Contact John Pfleger Street Address 3301 Benson Drive Suite 601 City Raleigh State NC ZIP Code 27609 Telephone No. 919 877-7523 Fax: 919 325- Email LIS wa i nd 1 ri es Com n j2 k�5LSry� �—�7� f1IIjUUI/L�QI/j Page 1 of 7 DEC 2 B 2015 S W U-N E-12Aug201 o NCGNE0000 No Exposure Certification 2) Location of facility producing discharge: Facility Name Waste Industries LLC Wilmington Facility Contact Brent Kirchhoff Facility Street Address 3618 Hwy 421 N City Wilmington State NC ZIP Code 28401 County New Hanover Telephone No. 800 942-8647 Fax: 910 762-6880 Email Brent.kirchhoff@wasteindustries.com 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). F12ancis parer Fensel Hvrv_ 421 N_ _ aporoxima elY 0_ 5 miles pacer HWy 140 on right - (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 M No 5) Is this a Federal facility? ❑ Yes It No 6) Latitude 34, 17, 36.98 Longitude-77, 58. 12.03 (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 M Existing Date operation began October 1988 ❑ 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: 4 9 5 3 10) Provide a brief description of the types of industrial activities and products produced at this facility: Vehicle maintenance washing fueling and parking Storage of emptv waste on ain rc Office space for administration and operations. 11) Does this facility have any Non -Discharge permits (ex: recycle permits)? t No ❑ Yes If yes, list the permit numbers for all current Non -Discharge permits for this facility: Page 2 of 7 SWU-NE-12Aug2010 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 IN 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 ffi No c. Materials or products from past industrial activity ❑ Yes IN No d. Material handling equipment (except adequately maintained vehicles) ❑ Yes & No e. Materials or products during loading/unloading or transporting activities ❑ Yes M No f. Materials or products stored outdoors (except final products intended for outside ❑ Yes K 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 KI No and similar containers h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes X No the discharger Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes N No Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes 0 No k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes M 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 M 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 ¢0 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 KI 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 S W 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 M Yes ❑ No ❑ N/A containers (including drums, barrels, etc.) with a capacity of more than 660- gallons? b. Is secondary containment provided for above ground storage containers stored X1 Yes ❑ No ❑ 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 III Section 313 Superfund ❑ Yes ❑ No M N/A Amendments and Reauthorization Act (SARA) water priority chemicals'? d. Is secondary containment provided for hazardous substances" designated in 40 X] Yes ❑ No ❑ N/A CFR §116? e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No CXN/A 15) Hazardous Waste: a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes PO No b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste N Yes ❑ No generated per month) of hazardous waste? c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes M No generated per month) of hazardous waste? If you answered yes to questions b. or c., please provide the following information: Type(s) of waste: Used petroleum products solvents other flammables How is material stored:_Flammables locker, 55 gallon drums 1000 gal AST Where is material stored: Shoo How many disposal shipments per year: Every other month Name of transport/disposal vendor: Safety Kleen and Noble Oil Vendor address: Safety Kleen: 934 N. 5th St St Pauls NC 28384 Noble: 5617 Clyde Rhyne Dr., Sanford NC 27330 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. "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-NE-12Aug2010 NCGNE0O00 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 KI No b. Does your facility have coal piles on site? ❑ Yes t No c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes KI 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 ❑ No KI N/A 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: SW8880213 Program: Stormwater Management Permit: Program: Permit: Program: Permit: Program: Permit: Program: Permit: Program: Permit: Program: Page 5 of 7 S W U-NE-12Aug2010 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 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 Duality, 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. n Printed Name of Title: C (Signature of (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 S W U-NE-12Aug2010 Waste Industries - Google Maps Page I of 1 Google Maps Waste Industries 'q \� h.A, C a I• f ':wN ul•Ne :..•:. iylnnV . a.e flwGr Nmxr..,,.�•p� Google ri Map data @2015 Google 1000 ft Waste Industries Waste Management Service 3618 Highmy 421 N, Wilmington, NC 28401 waste industries.com (910) 762-2301 littps://www.google.com/iiiaps/place/W,iste+liidListries/@i 34.2949753,-77.9803921,1571d... 12/21/2015