NCGNE1111_COMPLETE FILE - HISTORICAL_20160105

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE I
DOC TYPE
N HISTORICAL FILE
DOC DATE
❑ b 15_
YYYYMMDD

rleo
WA
4 1, Division of Energy, Mineral, and Land Resources
NCDENR National Pollutant Discharge Elimination System
r ROUN.oe°.q,.eN,oq NO EXPOSURE CERTIFICATION for Exclusion
Exngoxnexr sxo N40ReL gesouwCes
NCGNE0000
AGENCY USE ONLY
_FOR
Dale Received
Year
Month
1 Day
cmfi=m
ofCor mgc
N G N F
xNO EXPOSURE CERTIFICATION JAN 0 5 2016
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit based
on NO EXPOSURE: DFt ;\-I /;I!n C t", i-Y
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Exposure Certification and your NPDES permit is rescinded, your facility must continue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 fro m, you
certify that a condition of no exposure exists at this facility or site and are obligated to comply with:the
terms and conditions of 40 CFR 122.26(g). =
You are required to self re-certifv vour No Exoosure Exclusion annually.
For questions, please contact the DEMLR Regional Office for your area. (Seepage 6)
cu
(Please print or type) p
1) Mailing address of owner/operator
Name
Contact
Street Address
City
Telephone No.
Email
Cloverleaf Cold Storage
Thomas Hardy
401 Douglas Street, Suite 406
Sioux City
712 _279-8000
[e-mail]
State IA ZIP Code 51101
Fax:712 _ 279-0915
N
S W U-NE-21 Feb2014
Page 1 of 7

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Cloverleaf Cold Storage
Facility Contact
Scott Moorefield
Facility Street Address 444 Gilbert Road
City
Benson
County
Johnston
Telephone No.
919-207-4420
Email
[e-mail]
3) Physical location information:
State NC ZIP Code 27504
Fax: [phone]
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). Imperial Drive is off of Boone Trail Road/Route 421 on
the northwest side of Sanford.
(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 35.413914 Longitude-78.51478199999997 (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility
❑X Existing
Date operation is to begin
Date operation began 6-30-2010
❑ Renewal of existing No Exposure 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 2 2 2
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Refrigerated Warehousing and Storage — customer food product can be refrigerated or frozen, stored and/or
shipped depending upon customer needs
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
❑X No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SW U-NE-21 Feb2014

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
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes ❑X No
c. Materials or products from past industrial activity
❑ Yes
❑X No
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
❑X No
e. Materials or products during loading/unloading or transporting activities
❑ Yes
❑X No
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ❑X 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 ❑X No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ❑X No
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes ❑X No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes ❑X No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ❑X 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 ❑X 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 ❑X 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 ❑ Yes ❑ No ❑X
deterioration, or evidence of leaks? N/A
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No ❑X
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut? N/A
Page 3 of 7
S W U-NE-21 Feb2014

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
❑X Yes
❑ No ❑
containers (including drums, barrels, etc.) with a capacity of more than 660-
N/A
gallons?
b. Is secondary containment provided for above ground storage containers stored
❑ Yes
❑ No ❑X
in close proximity to each other with a combined capacity of more than 1,320-
N/A
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund
❑x Yes
❑ No ❑
Amendments and Reauthorization Act (SARA) water priority chemicals*?
N/A
d. Is secondary containment provided for hazardous substances** designated in 40
❑x Yes
❑ No ❑
CFR §116?
N/A
e. Are release valves on all secondary containment structures locked?
❑X Yes
❑ No ❑
N/A
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes ❑X No
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑X Yes ❑ No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes ❑X 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 Oil
How is material stored: 55 gallon barrels
Where is material stored: In the engine room _
How many disposal shipments per year: one
Name of transport / disposal vendor: Noble Oil Ser
Vendor address:5617 Clyde Rhyne Drive, Sanford,
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
SWU-NE-21 Feb2014

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
b. Does your facility have coal piles on site?
c. Does your facility store other fuel sources outside in piles, such as wood chips,
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
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: N/A
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
❑ Yes ❑X No
❑ Yes ❑X No
❑ Yes ❑X No
❑ Yes ❑ No ❑X
N/A
Page 5of7
SW U-NE-21 Feb2014

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
DEMLR 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 Energy, Mineral, and Land Resources (DEMLR),
or MS4 operator where the discharge is into the local MS4, to perform inspections to confine the condition of no exposure
and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing: _Thomas Hardy
Title: _Safety/Compliance
of
_12-16-2015
(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 fled or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
(Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SWU-NE-21 Feb2014

NOGNE0000 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:
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 7 of 7
S W U-NE-21 Feb2014

, Division of Energy, Mineral, and Land Resources
jr'
NC®ENR National Pollutant Discharge Elimination System
NU, NO EXPOSURE CERTIFICATION for Exclusion
Ervnnarvncrvr..xo Nauwi Reaaunco
NCGNE0000
POR AGENCY USE ONLY
Date Received
Year
Month
Day
Certificate
oCCoverzge
xNO 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, 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).
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 Cloverleaf Cold Storage
Contact
Street Address
City
Telephone No.
Email
Thomas Hardy
401 Douglas Street, Suite 406
Sioux City
712 _279-8000
[e-mail]
State IA ZIP Code 51101
Fax: 712 _ 279-0915
Page 1 of 7

D
NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Cloverleaf Cold Storage
Facility Contact Scott Moorefield
Facility Street Address 444 Gilbert Road
City Benson State NC _ ZIP Code 27504
County_ _ _ _ Johnston
Telephone No. 919-207-4420 Fax: [phone]
Email [e-mail]
3) Physical location. information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). Imperial Drive is off of Boone Trail Road/Route 421 on
the northwest side of Sanford.
(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 35.413914 Longitude-78.51478199999997 (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
❑X Existing. Date operation began 6-30-2010
❑ . Renewal of existing No Exposure 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_ 2 ' _2_ _2_
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Refrigerated Warehousing and Storage — customer food product can be refrigerated or frozen, stored and/or
shipped depending upon customer needs
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
❑X No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility

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
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes ❑X No
C. Materials or products from past industrial activity ❑ Yes ❑X No
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes ❑X No
e. Materials or products during loading/unloading or transporting activities ❑ Yes ❑X No
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ❑X 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 ❑X No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ❑X No
the discharger
I. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes ❑X No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes ❑X No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ❑X 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 ❑X 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 ❑X 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.
Are exterior ASTs and piping free of rust, damaged or weathered coating, pits, or ❑ Yes ❑ No ❑X
deterioration, or evidence of leaks? N/A
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No ❑X
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut? N/A

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.
Is secondary containment provided for all single above ground storage
containers (including drums, barrels, etc.) with a capacity of more than 660-
gallons?
b. is secondary containment provided for above ground storage containers stored
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund
Amendments and Reauthorization Act (SARA) water priority chemicals*?
Is secondary containment provided for hazardous substances** designated in 40
CFR §116?
e. Are release valves on all secondary containment structures locked?
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: Used Oil
How is material stored: 55 gallon barrels _
Where is material stored: In the engine room
How many disposal shipments per year: one
Name of transport / disposal vendor: Noble Oil Service
Vendor address:5617 Clyde Rhyne Drive, Sanford, NC
Footnotes to Questions 14) c. & d.
❑XYes ❑ No ❑
N/A
❑ Yes ❑ No ❑X
NIA____ _ _
❑x Yes ❑ No ❑
N/A
❑X Yes ❑ No ❑
N/A
❑X Yes ❑ No ❑
N/A
❑ Yes ❑X No
❑X Yes ❑ No
❑ Yes ❑X No
*Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for de minimis amounts of certain substances,
_and/or other qualifiers, as. described in the exemptions from reporting requirements of Title III SARA 313 in 40 CFR
§372.38.
**Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for amounts less than the Reportable
Quantities of the hazardous substances listed in 40 CFR §117.3.

0
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?
b. Does your facility have coal piles on site?
c. Does your facility store other fuel sources outside in piles, such as wood chips,
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
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: N/A
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Perm it:
Program:
❑ Yes ❑X No
❑ Yes ❑X No
❑ Yes ❑X No
❑ Yes ❑X No
❑ Yes ❑ No ❑X
N/A
Pano F of 7

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
DEMLR 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 Energy, Mineral, and Land Resources (DEMLR),
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 1 must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information; the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing: _Thomas
Title: —Safety/Compliance Manager_
(Signature of Applicant)
_12-16-2015
(Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at anytime in the future for compliance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document fled or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may Include a fine
not to exceed ten thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.

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:
Stormwater Permitting Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information,
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
0--- 7 -4 7

Energy, Mineral
and land Resources
!ENVIRONMENTAL QUALITY
Cloverleaf Cold Storage
Attn: Tom Hardy
401 Douglas Street, Suite 406
Sioux City, IA 51101
Subject: No Exposure Certification NCGNE1111
Cloverleaf Cold Storage
Johnston County
Dear Mr. Hardy:
PAT NiCCRORY
Governor
DONALD R. VAN DLR VAART
Secretary
TRACY DAVIS
The Division has reviewed your submittal of the No Exposure Certification for Exclusion from
NPDES Stormwater Permitting form. Based on your submittal and signed certification of no
exposure at the above referenced facility as well as observations made by Thad Valentine with
the Raleigh Regional Office on April 22, 2016, the Division is granting your conditional exclusion
from permitting as provided for under 40 CFR 122.26(g), which is incorporated by reference in
North Carolina regulations.
Please note that by our acceptance of your No Exposure Certification, you are obligated to
maintain no exposure conditions at your facility. If conditions change such that your facility can
no longer qualify for the No Exposure Certification, you are obligated to immediately obtain
NPDES permit coverage for your stormwater discharge. Otherwise, the discharge becomes
subject to enforcement as an un-permitted discharge. You must self re -certify annually using
the enclosed form or obtain NPDES permit coverage for any stormwater discharges from your
facility. The annual self re -certification does not need to be submitted to DEMLR unless
requested.
Your conditional exclusion from permitting does not affect your facility's legal requirements to
obtain environmental permits that may be required under other federal, state, or local
regulations or ordinances.
Division of Energy, Mineral, and Land Resources
Land Quality Section
Raleigh Regional Offce1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Phone: [phone] / FAX: [phone]/lnt@rnet:llttp://portat.nCdenr.org/web/IF/

Page Two
If you have any questions or need further information, please contact Thad Valentine at (919)
791-4200.
Sincerely,
for Tracy E. Davis, PE, CPM
Enclosure
cc: FRO — Land Quality Section, Stormwater Files (w/o enclosure)
Stormwater Permitting Program, No Exposure Files (w/o enclosure)

Valentine, Thad
From: Valentine, Thad
Sent: Wednesday, May 18, 2016 10:00 AM
To: 'Thomas Hardy'
Subject: RE: RE:
Attachments: No exposer's signed for Lee Co..pdf; No exposer's signed for Johnston Co.pdf; SelfRecertify
No Exposer.docx
Mr. Hardy
I have attached a copy of the No exposer certificates as well as recertification document that should be reviewed and
filled out for each facility every year. These recertification document should be kept on file at the respective plants and
not sent in to us. The hard copies of the No Exposer Certificates were mailed out from our central office and you should
receive them shortly
From: Thomas Hardy [mailto:[e-mail]]
Sent: Monday, May 02, 2016 2:38 PM
To: Valentine, Thad <[e-mail]>
Subject: RE:
Good Afternoon,
Whatever requirements that North Carolina has for these permits we will follow and make sure it is taken care of. Once
again I appreciate all of your efforts in this matter, have a safe week!
Tom
From: Valentine, Thad [mailto:thad.valentineCobncdenr gov]
Sent: Monday, May 02, 2016 1:33 PM
To: Thomas Hardy
Subject: RE:
Mr. Hardy
I am working on clarification for your no exposer request. There is some language in the confirmation letter that states
that you must Self Recertify yearly. I believe this is a document that you fill out annually and keep on file, nothing to
send to us. I will respond with that answer and send the letter granting no exposer once the regional engineer has a
chance to review it.
From: Thomas Hardy [mailto:thardv cloverleaf.com]
Sent: Wednesday, April 27, 2016 9:14 AM
To: Valentine, Thad <[e-mail]>
Subject:
Thomas A. Hardy (Tom)
Safety and Compliance Manager
Cloverleaf Cold Storage
401 Douglas Street
Suite 406

Sioux City, IA 51101
[e-mail]
Bus: 712-224-8110
Cell: 712-899-5063

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Cloverleaf Cold Storage
Attn: Tom Hardy
401 Douglas Street, Suite 406
Sioux City, IA 51101
Subject: No Exposure Certification NCGNE1111
Cloverleaf Cold Storage
Johnston County
Dear Mr. Hardy:
PA,r nICCRORY
Governor
DONALD R. VAN DER VAART
Secretary
TRACY DAVIS
The Division has reviewed your submittal of the No Exposure Certification for Exclusion from
NPDES Stormwater Permitting form. Based on your submittal and signed certification of no
exposure at the above referenced facility as well as observations made by Thad Valentine with
the Raleigh Regional Office on April 22, 2016, the Division is granting your conditional exclusion
from permitting as provided for under 40 CFR 122.26(g), which is incorporated by reference in
North Carolina regulations.
Please note that by our acceptance of your No Exposure Certification, you are obligated to
maintain no exposure conditions at your facility. If conditions change such that your facility can
no longer qualify for the No Exposure Certification, you are obligated to immediately obtain
NPDES permit coverage for your stormwater discharge. Otherwise, the discharge becomes
subject to enforcement as an un-permitted discharge. You must self re -certify annually using
the enclosed form or obtain NPDES permit coverage for any stormwater discharges from your
facility. The annual self re -certification does not need to be submitted to DEMLR unless
requested.
Your conditional exclusion from permitting does not affect your facility's legal requirements to
obtain environmental permits that may be required under other federal, state, or local
regulations or ordinances.
Division of Energy, Mineral, and Land Resources
Land Quality Section
Raleigh Regional Offce1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Phone: [phone] / FAX: [phone] / Internet: http://portal.ncdenr.org/web/Ir/

Page Two
If you have any questions or need further information, please contact Thad Valentine at (919)
791-4200.
Sincerely,
g
for Tracy E. Davis, PE, �CPP�M
Enclosure
cc: FRO — Land Quality Section, Stormwater Files (w/o enclosure)
Stormwater Permitting Program, No Exposure Files (w/o enclosure)