NCGNE1123_COMPLETE FILE - HISTORICAL_20160518

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
HISTORICAL FILE
DOC DATE
❑ 0101 h D5 I Cj
YYYYMMDD

Environmental
Quality
May 12, 2016
Mr. Jim O'Rourke
Classic Graphics
627 Distribution Drive
Morrisville, NC 27560
Subject: No Exposure Exclusion
Classic Graphics
627 Distribution Drive,
Durham County
Dear Mr. O'Rourke:
The Division has reviewed your submittal of the No Exposure Certification
stormwater permitting which we received on March 16, 2016: Based on yoi
conditions at the subject facility the Division is granting you conditional ex(
federal rules under 40 CFR 122.26(g). The Division has not inspected your
relying on your certification.
Please note that by our acceptance of your No Exposure Certification, you at
conditions at your facility. If conditions change such that your facility can or
exclusion, you are obligated to immediately obtain NPDES permit coverage
Otherwise, the discharge becomes subject to enforcement as an un-permitted
annually using the enclosed form or obtain NPDES permit coverage for any
facility. The annual self re -certification does not need to be submitted to the
requested.
Your conditional exclusion from permitting does not affect your facility's
environmental permits that may be required under other federal, state, or 1
If you have any questions or need further information, please contact me at
[e-mail].
Sincerely, f� /
Ken Pickle
Stormwater Program Specialist
DEMLR Stormwater Permitting
Enclosures
cc: John Holley, DEMLR Regional -Engineer, Raleigh Regional Office, w/o
SPP files, NCGNEI 123, w/o enclosures
State of North Carolina I Environmental Quality
217 West Jones Street 1 1601 Mail Service Center I Raleigh, North C
919 707 8600
z41Ft_
PAT MCCRORY
Governor
ALD R. VAN DER VAART
Secretary
Permitting NCGNE1123
NC
Exclusion from NPDES
;d certification of no exposure
from permitting as provided in
for no exposure, and we are
obligated to maintain no exposure
longer qualify for the permitting
it your stormwater discharge.
lischarge. You must self re -certify
ormwater discharges from your
hvision unless specifically
I requirements to obtain
regulations or ordinances.
9) 807-6376 or at
27699-1601

% see ,�, rJ(/r`1J -Yo/ /� !P ✓/Pr11 f /Iv`�
J
AjA Division of Energy, Mineral and Land Resources
Land Quality Section
NCDENRNational Pollutant Discharge Elimination System
N­ 'NoUN.o ..EMo, NO EXPOSURE CERTIFICATION for Exclusion
,.V �NMEN...o NATURAL RE50UNCES NCG N E0000
n (2 62--n �, / `
r►I[dttiiJiSt�f
MAR 16 2016
DENR-LAND QUALITY
National Pollutant Discharge Elimination System application for exclusion from §166 $0 NMI UWzd
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).
If approved, your conditional no -exposure exclusion must be self re -certified at least annually
Please see information here:
For questions, please contact the DEMLR Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of owner/operator
Name o 4 �C S
Contact
Street Address
City
Telephone No.
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NCGNE0000 No Exposure Certification
2) Location of facility producing discharge,
Facility Name Cal 4 SS G
Facility Contact rM /Zw
Street Address / a-7 .3-
City i it v / l �
County
Telephone No. 9 I q { 6 f C
3) Physical location information:
I
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).
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes ❑ No
5) Is this a Federal facility? ❑ Yes ❑ No
6) Latitude 35• $ 70272 Longitude —IS. 997 101, (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
Existing Date operation began /
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes I(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: �_ Z
10) Provide a brief description of a types of industrial activities and products produced at this facility:
�r,
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
)'No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
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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 XNo ❑ 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 }� No
/
El N/A
c. Materials or products from past industrial activity
El Yes )\ No
❑ NIA
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
✓No
❑ N/A
e. Materials or products during loading/unloading or transporting activities
`lo
❑ Yes
❑ N/A
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes XNo
❑ N/A
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks,
__ ''
❑ Yes yy rvo
❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by
❑ Yes Cal �lo
✓�
❑ N/A
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes Yi NN'''o
❑ N/A
j. Application or disposal of process wastewater (unless otherwise permitted)
❑ Yesrvo
O N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not
❑ Yes 1� No
❑ N/A
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 XNo
❑ 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 XNo
❑ 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
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
❑ Yes ❑ No )p N/A
❑ Yes ❑ NoYN/A
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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 III Section 313 Superfund
Amendments and Reauthorization Act (SARA) water priority chemicals*?
d. Is secondary containment provided for hazardous substances** designated in 40
CFR §116?
e. Are release valves on all secondary containment structures locked?
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material s
Where is materia
How many dispo!
Name of transpoi
Vendor address:
Footnotes to Questions 14) c. & d.
❑ Yes ❑ No N/A
❑ Yes ❑ No Yl N/A
❑ Yes ❑ Noj(N/A
❑ Yes ❑ No I/A
❑ Yes ❑ No_,k"N/A
❑ Yes 1 'No ❑ N/A
Yes ❑ No ❑ N/A
❑ Yes T'\No ❑ N/A
*Note that amounts below the 560-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.
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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 Jd No ❑ N/A
b. Does your facility have coal piles on site? ❑ YesX\ No ❑ N/A
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes�No ❑ N/A
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ❑ Yes '�No ❑ N/A
degreasing operations, plating, painting and metal finishing)? If so, describe the l�
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? ❑ Yes ❑ No XZN/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: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
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NCGNE0000 No Exposure Certification
17) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no
exposure' and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that there are no discharges of stormwater contaminated by exposure to industrial activities
or materials from the industrial facility or site identified in this document (except as allowed under 40 CFR 122.26(g)(2)).
I understand that I am obligated to submit a no exposure certification form once every five (5) years to the North Carolina
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system (MS4) into
which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing: �//1 rtr� (►C 6 c.,o /r�
Title: Ur�G1
of Applicant)
Date igned)
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.
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NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
❑ This completed application and all supporting documentation.
❑ A map with the location of the facility clearly marked.
❑ If the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8.
Mail the entire package to:
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
/. 5/Ccafe//99aJ'//` /s ea furlAd 6y /PI��Sru/P5, S/S/r!a/�i��a�w 27 S/L27�2, SPe C?,/o,
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Page 7 of 7
SWU-NCGNE Last revised 5/5/2015

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_ t
N, PAT McCRORY
Governor
DONALD R. VAN DER VAART
Environmental secretary
Quality
May 12, 2016
Mr. Jim O'Rourke
Classic Graphics
627 Distribution Drive
Morrisville, NC 27560
Subject: No Exposure Exclusion from Permitting NCGNE1123
Classic Graphics
627 Distribution Drive, Morrisville, NC
Durham County
Dear Mr. O'Rourke:
The Division has reviewed your submittal of the No Exposure Certification for Exclusion from NPDES
stormwater permitting which we received on March 16, 2016. Based on your signed certification of no exposure
conditions at the subject facility the Division is granting you conditional exclusion from permitting as provided in
federal rules under 40 CFR 122.26(g). The Division has not inspected your facility for no exposure, and we are
relying on your certification.
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 permitting
exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater discharge.
Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. 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 the Division unless specifically
requested.
Your conditional exclusion from permitting does not affect your facility's legal requirements to obtain
environmental permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact me at (9I19) 807-6376 or at
[e-mail].
Sincerely,
Ken Pickle
Stormwater Program Specialist
DEMLR Stormwater Permitting
Enclosures
cc: John Holley, DEMLR Regional Engineer, Raleigh Regional Office, w/o
SPP files, NCGNE1123, w/o enclosures
State of Not Carolina I Environmental Quality
217 West Jones Street 1 160) Mail Service Center I Raleigh. North C
919 707 8600

/ �O/u, V4 7D /SJ-"C it cry ivG
� .See ��, �j 7 mar �P✓iP�.J li� ,V Q� � C.,- l.Y / '-L !� ��
FOR AGENCY USE ONLY
© J Dee Re.i,cd
Division of Energy, Mineral and Land Resources Year Month Da
��� Land Quality Section
NCDENRNational Pollutant Discharge Elimination System °
GRa'A .A..,�°F NO EXPOSURE CERTIFICATION for Exclusion
ee,aA°� NCGNE0000 LIAR 16 2015
DENR-LAND QUALITY
National Pollutant Discharge Elimination System application for exclusion from a9§%34 iW 06FMII Bh&d
on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notification that your facility does not require a
permit forstormwater 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
outta/ls. 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: htto://portal ncdenr nrn/wPhnr/nnr1.o_OF rmu,Of.r
For questions, please contact the DEMLR Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of
Name G �y t ,'G99;:�
Contact J; wt fY Q o - -
Street Address 6a-)
City
Telephone No. It / q
Page 1 of 7
State /VC -
Fax: A,%=
ZIP Code
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NCGNE0000 No Exposure Certification
2) Location of facility producing discharg�
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
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).
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes ❑ No
5) Is this a Federal facility? ❑ Yes ❑ No
6) Latitude 35. 8702-72 Longitude 19.997 104 (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 / p
Existing Date operation began
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes /tINo
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: 01Z y5
10) Provide a brief description oVpe types of industrial activities and products produced at this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
) fNo
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
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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 XNo ❑ 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 }� No ❑ N/A
c. Materials or products from past industrial activity ❑ Yes )(No ❑ N/A
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes Flo ❑ N/A
e. Materials or products during loading/unloading or transporting activities ❑ Yes ✓hd No ❑ N/A
I. Materials or products stored outdoors (except final products intended for outside ❑ Yes,,. No ❑ N/A
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants) ___ ///
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes ty rvo ❑ N/A
and similar containers _
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ❑ N/A
the discharger ✓�
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes No ❑ N/A
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yesrvo ❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes No ❑ N/A
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 XNo ❑ 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 XNo ❑ 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
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
❑ Yes ❑ NoAl"N/A
❑ Yes ❑ Noo/A
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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 III Section 313 Superfund
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40
CFR §116?
e. Are release valves on all secondary containment structures locked?
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
generated per month) of hazardous waste?
C. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: I G f
How is material stored:
Where is material stored: /,,t Sr
How many disposal shipments per year:.
W
Name of transport / disposal vendor: V S nS
Vendor address: `I L(- 0 Je
Footnotes to Questions 14) c. & d.
❑ Yes ❑ No j /N/A
Ei Yes ❑ No Y1 N/A
❑ Yes ❑ No AV/A
❑ Yes ❑ No I/A
O Yes ❑ No_)j�N/A
❑ Yes �& ❑ NIA
)e Yes ❑ No ❑ N/A
❑ Yes TkAo ❑ N/A
'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.
SWU-NCGNE
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NCGNEOOOO 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 V'No ElN/A
b. Does your facility have coal piles on site?
❑ YeSXNo ❑ N/A
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes ❑ N/A
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ❑ Yes o ❑ N/A
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 ❑ NoN/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:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
SWU-NCGNE Page 5 of 7
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NCGNEOOOO 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))
1 understand that I am obligated to submit a no exposure certification form oncefive 5ears to the North Carolina
eve
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system (MS4) into
Which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing: �/ n /
Title: done �C p a he
of Applicant)
- 3
Dat�,gned)
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 your facility at any time inthefuture for complian P with the No Exposureegional
ice
Excl scion. also
inspect
North Carolina General Statute 143-215.6 B(i) provides that:
document filed or required to be maintained under this Article or a rule implementinAny person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
g 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 Managementl 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
no fee for a No
Exclusion.
SWU-NCGNE
Page 6 of 7
Last revised 5/5/2015

NCGNE0000 No Exposure Certification
Final
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 Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
The submission of this document does not gNote
uarantee the issuance of a No Exposure Exclusion.
For
contact the DEMLR Regional Office for your area.
DEMLR Re Tonal Office Contact Information:
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aci / /° curia/ �qo o i e viPkJ Eff �o 4-S7s-
or o� o�r�Js d✓e , 17 J
ISSc/e ^/�IvleF-
SWU-NCGNE
Page 7 of 7
Last revised 5/5/2015

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