NCGNE1322_COMPLETE FILE - HISTORICAL_20190521

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE 13�
DOC TYPE
01HISTORICAL FILE
DOC DATE
❑ ()19 05 3 1
YYYYMMDD

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Interim Director
NORTH CAROLINA
Environmental Quality
May 21, 2019
Martin -Brower Company, LLC
Attni Clif Anderson
1400 North Greenfield Parkway
Garner, NC 27529
Subject: No Exposure Certification NCGNE1322
Martin -Brower Distribution Center
Wake County
Mr. Anderson:
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
February 26, 2019, and the additional upgrades completed at our request, 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.
If you have any questions or need further information, please contact Thad Valentine at [phone].
Sincerely,
forS. Daniel Smith -Interim Director
Enclosure
cc: Stormwater Permitting Program, No Exposure Files (w/o enclosure)
— �- Not Carolina Department or Environmental Quality I Division of Energy, Mineral and Land Resources
•rJj Raleigh Regional Office 11628M1tail Service Center 13800 Barrett Drive I Raleigh, North Carolina 27609
NGI^CPNO�rvP
o•W jai m.iw�.�nm W.n� 919.791.4200

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Interim Director
Martin -Brower Company, LLC
Attn: Clif Anderson
1400 North Greenfield Parkway
Garner, NC 27529
NORTH CAROLINA
Environmental Quality
March 6, 2019
Subject: No Exposure Certification NCG
Martin -Brower Distribution Cen
Wake County
Mr. Anderson:
S
C
�
- MW g
40
The Division has reviewed your submittal of the No Exposure l.ertllll;alluiI U1 L.xclusion 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
February 26, 2019, the Division is granting your conditional exclusion from permitting as provided for
under 40 CFR 122.26(g), which is incorporated by reference in North Carolina regulations.
Please note that by our acceptance of your No Exposure Certification, you are obligated to maintain no
exposure conditions at your'facility. If conditions change such that your facility can no longer qualify for
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.
If you have any questions orneed further information, please contact Thad Valentine at [phone].
for S. Daniel Smith -Interim Director
Enclosure
cc: RRO — Land Quality Section, Stormwater Files (w/o enclosure)
Stormwater Permitting Program, No Exposure Files (w/o enclosure)
North Carolina Department of Environmental Quality I Division of Energy. Mineral and Land Resources
nr.an,
E��� Raleigh Regional Office 11628 Mail Service Center 13800 Barrett Drive I Raleigh, North Carolina27609
919791.4200

McCoy, Suzanne
Subject: RRO owes Itr re NCGNE1322 Martin -Brower
Start: Mon 3/4/2019 9:00 AM
End: Mon 3/4/2019 9:30 AM
Recurrence: (none)
Organizer: McCoy, Suzanne

a
NC&t10�22
VAS.. Dicisiun ol't:ncr�,t, Mineral and Lund Rcsour cca
Land Qualm Section
��®��� National Pollutant Disch a r� F lin-,m rtion av�tam TIT111NIF
NO EXPOSURE CERTIF iC A l IOV for Excl_,siou
_NCGNE0000
National Pollutant Discharge Elimination Systern appli- ;" Jnr exclusion from a Stormwater Permit based
on NO EXPOSURE:
Submission of this No Exposure Certification consbt ' t les not require a
permit for stormwater discharges associated with int ; �' �. Carolina because
it qualifies fora no exposure exclusion. A condition, Ity means all
industrial materials and activities are protected by a - xceptions) to
prevent exposure to rain, sno:v, snowmelt, and/or rr
For permitted facilities in North Carolina, 0____ lication for No
Exposure Certification before this exclusion is effective. Cilim"yo�,-,:, -:_sued 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, anr+ containers
that are tightly sealed, provided those containers are not deteriorated an "means
l banded or utherivise secured and with locket] or non-operat%^ — l \ itained
vehicles used in material handling: and final products, other `�'1QYf_l e) `--' ed in
.i stormwater discharges (e.y., rock salt). l
A No Exposure Certification must be provided for each 7acititt 1 Irsion. In
addition. the exclusion fran NPDES permitting is available on v (I ` dividual
outfails, If any industrial activities or materials arc, or will be, /� 's not
eligible for the no exposure exclusion. By signing and submitti. (� Gig C�,L�V" V i in, you
certify that a condition of no exposure exists at this facility ors, ,.., with the
woos and conditions of 40 CFR 122.26(g).
If approved, your conditional no -exposure exclusion must be,self re -certified at least annual.
Please see utformatlnn hr (:webll�ln)doL c,inwater
For, questions, please contact the DEMLR Regional Office for your area. (See page 6)
1) flailing address of
Name
Crntact
St. ee[ Address
Cif?
Telephone No.
SVdI.-NCGNG
(Please print or type)
oaee i of i
.. ..', L�•:iieviSEtl���ri DY. i��i..

NCGNE0000 No Exposure Certification
2) Location of facility
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 pumpers, and
distance and direction from a roadway intersection). -GYP Y )� rYl�.{,�J�)_C7�'1C?
(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 fWNo
5) Is this a Federal facility? ❑ Yes al to
6) Latitude'3`�• �n�� �%� Longitude' I C• 5L' I cam-) j2; J, (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 n
m 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 lb-NS
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: q a ,4 1
10) Provide a brief description of•the types of
and products produced at this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
5X0
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SWU-NCGNE Last revised 5/5/2015

m
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 ID Yes ❑ No D NIA
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored
i
R�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
Il
❑ No ❑ NIA
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40
Q-lames
❑ No ❑ NIA
CFR §116?
e. Are release valves on all secondary containment structures locked?
O'Yes
❑ No ❑ NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes [1,NZ O N/A
i
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste CO -Yes ❑ No ❑ N/A
generated per month) of hazardous waste?
C. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes L . o ❑ N/A
generated per month) of hazardous waste?
If you answered yes to
Type(s) of waste:
How is material st(
Where is material
How many dispose
Name of transport
Vendor address:
Footnotes to Questions 14) c. & d.
D (00U )
'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-NCGNE Last revised 5I5l2015

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 aN6 ❑ 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 spillsf eaks ❑ Yes ©'No ❑ N/A
c. Materials or products from past industrial activity
❑ Yes
G-Ko
C N/A
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
1 4
O N/A
—e:Materialsor-products during loadinglunloadingortransporting activities
❑ Yes-
M-ivo_❑WA_,__
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes
trNo
❑ 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
[9 No
❑ NIA
and similar containers
h. Materials of products handled/stored on roads or railways owned or maintained by
❑ Yes Erflo ❑ N/A
the discharger
.
I. Waste material (except waste in covered, non -leaking containers (e.g., dumpsters])
❑ Yes o-No ❑ N/A
j. Application or disposal of process wastewater (unless otherwise permitted)
❑ Yes C-No ❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not
❑ Yes -LAo ❑ N/A
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
1. Empty containers that previously contained materials that are not properly stored
❑ Yes O'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 t-No O NiA
stored outside, has the facility had any releases in the past three (3) years?
13) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or Fk4es ❑ No ❑ N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any k-Yes 0 No ❑ N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SN1U-NCGNE Last revised 51512015

NCGNE000O No Exposure Certification
17) Certification:
I certify under ponaItj of In, that I nano read and understand na atigioiI fy r_q:TfaiTlahis for claiming a condition cf'nc
exaosu're' and abtalrar'a ail e:r clUs 011 ircm NPDES stcrlTlM1'Jt I pemillttin--
I carir/ under 2enafy of',av: that them -are no discharnas of stormv,ster rorimminateC by ,resure to Industrial ac`-ivities
or materials from the nda.strial facility or si;a ider;i,led in this document (,except as allowed under4C C=R 122.26(g)(2)I
I .,nd,ers:.ne tint I an otllgaoSd to stbmlt a r crr- 00I:a_ep .i_ iv i Ve.3rs to the PWdt Carolina
Dirsion cf': dater Oualq'ard if raques:ec. to he ofer- t , ti'a local municipal Se a a,_ stcrrn sewer sys:em (IviSs) intc
which the facility discharges_ !where applioacle) I erdrnrsiarc :'.la: I ;lust allow :ha Norit Carolina Division of Water
Quality. or MSa operator where the dischar_e s into the !oral FuS to perorm irspec,ions to confirm the cond➢ion of no
exposuIe and fo make such Inspecilon Iapoits oubIlcly availao e open Ihgl.lost.
In the Event :hat the site no longer tltrallfles fur a Pic :Xposure ExclJsion, I understanr hat I ntUr obt',In coverage Under
an NPDES permit prior to any point source dist:herge, of stcrmwat-i frcn-, tfhe frizu r/ kddinonally, I centy under penalty of
law that this JOCUIT en: and all a`aehaents were, praparao under my dirtI or super^vision in accordance :Vl:M a system
designed to assura ins qualified personnel oroperly-gaihered and e'ia:uatec tre inforrnat„on su'cmgtad. Based on my
mauiry of the pu s r or pe'rsoi s wro mar ., ,h_ _/s'1- _ r .r o Is Iis .Iracty '-sponsible r oame,;rlo Ina
infornatlon, :ho icfrnmItI submitted is to'-ne -as: of my knolvletle= ano- belief true accurate and comol=_:e. I all awar_-
:I et lino a are slgnl an: penal: es for se.blr It➢ g =Ise for.,;ion, it Ding :he pirssicilittv of fine arid Imerls0mne If for'
V-nnm:no virriour ns.
I certify tnat I an; tam, liar rdth ine in brnauon ccntairred in tFds e.cpkc3ucn and inat to the best Y my knon edge and'oelief
E'Jc0 Infnrmatlon is true, cOnloleta. and accurate. ,
Printed Name of Person Sieniuy
Tifle:................._.____.___.._--_._...._... ....
A=plicect)
Please note This application for the No Exposure Exclusion is subject to approval by the l
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
l 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:
.^y [er-,ar v i„ F,,,,. i,tvl, r:?kCa ail, 'else ° +'rr L., rect3,erriwin, or ^ rtli „etior in an 'Icadce. acur.:, report. plan, or other
7orumenl flea., Or re. i lad S_ I.l,ir ldl.?C I Iris `nic' or 0 r!e implEr't,^bny lhis Arkore or'uho P.I. r inrlly makes a f]ISo
shl? •t?rl or a n'FI 'Ial `n tlla rjen aknvi ni "cec ,ding nl -on I L' Tc. utter Nhl- A4ml ' +no fasih_, ;ao•^2r5 \net nr'vnc,ingly
: nil L'd+CR e ,,Y re Cn(l:iNl or r➢ON101110 d,.ice or Iva• .l Ili 1I",! InJ -r MIS Artb]le Or r es C:.h?
:Jw ralxcn•a -. 'iag3rne ill 'Itn niC` ilnpl IL Jrb) :ll'S . - 19 atoll Le tjoil'y rlt a GI 3 IOIsoclneanrr Mire . may Inc. Ud0 a fine
not v; eaCC c: ;en thousanu doilHrs 61 O,-,n0',
........ _---- _.......... ___-_ ......
There is currently no fee for a No Exposure Exclusion
Pace 6Ci7
S9v'li-iF:G';l_ V I,os, revise;, N5,12015

NCGNE0000 No Exposure Certification
1 6) 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 Id No ❑ N/A
b. Does your facility have coal piles on site? ❑ Yes gYNo ❑ N/A
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes Z:l o ❑ N/A
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:
I. 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:
Page 5 of 7
SP/U-NCGNE
❑ Yes 0 o ❑ N/A
[]Yes ;td'No ❑ N/A
Last revised 5152015
M

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, Mineratand 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 ........
[phone]
Washington Office ...(252)�946-6481
Wilmington Office ...
(910)1796-7215
Winston-Salem ......
(336)1771-5000
Central Office .........(919)
807-6300
Page 7 of 7
SWU-NCGNE Last revised 5/5/2015

CANOPY
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THIS IS NOT AN INVOICE q '1114 q
Document No. 1 -±. li .l
FOR EMERGENCY RESPONSE: 1-800-662-5364
Call: CHEMTREC for Spill, Leak, Accident ArjOBLE
5617 CLYDE RHYNE DR.
1-800-424-9300 n I I c c n `x SANFORD, NC 27330
DATE 1 i ; <. f SERVICE RECEIPT CUST ID# GL6110,
GENERATOR BILLIKIr r% rd—r j r V 14R 1145
CUSTOMER
r,ULUEN'ilAT€FOOL]
ADDRESS"
1400 N. Gi1,EFNF?FLD ?I(0
Clry
GARNNER
STATE,1C
z<7529
CONTACT
MARK 33P-362-4315
PHONE
S;IA-LJJ-/�OLl
START TI ME:
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STOP TIME:
COUNTY
❑ PARTS WASHER SERVICE F-1 FILTER BIN SERVIrF
CUSTOMERjOLU _N J IAI L RULIU
ADDRESS
141JIJNUK1!I!NrJ-rLLYFNVVY
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MATERIAL -y"r �t9 0�OFI E# C'Li n- t�rlCf•
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NOBLE OIL EPA ID#: NCD9861-72476 Service Charge
Generator Certification and Indemnification: TOTAL DUE
$
���� yul �eiciuw of me marchers faonmlea serve, certify that these materials arc accurately and fully characterized, described, classified, packaged, marked and labeled and are in the proper condition
for transport in compliance with applicable State, U.S. EPA and U.S. Department of Transportation (DOT) regulations. I, the generator, also hereby certify, warrant and represent to Noble Oil
Services, Inc., with the exception of properly identified and manifested Toxic Substance and Control Act (TSCA) and Resource Conservation and Recovery Act (RCRA) materials, that (1) the material,
described above, contains no quantifiable concentration of polychlorinated biphenyls (PCBs) not any hazardous waste as defined by RCRA; and (2) accurate laboratory testing for this shipment
has been provided to Noble Oil Services, Inc. to verify that this shipment contains no quantifiable concentration of PCBs nor any waste as defined by RCRA. In the event that this certification is
inaccurate, I, the generator, will indemnify Noble Oil Services, Inc. and promptly pay for costs directly or indirectly resulting from this inaccurate certification including, but not limited to, contaminated
(including co -mingled) product or inventory, proper storage, shipment and disposal, sampling, testing, decontamination, attorneys fees, expert witness fees, penalties, fines and court costs.
Oil Screen Test: ❑ Positive ❑ Negative ❑ N/A ®Confirmation Test: Type
Authorized Customer Agent (Sign) X ; 4
Noble,gil Services Agent (Sign) X
Comments /.. /
L 1(At'tlirirY f_pi_I f J�
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!A °T� Division of Energy, Mineral and Land Resources
��J Land Quality Section
NCDENRNational Pollutant Discharge Elimination System
NomfiRw Rwnvin o, NO EXPOSURE CERTIFICATION for Exclusion
Lrnmwv[rrt wp Nuunr �p
NCGNE0000
rOR AGrNCY USE. ONLY
Dwe Received
Y.
MonN
Da
Cmifiu
.fCoven
—
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).
If approved, your conditional no -exposure exclusion must be self re -certified at least annually.
Please see information here: http://po tal.ncdenr.org/webtlr/nodes-stormwater
For questions, please contact the DEMLR Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of
Name
Contact
Street Address
City
Telephone No.
Page 1 of 7
SWU-NCGNE
RECEIVED
D,
DEC 04 20.13
DENR-LAND QUALITY
ST0T&V'kTkRFFi-n i3TING

NCGNE0000 No Exposure Certification
2) Location of facility
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 rumgers, and
distance and direction from a roadway intersection). 1 1!l a C�Q (ZQ
(A copy of a map with the facility clearly located on it should be includ d with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes i 0
5) Is this a Federal facility? ❑ Yes Flo
6) Latitude�b•tCq Ce, Longitude-5�5)83�,,(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
12' Existing Date operation began 0
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes M-Ntr
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: q_ a 4 Li
10) Provide a brief description ofthe
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
O
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
at this facility:
Page 2 of 7
SWU-NCGNE Last revised 5/5/2015

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
a4s
❑ No ❑ N/A
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
�
b. Is secondary containment provided for above ground storage containers stored
q/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
11kYes
❑ No ❑ N/A
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40
q lames
❑ No ❑ N/A
CFR §116?
e. Are release valves on all secondary containment structures locked?
11�'Yes
❑ No ❑ N/A
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yews QAo ❑ N/A
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste QIYes ❑ No ❑ N/A
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes P6' ❑ N/A
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the followin in rmation: IIn
Type(s) of waste: (A c I'
How is material stored: —' F" �
Where is material stored: li 000 0 PC%QIYI '�
How many disposal shipments per Aar: Ul ) ) �
Name of transport / disposal vendor: _ L S� _OS Il p r� / �
Vendor address: Q5 2C�h'�jmy YV I _ M) �rO t S'1 2Ai "! , cX,q-IC�IJ�
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-NCGNE Last revised 5/5/2015

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 m-N6 CI 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 �lo ❑ N/A
c. Materials or products from past industrial activity
D Yes
04o
❑ N/A
d. Material handling equipment (except adequately maintained vehicles)
0 Yes
Q-tdo
❑ N/A
e. Materials or products during loading/unloading or transporting activities
❑ Yes
®-No
❑ N/A
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes
11 o
❑ 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
1�
❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes 8- o ❑ N/A
the discharger
I. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes
P-ttgo
❑ N/A
j. Application or disposal of process wastewater (unless otherwise permitted)
❑ Yes
IT'No
❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes "o ❑ 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 Ao ❑ 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 tAo O 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 Woes ❑ No ❑ N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any &<es ❑ No ❑ N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NCGNE Last revised 5/52015

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 property 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: ���' / Z"
Title'
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 use 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.
RFrFNF.D
f?rC 04 20113
DENR-LAND QUALITY
Page 6 of 7 STORMWATER PERMITi ING
SWU-NCGNE Last revised 5/5/2015

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 "o ❑ N/A
b. Does your facility have coal piles on site? ❑ Yes M4o ❑ N/A
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes 0 l�o ❑ N/A
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ❑ Yes mNo ❑ 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 11;140❑ 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: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5 of 7
SWU-NCGNE Last revised 5/5/2015

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 .........
[phone]
Page 7 of 7
SWU-NCGNE Last revised 5/5/2015

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