NCGNE0031_COMPLETE FILE - HISTORICAL_20180905

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
C1' HISTORICAL FILE
DOC DATE
❑ 05
YYYYMMDD

Environmental
Quality
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge C'limiriation System
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month Da
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit. S d 0r'C�O �
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
iv I C I S N I c I G N E O 0 3 1�1-
�tiG
2) Owner/Facility Information: ' Final correspondence will be mailed to the address noted below
Owner/Facility Name Reliance Electric Ind. Co (Dodge Rockwell Automation)
Facility Contact
Street Address
City
County
Telephone No.
Corbin Overstreet
510 Rockwell Dr.
Marion
McDowell
828 655-3963
state NC
E-mail Address
Fax: 828
ZIP Code 28752
[e-mail]
659-1629
3) Reason for rescission request (This is required information. Attach separate sheet if necessary).
❑ Facility closed or is closing on . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
Facility sold to
on . if the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
✓❑ Other: It appears that a duplicate no exposure exclusion was activated (NCGNE0465). We have since gone
through two ownership changes, and NCGNE0465 was appropriately self -certified annually, latest date of 8/3118.
1 was unaware of NCGNE0031 until the state inspector brought it to my attention yesterday, so it has not been certified annually,
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complete and accurate.
Signature �� �_OQZ97�
Corbin Overstreet
Print or type name of person signing above
Please return this completed rescission request form to
Revised 20183an 10
Date 8/31/2018
Environmental Coordinator
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
6. IOU
111110

O�OJ Wl�7FRQ�i Michael , ossiey, Governor
William G. Ross Jr., Secretary
North Carolina Department of 1,nvironment and Natural Resources
1— Alan W. Klimek, P. F. Director
Division of Water Quality
Q Coleen H. Sullins, Deputy Director
Division of Water Quality
April 20, 2005
T Scott Fullbright
Reliance Electric Ind. Co
6040 Ponders Ct
Greenville, SC 29602-0499
Subject: No Exposure Certification NCGNE0031
Dodge Rockwell Automation - 510 Rockwell Automatio
McDowell County
Dear Permittee:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on August 7, 2001. We apologize for the extended period it
has taken us to get back to you on this request and we appreciate your patience as we have worked through
this process. Based on your submittal and signed certification of no exposure at the above referenced facility
the Division is granting your certification as provided for under 40 CFR 126.22(g) which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of your no exposure certification, you are obligated to maintain no
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no -
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no -exposure exclusion expires in five years (April 30, 2010). At that time you must re -certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your certification of no exposure 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 Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
for Alan W. Klimek, P.E.
cc: Asheville Regional Office Central Files -- wlattachments
Stormwater Permitting Unit Files
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
L;w
A_K
1CDNR E
Customer Service
1-877-623-6748

United States Environmental Protection Agency v Form Approved
g y OMB No. 2040.0211
NPDES Washington, DC 20460
FORM 14AY
3510-11 NO EXPOSURE CERTIFICATION for Exclusion from
NPDES Storm Water Permitting
Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit authorization for its storm water
discharges associated with industrial activity in the State identified in Section B under EPA's Storm Water Multi -Sector General Permit due to the existence
of a condition of no exposure.
A condition of no exposure exists at an industrial facility when all industrial materials and activities are protected by a storm resistant shelter to prevent
exposure to rain, snow, snowmelt, and/or runoff. 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 without operational taps or valves;
- adequately maintained vehicles used in material handling; and
- final products, other than products that would be mobilized in storm water discharges (a.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, the entity in Section A is certifying that a condition of no exposure exists at its facility or site,
and is obligated to comply with the terms and conditions of 40 CFR 122.26(g).
ALL INFORMATION MUST BE PROVIDED ON THIS FORM.
Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4.
A. Facility Operator Information
1. Name: IR 161 1-1 TI Al kl[I CI 971 IELLI E 6I?I14rI Cl I-TIA/yt I C i C11- I i .1 1 1 2. Phone: G'V I Z- Iq 171,41810 O
3. Mailing Address: a. Street { G I U1 Iy l i i� i 41 I E JtZJ SI i CJp I VI� 11 11 11 1 1 11 1 1 1 _I 1
b. City. 16 121 E EINI VI _,Fj t-iL1 CI 1 I I i I I, , I I I I I 1 c. State: KC d. Zip Code: I21l 16 101 LI - IdJ LI! q,l q II
B. Facility/Site Location Information
1. Facility Name: ID10101614:5I< Ir�01GIKIw,EILILI I I I I I
2. a. Street Address: '1'5 I r 1 OI 1 R10161 KI� � f-I LI I D I) I I VI E I I I I I I I I I I I I I
b. City: I► 41 1 01IV1 I I I I i I I I I I I I I i _� I I c. County: Im1610IA
d. State: LL-q e. Zip Code:
I2-1 lb17 1�
1 Zl - I I l I I
I
J
3. Is the facility located on Indian Lands?
Yes
NoFr_
CD
a Kr.
4. Is this a Federal facility?
Yes
No �2—
j
#
om
W
5. a. Latitude: W W I ► I ' I
b. Longitude:yA
^
6. a. Was the facility or site previously covered under an
NPDES storm water permit? Yes No
b. If yes, enter NPDES permit number:
<
ics o
°
7. SIC/Activity Codes: Primary: P15
j Secondary (if applicable):
8. Total size of site associated with industrial activity: -/ .Z , I J acres
9. a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure exclusion? Yes ❑ No 2
b. If yes, please indicate approximately how much area was paved or roofed over. Completing this question does not disqualify you for the no exposure
exclusion. However, your permitting authority may use this information in considering whether storm water discharges from your site are likely to have
an adverse impact on water quality, in which case you could be required to obtain permit coverage.
Less than one acre 0 One to five acres ❑ More than five acres
EPA Form 3510-11 (10-99) Page 1 of 4

NPDES A Form Approved
FORM -,EPA NO EXPOSURE CERTIFICATION for Exclusion from OMB No. 2040-0211
3510-11 NPDES Storm Water Permitting
C. Exposure Checklist
Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future?
(Please check either `Yes" or "No" in the appropriate box.) If you answer "Yes" to any of these questions
(1) through (11), you are not eligible for the no exposure exclusion.
Yes
No
1. Using, storing or cleaning industrial machinery or equipment, and areas where residuals from using, storing
or cleaning industrial machinery or equipment remain and are exposed to storm water
2. Materials or residuals on the ground or in storm water inlets from spillsAeaks
3. Materials or products from past industrial activity
4. Material handling equipment (except adequately maintained vehicles)
5. Materials or products during loading/unloading or transporting activities
1:1
lie
6. Materials or products stored outdoors (except final products intended for outside use [e.g., new cars] where
exposure to storm water does not result in the discharge of pollutants)
7. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers
8. Materials or products handled/stored on roads or railways owned or maintained by the discharger
9. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
10. Application or disposal of process wastewater (unless otherwise permitted)
11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated
(i.e., under an air quality control permit) and evident in the storm water outflow
D. Certification Statement
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 storm water permitting.
I certify under penalty of law that there are no discharges of storm water 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)).
understand that I am obligated to submit a no exposure certification form once every five years to the NPDES permitting authority 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 NPDES permitting authority, 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. I understand that I must obtain coverage under an NPDES permit prior
to any point source discharge of storm water 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.
Print Name: [I I_ ISIG101-11-0 _IFI U I L I l.161 al 1 160411I 1 1 1 1 1 _L_ 11 _I _ 1 I] 1 I I
Print Title: 14
Signature:
Date: 10 X 101 1 loll I
AINIAI&iC—
EPA Form 3510.11 (10-99) Page 2 of 4