NCGNE0338_COMPLETE FILE - HISTORICAL_20161021

NORTH CAROLINA
Department of Environmental Qua,

STORMWATER DIVISION CODING SHEET
.NCG PERMITS
DOC TYPE
L-2 HISTORICAL FILE
DOC DATE
YYYYMMDD

Energy, Vin
and Land Pesoi rcF,,S
h.Yw1�E3NMF, IJI :1. 0If C,I.II Y
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Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NO EXPOSURE CERT111CATION liar Exclusion
NCGNE0000
FOR AGENCY USE ONLY
Dare Ruceiced
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Mol)[h
Day
Cerlincate of co%vage
RECEIVED
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National Pollutant Discharge Elimination System application for exclusion from a 5btc� �t WARrui
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Exposure Certification and your NPDES permit is rescinded, your facility must continue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 (address to which all certification correspondence will be mailedl:
Name
Contact
Street Address
City
Telephone No.
Walmart Stores East, LP
Dave Matteson
508 SW 8`" Street
Bentonville
479-204-8717
State AR ZIP Code 72716-0505
Pax: NIA
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NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Walmart Distribution Center #6070
Facility Contact
Street Address
City
County
Telephone No.
Tish Pekala
200 Walmart Drive
Shelby
Cleveland
704-529-3628
3) Physical location information:
State NC ZIP Code 28150
Fax: NIA
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). Hwy 74 to Hwy 226 ( Polkville RD) to Southern Dr to_
Walmart Drive
(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 18 08 Longitude -81 33 06 (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
XERenewal of-existing.No•Exposure,Certification—Certification,No.�NCGNE03387 --�.
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes X No
If yes, what is the NPDES Permit Number?
J) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 4225
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Ship products to Walmart stores
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
X No
0 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 X No ❑ NIA
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 ❑ NIA
c. Materials or products from past industrial activity C Yes X No C] NIA
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes X No ❑ NIA
e. Materials or products during loadinglu n loading or transporting activities ❑ Yes X No 17 NIA
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes X No © NIA
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 © NIA
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes X No ❑ NIA
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes X No ❑ NIA
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes X No ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes X No ❑ NIA
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 ❑ NIA
(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 O Yes X No ❑ 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 X Yes ❑ No ❑ NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any X Yes ❑ No ❑ NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
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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 vaives 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 -.Damaged retail products
How is material stored: Drums
Where is material stored: Designated storage area
Now many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
Footnotes to Questions 14) c. & d.
ci Yes ❑ No X NIA
❑ Yes ❑ No X NIA
❑ Yes ❑ No X NIA
O Yes ❑ No X NIA
❑ Yes ❑ No X N/A
❑ Yes X No ❑ NIA
X Yes ❑ No ❑ NIA
❑ Yes X No ❑ NIA
*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.
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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 X No ❑ NIA
b. Does your facility have coal piles on site?
❑ Yes X No ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips,
❑ Yes X No ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
❑ Yes X No ❑ NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity.
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit?
❑ Yes ❑ No X NIA
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
C1AM 1_Nf'.(:NF f

NCGNEO000 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.
1 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: _David Matteson
Title: Senior Environmental Manager
(Signature of Applicant)
(Dal
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, representatlon, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article: or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
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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.
o 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 Re final Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 7 of 7
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Environmental Compliance
Dave Matteson, Sr. Environmental Manager
October 7, 2016
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
RE., Certificate of No Exposure Renewals and Application
To Whom It May Concern:
Save rnoney. Live better.
(301 N Walton Blvd
tbentcnviHo, AR 72716
Phone 479 AM.8747
Dave MattesonOwa3-rrwrt.com
Enclosed, please find the Certificate of No Exposure renewal forms, with original signature, being submitted on
behalf of Walmart Distribution Centers #6040, 6070, and 6091. Also, please find the CNE application for a new
Distribution Center facility #6858 in Mebane North Carolina.
Please feel free to contact me at 479/204-8717 with questions or concerns regarding any aspect of the
Certificate of No Exposure forms. Thank you.
Cordially,
Walmart Stores East, LP
Dave Matteson
Senior Environmental Manager

Building Relationships Since 1939
August 31, 2009
Sarah Ja�`n9
fe: /UC C-N6'o33S
Bob Sledge
North Carolina Department of Isnvironmental and Natural Resources
512 N. Salisbury Street, 96 Floor
Raleigh, NC 27601
RE: Wal-Mart Distribution Center #6070-01 Site Rehabilitation
Shelby, NC
Dear Mr. Sledge:.
Weis Builders, Inc.
2550 West Tyvola Rd. Suite 210
Charlotte, NC 28217
TEL [phone]
F x 704,424.1035
WEISBUILQFRS.COM
In accordance with project requirements, Weis Builders, Inc. will be conducting a pre -construction meeting on
September 9, 2009 beginning at 10:00 A11,1 This meeting will be conducted on site at the Wal-Mart Distribution
Center (#6070-01) located at 190 Wal-Mart Drive, Shelby, NC 28150.
Should you have any questions, please feel free to contact me at (70 4) 424-1034.
Sincerely,
Weis Br•;
llrjea
dk/hd
CC: Bile
S E P - 1 2009
DENR - WATER QUALITY
POINT SOURCE BRANCH
Weis, Builders, Inc. is an
Affirmative Action/Equal Opportuni ty Employer

DE,I�Q
p 17

AT
1
Michael F. Easley, Governor
9pG
William G. Ross Jr., Secretary
North Carolina Depart of Environment and Natural Resources
�O�a
00
Alan W, Klimek, n. E. Director
Division of water Quality
p
Coleen H. Sullins, Qcpoty Director
•' +- DloiiioriirfWatf7 Quality
._ ..o
AND KIATI' _
r IWRESUILLE _ ,� _•.,,
May 28, 2007 F f `'
.
Ms. Monica Mullins , MAY '7
Wal-Mart Stores East, LP
702 SW 81" Street
Bentonville, AR 72716-0710 j
I1ATER P';i>
Subject: No Exposure Certification NCGNE0338
Wal-Mart DC #6070
435 Polkville Road, Shelby, NC
Cleveland County
Dear Ms. Mullins:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on February 27, 2007. 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 (May 31, 2012). 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 Sarah Young at [phone], ext.
502, or at sarah. young@ncmail- net.
cc: Mooresville Regional Office
Stormwater Permitting Unit Files
Sincerely,
ORIGINAL SIGNED BY
KEN PICKLE
for Alan W. Klimek, P.E.
Central Files — wlattachments
N- C, Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
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Customer Service
1-877-623.6748

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0 W A TF Michael F. Easley, Governor
� �QG William G. Ross Jr., Secretary
North Carolina Department of Environment acid Natural Resources
vJ Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
May 28, 2007.
Ms. Monica Mullins
Wal-Mart Stores East, LP
702 SW 8'h Street
Bentonville, AR 72716-0710
Subject: No Exposure Certification NCGNE0338
Wal-Mart DC #6070
435 Polkville Road, Shelby, NC
Cleveland County
Dear Ms. Mullins:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on February 27, 2007. 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 (May 31, 2012). 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 Sarah Young at [phone], ext.
502, or at sara h. young @ncmai I -net.
Sincerely,
� � P,4 �I&
for Alan W. Klimek, P.E.
cc: Mooresville Regional Office Central Files — wlattachments
Stormwater Permitting Unit Files
N, C. Division or Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
MENR
Customer Service
1-877.623-6748

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m(dy C0338
United States Environmental Protection Agency Form Approved
OMB No. 2040 0211
NPDES A Washington, DC 20460
FORM
3510-11 `80 EPA 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 (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, 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: 1"IMI-I-I
ll li4il
3. Mailing Address: a. Street: 17,012, ISIYyI l8tl�2 I';t,rg
b. City: Aelnitlgrnyjil1I1Ief I I I I( 1 1 1 1 1
8- FacititylSlte Location Information
1. Facility Name' Y�I`
7
2.Phone: [phone]
71, 0, /,L 2, 8, i I
c. State: rRRJ d. Zip Code: 22tlt1 1- 101711 01
2. a. Street Address: I413151 tP,g1,Kyi,1,1,e, lRgc- I4 I I I I I I I II[
b. City: [Shte,1lbly, 11 1 1I-I 1 1 1 1 1 I 1 1 1 1 11 c.County; l ev
d. State: �L�J e. Zip Code: 2181115101 --1 1 1 1
3. Is the facility located on Indian Lands? Yes ❑ No
4. Is this a Federal facility? Yes ❑ No
5. a. Latitude: 13,5 1 o -LILLCO)� - b. Longitude: - 8 �1J
5. a. Was the facility or site previously covered under an NPDE.S storm water permit? Yes ❑ No �/❑
b. If yes, enter NPDES permit number:
7. SIC/Activity Codes: Primary: 412,2151 Secondary (if applicable):
8. Total size of site associated with industrial activity: 390 acres
9. a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure exclusion?
Yes 0 No 0
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 ❑ One to five acres ❑ More than five acres ❑
EPA Form 3510-11 (10-99) Page 1 of 4

C�-Njv

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
0
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 spills/leaks
3. Materials or products from past industrial activity
4. Material handling equipment (except adequately maintained vehicles)
S. Materials or products during load inglunloading or transporting activities
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
0
8. Materials or products handledlstored on roads or railways owned or maintained by the discharger
9. Waste material (except waste in covered, non -leaking containers [e.g.. dumpsters))
El
z
10. Application or disposal of process wastewater (unless otherwise permitted)
11. Particulate matter or visible deposits of residuals from roof stacks andlor vents not otherwise regulated
(i.e., under an air quality control permit) and evident in the storm water outflow
D. Certification Statement
1 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)).
I 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 NPOES 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 tine and imprisonment for knowing violations.
Print Name: MQy� �q4 IML;1 11 nq I I I I 1, -1 1 1 1 1 1 1 1 1 1 11 1 1
Print Title: 1 VIP, ���"I� IPrgt,�� Iqt iigi l� IggMp ,�aq�gq
Signature: [n'Lf7N/C U" f/tiL;.i✓CNLitil ✓
Date: 1 U 1 Z / 15'1 017I
EPA Form 3510-11 (10-99) 1 Page 2 of 4

Re: No Exposures-MRO
Subject: Re: No Exposures-MRO
From: Michael Parker <[e-mail]>
Date: Thu, 15 Mar 2007 08:57:18 -0400
To: Sarah Young <[e-mail]>
Jssue at your leisure.
Sarah Young wrote:
Here's the next round of no -exposures for your region. Please let me know within
30 days if 1 can issue these. Thanks, Sarah
Michael Parker - Michael.Parker@ncmai.l..net
Environmental Engineer II
North Carolina Dept. of Environment & Natural Resources
Division of Water Quality
610 East Center Avenue
Suite 301
Mooresville, NC 28115
Ph: [phone] Fax: [phone]
1 of 1 5/18/2007 12:25 PM

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