NCGNE1016_COMPLETE FILE - HISTORICAL_20140630

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NORTH CAROLINA ...�
Department of Environmental Qual

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V Cc, IV .E f pLoo
DOC TYPE
ef HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ Q() /� v b 3 D
YYYYMMDD

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NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
Land Quality Section Pat McCrory, Governor
Tracy E. Davis, PE, CPM John E. Skvarla, Ili, Secretary
Director
June 30, 2014
Mr. David Felix
Axon LLC
3080 Business Park Drive
Raleigh, North Carolina 27610
Subject: Approval of No -Exposure Certification
Axon LLC
NCGNE1016
Wake County
Dear Mr. Felix:
The Division of Energy, Mineral and Land Resources (DEMLR) has reviewed your submittal of the No -
Exposure Certification for Exclusion from the NPDES Stormwater Permitting form and made a site visit to
assess the potential for stormwater pollution. Based on our observations and your submittal and signed
certification of no exposure at the above referenced facility, the Division is granting your conditional
exclusion from permitting 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 (subject to civil penalties of up to $25,000 per day). Your conditional no -exposure exclusion
does not expire. However, you must self re -certify annually, or obtain NPDES permit coverage for any
stormwater discharges from your facility. Please retain the completed re -certification forms to have
them available during future inspections by DEMLR.
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Drive, Raleigh, North Carolina 27609
Phone: 919-791 A2001 FAX: [phone]
Internet: http:porta1.n0denr.orglwebAr1
An Equal Opportunity 1 Affirmative Action Employer
o e
NCarolina
Naturally

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 Dave Parnell at [phone] or at
david.parnell [e-mail],
Sincerely,
L. Holley, Jr., Plt, CPESC
onal Engineer
igh Regional Office
cc: Stormwater Permitting Program Files - with attachment
Raleigh Regional Office DEMLR No Exposure Files - with attachment
1628 Mail Service Center, Raleigh, North Carolina 27699.1628
Location: 3800 Barrett Drive, Ralegh, North Carolina 27609 i�TOne N
Phone: [phone]FAX: 919-571A718 bCarolina
Internet: http:poRal.nodenr,orglwebllr! Naturally An Equal Opportunity 1 AMrrnatya Action Employer

Permit: NCGNE1016
SOC:
County: Wake
Region: Raleigh
Compliance Inspection Report
Effective: Expiration: Owner: Axon LLC
Effective: Expiration: Facility: Axon LLC
3080 Business Park Dr
Contact Person: David Felix Title:
Directions to Facility:
Wake County Industrial Park located off 1440 & Poole Rd
System Classifications:
Primary ORC: Certification:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Raleigh NC 27610
Phone: [phone]
Phone:
Inspection Date: 06/2012014 Entry Time; 10:30AM Exit Time: 11:30AM
Primary Inspector: David R Parnell Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: Compliant ❑ Not Compliant
Question Areas:
M Miscellaneous Questions Mlsc
(See attachment summary)
page: 1

Permit; NCGNE1016 Owner - Fed ltty:Axon LLC
Inspection Oats: 06120/2014 Inspection - ype : Compiienoe Evaluation Reason for Vistt Routine
Inspection Summary:
Page: 2

parmit NCGNE1016
Impaction Gate. 0612012014
Misc
Is the facility compliant?
Owner - facipty; Afton LLC
Inspection Type : Compliance Evaluation
Reason for VIsIL• Routine
Yea Na NA NE
M ❑ ❑ ❑
Comment: No EXDOsure: The certification is approved for this facility. The discharge onto the pavement of
boiler blowdown water was an issue that had to be addressed prior to approval. David Felix
states that there are no additives such,! as salt and that the water used in the boiler is strictly City
water. Pallets will be kept under cover and dumpsters will have tight fitting covers as part of their
construction.
Page: 3

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�...
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
Land Quality Section Pat McCrory, Govemor
Tracy E. Davis, PE, CPM John E. Skvada, III, Secretary
Director
June 30, 2014
Mr. David Felix
Axon LLC
3080 Business Park Drive
Raleigh, North Carolina 27610
Subject. Approval of No -Exposure Certification
Axon LLC
NCGNE1016
Wake County
Dear Mr. Felix:
The Division of Energy, Mineral and Land Resources (DEMLR) has reviewed your submittal of the No -
Exposure Certification for Exclusion from the NPDES Stormwater Permitting form and made a site visit to
assess the potential for stormwater pollution. Based on our observations and your submittal and signed
certification of no exposure at the above referenced facility, the Division is'granting your conditional
exclusion from permitting 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 (subject to civil penalties of up to $25,000 per day). Your conditional no -exposure exclusion
does not expire. However, you must self re -certify annually, or obtain NPDES permit coverage for any
stormwater discharges from your facility. Please retain the completed re -certification forms to have
them available during future inspections by DEMLR.
1628 Mail Service Center, Ralegh, North Carolina 27699-1628
Location: 3800 Barrett Drive, Ralegh, North Carolina 27609 ��TTOne
Phone; 919-79IA200 1 FAX: 91M71A718 NCarolina
Intemet; http:portM.ncdenr.org1webllr1
An Equal Opportunity 1 Affirmatve Action Employer aturallry

19
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 Dave Parnell at [phone] or at
[e-mail].
Sincerely,
f L. Holley, Jr., PV, CPESC
rional Engineer
eigh Regional Office
cc: Stormwater Permitting Program Files - with attachment
Raleigh Regional Office DEMLR No Exposure Files - with attachment
1628 Mail Service Center, Ralegh, North Carolina 27699-1628
Location: 3800 Barrett Drive, Ralagh, North Carolina 27609
Phone: [phone] FAX: [phone]
4ntemet http:portal.nodenr.orgMeb/Ir/
An Equal Opporwnity 1 Affimma6ve Action Employer
One
No Carolina
aturally

i
Compliance Inspection Report
Permit: NCGNE"1016 Effective: Expiration:
soc- Effective: Expiration:
County: Wake
Region: Raleigh
Contact Person: David Felix Titlo:
Directions to Facility:
Wake County Industrial Park located off 1440 & Poole Rd
System Classifications:
Primary ORC: Certification:
Secondary ORC(s):
On -Site Roprosentative(s):
Related Permits:
Owner: Axon LLC
Facility: Axon LLC
3080 Business Park Dr
Raleigh NC 27610
Phone: [phone]
Phone:
Inspactlon Date: D612012014 Entry Time: 10:30AM Exit Time: 11:30AM
Primary Inspector: David R Parnell Phone: [phone]
Secondary Inspector(s):
Reason for lnspection, Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Faculty Status: , Compliant ❑ Not Compliant
Question Areas:
M Miscellaneous Questions Misc
(See attachment summary)
Page: 1

permit: NCGNE1o16 Owner -Facility: AxonLLG
Inspection Date: 06/2012014 Inspection Typo: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Page: 2

Mlsc
Permit: NCGNE1016 Owner • Facility: Axon LLC
Inspection Date: 06/20/2014 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Yes No NA NE
Is the facility compliant? M ❑ ❑ ❑
Comment: No Exposure: The certification is approved for this facility. The discharge onto the pavement of
boiler blowdown water was an issue that had to be addressed prior to approval. David Felix
states that there are no additives such as salt and that the water used in the boiler is strictly city
water. Pallets will be kept under cover and dumpsters will have tight fitting covers as part of their
construction.
Page: 3

A
"Ir
FWA A AdJPA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
Land Quality Section Pat McCrory, Govemor
Tracy E. Davis, PE, CPM John E. Skvarla, III, Secretary
Director
June 30, 2014
Mr. David Felix
Axon LLC
3080 Business Park Drive
Raleigh, North Carolina 27610
Subject: Approval of No -Exposure Certification
Axon LLC
NCGNE1016
Wake County
Dear Mr, Felix;
The Division of Energy, Mineral and Land Resources (DEMLR) has reviewed your submittal of the No -
Exposure Certification for Exclusion from the N PDES Stormwater Permitting form and made a site visit to
assess the potential for stormwater pollution. Eased on our observations and your submittal and signed
certification of no exposure at the above referenced facility, the Division is granting your conditional
exclusion from permitting 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 (subject to civil penalties of up to $25,000 per day). Your conditional no -exposure exclusion
does not expire. However, you must self re -certify annually, or obtain NPDES permit coverage for any
stormwater discharges from your facility. Please retain the completed re -certification forms to have
them available during future inspections by DEMLR.
1628 Mail Service Center, Ralegh, North Carolina 27699-1628
Location, 3800 Barrett Drive, Raleigh, North Carolina 27609
Phone: [phone] FAX: 91 M71.4718
Intemat: http:porW.ncdanr.org1web1lrl
An Equal Opportunity 4 Affirmative Action Employer
oe NCarolina
Naturally

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 Dave Parnell at [phone] or at
[e-mail].
Sincerely,
L. Holley, Jr., Ply, CPESC
onal Engineer
igh Regional Office
cc: Stormwater Permitting Program Files - with attachment
Raleigh Regional Office DEMLR No Exposure Files - with attachment
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Drive, Raleigh, North Carolina 27609
Phone: [phone] FAX:[phone]
Internet http:portal. ncdenr.orglweWr/
An Equal Oppondnity 1 Affirmative Action Employer
NorthCarolina
Naturally

r
Permit: NCGNE1016
SOC:
County: Waite
Region: Raleigh
Compliance Inspection Report
Effective: Expiration: Owner: Axon LLC
Effective: Expiration: Facility: Axon LLC
3080 Business Park Dr
Contact Person: David Felix Title:
Directions to Facility:
Wake County Industrial Park located off 440 & Poole Rd
System Classifications:
Primary ORC: Certification:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Raleigh NC 27610
Phone: [phone]
Phone:
Inspection Date: 06/20I2014 Entry Time: 10:30AM Exit Time: 11:30AM
Primary Inspector: David R Parnell Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliances Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: Compliant F1 Not Compliant
Question Areas:
E Miscellaneous Questions Misc
(See attachment summary)
Page: 1

permit: NCGNE1016 Owner - Facility: Axon LLC
Inspection Data: 06/20/2014 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Page; 2

FA
permit: NCGNE1016 Owner - Faci ty:Axon LLC
Inspection Date: 06/20/2014 Inspection Type : Compliance Evaluation Reason for Visit Routine
Misc Yes No NA NE
Is the facility compliant? e ❑ ❑ ❑
Comment: No Exposure: The certification is approved for this facility. The discharge onto the pavement of
boiler blowdown water was an issue that had to be addressed prior to approval. David Felix
states that there are no additives such as salt and that the water used in the boiler is Strictly city
water. Pallets will be kept under cover and dumpsters will have tight, fitting covers as part of their
construction.
Page: 3

i2l2 v
�.-Parnal
A s +1
Division of Water Quality / Surface Water Protection
NCDENRNational Pollutant Discharge Elimination System
c..m.wi. tX.H.rw UI NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000
NO EXPOSURE CERTIFICATION
FOR AGENCY USH ONLY
Date Received
Year
Mon
Da
Cenificate of Coverage
MCIGINIE
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 storm water 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, DWO 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 th,
rar7.—
terms and conditions of 40 CFR 122.26(g).
You are required to self re -certify your No Exposure Exclusion annually.
For questions, please contact the DINO Regional Office for your area. (See page 6) Ov
(Please print or type) ,
1) Mailing address of ow er/ope`rator {address to which all certification correspondence will be mail
Name
Contact
Street Address
City
Telephone No.
Email
SWU-NE-12Aug2010
Page 1 of 7
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NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name
Facility Contact
Facility Street AddreC
City
County
Telephone No.
Email
3) Physical location information:
Please provide a narrative description of how to get to the facilit (use street names, state roa numbers, and
distance and directi n fro a r dway inter ction). VAka h SVnA-L_ 1fT< i
(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 �Oo
5) Is this a Fedgral facility?
� i �❑ Yes 1% No a�j,1 ,�. "] i i
8) Latitude3S'"fID+�I.�y✓ _ Longitude ! � ` � !� (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
/v Existing Date operation began
4--
0 Renewal of existing No Exposure Certification Certification No.: NC NE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes 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: (W
10) Provide a brief descripti�j�1 of t e types of industrial activities and p,Coducts pro uced at this facility:
;%A A.. f� C.N . -n lnai 1�L1! i,Al . _ i/_ AAA / i L _ lLt)�, � , I[ln. l trnM 1 k69.1., i n(- O'c
11) Does this facility have any Non -Discharge permits (ex: recycle permits)? 66117//4/_m
�_No
Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SW U-NE-12Aug2010

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 I$No
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes *No
c. Materials or products from past industrial activity ❑ Yes No
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes ` No
e. Materials or products during loading/unloading or transporting activities ❑ Yes *No
f. Materials or products stored outdoors (except final products intended for outside ❑ YesNo
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 �,No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes )&No
the discharger
L Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes \ No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes ¢4,No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes No
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes �_No
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes No
stored outside, has the facility had any releases in the past three (3) years?
13) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs and piping free of rust, damaged or weathered coating, pits, or ❑ Yes ❑ No N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWV-NE-12Aug2010

NCGNE0000 No Exposure Certification
14) Secondary Containment: It you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for all single above ground storage
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 stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
Footnotes to Questions 14) c. & d.
❑ Yes ❑ No *-N/A
❑ Yes ❑ No �N/A
❑ Yes ❑ No 11
N/A
❑ Yes ❑ No N/A
❑ Yes ❑ No N/A
❑ Yes ` No
❑ Yes No
❑ Yes Po
'Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for de minimis amounts of certain substances,
and/or other qualifiers, as described in the exemptions from reporting requirements of Title III SARA 313 in 40 CFR
§372.38,
"Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for amounts less than the Reportable Quantities
of the hazardous substances listed in 40 CFR §117.3.
Page 4 of 7
SWU-NE-12Aug2010

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 '�.,No
b. Does your facility have coal piles on site? ❑ Yes #0
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes �No
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ❑ Yes �No
de reasin o erations latin aintin and metal finishin )? If so describe the
industrial activity:
e. if you answered yes to d.,
are those emissions permitted by an Air Quality Permit?
Please specify:
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
❑ Yes ❑ No NIA
Page 5 of 7
SwU-NE-12Aug2010

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)).
I understand that I am obligated to annually self re-certifv No Exposure and, if requested, submit the re -certification to
DWQ or the operator of the local municipal separate storm sewer system (MS4) into which the facility discharges (where
applicable). I understand that I must allow the North Carolina Division of 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.
f
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.
Page 6 of 7
SWU-NE-12Aug2010

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
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ...... [phone]
Central Office .........(919)
807-6300
Page 7 of 7
SWII-NE-12Aug2010

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