NCGNE1335_COMPLETE FILE - HISTORICAL_20190610

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE i 33
DOC TYPE
HISTORICAL FILE
DOC DATE
❑ ��1 O�� O
YYYYMMDD

El
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
interim Director
Plasticard Locktech International
Attn: Pam Parsons
605 Sweeten Creek Industrial Park
Asheville, North Carolina 28803
NORTH CAROLINA
Environmental Quality
June 10, 2019
Subject: No Exposure Certification -approval
Certification Number: NCGNE1335
Facility Name: Plasticard Locktech International
Facility County: Buncombe County, North Carolina
Dear Ms. Parsons:
The Division has reviewed your application for a No Exposure Certification for Exclusion (NEC) for
the subject facility. Based on the information provided and a site visit conducted on May 16, 2019,
the NEC has been approved.
Please note that you are obligated to maintain no -exposure conditions at your facility. if conditions
change such that your facility can no longer qualify for a NE, you are obligated to immediately
obtain N PDES permit coverage for your stormwater discharge. Otherwise, the discharge becomes
subject to enforcement as an un-permitted discharge. Your NE does not expire. In order to help
assure that your facility stays in compliance with all of the conditions in the Certification, you must
self -recertify your facility at least annually. Please see the attachment for information on self -
recertification.
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 Isaiah Reed at (828) 296-
4500,
Sincerely,
for S. Daniel S h
Director
Enclosure: inspection report
_ D_IE
Gft
Nora" 98
North Carolina Department of Environmental Quality I Division of Energy. Mineral and Land Resources
Asheville Regional Office 1 2090 U.S. Highway 70 1 Swannanoa, North Carolina 28778
828,296.4500

ec:
Suzanne McCoy, Administrative Specialist
[e-mail]
Bethany Georgoulias, Environmental Engineer, Stormwater Program,
[e-mail]

t`
Compliance Inspection Report
Permit: NCGNE1335 Effective: Expiration: Owner: Plasticard Locktech International
SOC: Effective: Expiration: Facility: Plasticard Locktech International
County: Buncombe 605 Sweeten Creek Industrial Park
Region: Asheville
Biltmore Frst NC 28803
Contact Person: Pam Parsons Title: Phone: [phone]
Directions to Facility:
Facility is located in the rear of the Sweeten Creek Industrial Park at the intersection of Sweeten Creek Road & Sweeten Creek
Industrial Park Road.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 05/16/2019 EntryTime: 09:OOAM Exit Time: 10700AM
Primary Inspector: Isaiah L Reed 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 ® Misc
(See attachment summary)
Page 1 of 3

0
Permit: NCGNE1335 Owner-Facility:Plasticard Locktech International
J
r
Inspection Date: 0511612019 inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
On May 16, this facility was inspected as a follow up to a previous inspection to determine compliance with the No
Exposure certification. No issues were observed, and previous issues had been addressed. NEC is granted.
Page 2 of 3

Permit: NCGNE1335
Inspection Date: 05116/2019
Misc
Is the facility compliant?
Comment:
Owner - Facility: plasticard t_ocktech International
Inspection Type : Compliance Evaluation
Reason for Visit: Routine
Yes No NA NE
❑ ❑ ❑
Page 3 of 3

z ® •
Compliance Inspection Report
Permit: NCGNE1335 Effective: Expiration:
Owner: Plasticard Locktech International
SOC: Effective: Expiration:
Facility: Plasticard Locktech International
County: Buncombe
605 Sweeten Creek Industrial Park
Region: Asheville
Biltmore Frst NC 28803
Contact Person: Pam Parsons
Title:
Phone: [phone]
Directions to Facility:
Facility is located in the rear of the Sweeten Creek Industriaf Park at the intersection of Sweeten Creek Road & Sweeten Creek
Industrial Park Road.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 05/16/2019 Entry Time: 09:00AM Exit Time: 10:00AM
Primary Inspector: Isaiah L Reed 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:
0 Miscellaneous Questions Misc
(See attachment summary)
Page 1 of 3

Permit: NCGNE1335 Owner -Facility: Plasticard Locktech International
Inspection Date: 0511612019 Inspection Type ;Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
On May 16, this facility was inspected as a follow up to a previous inspection to determine compliance with the No
Exposure certification. No issues were observed, and previous issues had been addressed. NEC is granted.
Page 2 of 3

0 0
Permit: NCGNE1335 Owner - Facility: Plasticard Locktech International
Inspection Date: 05116/2019 Inspection Type : Compliance Evaluation
Misc
Is the facility compliant?
Comment:
Reason for Visit: Routine
Yes No NA NE
■ ❑ ❑ ❑
Page 3 of 3

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Interim Director
Plasticard Locktech International
Attn: Pam Parsons
605 Sweeten Creek Industrial Park
Asheville, North Carolina 28803
NORTH CAROLINA
Environmental Quality
April 16, 2019
Subject: No Exposure Certification - Disapproval
Certification Number: NCGNE1335
Facility Name: Plasticard Locktech International
Facility County: Buncombe County, North Carolina
Dear Ms. Parsons:
The Division has reviewed your application for a No Exposure Certification for Exclusion (NEC)
from NPDES Stormwater Permitting for the subject facility.
Based on an inspection of your facility on April 9, 2019, Asheville Regional Office staff found
that industrial activities or materials on your site either are exposed, or have the potential to
be exposed to stormwater discharge.
The Division of Energy Mineral and Land Resources is unable to grant your requested
exemption from permit coverage when industrial activities or materials are exposed or have
the potential to be exposed. Please see attached inspection report.
If you have any questions or need further information, please contact Isaiah Reed at (828) 296-
4500, or at [e-mail].
Sincerely,
for S. Daniel m' h
Interim Du ctor
M
� Q'I
North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
er Asheville Regional Office 1 2090 U.S. Highway 70 1 Swannanoa, North Carolina 28778
�� /"� 828.296.4500

ec:
Suzanne McCoy, Administrative Specialist
Suzann e.mccoyRncdPn.-
Bethany Georgoulias, Environmental Engineer, Stormwater Program,
[e-mail]

111 0
Compliance Inspection Report
Permit: NGC3NE1335' Effective: Expiration: Owner: Plastirard Locktech International
SOC: Effective: Expiration: Facility: Plasticard Locktech International
County: Buncombe 605 Sweeten Creek Industrial Park
Region: Asheville
Biltmore Frst NC 28803
Contact Person: Pam Parsons Title: Phone: [phone]
Directions to Facility:
Facility is located in the rear of the Sweeten Creek Industrial Park at the intersection of Sweeten Creek Road & Sweeten Creek
Industrial Park Road.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 04/09/2019 Entry Time: 12MPM Exit Time: 01:00PM
Primary Inspector: Isaiah L Reed 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:
® Miscellaneous Questions IN Misc
(See attachment summary)
Page 1 of 3

L]
Permit: NCGNE1335 Owner- Facility:Plasticard Locktech International
Inspection Date: 04/0912019 Inspection Type : Compliance Evaluation Reason for visit: Routine
Inspection Summary:
On April 9, 2019, this facility was inspected for compliance with the No Exposure Certification Application (NEC). I met with
Tim Tramel and Pam Parsons on site. During the inspection, the following items were noted, and the facility was not found
to be in compliance with the NEC.
1) Dumpsters were observed uncovered and leaking.
2) Used pallets,were exposed to precipitation.
3) Intermediate product (plastic trimmings) were observed in the dumpster area on the asphalt and in the grass.
Due to the above findings, NEC is disapproved at this time.
This facility will be re -inspected on or after May 16, 2019. If the above items are not addressed, and the facility has not
applied for coverage under a General Permit, further action will be taken.
If you have any questions, please contact this office at [phone]
Page 2 of 3

Permit: NCGNE1335 owner - Facility;Plasticard Locktech International
Inspection Date: 04/09/2019 Inspection Type : Compliance Evaivation Reason for Visit: Routine
Mist;
Yes Nc NA NE
Is the facility compliant? ❑ ® ❑ ❑
Comment: See summary for more information.
Page 3 of 3

® •
Compliance Inspection Report
Permit: NCGNE1335 Effective: k Expiration: Owner : PlAticd'rd L'ocktech International
SOC: Effective: Expiration: Facility: Plasticard Locktech International
County: Buncombe 605 Sweeten Creek Industrial Park
Region: Asheville
Biltmore Frsi NC 28803
Contact Person: Pam Parsons
Title:
Phone: [phone]
Directions to Facility:
Facility is located in the rear of the Sweeten Creek Industrial Park at the intersection of Sweeten Creek Road & Sweeten Creek
Industrial Park Road.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 04/09/2019 Entry Time: 12:00PM Exit Time: 01:00PM
Primary Inspector: Isaiah L Reed 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:
0 Miscellaneous Questions Misc
(See attachment summary)
Page 1 of 3

Permit: NCGNE1335 Owner - Facility: Plasticard Locktach International
Inspection Date: 04/09/2019 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Ots April 9, 2019, this facility was inspected for compliance with the No Exposure Certification Application (NEC). I met with
Tim Tramel and Pam Parsons on site. During the inspection, the following items were noted, and the facility was not found
to be in compliance with the NEC.
1) Dumpsters were observed uncovered and leaking.
2) Used pallets were exposed to precipitation.
3) Intermediate product (plastic trimmings) were observed in the dumpster area on the asphalt and in the grass.
Due to the above findings, NEC is disapproved at this time.
This facility will be re -inspected on or after May 16, 2019. If the above items are not addressed, and the facility has not
applied for coverage under a General Permit, further action will be taken.
If you have any questions, please contact this office at [phone]
Page 2 of 3

,7
Permit: NCGNE1335 Owner - Facility: Plasticard Locktech International
Inspection Date: 04/0912019 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Misc Yes No NA NE
Is the facility compliant? ❑ ! ❑ ❑
Comment: See summary for more information.
Page 3 of 3

E
0 Kc&pr,-
Fnvlronaten tal
Quality
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NCCNEooaa
FOR AGENCY USE ONLY
Date Received
Year I Month
I ft
Olt
Certificate ofCovcrae
RS
MAR 0 4 2013
National Pollutant Discharge Elimination System application for exclusion from a St ���jpr�1w,a�tterr Permit based
.,., KinCYDnQ1 IDC• o�ro LAND QL ALIN
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 has no expiration date
BUT MUST BE self re -certified at least annually.
Please look for information about re -certification under the Nio Exposure section on this page:
https://deq,nc.gov/about/divisions/energv-mineral-land-resources/energy-mineral-land-permits/stormwater-
permits/nPdes-industrial-sw
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 mailed):
Name Plasticard Locktech lntemational
Contact
Street Address
City
Telephone No.
SWU-NCGNE
Robert Keshura
605 Sweeten Creek Industrial Park
Asheville State NC ZIP Code 28803
Boo 752-1017 Fax: [phone]
Page 1 of 7
S`
Last revised 9128/2016
�inc�� a�� PSc,nntn dz, �o?d.:-cr5��. ISi4�-ti on �}-e.

P_.�
,7
NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Plasticard Locktech Intemational
Pam Parsons
605 Sweeten Creek Industrial Park
Ashevllie State NC ZIP Code 28803
Buncombe
828 418-8253 Fax: [phone]
3) Physical location information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). Facility is located in the rear of the sweeten creek Industrial Park
at the intersection of Sweeten Creek Road & Sweeten Creek Industrial park Road.
(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 [.ands?M Yes 1KNo
5) is this a Federal facility? M Yes X No
6) Latitude 39.i46780
Longitude -82.516376 (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
G New or Proposed Facility Date operation is to begin
ID Existing Date operation began October, 2005
0 Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? 13 Yes ot 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: 2 7 5 2
10) Provide a brief description of the types of industrial activities acid products prudueed at this facility:
I_ithoaraDhic Drintina and flnishina of DlaStic and paper Droducts
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
1K No
© Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SWU-NCGNE Last revised 9/28/2016

NCGNE0000 No Exposure Certification
Exposure Checklists (1 Z - 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 E3 Yes 'X No E3 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 spillslleaks p Yes 1Q No In NIA
c. Materials or products from past industrial activity p Yes V No [3 N/A
d. Material handling equipment (except adequately maintained vehicles) © Yes K No © NIA
e Materials or products during loading/unloading or transporting activities 0 Yes K No E3 NIA
f. Materials or products stored Outdoors (except final products intended for outside 0 Yes jL No EI NIA
use [e.g., new carsf where exposure to stormwater does not result in the
discharge of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels, 13 Yes %[No 13 NIA
tanks, and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained El Yes 1;No IO NIA
by the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., G Yes 11 No 0 NIA
dumpsters])
j. Application or disposal of process wastewater (unless otherwise permitted) © Yes A No © NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents 0 Yes 19 No C3 NIA
not 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 0 Yes 10 No p 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 0 Yes in No Ur NIA
stored outside., has the facility harl any releases in the Mast three (�I) 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 0 Yes 0 No W 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 of NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked
shut?
14) Secondary Containment: If you answer "No" to any of the following Items, you are not eligible for the
no exposure exclusion.
Page 3 of 7
SWU-NCGNE Last revised 9128/2016

�71
NCGNE0000 No Exposure Certification
0
a. Is secondary containment provided for single above ground storage containers 0 Yes © No Ik NIA
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
In Is secondary containment provided for above ground storage containers stored M Yes p No Z NIA
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 ©Yes t3No W NIA
Amendments and Reauthorization Act (SARA) water priority chemicals"?
d. Is secondary containment provided for hazardous substances" designated in ❑ Yes ❑ No 1K NIA
40 CFR §116?
e. Are release valves on all secondary containment structures locked? 0 Yes in No gj NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? MYes X No p NIA
b. Is this facility a Small Quantity Generator (less than 1000 kg, of hazardous V Yes 13 No t3 NIA
waste generated per month) of hazardous waste? *N�6" S MPLA—
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste EM Yes 10 No p NIA
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of
waste: screen Press waste, UN 1210, Waste Printing Ink, 3, PG tl, ERGS! 120, D001, F003
How is material stored: In 55 gallon steel drum
Where is material stored: External locked building for flammables, with Integrated spill containment.
How many disposal shipments per year: 4
Name of transport / disposal
vendor: Pinnacle Environmental Services
Vendor address. 2403 Powdersville Road, Easley SC N842
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. I lowever, some exceptions may be made for de minlmis 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.
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.
Page 4 of 7
SWU-NCGNE Last revised 9/28/2016

NCGNE0000 No Exposure Certification
a. Does your facility store used, recycled, or otherwise rec[[arM ed pallets outside?
S im
IMYes ® No 13 NIA
VueON'T-gMtN)ATEh Q;)s A
Ro�.-e� ���� C.'c�rt3ro'ttJ t�
b. Does your facility have coal piles on site?
p Yes 'fib No © NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips,
p Yes IR No In NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g,,
1%Yes O No p NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: printing
e. If you answered yes to d., are those emissions permitted by an Air Quality
0 Yes © No 13 NIA
Permit? Please specify: Permit# 11-905-148, WNC Regional Air Quality Agency
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit. NO-0991302806, CFSQG pfugralri. N[1+0, Haz Waste Section
Permit: 1-149-15, Waste Water Program: MSD, Buncombe Co.
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit, Program,
Page 5 of 7
SWU-NCGNE Last revised 912812016

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 maintain no exposure conditions and complete a Self -Recertification form at least once
each year, and if requested, provide this certification 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
Energy, Mineral, and Land Resources, 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 I
must keep a copy of annual re -certifications on file at the facility.
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 11iat lldd duuuinelit and all attaulimetils weie piopored uirdur my (Tio dull ur auueivlslu>> Ili hwurdaliue Willi a syslern
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 famlllar with the Informatlon 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: r n ly')-V)H4-S0✓i
(Signature of Applicant)
(Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the NCDEQ
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
5WU-NCGNE Last revised 912812016

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
NI his 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:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
NQI@
The suhmission of this documont door not guarantoo tho issuanco of a No Exposure Exclusion.
For questions, please contact the DEMLR Regional Office for your area.
Asheville Office ......
[phone]
Fayottevillo Office ...
[phone]
Mooresville Office...
[phone]
Raleigh Office ........
[phone]
Washington Office ...
[phone]
Wilmington Office..,
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 7 of 7
SWU-NCGNE Last revised 9128/2016