NCGNE1475_Application_20210415

FOR AGENCY USE ONLY
Date Received:
NCGNE t q 5
Division of Energy, Mineral, and Land Resources
National Pollutant Discharge Elimination System
No Exposure Certification for Exclusion
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. Industrial materials or activities include, but are not limited to:
• material handling equipment or activities, ® by-products,
• industrial machinery, 0 final products, or
• raw materials, w waste products.
• intermediate 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 industrial materials stored in the following container types, provided
the containers are not deteriorated and do not leak:
® drums, f tanks, and
barrels, ® similar containers.
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rescinded, your facility must continue to abide by the terms and conditions of the current permit.
A No Exposure Certification must be provided for each facility qualifying forthe no exposure exclusion. Additionally,
the exclusion from NPDES permitting is available on a facility -wide basis only'- not for individual outfalls. If any
industrial activities or materials are, orwill be, exposed to precipitation, the facility is not eligible forthe 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 Certification has no expiration date but must be self -recertified at least
annually. Please look for information about recertification under the No Exposure section on this page:
htt s: de .nc. oy about divisions ener -mineral-land-resources n des -no -ex osure.
Directions: Print or type all entries on this application form. Send the original, signed application to: NCDEMLR
Stormwater Program, 512 N. Salisbury St., 1612 MSC, Raleigh, NC 27699-161.2. The submission of this form does
not guarantee exclusion from NPDES stormwater permitting. Priorto exclusion from NPDES stormwater permitting
a site inspection will be conducted.
Page 1 of 5

1. Owner/Operator (towhorn all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person (as signed in Itern 7 below):
Clearwater Paper Shelby, LLC
James Sloan
Street address:
City:
State and zip code:
�NC
671 Washburn Switch Rd.
Shelby
28150
Telephone number:
Email address:
Type of Ownership:
Government
&Business (if ownership is business, a copy of NCSOS report must be included with this application)
2. Industrial Facility (facility requesting exdusion):
Facility name:
Facility environmental contact:
Clearwater Paper Shelby, LLC
Kim Gissy
Street address:
Telephone number:
City:
State and zip code:
Email address:
Latitude of entrance: 35.32378
Longitude of entrance: -80,60606
Parcel Identification Number (PIN):
63602,32624,62648,73679
Date operation began:
Standard Industrial Classification (SIC) Code:
Brief description of the types of industrial activities and products produced at this facility:
Manufacturer of consumer tissue products. Operations include paper -making, converting, and distribution,
` ' ^
3. Consultant (if applbmbke):
Name of consultant:
Consulting firm:
Street address:
City:
State and zip code:
Telephone number:
Email address:
4. Exposure Checklists
Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future? If you
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 stormwater
0Yes(@No
Materials or residuals on the ground or in stormwater inlets from spills/leaks
0Yes(F)No
Materials or products from past industrial activity
0 Yes (F) No
Material handling equipment (except adequately maintained vehicles)
OYesE)No
Materials or products during loading/unloading or transporting activities
0Yes(F)No
Page 2 of 5

Materials or products stored outdoors (except final products intended for outside use [e.g., new cars]
(DYeseNo
where exposure to stormwater does not result in the discharge of pollutants)
Materials contained in open, deteriorated, non -sealed', or leaking storage drums barrels, tanks, and
0Yes0No
similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger
OYeseNo
Final products that would be mobilized in stormwater discharges (e.g., rock salt)
OYeseNo
Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
(D
Yes (F) No
Application or disposal of process wastewater (unless otherwise permitted)
OYes(F)No
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated
OYesoNo
(i.e. under an air quality control permit) and evident in the stormwater outflow
Empty containers that previously contained materials that are not properly stored (i.e., not closed and
OYes(F)No
stored upside down to prevent precipitation accumulation)
For any exterior ASTs, as well as drums, barrels, tanks and similar containers stored outside, has the facility
0
Yes (@ No
had any releases in the past three (3) years?
'Sealed means banded motherwise secured and with locked mnon-operational taps mvalves.
Above Ground Storage Tanks (ASTy) and Secondary Containment
Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or deterioration, or evidence
Is secondary containment provided for all exterior ASTs? If so, is it free of any cracks, holes, or evidence of
(F)Yes ONo
leaks, and are drain valves maintained locked shut?
Is secondary containment provided for single above ground storage containers (including drums, barrels,
(F)YesoNo
etc.) with a capacity of more than 660-gallons?
Is secondary containment provided for above ground storage containers stored in close proximity to each
(j)YesoNo
other with a combined capacity of more than 1,320 gallons?
Is secondary containment provided for Title III Section 313 Superfund Amendments and Reauthorization
(F)YesoNo
Act (SARA) water priority chemicals?
Is secondary containment provided for hazardous substances designated in 40 CFR §116?
&YesoNo
Are release valves on all secondary containment structures locked?
OYesoNo
Other information
ifyou answer "Yes"toany ofthe following items you might not 6eeligible for the noexposure exclusion. Amore
Are vehicles used in material handling in disrepair and/or leaking fluid?
0yes(H)No
Does this facility store used, recycled, or otherwise reclaimed pallets outside?
OYes(H)No
Does this facility have coal piles on site?
0Yes(F)No
Does this facility store other fuel sources outside in piles, such as wood chips, sawdust, etc.?
OyesE)No
Does this facility have air emissions associated with industrial activity (e.g., clegreasing operations, plating,
(@Yes ONo
painting, or metal finishing)?
If yes:
Describe the industrial activity:
Paper -making, gluing, and printing operations
Are those emissions permitted by an Air Quality Permit? (j)YesoNo
Please specify: Title V Permit 10139TO8
Page 3 of 5

5. Other Facility Conditions (check all that apply and explain accordingly):
If checked, list the permit numbers for all current NPIDES permits:
11 This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
D This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
0 This facility is a (mark all that apply)
0 Hazardous Waste Generation Facility
D Hazardous Waste Treatment Facility
11 Hazardous Waste Storage Facility
171 Hazardous Waste Disposal Facility
if checked, indicate:
• Kilograms of waste generated each month: <1 00
• Type(s) of waste: videolet make-up fluid; aerosol can residual
• How material is stored: buckets; drums
• Where material is stored: flammable cabinet; maintenance areas
• Number of waste shipments per year: 12
• Name of transport/disposal vendor: Veolia; Clean Harbors
• Transport/disposal vendor EPA ID: SCR000786136; MAD039322250
• Vendor address: Mooresville, NC; Reidsville, NC
El This facility is located on a Brownfield or SUPERFUND site.
If checked, briefly describe the site conditions:
El This facility is located on Native American Lands.
0 This facility has other NPDES permits. Required Items (Application will be returned unless all of the following items have been included):
OCopy nfmost recent Annual nport to the NCSecretary of State (if applicable)
OThis completed application and any supporting documentation
Page 4 of 5

7. Applicant Certification
North Carolina General Statute 143-215.6B (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 ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000), 1 hereby request exclusion from NPDES stormwater permitting.
Under penalty of law, I certify that:
Ej I am the person responsible for the industrial activity, for satisfying the requirements of this exclusion, and for any civil
or criminal penalties incurred due to violations of this exclusion.
C1 1 have read and understand the eligibility requirements for claiming a condition of "no exposure" and obtaining an
exclusion from NPDES stormwater permitting.
[ 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)).
�r
t=I l 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 applicable, 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 recertifications on file at the facility.
Q 1 understand that in the event that the site no longer qualifies for a No Exposure Exclusion that I must obtain coverage
under an NPDES permit prior to any point source discharge of stormwater from the facility.
0 The information submitted in this N01 is, to the best of my knowledge and belief, true, accurate, and complete based on
my inquiry of the person or persons who manage the system, or those persons directly responsible forgathering the
information.
Printed Name of Person Signing:fti; } y f,
Title: 1. J\A f�4,4 f :s
Signafure of Applicant Date Signed
„r=
Mail the entire package to: DEMLR—Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 5 of 5

®r'N*RS"ai
BUSINESS CORPORATION ANNUAL REPORT
ro-2or7
NAME OF BUSINESS CORPORATION:
SECRETARY OF STATE ID NUMBER: 081452
Clearwater Paper Corporation
Filing Office Use Only
STATE OF FORMATION: DE
E -Filed Annual Report
0814526
REPORT FOR THE FISCAL YEAR END: 12/31 /2019 CA202009802501
4/7/2020 11:15
SECTION A: REGISTERED AGENT'S INFORMATION Q Changes
1. NAME OF REGISTERED AGENT: United Agent Group Inc.
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
15720 Brixham Hill Avenue #300
Charlotte, NC 28277 Washington County
SECTION B: PRINCIPAL OFFICE INFORMATION
15720 Brixham Hill Avenue #300
Charlotte, NC 28277
1. DESCRIPTION OF NATURE OF BUSINESS: Paper Manufacturer
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
5. PRINCIPAL OFFICE MAILING ADDRESS
601 W. Riverside Avenue, Suite 1100 601 W. Riverside Avenue, Suite 1100
Spokane, WA 99201-0644 Spokane, WA 99201-0644
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
The company is a service -disabled veteran -owned small business
SECTION C: OFFICERS (Enter additional officers in Section E.)
NAME: Terry J Borden
TITLE: Vice President
ADDRESS:
601 West Riverside Avenue
Spokane, WA 99201
NAME: Michael S Gadd
TITLE: General Counsel
ADDRESS:
NAME: Kari G Moyes
TITLE: Senior Vice President
ADDRESS:
601 W, Riverside Avenue, Suite 1100 601 West Riverside Avenue
Spokane, WA 99201 Spokane, WA 99201
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person1business
ent Michael S Gadd 4/7/2020
SIGNATURE
Form must he signed by an officer listed under Section C of this form.
Michael S Gadd
Print or Type Name of Officer
DATE
General Counsel
Print or Type Title of Officer
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

SECTION E: ADDITIONAL OFFICERS
NAME: Jason C Roggenbauer NAME: Joanne P Shufelt
TITLE: V7rP, PrP�irlPnt TITLE: Virn PrPcirlPnt
ADDRESS:
601 West Riverside Avenue
ADDRESS:
601 West Riverside Avenue
NAME: Ravi V Waran
TITLE: Nice President
ADDRESS:
601 West Riverside Avenue
Spokane, WA 99201 Spokane, WA 99201 Spokane, WA 99201
NAME: Steve M. Bowden NAME: William A. Horne NAME: Mark L. Ohleyer
TITLE: Senior Vice President TITLE: Vice President TITLE: Vice President
ADDRESS: ADDRESS: ADDRESS:
601 West Riverside Avenue 601 W. Riverside Ave., Suite 1100 601 W. Riverside Ave., Suite 1100
Spokane, WA 99201 Spokane, WA 99201 Spokane, WA 99201
NAME: Travis D. Perrin NAME: Carol K Haugen NAME: Robert G Hrivnak
TITLE: Vice President TITLE: Assistant Secretary TITLE: Chief Financial Officer
ADDRESS: ADDRESS: ADDRESS:
601 W. Riverside Ave., Suite 1100 601 West Riverside Avenue 601 West Riverside Avenue
Spokane, WA 99201 Spokane, WA 99201 Spokane, WA 99201
NAME: Arsen S Kitch NAME: Rebecca Barckley NAME: Stuart R. White
TITLE: Chief Executive Officer TITLE: Corporate Controller TITLE: Vice President
ADDRESS: ADDRESS: ADDRESS:
601 W. Riverside Avenue, Suite 1100 601 West Riverside Avenue 601 West Riverside Avenue
Spokane, WA 99201 Spokane, WA 99201 Spokane, WA 99201
NAME: W. Jay Backus NAME: Heidi S. Blair Name:
TITLE: Vice President TITLE: Treasurer TITLE:
ADDRESS: ADDRESS:
601 West Riverside Avenue 601 West Riverside Ave.
Spokane, WA 99201 Spokane, WA 99201
NAME:
TITLE:
ADDRESS:
NAME:
TITLE:
ADDRESS:
ADDRESS:
NAME:
TITLE:
ADDRESS:

v
0

McCoy, Suzanne
From: Kim Gissy <[e-mail]>
Sent: Thursday, April 15, 2021 10:54 AM
To: McCoy, Suzanne
Cc: James Sloan; John Heitkamp
Subject: [External] Clearwater Paper -No -Exposure Stormwater Certificate Application
Attachments: 2021-04-15 Clearwater Paper No Exposure Cert App.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam:
Good Morning, Suzanne,
Attached is a completed "No Exposure" Certification application for the Clearwater Paper facility located at 250
Leadership Dr., Shelby, NC 28150. This facility is a manufacturer of consumer tissue products, with operations including
paper -making, converting, and distribution.
Please review the application and feel free to reach out if additional information is needed. I will also be
mailing hard copies of the attachment to the Raleigh address.
Thank you,
Kini Gissy
Environmental Engineer II
Clearwater Paper Corporation
671 Washburn Switch Rd
Shelby, NC 28150
C 704.418.7121
learwatcrlper.com
CLEAM,"VATER
PAPER

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Limited Liability Company
Legal Name
Clearwater Paper Shelby, LLC
Information
Sosld: 2097558
Status: Current -Active O
Date Formed: 12/16/2020
Citizenship: Foreign
State of Incorporation: DE
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: United Agent Group Inc.
Addresses
Reg Office
15720 Brixham Hill Avenue #300
Charlotte, NC 28277
Company Officials
Reg Mailing Mailing Principal Office
15720 Brixham Hill Avenue #300 687 Washburn Switch Rd. 687 Washburn Switch Rd.
Charlotte, NC 28277 Shelby, NC 28150 Shelby, NC 28150
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Corporate Secretary Chief Executive Officer Chief Financial Officer
Michael S. Gadd Arsen S. Kitch Michael J. Murphy
601 W. Riverside Ste 1100 601 W. Riverside Suite 1100 601 W. Riverside Ste 1100
Spokane WA 99201 Spokane WA 99201 Spokane WA 99201