NCGNE1490_Application_20210802

FOR AGENCY USE ONLY
NCGNE I L4
Assigned to: A. LUCA C R FC E IVE D
ARO FRO &
RRO WARO WIRO WSRO r.'JG 02 2021
DENR-LAND QUALITY
"T^�'"" ' ER PERMITTING IT
Division of Energy, Mineral, and Land Res&Wkis
National Pollutant Discharge Elimination System
No Exposure Certification for Exclusion
NCGNE0000
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, • final products, or
• raw materials, • 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, • 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rescinded, your facility must continue to abide by the terms and conditions of the current permit.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, or will 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:
https://deg.nc.gov/about/divisions/energy-mineral-land-resources/npdes-no-exposure.
Directions: Print or type all entries on this application form. Send the original, signed application to: NCDEMLR
Stormwater Program, 1612 MSC, Raleigh, NC 27699-1612. The submission of this form does not guarantee
exclusion from NPDES stormwater permitting. Prior to exclusion from NPDES stormwater permitting a site
inspection will be conducted.
Page 1 of 5

1. Owner/Operator (to whom all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person (as signed in Item 7 below):
VSP Labs Inc
William Wan erien
Street address:
City:
State
Zip Code
1920 Starita Rd Suite G
Charlotte
NC
28206
Telephone number:
Email address:
704-572-6304
[e-mail]
Type of Ownership:
Government
❑ County ❑ Federal ❑ Municipal ❑ State
Non -government
0 Business (If ownership is business, a copy of NCSOS report must be included with this application)
❑ Individual
2. Industrial Facility (facility requesting exclusion):
Facility name:
Facility environmental contact:
VSPOne Charlotte
William Wangerien
Street address:
Telephone number:
1920 Starita Rd Suite G
704-572-6304
Email address:
[e-mail]
City
County
I
State
Zip Code
Charlotte
Mecklenburg
NC
28206
Latitude of entrance: 35.227453
Longitude of entrance:-80.82093
Parcel Identification Number (PIN):
704-531-55550
Date operation began:
Standard Industrial Classification (SIC) Code:
7/14/2014
Brief description of the types of industrial activities and products produced at this facility:
Rx Optical Lens Finishing
3. Consultant (if applicable):
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
answer "Yes" to any of these items, you are not eligible for the no exposure exclusion.
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
❑ Yes 0 No ❑ N/A
Materials or residuals on the ground or in stormwater inlets from spills/leaks
El Yes 0 No ❑ N/A
Materials or products from past industrial activity
❑ Yes 0 No ❑ N/A
Material handling equipment (except adequately maintained vehicles)
❑ Yes ❑ No 0 N/A
Page 2 of 5

Materials or products during loading/unloading or transporting activities
❑ Yes ❑ No ❑ N/A
Materials or products stored outdoors (except final products intended for outside use [e.g., new
[I Yes El No El N/A
cars] 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,
❑Yes ❑ No ❑ N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger
❑Yes 0 No ❑ N/A
Final products that would be mobilized in stormwater discharges (e.g., rock salt)
❑ Yes ❑ No ❑ N/A
Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes [D No ❑ N/A
Application or disposal of process wastewater (unless otherwise permitted)
[I Yes ❑ No 0 N/A
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise
0 Yes l No ❑ N/A
regulated (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
❑ Yes ❑ No ❑ N/A
and stored upside down to prevent precipitation accumulation)
For any exterior ASTs, as well as drums, barrels, tanks and similar containers stored outside, has
El Yes El No 0 N/A
the facility had any releases in the past three (3) years?
'Sealed means banded or otherwise secured and with locked or non -operational taps or valves.
Above Ground Storage Tanks (ASTs) and Secondary Containment
If you answer "No" to any of the following items, you are note I igiblefor the no exposure exclusion.
Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or deterioration, or
❑Yes [I No 0 N/A
evidence of leaks?
Is secondary containment provided for all exterior ASTs? If so, is it free of any cracks, holes, or
El Yes 0No N/A
evidence of leaks, and are drain valves maintained locked shut?
Is secondary containment provided for single above ground storage containers (including drums,
❑Yes ❑No El N/A
barrels, etc.) with a capacity of more than 660-gallons?
Is secondary containment provided for above ground storage containers stored in close proximity
El Yes ❑No El N/A
to each other with a combined capacity of more than 1,320 gallons?
Is secondary containment provided for Title III Section 313 Superfund Amendments and
❑Yes 0 No El N/A
Reauthorization Act (SARA) water priority chemicals?
Is secondary containment provided for hazardous substances designated in 40 CFR §116?
❑Yes El No El N/A
Are release valves on all secondary containment structures locked?
El Yes ❑ No ❑ N/A
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.
Are vehicles used in material handling in disrepair and/or leaking fluid?
❑ Yes ❑ No ❑ N/A
Does this facility store used, recycled, or otherwise reclaimed pallets outside?
El Yes El No ❑ N/A
Does this facility have coal piles on site?
❑ Yes E No ❑ N/A
Does this facility store other fuel sources outside in piles, such as wood chips, sawdust, etc.?
El Yes 0 No ❑ N/A
Page 3 of 5

Does this facility have air emissions associated with industrial activity (e.g., degreasing operations, ❑ Yes I] No ❑ N/A
plating, painting, or metal finishing)?
If yes:
Describe the industrial activity:
Are those emissions permitted by an Air Quality Permit? ❑ Yes ❑ No
Please specify:
5. Other Facility Conditions (check all that apply and explain accordingly):
❑ This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
❑ This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
❑ This facility is a (mark all that apply)
❑ Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility
If checked, indicate:
• Kilograms of waste generated each month:
• Type(s) of waste:
• How material is stored:
• Where material is stored:
• Number of waste shipments per year:
• Name of transport/disposal vendor:
• Transport/disposal vendor EPA ID:
• Vendor address:
❑ This facility is located on a Brownfield or SUPERFUND site.
If checked, briefly describe the site conditions:
❑ This facility is located on Native American Lands.
6. Required Items (Application will be returned unless all of the following items have been included):
❑ Copy of most recent Annual Report to the NC Secretary of State (if applicable)
❑ This completed application and any supporting documentation
0 Copy of county map or USGS quad sheet with the location of the facility clearly marked
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:
I] 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.
121' 1 have read and understand the eligibility requirements for claiming a condition of "no exposure" and obtaining an
exclusion from NPDES stormwater permitting.
0 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)).
ID 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 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.
171 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 NOI 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 for gathering the
information.
Printed Name of Person Signing: William Wangerien
Title: Lab Manager
William Wangerien
Signature of Applicant
7/30/2021
Date Signed
Mail the entire package to: DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Signature: G>lzaG ' 1 L&W'LL
William Wangerien (Jul 3 , 20211(T 4:01 EDT)
Email: [e-mail]
Page 5 of 5

VSPOne Charlotte
1920 Starita Rd Suite G
Charlotte NC 28206

• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online • Add Entity to My Email Notification List • View Filings
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Business Corporation
Legal Name
VSP Labs, Inc.
Information
Sosld: 1322029
Status: Current -Active O
Date Formed: 6/10/2013
Citizenship: Foreign
State of Incorporation: DE
Fiscal Month: December
Annual Report Due Date: April 15th
Currentgnnual Report Status:
Registered Agent: Corporation Service Company
Addresses
Reg Office
Reg Mailing
Mailing
Principal Office
2626 Glenwood Avenue, Suite 550 2626 Glenwood Avenue,
Suite 550 3333 Quality Dr
3333 Quality Dr
Raleigh, NC 27608
Raleigh, NC 27608
Rancho Cordova, CA 95670-7985 Rancho Cordova, CA 95670-7985
Officers
Vice President
Chief Executive Officer
Chief Financial Officer
President
Thomas Allan Fessler
Michael J. Guyette
Kassim "Alec" A. Mahmood
Donald Eugene Oakley
3333 Quality Drive
3333 Quality Drive
3333 Quality Drive
3333 Quality Drive
Rancho Cordova CA 95670
Rancho Cordova CA 95670
RANCHO CORDOVA CA 95670
Rancho Cordova CA 95670
Secretary
Michael Wood
3333 Quality Drive
Rancho Cordova CA 95670
Stock