NCGNE1550_Application_20220825

FOR AGIjNCY USE ONLY RECEIVED
NCGNE! 5.5 ® �c 11,, fJ
Assigned to: ' i' �R7o N AUG 2 5 2022
ARO FRO MRO RRO WARO WIRO W5R0
DEPJROND QUALITY
STORNMIATER PEWITTiNG
Division of Energy, Mineral, and Land Resources
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,
• barrels,
• tanks, and
• similar containers.
For new facilities, applicants should apply no earlier than 60 days before the start of operation. This will allow
DEMUR staff to verify conditions during active operation. For facilities that already have an industrial stormwater
permit in North Carolina, DEMUR 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 Until you are issued a No Exposure Certification and your NPDES permit is rescinded, your facility must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 for the 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).
For new facilities, applicants should not apply more than 60 days before the start of operation date. This
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 6

1. Owner/Operator (to whom all permit correspondence will be mailed):
Name of legal or anizational entity:
Stericycle,ginc. Shred -It
Le ally responsible person (as signed in Item 7 below):
[gon Nuss
Stre14fl,posskins Court
;;ii 1
City. Hamilton
StateOH
zip Code
45011
Telephone number: 513-543-7070
Email address: [e-mail]
Type of Ownership:
Government
❑ County ❑ Federal ❑ Municipal ❑ State
Non -government
X 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: Shred- It
Facility environmental contact:
Derek Culler
Street address: 1775Industrial Drive
Telephone number: 336-655-9836
Email address: [e-mail]
City Winston-Salem
County Forsyth County
State NC
Zip Code 27105
Latitude of entrance: 36.14973
Longitude of entrance.-80.24078
Parcel Identification Number (PIN): N/A
Date operation began: Approx 2007
Standard Industrial Classification (SIC) Code: 5093
Brief description of the types of industrial activities and products produced at this facility:... The facility is a document
destruction facility. Documents are collected/ shredded and baled inside the facility. then sent to be rec cled
3. Consultant (if applicable):
Name of consultant: N/A
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 EXNo ❑ N/A
Materials or residuals on the ground or in stormwater inlets from spills/leaks
❑ Yes 19No ❑ N/A
Materials or products from past industrial activity
❑ Yes ❑ No lK N/A
Material handling equipment (except adequately maintained vehicles)
❑ Yes EXNo ❑ N/A
Page 3 of 6

Materials or products during loading/unloading or transporting activities
❑ Yes IX No ❑ N/A
Materials or products stored outdoors (except final products intended for outside use [e.g., new
❑ Yes CX No ❑ 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 U No ❑ N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger
❑ Yes ❑ No U N/A
Final products that would be mobilized in stormwater discharges (e.g., rock salt)
❑ Yes ❑ No lI N/A
Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes R No ❑ N/A
Application or disposal of process wastewater (unless otherwise permitted)
❑ Yes ❑ No ® N/A
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise
❑ Yes IX 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 (A 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 ❑ No IKN/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 not eligible for the no exposure exclusion.
Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or deterioration, or
❑yes ❑ No W N/A
evidence of leaks?
Is secondary containment provided for all exterior ASTs? If so, is it free of any cracks, holes, or
❑ yes ❑ No iA 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 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
❑yes ❑ No ®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 ❑ No IX N/A
Reauthorization Act (SARA) water priority chemicals?
Is secondary containment provided for hazardous substances designated in 40 CFR §116?
❑ Yes ❑ No EX N/A
Are release valves on all secondary containment structures locked?
❑ Yes ❑ No Cx 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 IN No ❑ N/A
Does this facility store used, recycled, or otherwise reclaimed pallets outside?
❑ Yes W No ❑ N/A
Does this facility have coal piles on site?
❑ Yes ❑ No W N/A
Does this facility store other fuel sources outside in piles, such as wood chips, sawdust, etc.?
❑ Yes ❑ No IB N/A
Page 4 of 6

Does this facility have air emissions associated with industrial activity (e.g., degreasing operations, ❑ Yes X 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:
S. 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):
X Copy of most recent Annual Report to the NC Secretary of State (if applicable)
X This completed application and any supporting documentation
K Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 5 of 6

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). I hereby request exclusion from NPDES stormwater permitting.
Under penalty of law, I certify that:
�( 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.
I have read and understand the eligibility requirements for claiming a condition of "no exposure" and obtaining an
exclusion from NPDES stormwater permitting.
IIM 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 applicable, to perform inspections to confirm
the condition of no exposure and to make such inspection reports publicly available upon request. I understand 1 must
keep a copy of annual recertifications on file at the facility.
I 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.
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 for gathering the
infnrmatinn
Printed Name of Person Signing: Don Nuss
Title: Regional Permit Compliance Manager
LL K."V2
Signature of Applicant
Mail the entire package to:
August 17, 2022
Date Signed
DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 6 of 6

v
ps
i-•----Cintas Document
anagement
v -
slow
m
9
Ol
Google
f
m
c
0
U
� m
Moyer Diebel
rah
G
ca!

n16 , BUSINESS CORPORATION ANNUAL REPORT
�k
1/6/]A22
NAME OF BUSINESS CORPORATION: Stericycle, Inc.
SECRETARY OF STATE ID NUMBER: 0416448 STATE OF FORMATION: DE
REPORT FOR THE FISCAL YEAR END: 12/31/2021
SECTION A:
1. NAME OF REGISTERED AGENT: CT Corporation System
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
0416448
CA202210319073
4/13/2022 06:00
R Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
160 Mine Lake Ct Ste 200
160 Mine Lake Ct Ste 200
Raleigh, NC 27615-6417 Wake County Raleigh, NC 27615-6417
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Medical Waste Services
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
5. PRINCIPAL OFFICE MAILING ADDRESS
2355 WAUKEGAN RD 2355 WAUKEGAN RD
BANNOCKBURN, IL 60015 BANNOCKBURN, IL 60015
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: Cindy J Miller NAME: Cindy J Miller NAME: Janet Zelenka
TITLE: President TITLE: Chief Executive Officer TITLE: Chief Financial Officer
ADDRESS: ADDRESS: ADDRESS:
2355 WAUKEGAN RD 2355 WAUKEGAN RD 2355 WAUKEGAN RD
BANNOCKBURN, IL 60015 BANNOCKBURN, IL 60015 BANNOCKBURN, IL 60015
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in Its entirety by a person/business
entiailet Zelenka 4/13/2022
SIGNATURE DATE
Form must be signed by an officer listed under Section C of this loon.
Janet Zelenka Chief Financial Officer
Pdnt or Type Name of Officer Prat or Type Title of Officer
This Annual Report has been filed electmnicallV.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box29526, Raleigh, NC 27626-0525

d �p Stericycle`
• Protecting People. Reducing Risk.'
August 17, 2022
NCDEMLR
Storm Water Program
Attn: Brittany Carson
1612 Mail Service Center
Raleigh, North Carolina, 27699-1612
RE: Stericycle, Inc./Shred-it Winston Salem Facility
No Exposure Application
Dear Sir or Madam:
Please find a completed No Exposure Certification for Exclusion Form NCGNE0000 for the Stericycle,
Inc./Shred-it
Winston Salem, NC facility in Forsyth County, North Carolina.
If additional information is required, please feel free to contact me at 513-543-7073 or via email at
dnuss .stericycle.com .
Sincerely,
Don Nuss
Regional Permit Compliance Manager
Stericycle, Inc.