NCGNE1594_Application_20230313

FOR AGENCY USE ONLY
NCGNE15'?
Assigned to: %f• Go-oli
ARO FRO MRO R WARO WIRO WSRC
Division of Energy, Mineral, and Land Resources
National Pollutant Discharge Elimination System
�1 No Exposure Certification for Exclusion
NCGNE0000
STtl3mission 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 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, 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 Until you are issued a No Exposure Certification and your NPDES permit is rescinded, your facility must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 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, 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).
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.goy/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 o legal orggaanizationa`
entity:
Legally responsib a person (as signed in Item 7 below):
0�
Street address:
City:
State
Zip Code
s i "WL9 �,,��
>-
Q--
azz la
Telephone number:
Email address:
— 5 r-i— 8-3 �►
Type of Ownership:
Government
❑ County ❑ Federal ❑ Municipal ❑ State
Non -government
)SCgusiness (If ownership is business, a copy of NCSOS report must be included with this application)
❑ Individual
2. Industrial Facility (facility requesting exclusion):
Facility name: r f
Facility environmental contact:
C.J¢b trJ—�.n�i
1�T 4ALq
Street add ss:
Telephone number:
5 1 q 0ra`i , Y.
c[
Email address:
City
County
State —, _ >,Zip
Code
Latitude of entrance: 36----
Longitude of entrance fi r .} ! i; $ ''l1 •'",
Parcel Identification NumberN 5 5 5 a4 ZS f
l 6 3 o?,- 9
J
— ga
Date operation°began:.
` �`-`'-Standard`Indostrial
i it Coder
SICu
Clas'sfication,()
is �003
`,
Brief description ofithe,types_of;)ridustria)activities,andprdducts-producedatthis faalityy
I•
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)'No ❑ N/A
Materials or residuals on the ground or in stormwater inlets from spills/leaks
❑ Yes f CNo ❑ N/A
Materials or products from past industrial activity
❑ Yes$No ❑ N/A
Material handling equipment (except adequately maintained vehicles)
❑ Yes,<No ❑ N/A
Page 3 of 6

Materials or products during loading/unloading or transporting activities
❑ Yes KNo ❑ N/A
Materials or products stored outdoors (except final products intended for outside use [e.g., new
❑Yes �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,®,'No El N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger
❑ Yes,;R'No ❑ N/A
Final products that would be mobilized in stormwater discharges (e.g., rock salt)
❑ Yes KNo ❑ N/A
Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes.'No ❑ N/A
Application or disposal of process wastewater (unless otherwise permitted)
❑ Yes5?'NO ❑ N/A
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise
❑yes J£�lo El 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 Fo ❑ 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
❑Yeso ❑ 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'rrot`ehgiblefior the no exposure exclusionI
Are exterior ASTs or m frei ,rust; damaged or weathered co'atin ,. its, -or deterioration or
piping ge.of g_eB P 1❑-Yes
evidence of leaks? t `
C ffNo R<//A
Is secondary containment provided for all exteriorlASTs? if so) is it}free�ofany cracks, holes, or i
❑1es`❑ NdF/A
evidence of leaks, and are drainyalvermaintainedlocked shut? }
Is seconds for single above ground storage containers (including drums,❑Yes❑
,gopttaiunment.provided
barrels, etc.) with a capacity of more than 660-gallons? .. , r
No�l�/A
Is secondary, contaipment,provided for above.gfou,nd,storage containers stored in close.proximiT'°�
to each other with a combined capa'citq of more ttian 1,320 gallons? %'
❑Yes ❑ No J 1/A
_
._:g. �_r
H-'
Is secondary containment provided for Title III Section 313 Superfund Amend`mentS'and
❑Yes El No�'I�1/A
Reauthorization Act (SARA) water priority chemicals?
Is secondary containment provided for hazardous substances designated in 40 CFR §116?
❑ Yes ❑ No Nt`N/A
Are release valves on all secondary containment structures locked?
❑ Yes ❑ No PN/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 KNo ❑ N/A
Does this facility store used, recycled, or otherwise reclaimed pallets outside?
❑ Yes kNo ❑ N/A
Does this facility have coal piles on site?
❑ Yes I3<No ❑ N/A
Does this facility store other fuel sources outside in piles, such as wood chips, sawdust, etc.?
❑ Ye No ❑ N/A
Page 4 of 6

Does this facility have air emissions associated with industrial activity (e.g., degreasing operations, ❑ Yes Plo ❑ N/A
plating, painting, or metal finishing)?
!f 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 Facili
_
If checked, indicate:
• Kilograms of waste ger rated each month
• Type(s) of waste 0'
11
• How mY rial is stored x
{ 4 f
y
M`
• Whgregtaterialisgtored:
• N u mber of waste shipments per year:y
1 -
• Nameofitransport/disposalvendof;;
�a
• 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):
GYCopy of most recent Annual Report to the NC Secretary of State (if applicable)
E;Mis completed application and any supporting documentation
2rCopy 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 143-215.613 (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:
GY 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
_e lusion 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)).
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 M54 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 I understand that in the event that the site ger qualifies for a No Exposuree Exclusion__thatJ_must.obtain coverage
er an NPDES permit prior to any_poin
The information submittedn.thr`s NOI is,
and o plete based on
my inquiry of the perso:6torpersons who manage the system,!or
those persons
directly responsible forgathering the
information. 7
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if
f
.I!
Printed Narpe Person Signing:'
Title:
s
z"
•
1�-��is�L
3��9R:2D.23
Signature of Applicant
Date Signed
Mail the entire package to: DEMLR—Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 6 of 6

Aa° BUSINESS CORPORATION ANNUAL REPORT
Ls/non
NAME OF BUSINESS CORPORATION: Kolb, Boyette & Assoc., Inc.
D301216 Fftg M. Use only
SECRETARY OF STATE ID NUMBER: STATE OF FORMATION: NC
REPORT FOR THE FISCAL YEAR END: 2023 ��Q
SECTION A: REGISTERED AGENT'S INFORMATION O ❑K Changes
1. NAME OF REGISTERED AGENT: ErIC Kolb
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
514-A United Drive
Durham, NC 27713 Durham
SECTION
PO Box 13345
Durham, NC 27709 Durham
1. DESCRIPTION OF NATURE OF BUSINESS: commercial printing
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: [e-mail]
4. PRINCIPAL OFFICE STREET ADDRESS
514-A United Drive
Durham, NC 27713 Durham
S. PRINCIPAL OFFICE MAILING ADDRESS
PO Box 13345
Durham, NC 27709 Durham
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: Eric Kolb
TITLE: Secretary/Treasurer
ADDRESS:
PO Box 13345
NAME: Willis Roberson NAME: Al Thom
TITLE: Vice President TITLE: President
ADDRESS:
PO Box 13345
ADDRESS:
PO Box 13345
Durham, NC 27709-3345Durham Durham, NC 27709-3345Durham Durham, NC 27709-3345Durham
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
entity. l _/lAlOa3
T SIGNATURE DATE
Fomt must be signed by an officer fisted under Section C of this forth.
K'o /�
Print arType Name of Officer Print or Type Tide of Officer
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF $25
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

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