NCGNE1597_Application_20230309

FOR AGENCY USE QNLY
NCGNE I .S
Assigned to: i3 COO K
ARO FRO 9
RRO WARO WIRO WSRO
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, • tanks, and
• barrels, • similar containers.
For new facilities, applicants should apply no earlier than 60 days before the start of operation. This will allow
DEMLR 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 Until you are issued a No Exposure Certification and your NPDES permit is rescinded, your facility must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, 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 organizational entity:
Legally responsible person (as signed in Item 7 below):
C-t-rwtgr,at�
r,wJ Sco %0
Street address:
City:
State
Zip Code
31 (o Co-'4l 60- .re,
Le Sve,
1,10-3
(o05B'
Telephone number:
Email address:
507-(v&5-5W3
anf,Scp �� `c�vsk.GoM
Type of Ownership:
Government
❑ County ❑ Federal ❑ Municipal ❑ State
Non -government
;[ 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:
W6o-.-
T0.M.
Street address:
5j;k
Telephone number:
(00
Or
Nlt) 6
?oaf- S5q-- 7047
Email address:
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City
COA 0 (14
County
State
Zip Code
Latitude of entrance:
35 , y l fe ZS
Longitude of entrance:
Parcel Identification Number
(PIN):
Date operation began:
Standard Industrial Classification (SIC) Code:
/m I I
Brief description of the types of industrial activities and products produced at this facility:
S' I or
' uv
10A
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
❑ YesAl No ❑ N/A
Materials or products from past industrial activity
❑ Yes §J No ❑ N/A
Material handling equipment (except adequately maintained vehicles)
❑ Yes M No ❑ N/A
Page 3 of 6

Materials or products during loading/unloading or transporting activities
❑ Yes K, No ❑ N/A
Materials or products stored outdoors (except final products intended for outside use [e.g., new
❑ Yes IR 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 X No ❑ N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger
❑ Yes 50 No ❑ N/A
Final products that would be mobilized in stormwater discharges (e.g., rock salt)
❑ Yes 5� No ❑ N/A
Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes 4f] 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 14 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
❑ Yes No ❑ 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 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 1X 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 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 Q 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 O No kJ N/A
Reauthorization Act (SARA) water priority chemicals?
Is secondary containment provided for hazardous substances designated in 40 CFR §116?
❑ Yes ❑ No N/A
Are release valves on all secondary containment structures locked?
❑ 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 54 No ❑ N/A
Does this facility store used, recycled, or otherwise reclaimed pallets outside?
❑ Yes RNo ❑ N/A
Does this facility have coal piles on site?
❑ Yes 14 No ❑ N/A
Does this facility store other fuel sources outside in piles, such as wood chips, sawdust, etc.?
❑ Yes [A No ❑ N/A
Page 4 of 6

Does this facility have air emissions associated with industrial activity (e.g., degreasing operations, ❑ Yes XNo ❑ 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):
Copy of most recent Annual Report to the NC Secretary of State (if applicable)
This completed application and any supporting documentation
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 143-215.6E (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:
❑ lam 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.
❑ 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 I must
keep a copy of annual recertifications on file at the facility.
❑ 1 understand that in the event that the site no longer qualifies for a -No Exposure. Exclusion that.l must obtain coverage
under an NPDES permit prior to any,point source discharge of'stormwater fromthe facility.
❑ The information submitted inthis-NO1 is, to the best of knowledge and belief, true, accurate, and complete based on
my inquiry of the persor:orpersons who manage system, or those persons directly responsible forgathering the
_ 3
information_
Printed Name of Person "Signing:- n.f
Title: Clap-
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

State of North Carolina
Department of the Secretary of State
SOSID: 2477362
Date Filed: 8/26/2022 12:05:00 PM
Elaine F. Marshall
North Carolina Secretary of State
C2022 233 00165
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR LIMITED LIABILITY COMPANY
Pursuant to §57D-7-03 of the General Statutes of North Carolina, the undersigned limited liability company hereby applies for a
Certificate of Authority to transact business in the State of North Carolina, and for that purpose submits the following:
1. The name of the limited liability company isCarnbria DC Holdings, LLC
and if the limited liability company name is unavailable for use in the State of North Carolina, the name the limited
liability company wishes to use is
2. The state or country under whose laws the limited liability company was formed is MN, United States
3. Principal office information: (Select either a or b)
a. F1 The limited liability company has a principal office.
The principal office telephone number: [phone]
The street address and county of the principal office of the limited liability company is:
Number and Street:805 Enterprise Drive East Suite H
City: Belle Plaine State:MN Zip Code:56011-2345 County: Scott County
The mailing address, rf differentfrom the street address, of the principal office of the corporation is:
Number and Street:
City:
State: Zip Code: County:
b. ❑ The limited liability company does not have a principal office.
4. The name of the registered agent in the State of North Carolina is: CT Corporation System
5. The street address and county of the registered agent's office in the State of North Carolina is:
Number and Street:160 Mine Lake Ct Ste 200
City:Raleigh State: NC
Zip Code27615 County: Wake
6. The North Carolina mailing address, if different from the street address, of the registered agent's office in the State of North
Carolina is:
Number and Street:160 Mine Lake Ct Ste 200
City:Raleigh State: NC
BUSINESS REGISTRATION DIVISION
(Revised July 2017)
Zip Code:27615 County: Wake
P.O. BOX 29622
RALEIGH, NC 27626-0622
(Form L-09)

APPLICATION FOR CERTIFICATE OF AUTHORITY
Page 2
7. The names, titles, and usual business addresses of the current company officials of the limited liability company are:
(use attachment if necessary) (This document must be signed by a person listed in item 7.)
Name Title Business Address
James T. Ward Chief Financial 805 Enterprise Drive East Suite H Belle Plaine MN,
Officer 56011-2345 United States
8. Attached is a certificate of existence (or document of similar import), duly authenticated by the secretary of state or other official
having custody of limited liability company records in the state or country of formation. The Certificate of Existence must be
less than six months old. A photocopy of the certification cannot be accepted.
9. if the limited liability company is required to use a fictitious name in order to transact business in this State, a copy of the
resolution of its managers adopting the fictitious name is attached.
10. (Optional): Please provide a business e-mail address: Privacy Redaction
The Secretary of State's Office will e-mail the business automatically at the address provided above at no cost when a document
is filed. The e-mail provided will not be viewable on the website For more information on why this service is offered, please see
the instructions for this document.
11. This application will be effective upon filing, unless a delayed date and/or time is specified:
This the 19th day of August 1 2022
Cambria DC Holdings, LLC
Name of Limited Liability Company
James T. Ward Chief Financial Officer
Signature of Company Official
James T. Ward Chief Financial Officer
Type or Print Name and Title
Notes:
1. Filing fee is $250. This document must be filed with the Secretary of State.
BUSINESS REGISTRATION DIVISION P.O. BOX 29622 RALEIGH, NC 27626-0622
(Revised July 2017) (Form L-09)

2/13/23, 10:12 AM
160 International or NW - Google Maps
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160 International Dr NW
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