NCGNE1652_Application_20231204

FORAGE Y UGSE ONLY Revised 10/6/2023
NCGNEEN ,—
Assigned to: S. C0016161
ARO FRO MRO RRO ARV WIRO WSRO
Division of Energy, Mineral, and Land Resources
National Pollutant Discharge Elimination System 4-
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 Until you are issued a No Exposure Certification and your NPDES permit is rescinded,your facility must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).
NC DEQ Stormwater Program requires a one-time$250 application fee via check made payable to NC DEQ. There
is no annual fee once covered under a No Exposure Certification. 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:Hdeg.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.Owne-r/Operator(to_whom-all_permit-correspondence_will-be-nailed)
Name of legal organizational entity: Legally respo ible erson(as signed in Item 7 below):
Hosokawa Custom Processing Services LLC RAY
Mailing address: City: State Zip Code
400 Challen Court Goldsboro NC 2-'53N'
Telephone number: Email address:
430 - a5© I voor llnc . .c
Type of Ownership:
Government
❑ County - ❑ Federal ❑ Municipal ❑ State
Non-government
EXBusiness(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:
Hosokawa Custom Processing Services Rob Voorhees
Street address: - Telephone number:
400 Challen Court, Goldsboro, NC [phone]
Email address: -
[e-mail]--- ------- — .—
city County-•" State Zip Code _
Goldsboro _Wayne North Car_o_lina 27534
Latitude of entrance: 35:3847222
}:y
Longitude of entrance:f 77 9930556
Parcel Identification Number(PIN):.--•-- - �+
35292.11787 - - -
Date operation began: :Standard Industrial Classification(SIC)Code" }'
August 2023 'SIC/NAICS 8999/54.1990.+ '
Brief description of the types of industrial activities and products produced at this facility-,---
Toll processing of chemicals, Minerals and polymers
3. Consultant(if applicable):
Name of consultant: Consulting firm:
Not applicable
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 ❑Yes M No ❑ N/A
stormwater
Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes ® No ❑ 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 2 of 5

Materials-or-products.dudng_loading/_unloading.or-transporting_activities. _... _ _. Yes-E-No-❑-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 ❑ N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger ❑ Yes ® 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 ® No ❑ N/A
Application or disposal of process wastewater(unless otherwise permitted) ❑Yes lR No ❑ N/A
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise ❑Yes ® 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 El 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 fo?the no exposure exclusion.'`
Are exterior ASTs or piping free,ofrust,damaged or,weathered coating,pits,.or deterioration,or
evidence of leaks? - - - - ®Yes❑'No ❑ N/A
Is secondary containment provided for all exterior ASTs?If so,is it free of any cracks,holes,or
evidence of leaks,and are drain-valves-maintained locked shut? ®Yes No ❑ N/A
Is secondary+containment.provided for single above ground storage containers(including drums,
barrels,etc.)with a capacity of more than 660-gallons? `- ❑Yes❑No Gcl N/A
Is secondary containment provided for above ground storage containers stored in close proinmity� ❑Yes El 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 ® N/A
Reauthorization Act(SARA)water priority chemicals?
Is secondary containment provided for hazardous substances designated in 40 CFR§116? ❑Yes❑No IN N/A
Are release valves on all secondary containment structures locked? ❑Yes❑No [N 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? ❑Yes Q No ❑ N/A
Does this facility have coal piles on site? ❑ Yes ® No ❑ N/A
Does this facility store other fuel sources outside in piles,such as wood chips,sawdust,etc.? ❑ Yes ® No ❑ N/A
Page 3 of 5

DDes-this-facility.haveair-emissions.associated-with-industrial-activity-(e.g,degreasing-operations,— Yeses-No-❑--N/A—
plating, painting,or metal finishing)?
If yes:
Describe the industrial activity:Toll processing of chemicals, Minerals and polymers
Are those emissions permitted by an Air Quality Permit? IN 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'-
-- - `-- '- -"-- --'- -
Ifchecked,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: a
• Name of transport/disposal vendor.. ,i j
• 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):
IN Check for$250 made payable to NCDEQ
_®.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 4 of 5

7. Applicant Certification
North Carolina General Statute 143-215.66(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:
® 1 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.
® 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)).
® 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.
® 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
information.
Printed Name of Person Signing: Rob Voorhees
Title: �reS G(ev`-�'
2/ pL3
Signat r of Applicant Date igne
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 LIMITED LIABILITY COMPANY ANNUAL REPORT
�r�zou
NAME OF LIMITED LIABILITY COMPANY: Hosokawa Custom Processing Services LLC
Filing Office Use Only
SECRETARY OF STATE ID NUMBER: 2209789 STATE OF FORMATION: NC E-Filed Annual Report
2209789
CA202310305598
REPORT FOR THE CALENDAR YEAR: 2023 4/13/2023 12:47
SECTION A:REGISTERED AGENT'S INFORMATION ❑Changes
1. NAME OF REGISTERED AGENT: CT Corporation System
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
160 Mine Lake Ct Ste 200 160 Mine Lake Ct Ste 200
Raleigh, NC 27615 Wake County Raleigh NC 27615
SECTION B:PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Toll processing Ot pOWderS
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
400 Challen Ct 10 Chatham Road
Goldsboro, NC 27534 Summit, NJ 07901
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:COMPANY OFFICIALS(Enter additional company officials in Section E.)
NAME: Rob Voorhees NAME: Deborah A Scott NAME: ,John McGovern
TITLE: President TITLE: Managing Member TITLE: Manager
ADDRESS: ADDRESS: ADDRESS:
10 Chatham Road 10 Chatham Road 10 Chatham Road
Summit, NJ 07901 Summit, NJ 07901 Summit,NJ 07901
SECTION D:CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Deborah A Scott 4/13/2023
SIGNATURE DATE
Forth must be signed by a Company Official listed under Section C of This form.
Deborah A Scott Managing Member
Print or Type Name of Company Official Print or Type Title of Company Official
SUBMIT THIS ANNUAL REPORT WITH THE REQUIRED FILING FEE OF$200.00
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27626-0525

SECTION E: ADDITIONAL COMPANY OFFICIALS
NAME: Judi MacGregor NAME: NAME:
TITLE: Manager TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
10 Chatham Road
Summit, NM 07901
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: Name:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:

A.°E Golf�s — Certificate of Occupancy
City of Goldsboro
200 N.Center Street Goldsboro,INC 27530 (919)5804389
Department of Inspections,Planning,and Engineering
9JH CAR �
The work authorized by the permit listed herein has been completed and approved by the
City of Goldsboro Inspections Department.
Permit Type: Commercial Permit C.O. Number: TCOPMACT-004290-07-23Y
Work Class: Interior Upfit Bldg. Permit No. COMM-07-22-058610
Construction Type: Tvoe II Date C.O. Issued 7/7/2023 12:00:OOAM
Project Location: 400 Challen Ct Parcel Number: 3529211787
Owner: Chip Crumpler COUNTY OF WAYNE Contractor: JACKSON BUILDERS INC
Description of Work App#236240-Hosokawa fit-up existing shell building-TCO ISSUED 7/7/2023
InspectionDep/ t)mentSiignatu �s�
Building Code: C "0 ( C�.—�t-.
Electrical Code:
eating Code: -
Plumbing.Code: 0
Air Conditioning ode:
ire Code:
ngineering:
tanning: t
Non Transferable
POST IN A CONSPICUOUS PLACE

��� ! I`i[T V '(EIY�i ir'bU avy49P
' Da]: .5°c0:.1CCC G P'n
-`s Wmv.11 J iPSM F 1G ?9A J,
/ M PS G JL C LA is IJ P."l• dGO
) ( $1 � 3��E
x '
a'
"i o ft'�FE—1 1 e GI
° 1
GO
GO
. ay ik:,� III II 2
.,,m II
PROPOSED 50,277SF FUTURE BUILDING I $ ;
SHELL BUILDING EXPANSION
W
U)
I 1 N
1 I C7
J I i Z Q
Ql --------- ° I s
° nrnTrt W 7
TRn It
T 1 W GO
I Ill liii ll li n"iil i i �/ I
I - I I I I 11111J 11 11 1 �� F J
xso 1 I I I I I I ` J W
NpEpu yM HuwL[a�M 11 I I I I I I
I h
mu[PER 111J YIyL ILIy L11� 1
�" • Illil Il lillll % ❑
° ( ) I 11B 11111J LL1111J1J Q ZF
TIT n'1 Tn'f1T nl�`i I'-j j jI r1T IL/ I o_
F n T IT n l r rrt nl I I I I 1 II 11 ; 1 I >
f 1 Nna 11 I I I 1 I l l i 1 I I 1 I M`°MXx°Somas �'• Q O F
U� 1 Q1 pmry 1111 1l llllll '\ I >
• �o I ,R O�V'11�•� 1111111111Y11 IJ 11J Ly IJ1111 1 U, }
yL
ILIL1l1l 1LJ Y11L nT TT;Tn� I / F Q
_ ym fIT nTIT TjTrt jjT11\ I1 11ii I1II11IL/ I f9• 3
U_ ���� �1111 1111 II IIIIIII
C_- II1111111 �p6
[ Iiuy�y� l'yiiu Ylil � I /•
IJ 11 � 11 � I
j �f ^ly lJ 1111J J LL IJ 111 I $ I
ICI
II f 2 f /.•
I I f
GAI-EWAYDRIVE
(yIFLroLtifi5,1 l
I $`
C$.l)
e
I

i
North Carolina INVOICE
Zt_ !_!MDEQ03§ Department-of Environmental-Quali - - -
°.a�Q.knn Annual Air Permit Fee
Rlr,,CF�gVE�I3
Invoice Date: 11/16/2023
Hosokawa Custom Processing - Invoice No.: 76503
10 Chatham Road NOV 2 0 2023 Facility ID: 9600284
Summit,NJ 07901 n r I/ Permit No.: 10706
1 /{("4/-�/ Federal Tax ID:
13Y; - Anniversary Month: October
Permitted Site: Hosokawa Custom Processing Services LLC
Due Date: 12/17/2023
Pursuant to l5A�NCAC 2Q.0103,the
_ Perminee is charged an Annual Pcmdr Fee Description Fee
for the period 1012023 through 912024. Synthetic Minor Basic Permit Fee $1,500.00
For Tide Vfacili(ies,the reverse ofthlspage
shows detailed listing bleeon( vk 2v2b
pollutant nnissimsfor the 2019 calendar
year V� G✓/l( ,• ( and a calculation ofrhe complerilyfee.
Effective Norember 18,2011,1Q.0203 ryas
amended to include(he cnnrplesi0•fee as well Compliance Discount -$375.00 -
as an increase in the basic permit fee and the -
mnnagefee:.Additionally,all onnualfees
listed ar'esubject rb an annual consurnerprice Net Annual Fee* $1,125.00
i, ardee(CPI)adjusiment effective Januan•I of
each rearteursuanr to 15A NCAC 2Q.0304. - - - -
.. 'THISAMOVNTIS DUE B]'THE DUE DATE LISTEDABOVE. IFTIIE PAIMENTIS VOT
RECEIVED BYTHAT DATE,THE PERMIT REVOCATIONPROCESS WILL BE INITIATED.
I NOTE:An emission inventory is conducted annually in North Carolina for all Title V and additional selected facilities: For
facilities other than Title V,. this(calendar year)requirement must be fulfilled When the permit renewal application is due.(90'days
prior to permit expiration): You should expect,to receive a reminder/notification to report emissions(and further specifications for
I� I • the inventory)180 days prior to permit expiration. You Must maintain your records adequately so you can provide the emission
estimates when required. General instructions and information fire maintained at https:/Ideq:nc.gov/about/divisions/air-quality/
I air-quality-data/general-inforination-for-emission-inventories.
Questions concerning this invoice?Please contact Jennifer-McHone Sides at 252-946-6481 or Betsy Huddleston at 252-946-6481.
1
(KEEP THIS POR TIO.N FOR FOUR RECORD)
(RETURN THIS POR TION IVITH CHECK) —
Make Check Payable to: Department of Environmental Quality This payment may also be made online
Please send check and this portion of invoice in the enclosed return envelope to:, by Credit Card,Debit Card or eCheck.
(See reverse for details.)
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF AIR QUALITY BUDGET OFFICE -- ----
1641 MAIL SERVICE CENTER Invoice Amt.: $1,125.00
RALEIGH,NC 27699.1641
Due Date: 12/17/2023
In accordance with the North Carolina General Statute 25-3-506, Facility ID: 9600284
a$35.00 processing fee will be charged for returned checks. permit No.: 10706
Federal Tax ID: Invoice No.: 76503
HOSOKANVA CUSTOM PROCESSING Invoice Date: 11/16/2023
10 CHATHAM ROAD
SUMMIT,NJ 07901 Check Amount
ATTN: ROB VOORHEES OR ACCOUNTS PAYABLE Check No.