NCGNE1658_Application_20240105

FOR AGEN Y USE ONLY Revised 10/6/2023
NCGNE 15%
Assigned to: S. C00W
ARO FRO MRO RRO WARO WIRO SR
Division of Energy, Mineral, and Land Resources aka
6
National Pollutant Discharge Elimination System
No Exposure Certification for Exclusion
N CG N E0000
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)tqualifies 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 deteriud 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 Until you are issued a No Exposure Certification and your NPDES permit is rescinded,yourfacility must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://deg.nc.gov/about/divisions/energV-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):
Meyer Laboratory,Inc. William Godwin
Mailing address: City: State Zip Code
2401 NW Jefferson Street Blue Springs MO 64015
Telephone number: Email address:
816-228-4433 [e-mail]
Type of Ownership:
Government
❑ County ❑ Federal ❑ Municipal ❑ State
Non-government
8 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:
Meyer Laboratory Frank Russo
Street address: Telephone number:
111 Woodside Drive 980-621-6555
Email address:
[e-mail]
City County State Zip Code
Lexington Davidson NC 27295
Latitude of entrance: 35.771881
Longitude of entrance: -80.312591
Parcel Identification Number(PIN):
6713-01-08-6683
Date operation began: Standard Industrial Classification(SIC)Code:
Estimated February 2024 3589-06
Brief description of the types of industrial activities and products produced at this facility:
Manufacturer of industrial cleaning chemicals. Mixing of raw materials and bottling finished products.
3. Consultant(if applicable):
Name of consultant: Consulting firm:
Greg Kanellis Hart&Hickman,PC
Street address: City: State and zip code:
3921 Sunset Ride Road Suite 301 Raleigh NC 27607
Telephone number: Email address:
919-723-2512 [e-mail]
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 G No❑ N/A
stormwater
Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑Yes G No❑ N/A
Materials or products from past industrial activity ❑Yes G No❑ N/A
Material handling equipment(except adequately maintained vehicles) ❑Yes Q No❑ N/A
Page 2 of 5

Materials or products during loading/unloading or transporting activities ❑Yes 8 No❑ N/A
Materials or products stored outdoors(except final products intended for outside use[e.g.,new ❑ Yes 8 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 44 No❑ N/A
Final products that would be mobilized in stormwater discharges(e.g.,rock salt) ❑ Yes 8 No❑ N/A
Waste material(except waste in covered,non-leaking containers[e.g.,dumpsters]) ❑ Yes 8 No❑ N/A
Application or disposal of process wastewater(unless otherwise permitted) ❑Yes 8 No❑ N/A
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise ❑Yes 8 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 8 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 8 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 fregof'rust,damaged or weathered coating,pits,or deterioration,or ❑Yes❑ No E4 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 aboveground storage containers(including drums, gYes❑ 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 gYes❑ 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
Reauthorization Act(SARA)water priority chemicals? g Yes❑ No ❑ N/A
Is secondary containment provided for hazardous substances designated in 40 CFR§116? gYes❑No ❑ N/A
Are release valves on all secondary containment structures locked? ❑Yes❑No G 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 8 No❑ N/A
Does this facility store used,recycled,or otherwise reclaimed pallets outside? ❑ Yes 8 No❑ N/A
Does this facility have coal piles on site? ❑ Yes 8 No❑ N/A
Does this facility store other fuel sources outside in piles,such as wood chips,sawdust,etc.? ❑ Yes G No❑ N/A
Page 3 of 5

Does this facility have air emissions associated with industrial activity(e.g.,degreasing operations, ❑ Yes G 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 mont �S
• T of waste:
• Howow material is stored:
• Where material is stored:
• Number of waste shipments per year;
• Name of transport/disposal vendor: in,114!1!),11 i11r.1lily
• 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):
8 Check for$250 made payable to NCDEQ
8 Copy of most recent Annual Report to the NC Secretary of State(if applicable)
GThis completed application and any supporting documentation
8 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 143-215.6E(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:
ER 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.
® 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 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.
® 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 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 Na of Person Signing: {✓ GVO'�OF4eo
Title: CX.t�OPLra�� �'�Cr
��Y��aikftit'f+tif '=,5� �tlrtRti'i'IfSl17(8),t� ��1#.R�1t}
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 5 of 5

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,Program,,Gt5ographic Names Infdrtnation System,National Hytlrography
Dataset NaLonal,Lantl Cover Database,National Structures Dataset,and
National Transportation Dataset USGS Global Ecosystems;U.S.Census
Bu eau TIGER/Line data;USFS Road Data;Natural Earth Data;U.S.
Department of Stale Humanitarian Information Unit and NOAA National
i /Centers for Environmental Information, U.S.Coastal Relief Model. Data
4nwo t--�" refreshed April,2023.
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a 0 2000, 4,000 SITE LOCATION MAP
® SCALE IN FEET MEYER LABORATORY
g 111 WOODSIDE DRIVE
's LEXINGTON, NORTH CAROLINA
U.S.G.S. QUADRANGLE MAP 14 1921 Sunset Ridge Road,Suite 301
hart 'hiii, hiekman Raleigh,North Carolina 27607
LEXINGTON WEST, NORTH CAROLINA 2023 Iitense C.1tpI 9e C-245 eolo
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QUADRANGLE DATE: 12-27-23 REVISION NO: 0
7.5 MINUTE SERIES (TOPOGRAPHIC) JOB NO: MEY-001 I FIGURE NO. 1

BUSINESS CORPORATION ANNUAL REPORT
r,Q2D22
NAME OF BUSINESS CORPORATION: Meyer Laboratory,Inc.
t77677ti Fuing Office Use Only
SECRETARY OF STATE ID NUMBER: STATE OF FORMATION: MO E-Filed Annual Report
1776770
REPORT FOR THE FISCAL YEAR END: 12/31/2022 CA202308001273
3/21/2023 10:33
SECTION A:REGISTERED AGENT'S INFORMATION 0 Changes
1. NAME OF REGISTERED AGENT: Northwest Registered Agent Service, Inc.
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
4030 Wake Forest Road, Ste 349 4030 Wake Forest Road, Ste 349
Raleigh, NC 27609 Wake County Raleigh, NC 27609
SECTION B: PRINCIPAL OFFICE INFORMATION
1.DESCRIPTION OF NATURE OF BUSINESS: Janitorial Supplies& Cleaning Chemicals for Resale
2.PRINCIPAL OFFICE PHONE NUMBER: [phone] 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction
4.PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
2401 NW Jefferson 2401 NW Jefferson
Blue Springs,MO 64015 Blue Springs,MO 64015
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: William Meyer NAME: NAME:
TITLE: President TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
2401 NW Jefferson ---
Blue Springs,MO 64015
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
Britt Meyer 3/21/2023
SIGNATURE DATE
Form must be signed by an officer listed under Section C of this form.
William Meyer President
Print or Type Name of Officer Print or Type Tide of Officer
This Annual Report has been filed electronically.
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27626-0525