NCGNE0226_COMPLETE FILE - HISTORICAL_20180123

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE TJ HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ �UI � U I a�
YYYYMMDD

f f
Division of Energy, Mineral and Land Resources FOR AGENCY USE ONLY
e Date Received
Land Quality Section /Stormwater Permitting Program year Month Day
1�rr
NC®ENR National Pollutant Discharge l.limination System (NPDES)
NO TM CA OLIHA DE mEH of
Ro"�EM�oNatnA�REsa�Es PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
if NO CHANGE in company or facility ownership or name has occurred.
If a Name Change and/or Ownership Transfer at the facility has prompted this change, do
NOT use this form. You must fill out the Name-Ownership Change Form and provide all
necessary supporting documentation instead.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner
Affiliation") applies:
Individual Permit (or) Certificate of Coverage
„.N. C . !- N E 1 o 1 2 1 a I 6
2) Facility Information:
Facility name: D O t t-P r N e, E
Company/Owner Organization: q o V.V p
Facility address: 19 0-7 P( o In c til- 1X IA A PA aK4-jAy
Address
+j c- - - 27 It o
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
httpalportal.ncdenr.or,e/web/Ir/sw-permit-contacts and run the Permit Contact Summary Report.
3) OLD OWNER AFF[LIATION that should be removed: 11
Previous legally responsible individual: M c h a o o v er
First Ml Last
4) NEW OWNER AFFILIATION(Legally responsible for the permit):
Person Iegally responsible for this permit: S -l-e v e Qect 0
First M1 Last
P gEc-Ma a FAcILI_nES
Title.
76aB T►�a,2N O I k� � [�
RECEI /Et) Mailing Address
1/ Cl1EE+ispasa0 PC 09
JAN 23 2018 City State Zip
DNR-LAND �7 8 ~ g o 0 8
QupLITy Telephone r-mail Address
STpRMy�T R
PERMITTING ( )
Fax Number
Page 1 of 2
SVVU-0WNERAFF I L-22May2014

NPDESStormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
5) Reason for this change:
A result of: employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
What does"legally responsible person"mean?
That person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality,
State, Federal, or other public agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or the duly authorized representative of that person above.
......................:...............................................................................................
The certification below must be completed and signed by the permit
holder.
PERMITTEE CERTIFICATION:
1, S{C attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processed.
Z
Signature 6ate
.....................................
PLEASE SEND THE COMPI.,ETED FORM TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh,North Carolina 27699-1612
For more information or staff contacts, please visit our website:
http://portal.ncdenr.org/web/ir/stormwater
Page 2 of 2
SWU-0WNERAFFI L-22May2014

\NA7'LC Michael F.Easley,Governor
O 9aG William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
co F Alan W.Klimek,Y.E.Director
>_ Division of Water Quality
Q Coleen H.Sullins,Deputy Director
Division of Water Quality
April 20, 2005
TAPR
Ef}
of ENa
Ken Baker
2=alem
RF Micro ❑eVICeS Regicnai O'�ice
7625 Thorndike Rd
Greensboro, NC 27409
Subject: No Exposure Certification NCGNE0226
RF Micro Devices Packaging -7907 Piedmont Triad Pkwy
Guilford County
Dear Permittee:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on March 22, 2004. We apologize for the extended period it
has taken us to get back to you on this request and we appreciate your patience as we have worked through
this process. Based on your submittal and signed certification of no exposure at the above referenced facility
the Division is granting your certification as provided for under 40 CFR 126.22(g)which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of your no exposure certification, you are obligated to maintain n6
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no-exposure exclusion expires in five years (April 30, 2010). At that time you must re-certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your certification of no exposure does not affect your facility's legal requirements to obtain environmental
permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
for Alan W. Klimek, P.E.
cc: Winston-Salem Regional Office Central Files—wlattachments
Stormwater Permitting Unit Files
S
N(:DENR
N.C.Division of Water Quality f 617 Mail Service Center Raleigh,North Carolina 27699-1617 [phone] Customer Service
1-877-623-6748

{� \NA Michael P.Easley,Governor
�� 9v William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
r- flan W.Klimek,P.I:.Director
Division of Water Quality
Q t Coleen H.Sullins,Deputy Director
Division of Water Quality
April 20, 2005
Ken Baker
RF Micro Devices
7625 Thorndike Rd
Greensboro, NC 27409
Subject: No Exposure Certification NCGNE0226
RF Micro Devices Packaging - 7907 Piedmont Triad Pkwy
Guilford County
Dear Permittee:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on March 22, 2004. We apologize for the extended period it
has taken us to get back to you on this request and we appreciate your patience as we have worked through
this process. Based on your submittal and signed certification of no exposure at the above referenced facility
the Division is granting your certification as provided for under 40 CFR 126.22(g)which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of your no exposure certification, you are obligated to maintain no
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no-exposure exclusion expires in five years (April 30, 2010). At that time you must re-certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your certification of no exposure does not affect your facility's legal requirements to obtain environmental
permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact,Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
for Alan W. Klimek, P.E.
cc: Winston-Salem Regional Office Central Files—wlattachments
Stormwater Permitting Unit Files
f lrA
MCDENR
N.C. Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 [phone] Customer Service
1-877-623-6749

United States Environmental Protection Agency F❑ Approved
9 Y OMB No.2040-0211
NPDES rA Washington, DC 20460
FORM `mvt NO EXPOSURE CERTIFICATION for Exclusion from
3510-11 E PA
NPDES Storm Water Permitting
Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit authorization for its storm water
discharges associated with industrial activity in the Slate identified in Section B under EPA's Storm Water Multi-Sector General Permit due to the existence
of a condition of no exposure.
A condition of no exposure exists at an industrial facility when all industrial materials and activities are protected by a storm resistant shelter 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,
• industrial machinery,raw materials,intermediate products,by-products,final products,or waste 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 the following industrial materials and activities:
— drums,barrels,tanks, and similar containers that are tightly sealed, provided those containers are not deteriorated and do not leak. "Sealed"
means banded or otherwise secured and without operational taps or valves;
— adequately maintained vehicles used in rrialerial handling;and
—"Final products,other than products that would be mobilized in storm water discharges(e.g.,rock salt).
.A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In addition, the exclusion from NPDES permitting is'
available on a facility-wide basis only, not for individual outfalls. if any industriai activities or materials are or will he exposed to precipitation,the facility is
not eligible for the no exposure exclusion.
By signing and submitting this No Exposure Certification form,the entity in Section A is certifying that a condition of no exposure exists at its facility or site,
and is obligated to comply with the terms and conditions of 40 CFR 122.26(g).
ALL INFORMATION MUST BE PROVIDED ON THIS FORM.
Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4.
A. Facility Operator Info?mation
1. Name: IZIrt IMII 1cI1ZIgI I0IelyIV IclCj51— 1 1 1 I 1 _1 .1 1 1 1 1 1 _i 2.Phone: I31114 91-311 I8101YIa
3. Mailing Address: a.Street: 1 71 6 I a 1,6 I I-r I µ l o i R I N i 0 1 1 114 1 E7 1 I f-I d I R I D i I I 11 1 1 1 1 1 1 1 1
b.City: LIRIE161NISISIo & Io1 1 1 1 1 1 1 1 1 1 1 1 I c.State: jJI C d.Zip Code: 1711410 I-191 I ( I
B. FacilitylSfte Location Information
1. Facility Name: 11311 Mi I C i.si D i I D I E I V1 1 C S 1 IP IA IC If, I At G I t I o
2.a. Street Address: 11 i'l r0i hLiP I f 19 IV Irn 10 IN T R ! 1 R ID I IF 16 1 R w
b. City: . ICIR-I61CINIS Ia101 RIO I I I I I I I I I I I I I I c.County: Ca JU I t ILIFJOIX101
d.State: L,1 Gj e.Zip Code: I 17 1 4 1 0 1 1 1—I I I I
3. Is the facility located on Indian Lands? Yes No �✓`
4. Is this a Federal facility? Yes No ✓�
5.a. Latitude; 13 t 14 Ia,�]�- b. Longitude: (D 17 1`Ll 5 7 ITR I
6. a.Was the facility or site previously covered under an NPDES storm water permit? Yes No
b. If yes,enter NPDES permit number:
7.SIC/Activity Codes: Primary: 3�i 7i q! Secondary(if applicable): I I I I
8.-Total size of site associated with induslriai activity: S' S acres
9.a.Have you paved or roofed over a formerly exposed,pervious area in order to qualify for the no exposure exclusion? Yes No
b. If yes,please indicate approximately how much_area was paved or roofed over. Completing this question does not disqualify you for the no exposure
exclusion. However,your permitting authority may use this information in considering whether storm water discharges from your site are likely to have
an adverse impact on water quality,in which case you could be required to obtain permit coverage.
Less than one acre One to Five acres More than five acres
EPA Form 3510-11 (10-99) Page 1 of 4

NPDES e� NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
FORM \Sr,EPq OMB No.2040-0211
3510-11 NPDES Storm Water Permitting
C. Exposure Checklist
Are any of the following materials or activities exposed to precipitation,now or in the foreseeable future?
(Please check either"Yes"or"No"in the appropriate box.) If you answer"Yes"to any of these questions
(1)through(11),you are not eligible for the no exposure exclusion. _
Yes No
1. 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 storm water
2. Materials or residuals on the ground or in storm water inlets from spills/leaks
3. Materials or products from past industrial activity
4- Material handling equipment(except adequately maintained vehicles)
5. Materials or products during load inglu nice ding or transporting activities
6. Materials or products stared outdoors(except final products intended for outside use[e.g.,new cars]where
exposure to storm water does not result in the discharge of pollutants)
7. Materials contained in open,deteriorated or leaking storage drums,barrels,tanks,and similar containers
8. Materials or products handled/stored on roads or railways owned or maintained by the discharger
9. Waste material(except waste in covered,non-leaking containers[e.g.,dumpsters])
10. Application or disposal of process wastewater(unless otherwise permitted)
11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated
(i,e.,under an air quality control permit)and evident in the storm water outflow
D. Certification Statement
I certify under penalty of law that 1-have read and understand the eligibility requirements for claiming a condition of"no exposure"and obtaining an
exclusion from NPDES storm water permitting.
I certify under penalty of law that there are no discharges of storm water 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 submit a no exposure certification form once every five years to the NPDES permitting authority and,if requested,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 NPDES permitting authority,or MS4 operator where the discharge is into the local MS4,to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly avaiiabie upon request. I understand that I must obtain coverage under an NPDES permit prior
to any point source discharge of storm water from the facility.
Additionally, I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or
persons who manage the system, or those persons directly responsible for gathering the information,the information'submitted is to the best of my
knowledge and belief true,accurate and compiete. I am aware that there are significant penalties for submitting false information,including the possibility
of fine and imprisonment for knowing violations.
Print Name: 1 El I I I C I Hl 18 i U 1 91l<I E'I_II I l i t i I I I I I 1 1
Print Title: LI�_ 11NIyl1 iTZl0l^IIMIEIN171a1L1 _I_ lN�6,1 t INIEIEIt!I
Signature: /LR
Date: 101,31,( tglolyl
EPA Form 3510-11 (10-99) Page 2 of 4