NCGNE0569_COMPLETE FILE - HISTORICAL_20090317

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE ff/HISTORICALFILE
❑ MONITORING REPORTS
DOC DATE ❑ 5a)q
YYYYMMDD

RECEIVED
{ y N.C.DeDL of ENR
1 i
MAR l Z009
NCDENR
Winston-Salem i
North Carolina Department of Environment and Natural Resources Regional Office
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
March 13, 2009
Mr. Don Brown
Hanesbrands, Inc.
1000 E. Hanes Mill Road
Winston-Salem, NC 27105
Subject: No-Exposure Certification NCGNE0569
Almond Ridge Distribution Center
710 Almondridge Road, Winston-Salem, NC 27046
Forsyth County
Dear Mr. Brown:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater
Permitting form. Based on your submittal and signed certification of no exposure at the above referenced facility,
the Division is granting your conditional exclusion from permitting 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 (March 13, 2014). At that time you must re-certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your conditional exclusion from permitting 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 Jennifer Jones at [phone], or at
[e-mail].
Sincerely,
for Coleen H. Sullins
cc: Winston-Salem Regional Office
Stormwater Permitting Unit, No-Exposure Files
[Mecklenburg or Wake County, if appropriate]
Wetlands and Stormwater Branch
1617 Mail Service Center,Raleigh,North Ca€ol}na 27699-1617 NorthCarolina
Location:512-8 N.Salisbury\FA St.Raleigh,North Carolina r Service:
Naturally
Phone:[phone] FAX:[phone] Customer Service:1.877-623.67�t8 F i
Internet:www.r)cwaterquality.org
An Equal OpporFunity 1 Affirmative Achon Employer

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NCGNE0569 Hanesbrands, Inc.
Almond Ridge Dist. Center
N
Latitude: 360 13' 31" N
W E Longitude: 801 18' 12" W
County: Forsyth County '
S " Receiving Stream: Grassy Creek
Stream Class: C
Map Scale 1:15,219 Sub-basin; (Yadkin Pee-Dee River Basin) Facility location

Hanesbrands NCGNED569
Subject: Hanesbrands NCGNE0569
From: Rose Pruitt <[e-mail]>
Date: Fri, 27 Feb 2009 11:56:01 -0500
To:[e-mail]
Jennifer
OK to isCNOGNE0569 for anesbrands.
Rose Pr
NCDENR-DWQ Winston-Salem Regional Office
Division of Water Quality, Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
Voice: (336) 771-5000
FAX: (336) 771-4630
E-mail correspondence to and from this address may be subject to the
North Carolina Public Records Law and may be disclosed to third parties.
I of 1 2/27/2009 11:56 AM

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
March 13, 2009
Mr. Don Brown
Hanesbrands, Inc.
1000 E. Hanes Mill Road
Winston-Salem, NC 27105
Subject: No-Exposure Certification NCGNE0569
Almond Ridge Distribution Center
710 Almondridge Road, Winston-Salem, NC 27045
Forsyth County
Dear Mr. Brown:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater
Permitting form. Based on your submittal and signed certification of no exposure at the above referenced facility,
the Division is granting your conditional exclusion from permitting 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 (March 13, 2014). At that time you must re-certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your conditional exclusion from permitting 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 Jennifer Jones at [phone], or at
[e-mail].
Sincerely,
ORIGINAL.SIGNED BY
KEN PICKLE
for Coleen H. Sullins
cc: Winston-Salem Regional Office
Stormwater Permitting Unit, No-Exposure Files
[Mecklenburg or Wake County, if appropriate]
Wetlands and Stormwater Branch One
1617 Mail Service Center,Raleigh,North Carolina 27699.1617 North Carol i na
Location:512 Salisbury Si.Raleigh,North Carolina 27604 fah rall#
Phone;919-8-807fi3001 FAX:[phone] Customer Service:1-877.623-6748
Internet:www.ncwaterquality.org
An Equal opportunity L Affirmative AcEion Emptoyer

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NCGNE0569 Hanesbrands, Inc.
Almond Ridge Dist. Center
N
Latitude: 361 13' 31" N
W� " ' E Longitude: 800 18' 12" W
County: Forsyth County
S ' Receiving Stream: Grassy Creek
Stream Class: C
Map Scale 1:15,219 Sub-basin: (Yadkin Pee-Dee River Basin) Facility Location

Hanesbrands NCGNE0569
Subject: Hanesbrands NCGNE0569
From: Rose Pruitt <[e-mail]>
Date: Fri, 27 Feb 2009 11:56:01 -0500
To:[e-mail]
Jennifer
OK to issue NCGNE0569 for Hanesbrands.
Rose Pruitt
NCDENR-DWQ Winston-Salem Regional Office
Division of Water Quality, Surface Water Protection
585 Waughtown Street
Winston-Salem, NC 27107
Voice: (336) 771-5000
FAX: (336) 771-4630
E-mail correspondence to and from this address may be subject to the
North Carolina Public Records Law and may be disclosed to third parties.
1 of 1 3/3/2009 8:53 AM

® Division of Water Quality
n Division of Soil and Water Conservation
❑ Other Agency
Facility Number: Facility Status: Active Permit: NCGNE0569 ❑ Denied Access
Inspection Type: CompliancQ Eypluation Inactive or Closed Date:
Reason for Visit: Routine County: Forsyth Region: Winston-Salem
Date of Visit: 02125120013 Entry Time:08:45 AM Exit Time:09-15 AM Incident#:
Farm Name: Almond Ridge Distribution Center Owner Email:
Owner: Hanesbrands Inc Phone: [phone]
Mailing Address: 1000 E Hanes Mill Rd Winston Salem NC 27105 _
Physical Address: 710 Aimondridge Rd _ Rurgl Hall NC 27045
Facility Status: ❑ Compliant ❑ Not Compliant Integrator:
Location of Farm: Latitude: Longitude:
Question Areas:
Certified Operator: Operator Certification Number:
Secondary OIC(s):
On-Site Representative(s): Name Title Phone
On-site representative Don Brown Phone:
Primary Inspector: Rose Pruitt Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
site visit to evaluate for no exposure. ok to issue
Page: 1

Permit: NCGNE0569 Owner-Facility: Hanesbrands Inc Facility Number:
Inspection Date: 02/25/2009 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Page: 2

NCGNE0569 Hanesbrands, Inc.No exposure
Subject: NCGNE0569 Hanesbrands, Inc. No exposure
From: Jennifer Jones <Jennifer.Jones @nc mail.net>
Date: Fri, 30 Jan 2009 09:35:17 -0500
To: [e-mail]
Hi Rose,
We've received an NOI from Hanesbrands, Inc. (Almond Ridge Distribution Center) for
their site in Winston-Salem (Forsyth County) for coverage of their sand mine under
the No Exposure Cert. The site discharges stormwater into a UT to Grassy Creek. The
NOT is attached.
Does the Winston-Salem Regional Office have any concerns about issuing this facility
a cent. for no exposures? If we don't receive any objections, we'll issue the COC
in 30 days.
Thanks,
Jen
Jennifer Jones
Environmental Engineer
NCDENR I DWQ I Stormwater Permitting Unit
1617 Mail Service Center, Raleigh, NC 27699-1617
512 N. Salisbury St, Raleigh, NC 27604
Phone: (919) 807-6379
Fax: (919) 807-6494
Email: jennifer.jones0ncmail.net
Website: http://h2o.enr.3tate.nc.us/su
**E-mail correspondence to and from this address may be subject to the North
Carolina Public Records Law and may be disclosed to third parties.**
NCGNE0569 NOI. df Content-Type: application/pdf
i p Content-Encoding: base64
1 of 1 1/30/2009 9:52 AM

S Y
tic) StizD 1;1;1- t�5
• FOR AGENCY USt.ONLY
Division of Water Quality/Surface Water'Protection PcoerdficnV"�UnL��r
Date
I
ay
��QE�R National Pollutant Discharge Elimination System
NC N - 5
„ r�R N NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000
NO EXPOSURE CERTIFICATION Please check here if this i5 a renewal:-O REt EW.AL
National Pollutant Discharge Elimination System application for exclusion front a or m1w 244 >?ermi
based on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notice that your facility doe ire p6rrmi
authorization for its stormwater discharges associated the with industrial activity in State
Carolina because it qualifies for a no exposure exclusion.A condition of no exposure at an in ill
facility means all industrial materials and activities are protected by a storm resistant shelter(with some
exceptions)to prevent exposure to rain, snow, snowmelf,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 with locked or non-operational taps or valves;
adequately maintained vehicles used Sri material 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 industrial activities or materials are, or will be,exposed to precipitation, the
facility is not eligible for the 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 12226(g).
You must re-apply for the No Exposure Exclusion once every five (5) years.
For questions,please contact the DWQ Regional Office for your area_ (See page 5)
I
Y (Please print or type)
' 1) Mailing address lof�wnerloperator(address to which all certification correspondence will be mailed):
Name L/ HAN(1!-_ S b KAfl J D S �J G
Contact n O N Ko wt�/
Street Address G EL A.l e-
s l�l LL /Z Gf 17
City \r.J_g4 5:10 t-f .SA State C ZIP Code ��] o 37
N Telephone No. 3(. .5 l9 - 5E 10 Fax: -3 E sl`� - 27 G,j^
2) Location of facili �ALP-\OWD
roducing discharge:
Facility Name Ri1Dt-E- b(STtt1 Gt;(Gr�� CF_AJ' � R
Facility Contact _SKI�' O LE_ SACS C Z Y K
Street Address A/_(1t O 1J D f I r� 6-1,7-.
City \,)i tj-S 7-0N- S AI-E-f.\ State ZIP Code 'Z-1 O 4 5-
County 1=0 N
Telephone No. 33 `b 4 Fax:
Page 1 of 5
SWU-NE-060508 Last revised 06/0512008

NCGNE0000 No Exposure Certification
3) Physical location information:
Please provide a narrative description of how to get to the facility(use street names, state road numbers, and
distance and direction from a roadway intersection). �JS yi_ 1vo l _-vl t x 1T B ffTF{�{ �(A
��4La�L NULL R� D fkZDCOF-4 D No2TAt- TO b j2pA, tS o1✓ K1&+FF
(A copy of a map with the facility clearly located on it should be included with the certification application-)
4) Is the facility located on Native American Lands? ❑ Yes X No
5) Is this a Federal facility? ❑ Yes )(No
6) Latitude 3 13 3) Longitude -80 d r 4_: (deg.,min.,seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
,1 New or Proposed Facility Date operation is to begin _[__d { Z
❑ Existing Date operation began
. ❑ Renewal of existing No Exposure Certification- Certification No.: NCGNE
- 8) Was this facility or site ever covered under an NPDES stormwater Permit? ❑ Yes %No
If yes,what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility V 01_ �
SIC Code: 3 2- 2
10) Provide a brief description of the ty of industrial activities and products produce at this facility:
ACiL t_r {S A D1STR� f'�cl fc� tJ CAN C'� olt
11) Does this facility have any Non-Discharge permits(ex: recycle permits)?
^No
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
Exposure Checklists(12. - 14.)
12) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable
future? (Please check either"Yes"or"No.") If you answer "Yes" to any of these items, you are not
eligible for the no exposure exclusion.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes XNo
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes X No
c. Materials or products from past industrial activity ❑ Yes )(No
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes KN0
e. Materials or products during loading/unloading or transporting activities ❑ Yes XNo
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes X No
use[e.g., new cars]whore exposure to stormwater does not result in the discharge
of pollutants)
Page 2 of 5
SWU-NE-060508 Last revised 06/05/2008

NCGNEOOOO No Exposure Certification
g. Materials contained in open,deteriorated or leaking storage drums, barrels,tanks, ❑ Yes )(No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes XNo
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g.,dumpsters]) ❑Yes X No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes P(No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ' No
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes No
(i.e., not closed and stored upside down to prevent precipitation accumulation) •;
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers 0 Yes l No
stored outside, has the facility had any releases in the past three (3) years?
13) Above Ground Storage Tanks(ASTs): If you answer"No"to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust,damaged or weathered coating, pits,or )(Yes 0 No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any XYes ❑ No
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
14) Secondary Containment: If you answer"No" to any of the following items,you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for single above ground storage containers ` Yes ❑ No
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored XYes ❑ No
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for any amount of Title III Section 313 xYes ❑ No
Superfund Amendments and Reauthorization Act(SARA)water priority
chemicals?
d. Is secondary containment provided for An
I amount of hazardous substances? )(Yes ❑ No
e. Are release valves on all secondary containment structures locked? Yes ❑ No
15) Hazardous Waste:
Page 3 of 5
SWU-NE-060508 Last revised wosi2008

,. NCGNE00O0 No Exposure Certification
a. is this facility a Hazardous Waste Treatment, Storage,or Disposal Futility? ❑ Yes KNo
b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste ❑ Yes X,No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator(i 000 kg. or more of hazardous waste ❑ Yes 00
generated per month) of hazardous waste?
If you answered yes to questions h_or c_,please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal vendor:
Vendor address:
16) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of"no
exposure"and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that 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 122.2E(g)(2)).
I understand that f am obligated to submit a no exposure certification form once every five(5)years to the North Carolina
Division of Water Quality 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 North Carolina Division of Water
Qualify,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 available upon request.
In the event that the site no longer qualities for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater 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 complete. I am aware
that there are significant penalties for submitting false information,including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and
belief such information is true, complete, and accurate.
Printed Name of Person Signing:_Ctfk)G ALLEiS
Title: t
��& ll
(Signature of Applicant) (Date Signet!)
Please note. This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
Page 4.of 5
5WU-NE-060508 Last revised 0610512008

i000 E. Hanes Mill Road
Winston-Salem,NC 27105
336 918 7056 tel
HANESbYL ndsINC
November 14, 2008
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service
Raleigh, NC 27699-1617
Re: No Exposure Certification for Exclusion
Dear Sirs and Madams:
Please find enclosed a completed No Exposure Certification for the Annapolis Distribution Facility
of Hanesbrands Inc.
Sincerely, � `�
YY
ffNO�Don Brown �-��
Environmental Manager s d ��j
H I

FOR AGENCY USt ONLY
Rece+ on o ua
Quality Y
' • Divisif Water lit 1 Surface Water Protection ea Month Date Month ved
Day
NCDENR National Pollutant Discharge Elimination System CutifieaeofCoverage
NICIGINIE1015161
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000 0
NO EXPOSURE CERTIFICATION Please check here if this is a renewal: .0-RENEi
AL
National Pollutant Discharge Elimination System application for exclusion from ormw�t2Y P mi
based on NO EXPOSURE: w FH,Q, �
�. 0
Submission of this No Exposure Certification constitutes notice that your facility doe ; e U re p rmi
authorization for its stormwater discharges associated with industrial activity in the State o
Carolina because it qualifies for a no exposure exclusion. A condition of no exposure at an in
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,
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 with locked or non-operational taps or valves;
adequately maintained vehicles used in material 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 industrial activities or materials are, or will be, exposed to precipitation, the
facility is not eligible for the 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 122.25(g).
You must re-apply for the No Exposure Exclusion once every five (5) years.
For questions, please contact the DWQ Regional Office for your area. (See page 5)
(Please print or type)
1) Mailing address'ofPwner/operator (address to which all certification correspondence will be mailed):
Name HAN 2 S b kA J D S C-
Contact D O N `�s RO k!N
Street Address 17-- A-N e_S 11-t I LL 0A4-b
City InJ(tJ5Tot-J- SA LI=—(vN State C ZIP Code 2_7 0
Telephone No. rr�od�uc�ing
.SI�J S6 10 Fax: 3- 3�— v�l� - 27 0 j
2) Location of facil discharge:
Facility NameoN D RtT)G—s ( c Rt 3L s (off
Facility Contact — —Ki P O LE TAR C? K
Street Address `Z/—O A4M o N D-f 16_C-,e /\G A-I _
City W_I_hJ ST0 N- S AL-_E_AV\- - - State �J C= ZIP Code O -4 S
County I=0 R S
Telephone No. 334 _T 19 - ����� Fax:
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NCGNE0000 No Exposure Certification
3) Physical location information:
Please provide a narrative description of how to get to the facility(use street names, state road numbers, and
distance and direction from a roadway intersection). U-5 S�) NQ rL, , F-?�rT 3ET4+A-1j1F-
Rv4tA,L tjA-1_L.. ArD , jpk�O _OF-_49D _NorzT iZD �Z e&r,e,;, or✓ P,k6- —
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes X No
5) Is this a Federal facility? ❑ Yes XNo
6) Latitude 3� � 13 3 Longitude - 80 r'G IZ (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
New or Proposed Facility Date operation is to begin TO ) �d I_z O
❑ Existing Date operation began
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes %No
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 3 2 2--
10) Provide a brief description of the types of industrial activities and products produced at this facility:
-r- j=-A C(L F-y (s A D t STft k 0 N Cr=N c iZ Fa IL
F(r.rt5 h+E 1> TE xTc L E- P R 0 b0C-l S -
11) Does this facllity have any Non-Discharge permits (ex: recycle permits)?
ANo
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
Exposure Checklists(12. - 14.)
12) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable
future? (Please check either "Yes" or "No.") If you answer "Yes" to any of these items, you are not
eligible for the no exposure exclusion.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes XNo
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes )(No
c. Materials or products from past industrial activity ❑ Yes )(No
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes No
e. Materials or products during loading/unloading or transporting activities ❑ Yes )(No
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes No
use [e.g., new cars) where exposure to stormwater does not result in the discharge
of pollutants)
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NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes )(No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes )l(No
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes X No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes �I(No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes No
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes YNo
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes [ No
stored outside, has the facility had any releases in the past three (3) years?
13) Above Ground Storage Tanks(ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or )(Yes ❑ No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any XYes ❑ No
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
14) Secondary Containment: If you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for single above ground storage containers XYes ❑ No
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored XYes ❑ No
in close proximity to each other with a combined capacity of more than 1,320-
gailons?
c. is secondary containment provided for amount of Title III Section 313 XYes ❑ No
Superfund Amendments and Reauthorization Act (SARA) water priority
chemicals?
d. Is secondary containment provided for gny amount of hazardous substances? )(Yes ❑ No
e. Are release valves on all secondary containment structures locked? Yes ❑ No
15) Hazardous Waste:
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NCGNEOOOO No Exposure Certification
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes kN0
b. is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes )(No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes 10
generated per month) of hazardous waste?
It you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal vendor:
Vendor address:
16) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of"no
exposure"and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that 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 submit a no exposure certification form once every five (5)years to the North Carolina
Division of Water Quality 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 North Carolina Division of Water
Quality, 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 available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater 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 complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and
belief such information is true, complete, and accurate.
Printed Name of Person Signing: [`f+uc iK A-LLc-NI
Title: f
(Signature of Applicant) (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
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SWU-NE-060508 Last revised 06/05/2008

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