NCGNE0889_COMPLETE FILE - HISTORICAL_20121030

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. IV C&IVEOW�
DOC TYPE IVHISTORICAL FILE
i MONITORING REPORTS
DOC DATE ❑ (�UIaI D�O
YYYYMMDD
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'IVA
MCDEN
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
October 30, 2012
TE Connectivity, Reidsville Road Campus
Attn: Becky Estep & Greg Jarrett
3700 Reidsville Road
Winston-Salem, NC 27101
Subject: No-Exposure Certification NCGNE0889
TE Connectivity, Reidsville Road Campus
3700 Reidsville Road, Winston-Salem, NC 27101
Forsyth County
Dear Ms. Estep:
The Division has reviewed your submittal of the No-Exposure Certification (NEC) for Exclusion from NPDES
Stormwater Permitting form. Based on your submittal and signed certification of no exposure at the above referenced
facility, as well as the on site visit conducted by Ron Boone, of the Division's Winston-Salem Regional Office, 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 NEC, 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. You must self re-certify annually using the self-
recertification form, or obtain NPDES permit coverage for any stormwater discharges from your facility. The annual
self re-certification does not need to be submitted to DWQ, unless requested. The annual self recertification form and
information may be downloaded from our Website at the following URL:
http://portal.ncdenr.oM/web/wq/ws/su/npdessw#tab-3
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.
Wetlands and Stormwater Branch One
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 NOI'thCal Ohna
t ovation:b N.Salisbury Raleigh,North Carolina 27604
Phone:919-8�07-63061 FAX::919-$07-64941 Customer Service:1.877-623-6748
Internet:www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Achon Employer

TE Connectivity, Reidsville Road Campus
Attn: Becky Estep&Greg Jarrett
No-Exposure Certification NCGNE0889
TE Connectivity,Winston-Salem, NC
October 30,2012
If you have any questions or need further information, please contact Ron Boone at (336) 771-4967, or at
[e-mail].
Sincerely,
fob Chuck Wakild, P.E.
Director
NC Division of Water Quality
cc: tWinston-Salem-Regianal_Offic—e----?
Stormwater Permitting Unit No- Exposure Files
i
i

FOR AGENCY USE ONLY
Dale Received
Division of Water Quality I Surface Water Protection veer maath oa
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NCGNE0000
NO EXPOSURE CERTIFICATION
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit based
on NO EXPOSURE:
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.
For permitted facilities in North Carolina, DWO 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.
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
stormwater 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 122.26(g).
You are required to self re-certify your No Exposure Exclusion annually.
For questions, please contact the DWO Regional Office for your area. (See page 6)
(Please print or type)
i) Mailing address of owner/operator{address to which all certification correspondence will be mailed):
Name .j n,n Ul'i
Contact 64 tft l
Street Address Ila Rl"dov"Ai- 14
City klir'41111 6611M State A/t ZIP Code 2
Telephone No. '31(. 7g 7.- Fax: 3:1G 727-S-6a1
Email l (ld
RECEIVED � U
N.C.aept.of ENR
. Page i of 7
SEP 2 8 2012 SEP 7 Zc�fz
SWU-NE-12Aug2010 + Winston-Salem
RegionalOffice Wand swr i''QU�t7-,
ateF Branch

NCGNEOOOO No Exposure Certification
2) Location of facility producing discharge:
Facility Name T E b d iyd - 1d Jj: Qd &do
i
Facility Contact B t
Facility Street Address PBID ✓, C O
City StateN_ZIP Code ,Z7/d/
County
Telephone No. JjG 1- 7- I�1 Fax: - �/ 797,- 611
Email arch-iAil - L- am
3) Physical location information:
Please provide a narrative description of how to get to the facility use street n mes, tate r numbers, and
distance and direction from a roadway intersection). ._ $u 4 YOZA I t , 1O AZ 'M mf
(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 i�(No
5) Is this a Federal facility? ❑ Yes )(No6) Latitude 36.1d� W Longitude -90. 1965 n {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
XExisting Date operation began H79
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes XNo
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:
Ill) Provide a brief descri t'on of types of indu trial activities and produ is gro uce¢at thi facility:
b �'mir�,` Sim< lfi li D II[Gt,411 h113
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
XINo
0 Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
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SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
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
'tvo
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 �WNo
c. Materials or products from past industrial activity ❑ Yes XNo
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes XNo
e. Materials or products during loading/unloading or transporting activities ❑ Yes DeNo
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes IR No
use [e.g., new cars]where exposure to stormwater does not result in the discharge
of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels,tanks, ❑ Yes jXNo
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by © Yes )rNo
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) • ❑ Yes XNo
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes C3eNo
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not a Yes >t'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 Pr 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 © Yes XNo
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 and piping free of rust, damaged or weathered coating, pits, or ❑ Yes ❑ No R(N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No VV N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
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 all single above ground storage .x,Yes ❑ No AINIA
containers (including drums, barrels, etc.) with a capacity of more than 660-
gallons?
b. Is secondary containment provided for above ground storage containers stored ❑ Yes ❑ No PcNIA
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund ❑ Yes ❑ No ),N/A
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances—designated in 40 X Yes ❑ No ❑ NIA
CFR §116?
e. Are release valves on all secondary containment structures locked? 1$Yes ❑ No ❑ NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes JrNo
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(1000 kg. or more of hazardous waste ❑ Yes (>t No
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stared:
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal vendor:
Vendor address:
Footnotes to Questions 14)c. &d.
'Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for de minimis amounts of certain substances,
and/or other qualifiers, as described in the exemptions from reporting requirements of Title III SARA 313 in 40 CFR
§372.38.
"Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for amounts less than the Reportable Quantities
of the hazardous substances listed in 40 CFR §117.3.
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NCGNE0000 No Exposure Certification
1 6) 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.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? ❑ Yes K'No
b. Does your facility have coal piles on site? ❑ Yes ;?'No
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes 9?�No
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity(e.g., [:] Yes X'No
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? 0 Yes 0 No KN/A
Please specify:
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
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NCGNE0000 No Exposure Certification
17) 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)),
understand that I am obligated to annually self re-certify No Exposure and, if requested,submit the re-certification to
DWQ or 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.
it J�
Printed Name of Per on Signin : 6ty I 101
Title: M
LAN
Jo z
(Signature of Appl t) ( ate 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.
North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation,or certification in any appiication,record,report,plan,or other
document filed or required to be maintained under this Article or a rule implementing this Article;or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article;or who falsifies,tampers with,or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
(Environmental Management]Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars($10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SWU-NE-12Aug2010

NCGNEOOOO No Exposure Certification
Final Checklist
This application should include the following items:
E/ This completed application and all supporting documentation.
d A map with the location of the facility clearly marked.
❑ If the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions,please contact the DWO Regional Office for your area.
DWO Regional Office Contact Information:
Asheville Office ...... [phone] Winiton Sale �
Fayetteville Office ... [phone] r �l sh !
Mooresville Office ... [phone]
Raleigh Office ........ [phone] , u� t le
Washington Office ...[phone]
Wilmington Office ... [phone]
F o Ilo �. ✓
Winston-Salem ...... [phone] �'
Central Office .........[phone]
Wil ngton
F
Page 7 of 7
5WU-NE-12Aug2010

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