NCGNE0951_COMPLETE FILE - HISTORICAL_20160204

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE C/HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ �UI ���o� D
YYYYMMDD

PAT MCCRORY
a Governor
DONALD R. VAN DER VAART
Secrelary
Energy,Mineral
and Land Resources TRACY DAVIS
ENVIRONMENTAL OVALITY
February 4, 2016 Direaur
Mr. Andrew Coffey
Hancock & Moore, LLC
P.O. Box 3444
Hickory, NC 28603
Subject: Name/Ownership Change Request
No Exposure Certification NCGNE0951
Hancock & Moore, LLC
Formerly RHF-HM, LLC
Guilford County
Dear Mr. Coffey:
The Division has reviewed your submittal of the permit name/ownership change form for the
subject No-Exposure Certification, which we received on December 29, 2015. Division
personnel have reviewed and approved your request to transfer the exclusion from NPDES
stormwater permitting requirements.
Please note that by our original acceptance of the No-Exposure Certification and by our
approval of your request to transfer it, you are obligated to maintain no-exposure conditions
at your facility. If conditions change such that your facility can no longer qualify for the 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.
Annual re-certification is required, and we have enclosed one blank Annual No Exposure
Exclusion Self Re-Certification form for your use. 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.
State of North Carolina J Environmental Quality I Energy,Mineral and Land Resources
1612 Mail Service Center 1 512 North Salisbury Street I Raleigh,North Carolina 27699-1612
919 707 9220 T

If you have any questions or need further information, please contact the Stormwater
Permitting Program at(919) 707-9220,
Sincerely,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land
Resources
cc: Winston-Salem Regional Office
Stormwater Permitting Program Files
Central Files

Division of Energy, Mineral & Land Resources FOR AGENCY USE ONLY
ua y Secon/Stormwat P er ermittin r Date Received
Land Quality} ti �, Year I Month I Day
National Pollutant Discharge Elimination System
NC®ENR
E---N-FZE-� PERMIT NAMEIOWNERSHIP CHANGE FORM
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C S O N G G N E 0 9 5 1
II. Permit status prior to requested change.
a. Permit issued to (company name): RFIF-I-IM, LLC
b. Person legally responsible for permit: Thomas J O'Connell
First Ml Last
Vice President Of Finance
Title
RECEIVED P.O. 13ox 3444
�9 2015 Pennil Holder Mailing Address
DECtL U Hickory NC 28603
DENR-LAND{QUALITY City State Zip
STORMWATER PERWTTVG [phone] [phone]
Phone Fax
c. Facility name (discharge): RFIF-HM, LLC dba Jessica Charles, LLC
d. Facility address: 535 "Townsend Avenue
Address
High Point NC 27263
City State Zip
e. Facility contact person: Kermit Pierce [phone]
First 1 MI I Last Phone
Ill. Please provide the following for the requested change (revised permit).
a. Request for change is a result of-. ❑ Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to(company name): Hancock & Moore, LLC
c. Person legally responsible for permit: Andrew Coffey
First M[ Last
Controller
"Title
P.O. Box 3444
Permit 1-folder Mailing Address
1-1ickory NC 28603
City State Zip
[phone] andy ahancockandmoore.com
Phone 1--mail Address
d. Facility name (discharge): Hancock & Moore, 111,C dba Jessica Charles
e. Facility address: 535 'Fownsend Avenue
Address
High Point NC 27263
City State Zip
f. Facility contact person: Kermit Pierce
First Nil Last
336 434-2124 inariaffjessiutcharles.com
Phone 1—mail Address
Revised Jan.27,2014

I�y�t i s I
Charles Watson
EHS Manager
4 ISO 9001:2008
® k���LNX Refining Redcfinet!
I A Precious Meta!Recycling Crunparry
I
I
Telephone:[phone] x 0218
251 Industrial Boulevard CeU:252.714,0522
Greenville,NC 27834 Fax:[phone]
www.metallixreiining.com charlesw0metallixrefning.com

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
1V. Pcrmit contact information (if different from the person legally responsible for the permit)
Permit contact: Joy S Bailey
First M I Last
Purchasing/Safety/lL"nvironntental
Title
P.O. Box 3444
Mailing Address
I-lickory NC 28603
City State Zip
[phone] joy r liancockandntoore.coni
Phone t:-mail Address
V.
Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
Required Items: "PHIS APPLICATION WILL 13E RE'CURNED UNPROCESSED IF ITEMS
V!. ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership(such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient For an ownership change.
.....................................................................................................................
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case ofan ownership change request. hor a name change request, the signed
Applicant's Certification is sufficient.
PERMITTED CERTIFICATION (Permit: holder prior to ownership change):
I, Andrew Coffey, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that: if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
rgnature Date
APPLICANT CERTIFICATION
I, Andrew Coffey attest that this application fora name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that ifall required supporting information is not included, this application
package will be returned as incomplete.
S' =nattt-e Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Storntwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan.27.2014

RTP ENVIRONMENTAL ASSOCIATES, INC.
(I nno--
AIR • WATER • SOLID WASTE CONSULTANTS
2123 Old Sportonburg Rood #288
Greer. South Corolino 29650
([e-mail]) ($ ) 848 1303
December 14, 2015
Mr. Ken fickle
NC Division of.Energy, Mineral, and Land Resources
Stormwater Permitting; Program
1612 Mail Service Center
Raleigh, NC 27699-1612
Subject: Hancock & Moore Plants 1, 2 and 3 and Jessica Charles/Ownership Name
Change
Dear Mr. fickle:
This letter is to notify you that RI-IF-I-IM, ITC, which recently purchased the Hancock & Moore
Plants 1, 2 and 3 and the Jessica Charles, LLC furniture manufacturing plant, has changed its
name and address. ]'he Articles of Amendment (attached) were filed with the North Carolina
Secretary of State on October 20, 2015. "I'he new legal corporate/owner name and address are as
follows;
Hancock & Moore, LI.,C
P.O. Box 3444
Hickory, North Carolina 28603
I'lius, on behalf of Hancock & Moore, LI-,C, we are submitting the attached NPDES Permit
Name/Ownership Change Forms for Hancock & Moore Plants 1, 2 and 3 and Jessica Charles
which reflect the proposed ownership change and new Responsible Official. "Elie contact names
and addresses for each plant will remain the same.
ff you have any questions, please call me at [phone] or Rhonda Nichols ol.,Century
Furniture at [phone].
Very truly yours,
RTP Enviromnental Associates, 1 nc.
aaw� RECEIVED
James 1-1. Laughlin, III +�
Principal DEC 2015
D NR-LAND QUALITY
ORNA A CR PERMITTING

Attachment A: Hancock & Moore Plant l/Form
Hancock & Moore Plant 2/Form
Hancock & Moore Plant 3/Form
Jessica Charles/horn

llivision of Energy, Mineral & Land Resources FORAGENCYUSI ONLY
Date Received
Land Quality Section/Stormwater Permitting Year n�omh Day
�" ®��� National Pollutant Discharge Elimination System l�
N�C/ CLi DE­EMT OE
`M°A°MMEMr-Nuu R_I-C- PERMIT NAMEIOWNERSHIP CHANGE FORM
1. Please enter the permit number for which the change is requested.
NPDhS Permit. (or) Certificate of Coverage
N G S O N C G N I 0 9 5 1
H. Permit status Lrior to requested change.
a. Permit issued to (company name): Jessica Charles, LLC
b. Person legally responsible for permit: "Thomas J O'Connell
First M I Last
Vice President Of Finance
Title
P.O. Box 3444
Permit Holder Mailing Address
Hickory NC 28603
City State Zip
[phone] [phone]
Phone Fax
c. Facility name (discharge): Jessica Charles, LLC
d. Facility address: 535 Townsend Avenue
Address
High Point NC 27263
City State Zip
e. facility contact person: Kermit Pierce [phone]
First / Ml / Last Phone
111. Please provide the following for the requested change (revised permit).
a. [Zequest 1'or change is a result af: ® Change in ownership of the facility
❑ Name change of the facility or owner
Tf other please e rplffin:
b. Permit issued to (company name): RHF-1-IM, LLC
c. Person legally responsible for permit: Thomas J O'Connell
First MI Last
RECEIVED Vice President Of Finance
Title
OCT 2 3 2015 P.O. Box 3444
Permit]Molder Mailing Address
GENR-LAND QUALITY Hickory NC 28603
STORMdATER PERMITT;NG City State Zip
[phone] tom a hancockandtnoore.com
Phone I.--mail Address
d. Facility name (discharge): RI-IF-HM, LLC dba Jessica Charles, LLC
c. Facility address: 535 Townsend Avenue
Address
High Point NC 27263
City State Zip
1'. Facility contact person: Kermit Pierce
First MI Last
[phone] maria i jessicacharles.com
Phone E-mail Address
Revised Jan.27,2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: Joy S Bailey
First M I Last
Purchasing/Safety/IsnvironmentaI
Title
P.O. Box 3444
Mailing Address
Hickory NC 28603
City State Zip
[phone] joya�hancockandmoore.com
Phone F-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership(such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
.....................................................................................................................
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PEIkM[TTEE CERTIFICATION(Permit holder prior to ownership change):
I, Thomas .l. O'Connell, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
Signature Date
APPLICANT CERTIFICATION
1, Thomas J. O'Connell, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package.will be returned as incomplete.
,lA,.ri, 1/4//Y
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Storrilwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan.27,2014

BILL OF SALE
(Jessica Charles, LLC)
This Bill of Sale ("Bill of Sale") is dated as of October 5. 2015 by and between Jessica
Charles, L'LC, a North Carolina limited liability company ("Seller"), and RHF-HM, LLC; a 1
North Carolina limited liability company ("Purchaser"). 1
s
f
RECITALS
Purchaser is a wholly owned subsidiary of RHF Investments, Inc., a North Carolina
corporation ("RHF"). RHF, Seller and other parties affiliated with Seller entered into an Asset f
Purchase Agreement dated as of October 5, 2015 (`'Purchase Agreement") pursuant to which
Seller has agreed to sell and RHF has agreed to purchase; or cause one or more affiliates of RHF
to purchase, substantially all of the assets of Seller. Capitalized terms used in and not otherwise ;
defined in this Bill of Sale have the meaning assigned to there in the Purchase Agreement unless
the context othemise requires.
Therefore, in consideration of the foregoing and the other valuable consideration given
by RHF and Purchaser to Seller, the receipt and sufficiency of which is hereby° acknowledged,
the parties, intending to be legally bound; hereby agree as follows:
E
AGREEMENT
1. Purchased Assets. Effective as of the date hereof; Seller hereby sells, transfers,
conveys, assigns and delivers to Purchaser; and Purchaser hereby accepts from Seller. all of the
right. title and interest of Seller in and to the Purchased Assets of the Seller. `
I
2. Purchase Price and Allocation. Pursuant to the terms of the Purchase Agreement,
RHF has the right to allocate the purchase price among the Purchased Assets of the Operating
Sellers, including Seller. The allocation of the total purchase price among the Purchased .Assets,
including the Purchased Assets of Seller, will be made at a later date.
1. Further Assurances. Seller further covenants and agrees with Purchaser that i
Seller will execute and deliver such other bills of sale, transfers, assignments and other
instruments of conveyance and will do such other acts as reasonable requested by the Purchaser
to further vest in Purchaser such title to the Purchased Assets and to fulfill and discharge Seller's
obligations of conveyance hereunder and under the Purchase Agreement.
4, Warranties. Seller covenants with Purchaser that Seller owns and has good and
valid title to each of the Purchased Assets owned by it, free and clear of all Liens (other than
amounts payable pursuant to the Purchased Contracts as expressly contemplated in the Purchase
Agreement), has the right to convey the same, and that Seller will warrant and defend the title to I
the same against the -lawful claims of all persons whomsoever, except for the Permitted
Exceptions.
i
Page 1 of 2
t

i
IN TESTIMONY WHEREOF, Seller and Purchaser have executed this Bill of Sale as
of the day and year first above written.
SELLER:
Jessica Charles, LLC i
By:
_ F _ I
Nb4 ..r S. S/K
Title:
s
PURCHASER:
R.HF-KM, LLC
By:
Brandon M. Hucks
Chief Financial Officer
Page 2 of 2

i
f
IN TESTEMONY WHEREOF, Seller and Purchaser have executed this Bill of Sale as
of the day and year first above written.
SELLER:
1
Jessica Charles, LLC
i
By:
Name:
a
Title:
i
i
PURCHASER:
I
RHF-HM, LLC
Bv
Brandon M. Hucks
Chief Financial Officer
i
i
I
i
I
i
i
i
i
PaLye 2 of 2
i
i

417
.y�v,,'t.f•'�i•r 1
0. WA
MCDENR
• ment of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor JUL 0 3 2013 Director Secretary
CENTRALFIL.ES June 24, 2013
DW(YWG
Mr. Tom O'Connell, VP Finance
Jessica Charles, LLC
P.O. Box 3444
Hickory, NC 28603
Subject: �No-Exposure Certification.NCGNE0951 J
Jessica Charles, LLC.
535 Townsend Avenue, High Point, NC
Guilford County
Dear Mr. O'Connell:
The Division has reviewed your submittal of the No-Exposure Certification form requesting Exclusion from NPDES
stormwater Permitting for the Jessica Charles, LLC facility located at 535 Townsend Drive in High Point. Based on
submittal of the signed certification and the site visit conducted by Mike Mickey on June 21, 2013, the Division is
granting the conditional exclusion from permitting as provided for under 40 CFR 122.26(g), which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of the no-exposure certification, Jessica Charles, LLC is obligated to maintain
no-exposure conditions at this facility. If conditions change such that the facility can no longer qualify for the no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for any stormwater discharge.
Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge.
Jessica Charles, LLC must re-certify the no-exposure status annually using the attached form. Any "Yes" answer
would require that you obtain NPDES permit coverage for stormwater discharges from the facility. The annual self
re-certification does not need to be submitted to DWQ unless requested. Please note that this 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 Mike Mickey at(336) 771-5000.
Sincerely,
for Thomas A. Reeder
cc: Winston-Salem Regional Office
Stormwater Permitting Unit, No-Exposure Files
Central Files ;
Wetlands and Stormwater Branch One
1617 Mail Service Center,Raleigh,North Carolma 27699.1617 NorthCarolxna
location:512 N.Salisbury St.Raleigh,North Carolina 27604 ���������
Phone:[phone] FAX:[phone] Customer Service:1-877-623-674$
Internet:www,ncwaterquality.org
An Equal Opportunity 1 Affrmative Action Employer

jessica charles
May 28, 2013
Mr. Ken Pickle
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service center
Raleigh, North Carolina 27699-1617
Subject: Jessica Charles, LLC-Request for No Exposure Certification
Dear Mr. Pickle:
Please find attached the completed Form NCGNE0000 request for No Exposure
Certification for the Jessica Charles, LLC facility. The Jessica Charles LLC, which is
located at 535 Townsend Avenue in High Point, North Carolina, manufactures
upholstered furniture.
,If you have any questions, please call me at [phone] or Jim Laughlin of RTP
Environmental Associates, Inc. at [phone].
Very truly yours,
Jessica Charles, LLC
Tom O'Connell
Vice President Finance
Enclosures
535 Townsend avenue f sigh Point NC 27261 Phone: [phone] i24 Fax: [phone] wv.w.jessiczcharles.cotr

1uL•uept.orsrNR
� i zoo Wiwston -Sc�lerl7
J
3 FOR AGENCY USE ONLY
;i Date Received
k,Y
Division of Water Quality /Surface WaMr—P-ratection Year month 5a
egional Office
®E�� National Pollutant Discharge Elimination System). I I
CertificateoECov"age
N GNE
NprriNC 0— o. NO EXPOSURE CERTIFICATION for Exclusion
E:ma Me mo N.mlr+ Res aces
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, DWQ 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 DWQ Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of ownerioperator(address to which all certification correspondence will be mailed
Name: Jessica Charles I-L.0
Contact: Tom O'Connell Vice President of Finance
Street Address: P.O. Box 3444
City: ZIP
Telephone No.: 828 495-8235 Fax: [phone] f
ar
Email: [e-mail] J` `0 s
Page 1 of 7
SWU-NE-12Aug2010

NCGNEOOOO No Exposure Certification
2) Location of facility producing discharge:
Facility Name: Jessica Charles. LLC
Facility Contact: Kermit Pierce, Vice President„Manufacturing
Facility Street Address: 535 Townsend Avenue
City: High Point State: NC ZIP Code: 27264
County: Guilford
Telephone No.: (33�Q4�24 L*WM)6 _ 1=ax:_(336)434-4127 ---- ----
Email: maria(cDaessicacharles.com
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). 1-8513usiness North, right on Brentwood left on
Townsend Avenue. Plant is on the left.
(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 ONo
5) Is this a Federal facility? ❑ Yes 0 No
6) Latitude : 35.939387 Longitude:_79.971340 e.g, min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
0 Existing Date operation began: Purchased in 1996
❑ Renewal of existing No Exposure Certification Certification No.:
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: 2512
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Manufacture of upholstered furniture _
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
0 No
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
j
I
Page 2 of 7 I
SVVU-NE-12Aug2010 I

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 0No
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 0 No
c. Materials or products from past industrial activity ❑ Yes ONo
d. Material handling equipment(except adequately maintained vehicles) ❑ Yes 0No
e. Materials or products during loading/unloading or transporting activities ❑ Yes ❑X No
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes Z 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 0 No
and similar containers
h.'Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes Z No
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes Z No
j. Application or disposal of process wastewater(unless otherwise permitted) © Yes 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
1. Empty containers that previously contained materials that are not properly stored ❑ Yes ❑x 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 0 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 and piping free of rust, damaged or weathered coating, pits, or ❑Yes ❑ No 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 0 N/A
cracks, Boles, 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 ❑ Yes ❑ No ❑X NIA
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 ZN/A
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 ❑X Yes ❑ No ❑ NIA
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? ❑ Yes ❑ No ❑x NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes 0 No
b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste 0 Yes ❑ No
generated per month)of hazardous waste?
c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑ Yes x❑ 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:_••,,,, Finishing rags, waste finishing materials
How is material stored: Sealed drums stored under cover
Where is material stored: Rear of building under covered area
How many disposal shipments per year: 3 shipments/total of six(6) 55-gallon drums
Name of transport/disposal vendor: North State
Vendor address: 917 Beaverdam Doad, Canton, NC 28716
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.
Page 4 of 7
5WU-NE-12Aug2010

NCGNEQ000 No Exposure Certification
16) 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 0 No
b. Does your facility have coal piles on site? ❑ Yes 0 No
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes 0 No
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., Yes ❑ No
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: Spray inishing booths
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? x❑ Yes ❑ No ❑ NIA
Please specify: NC Air Permit No. 08857
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: SQG ID# NCCESQG Program: Hazardous waste
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
I
Page 5 of 7
5WU-NE-12Aug2010

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.
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: Tom O'Connell
Title: Vice President of Finance
(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.
North Carolina General Statute 143-215.6 B(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;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

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
This completed application and all supporting documentation.
❑x A map with the location of the facility clearly marked.
0 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 DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ...... [phone] S01
Fayetteville Office ... [phone]
Mooresville Office ... [phone] `�
Raleigh Office ........ [phone] '°` r f ;s
"''41 1s �,
Washington Office ...[phone]
Wilmington Office ... [phone]
Winston-Salem ...... [phone] ;�"•', .
Central Office .........[phone]
n9ton
Page 7 of 7
SWU-NE-12Aug2010

Ar '
MCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder John E. Skvarla, III
Governor Director Secretary
June 24, 2013
Mr. Tom O'Connell, VP Finance
Jessica Charles, LLC
P.O. Box 3444
Hickory, NC 28603
Subject: No-Exposure Certification NCGNE0951
Jessica Charles, LLC.
535 Townsend Avenue, High Point, NC
Guilford County
Dear Mr. O'Connell:
The Division has reviewed your submittal of the No-Exposure Certification form requesting Exclusion from NPDES
stormwater Permitting for the Jessica Charles, LLC facility located at 535 Townsend Drive in High Point. Based on
submittal of the signed certification and the site visit conducted by Mike Mickey on June 21, 2013, the Division is
granting the conditional exclusion from permitting as provided for under 40 CFR 122.26(g), which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of the no-exposure certification, Jessica Charles, LLC is obligated to maintain
no-exposure conditions at this facility. if conditions change such that the facility can no longer qualify for the no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for any stormwater discharge.
Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge.
Jessica Charles, LLC must re-certify the no-exposure status annually using the attached form. Any "Yes" answer
would require that you obtain NPDES permit coverage for stormwater discharges from the facility. The annual self
re-certification does not need to be submitted to DWQ unless requested. Please note that this 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 Mike Mickey at(336) 771-5000.
Sincerely,
for Thomas A. Reeder
cc: Winston-Salem Regional Office
Stormwater Permitting Unit, No-Exposure Files
Central Files
Wetlands and Stormwater Branch One
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 NorthCarolina
Location:512 N.Salisbury St.Raleigh,North Carolina 27604 Nahma`ly
Phone:[phone] FAX:919$07-64941 Customer Service:l-877�23-6748
Internet:www.ncwaterquality.org
An Equal opportunity l Affirmative Action Employer

Jessica cha rles
May 28, 2013
Mr. Ken Pickle
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service center
Raleigh, North Carolina 27699-1617
Subject: Jessica Charles, LLC-Request for No Exposure Certification
Dear Mr. Pickle:
Please find attached the completed Form NCGNE0000 request for No Exposure
Certification for the Jessica Charles, LLC facility. The Jessica Charles LLC, which is
located at 535 Townsend Avenue in High Point, North Carolina, manufactures
upholstered furniture.
'If you have any questions, please call me at [phone] or Jim Laughlin of RTP
Environmental Associates, Inc. at [phone].
Very truly yours,
Jessica Charles, LLC
Tom O'Connell
Vice President Finance
Enclosures
535 Townsend Avenue High Point NC 27261 Phone: [phone] Fax: [phone] www.jessicacharies.com

"tVt:ivf_o
N.C.Dept.of ENR
' .IUN 1 8 2013 Uv 1�5�on -sa�ein�
FOR AGENCY USE ONLY �r t
Y Dale Received
Division of Water Quality / Surface Wa &>+SRrotection Year Mon,h nay
egional Office
d L
.GPMTMENT 1N�`®ENR National Pollutant Discharge Elimination System NO EXPOSURE CERTIFICATION for Exclusion CcrlificalcofCov.Qgc
l� N C N E
NaaTM CMOIINI,. OF
ENV✓ o—ENT—o NauR.L REs RCe
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, DWQ 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 DWQ Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of ownerloperator(address to which all certification correspondence will be mailed):
Name: Jessica Charles L.I.0
Contact: Tom O'Connell Vice President of Finance
Street Address: P.O. Box 3444 11.V LP I Aq,jrd]
City: i
Telephone No.: 828 495-8235 Fax: [phone] j
Email: [e-mail] 1 2013
lY - vVP,rW
UAIITy
"anda d Bran ch
Page 1 of 7
SWU-NE-12Au92010

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name: Jessica Charles, LLC
Facility Contact: Kermit Pierce, Vice President Manufacturing
Facility Street Address: 535 Townsend Avenue
City:_ High Point State: NC ZIP Code: 27264
County: Guilford ^
Telephone No.: [phone] Qy. &U- - Fax: [phone]
Email: maria(cjessicacharles.com
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). 1-85113usiness North, right on Brentwood left on
Townsend Avenue. Plant is on the left.
(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? 13 Yes 0 No
6) Latitude : 35.939387 Longitude:-79.971340 e.g.. min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
R Existing Date operation began: Purchased in 1996
❑ Renewal of existing No Exposure Certification Certification No.:
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes 0 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: 2512
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Manufacture of upholstered furniture
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
0 No
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
Page 2 of 7
SWU-NE-12Aug2010

NCGNEOOOO 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 1:1 Yes ED%
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 0 No
c. Materials or products from past industrial activity ❑ Yes NNo
d. Material handling equipment(except adequately maintained vehicles) ❑ Yes ONo
e. Materials or products during loading/unloading or transporting activities ❑ Yes x❑ 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)
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 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 0 No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not 0 Yes x❑ 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 ❑x No
(Le., 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 and piping free of rust, damaged or weathered coating, pits, or ❑Yes ❑ No ❑x NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? if so, is it free of any ❑ Yes © No x❑ 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 0 Yes ❑ No ❑X NIA
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 ❑X NIA
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 ❑X Yes ❑ No ❑ NIA
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? ❑ Yes ❑ No 0 NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes ❑X No
b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste ❑X Yes ❑ No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑ Yes 0 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: Finishing rags, waste finishing materials
How is material stored: Sealed drums stored under cover
Where is material stored: Rear of building under covered area
How many disposal shipments per year: 3 shipments/total of six (6) 55-gallon drums
Name of transport I disposal vendor: North State
Vendor address: 917 Beaverdam Doad, Canton, NC 28716
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.
Page 4 of 7
SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
16) 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 x❑ 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 ❑x No
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ❑x Yes ❑ No
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: ^Spray finishing booths
e. if you answered yes to d., are those emissions permitted by an Air Quality Permit? Z Yes ❑ No ❑ NIA
Please specify: NC Air Permit No. 08857
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: SQG ID# NCCESQG Program: Hazardous waste
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5 of 7
SWU-NE-12Aug2010

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)).
I 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.
Printed Name of Person Signing: Tom O'Connell
Title: Vice President of Finance
(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.
North Carolina General Statute 143-215.6 B(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; 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:
❑x This completed application and all supporting documentation.
❑x 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 DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
4
Asheville Office ...... [phone] in ton aIe
Fayetteville Office ... [phone] at el'
Mooresville Office ... [phone]
Raleigh Office ........ [phone]
Washington Office ...[phone]
Wilmington Office ... [phone]
F ctt Willa
Winston-Salem ...... [phone]
Central Office .........[phone] �y
Wit ngton
Page 7 of 7
SWU-NE-12Aug2010

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