Loading...
HomeMy WebLinkAboutNCGNE0959_COMPLETE FILE - HISTORICAL_20131024 STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. �V C�C�N CO 95 S DOC TYPE [I/HISTORICAL FILE ❑ MONITORING REPORTS DOC DATE ❑ (IIJ) 3 I oay YYYYMMDD Affia NCDENR North Carolina Department of Environment and Natural Resources Division of Energy, Mineral, and Land Resources Land Quality Section Tracy E. Davis, PE, CPM Pat McCrory, Governor Director John E. Skvarla, III, Secretary October 21, 2013 Megan Weidner Diebold, Inc 5995 Mayfair Road North Canton, OH 44720 OCT 2 4 2013 Subject: No Exposure Certification NCGNE0959 Diebold, Inc. WATERQURLITYSECTION1 1150 Pleasant Ridge Road, Greensboro, NC 27406 Guilford CoAPMATIONPROCE84iNsUNIT Dear Ms. Weidner: The Division has reviewed your submittal of the application for No Exposure Certification requesting exclusion from NPDES stormwater permitting for the Diebold facility located at 1150 Pleasant Ridge Road in Greensboro, NC. Based on your submittal of a signed certification of no exposure and on the site visit conducted by Sue White on October 15th, 2013, the Division is granting 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 your No Exposure Certification, Diebold, Inc. is obligated to maintain no exposure conditions at this facility. If conditions change such that the facility no longer qualifies for no exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for any stormwater discharge. Otherwise, the discharge becomes subject to enforcement as unpermitted discharge, Diebold Inc. must recertify the no exposure status annually using the included form. Any"yes" answer would require that you obtain NPDES permit coverage for stormwater discharge from the facility. The annual self-recertification form does not need to be submitted to DEMLR, 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 Sue White or me at(336) 771-5000. Sincerely, Matthew E. Gantt, PE Regional Engineer Land Quality Section Enclosures: Annual Self-Recertification Form CC: Debbie Shoffner(City or Greensboro Stormwater Management Division,via email:deborah shoffne(Qgreensboro-nc.goy) Scott Plath (Diebold Inc.,via email:scott.plath@diebold.com) Stormwater Permitting Unit— No Exposure Files Cent raI-FiIY es�DWRD VVSRO Files— Land Quality Winston-Salem Regional Office 585 Waughtown Street,Winston-Salem, NC 27107 . Phone: 336-771-50001 FAX:336-771-4631 FOR AGENCY USE ONLY ArT4 Date Received Division of Water Quality 1 Surface Water Protection Year Month oa NCDENRNational Pollutant Discharge Elimination System CcrtificateofCov`ge NO EXPOSURE CERTIFICATION for Exclusion E FIVM"MFIT JM HARRW RFW�FO il�0 7 NCGNE0000 ° NO EXPOSURE CERTIFICATION JUL O 2013 National Pollutant Discharge Elimination System application for exclusion fro a watec,Eermit based - WArER iSUAi�n on NO EXPOSURE: andiae Branch 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 our 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 3:EL30L1), TN(,.- Contact EC ArV Iry t;LDN E Street Address 5995 M AYE 1 K R D , City Nb97 H C-ANTOIJ State 0If ZIP Code 9`l72-0 Telephone No. _-J,D,- 910. Fax: Email tjE6AU, WG-2bNERP DX-E �OL-D- C0M FRegion NR Page 1 of 7 13 SWU-NE-12Aug2010 e u E NCGNEOOOO No Exposure Certification 2) Location of facility producing discharge: Facility Name DT E Qp L_b T C. — 6KEfN$ jjnKQ Facility Contact 3 L OT T f LAT H Facility Street Address 1150 PLEASANT R z:b G,F 9b City C�1 �ENSBaf2C) _ State )G ZIP Code 2-7ybb County Gj LL z L FoR Telephone No. 33CO 2 - Fax: Email 5 CD±l Lftj HjE$pL &0el 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 road+ ay intersection). ,�a , rt 2- R or, ahc! e 1N, Markej 5-t le+� an t��f�4,ah� icla e ,�7► , a n „?-t 16-k- (A copy of a map with the facility clearly located on it should b�uded with the certification application.) 4) Is the facility located on Native American Lands?❑ Yes WNo 5) Is this a Federal facility? ❑ Yes XNo 6) Latitude VU 34►5it Longitude a 2' 38'S U(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 ❑ Renewal of existing No Exposure Certification Certification No.: NCGNE 8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes q Jo 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 5 10) Provide a brief description of the types of industrial activities and products produced at.this.facility: Lj + assembly and piq any s1 ' p oAefa-fv-n ; pmdur_e auf� Ma�.G lky- mar_Y,� nes and LomOaheh-}5. _ 11) Does this facility have any Non-Discharge permits(ex; recycle permits)? X 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 ❑ Yes -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 A115\10 c. Materials or products from past industrial activity ❑ Yes 1(No d. Material handling equipment (except adequately maintained vehicles) ❑ Yes *No e. Materials or products during loadinglunloading or transporting activities ❑ Yes �(No f. Materials or products stored outdoors (except final products intended for outside ❑ Yes kNo 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 frNo and similar containers h. Materials or products handled/stored on roads or railways owned or maintained by d Yes I�No the discharger i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes � to j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes y 10 k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ro 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 + _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 )(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 k" deterioration, or evidence of leaks? b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No I/A cracks, holes, or evidence of leaks, and are drain valves maintained locked shut? Page 3of7 SW U-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 '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 */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 ❑ Yes ❑ No A IWA Amendments and Reauthorization Act (SARA) water priority chemicals*? d. Is secondary containment provided for hazardous substances**designated in 40 ❑ Yes C1 No 4�11/A CFR §116? e. Are release valves on all secondary-containment structures locked? ❑ Yes O'No kKA 15) Hazardous Waste: a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes _k"No b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste ❑ Yes 4 No generated per month) of hazardous waste? c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑ Yes ,�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 stored: 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. Page 4 of 7 S W U-N E-12Aug2010 NCGNEOOOO 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 41,10 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 4 N0 sawdust, etc.? d. Does your facility have air emissions associated with its industrial activity(e.g., ❑ Yes *N0 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? ❑ Yes ❑ No AA/A Please specify: f: Please'list any other environmental program permits,(federal, state,-etc.) not a -- 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: Page 5 of 7 SWU-NE-12Aug2010 i. 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 storm'water contaminated by exposure to industrial activities or materials from the industrial facility or site identified in this document (except as allowed under 40 CFR 12226(g)(2)). I understand that I am oNigated to annually self re-certify No Exposure and,if requested,submit the re-certification to DWO 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 Total 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 Person Signing: Linn- ��cLv' Title: J tom- [S+d�tr*� C� sv u rr j� U � r � I• l61•zo13 (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 a plication should include the following items:. /This completed application and all supporting documentation. C 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: Asheville Office ...... (828) 296-4500 Fayetteville Office ... (910) 433-3300 �� Mooresville Office ... (704) 663-1699 - Raleigh Office ....... (919) 791-4200 Washington Office ... 252 946-6481 `, .. Wilmington Office ... (910) 796-7215 Ufw.. � ate, .:,� • r Winston-Salem ...... (336) 771-5000 Central Office .........(919) 807 6300fr ;sic ' e.yy/ifj ngton Page 7 of 7 SWU-NE-12AU92010 �" rr'� .7_ + Iij. r_ ` y„ 4 � ^t 9a^� #-•o-t, I.L'S�.Sx.ESf r OW � .J•�a r� { ,a,i Z��j s . _- t;rii'stM� kQLs�a, yy,7i fi_s.�v L4f rR \: t. Yl FSSit�r:t� �i '7'.^ ti -f-� ;. i E 01, r• �vs✓� ,.' o� ��:�a-Yt-..r. sY,�f`�.i f..r j !� + mow+-, Sz sm r Iw .I .fit ���; � .i�`A"�"',��'�.d y ati, •I�r�a��, -��'' t,�v .- •'��}yr•- „`a �- k� r+ ... :•, &r.�?i'.�' lr.�rr"� � '�A•A�•"�: ! �_-.�.�f.[�?+►����{�, s �y,-k y� r ��5 a•- .�,. �•�� a� rat; j fr to" r e�+ r�.aslc�`•z 3.�La c '1" i�tl t�;, ti r '-� -r�rt -*S�ps��r21 ,..+ y.":`'y� r r..1 rvlt.. Tx•.-#, r1 ,9,e1 r y *V M tot,ri+'on i '_f� f�` 'J �tYGFyx �yq YY I' rt'^, tel: t:r' k�4� sil��T�e �W 4 � -� Y+.. ��r�T�"7•��.:�` � 7"� � y f'iir .a •-,rye � a '.t �yr A� YS-_Sj "tss"`���y�+'P,�ry� Y +,�. 7•.� L•..+ x-��''�—` sa �c� €'S t` �- �K, p3h\`�ti "d'�Gi t �•I.. fi-� 1.J"""' lye �, x-�,�•.^y • .r_� �;r #� •s R•. ,�.,,_ 7 s i F i • ;r�€i'' 5 ��_ r• rp yid C" !s ',, nIF�Fi �'4�' n �. �p �R�IY dal{!�.� dl��l�r,as� •. -� 'r'. i � TrIl �� •+ _ T F� �f-^ `F! a'[� st I t��.',,, f��3'r 6-�-' y+ L�'-x+ '�Y4 � t YG R�__�Y� � � -- 1e � •'/ � � �Ltt I f� �S. w � Y 7I4'.� -3y �. �lµ� �`���_ '#1� �a�ep�'St��� ��' YY` •�a�L��!{C'��CC ` !•,Y��� Y� t �'i^;5^-�q7.�-i PR� .i{�ceIv '�i r:a}f''�' l`����'""i�y 1f4—.6-b- I`, H-''-.e�p�n-.s�l t9`.'�Y '`yz'� <7. - "�• jA bi -a�i is4Pgr><f-y 1 ` ../�.,- .,,, �t''Iiq��"•,L 'yvfs r ! +: �~5a^� z �. !C V 1 �Ti+ �L •yy ty I'" 'i 1a' V� �� � —T�,F4 .,e, -twJ - xv /® 7#� ysl�+.TlJJI dgedt� Vt L `Ah ) .' G.� � ¢�f//.�L�r�4 'S�f��' �x�•'� ,`}i'�ii�: � ��;Idh '`�.r roc k nr�! - "c s \ i�r(�' ���` � t rr•N� sr A O ;!a;�s� ■��7rt f■yfi l�. I��]�`�_ �''s9 ' ��if f �-�� y,r- t � �''�.ry�.f�E~s5i� �;' ^s, r 14M � ¢ �� 7 v't y+ z -sr _vi cA • [-� tp n did J's -.We 1dd } y5.1 x3 ) ti,• 7 �j�i ••Sffr ram• 'T �` �,'1R '1 Y{iW' �•7 I�. �S,'� ;_ivr..�..�rs�r;r"���y .�,3� �y-� "4 I 7 •?�- 't ��i{ T� (��.}M�rtil.�n#-�'r--` -'� � +'.a � .i,Y3n• Irti.�r .�'�.i� ��� ¢'�Y:3 �'tl•s r: 'A- Y'i6q SRI r = ��� sSf �•�.! /Y r f'l. i �'y I Lys • >IS_ "M ;;'LJs� v ♦e- i s ; �" -l� III, Pst''� f"' [ �i;'; r t� t' =�-4` are-1`.j '"` fln, _ y�,�,.� .f• - *�'V"rs s -,z+ t f,�- %r° w• -ram d #I. 1T r r-�I r ,ti, ~!/• ,c,•;�, a"" � 1 1€__Y� _ �,�_y,. c. `YY � q f _ '_ .4•..} t - �n.:,. Iif , �3.jt,r. rasr'� rw.'�s w " �71 �.�{r �y': •-'� `'k'k�� '�/t; + �i :�'® C ', \ lr.�'` ,•l. �s- ,}; ��.-fL_,,1 I''. ''��a -I `� r�!' Ir uaY].���. _ NCDENR North Carolina Department of Environment and Natural Resources Division of Energy, Mineral, and Land Resources Land Quality Section Tracy E. Davis, PE, CPM Pat McCrory, Governor Director John E. Skvarla, Ili, Secretary October 21, 2013 Megan Weidner Diebold, Inc 5995 Mayfair Road !North Canton, OH 44720 Subject: No Exposure,Certification NCGNE0959 Dieboo , Inc. 115t) !oleo ant Ridge�Road, Greensbor ..P}C"2740B Guilford County Dear Ms. Weidner. `�� The Division has reviewed your submittal of the application for No Exposure Certification requesting exclusion from NPDES stormwater permitting for the Diebold facility located at 1150 Pleasant Ridge Road in Greensboro, NC. Based on your submittal of a signed certification of no exposure and on the site visit conducted by Sue White on October 15th, 2013, the Division is granting 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 your No Exposure Certification, Diebold, Inc. is obligated to maintain no exposure conditions at this facility. If conditions change such that the facility no longer qualifies for no exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for any stormwater discharge, Otherwise, the discharge becomes subject to enforcement as unpermitted discharge. Diebold Inc. must recertify the no exposure status annually using the included form. Any"yes" answer would require that you obtain NPDES permit coverage for stormwater discharge from the facility. The annual self-recertification form does not need to be submitted to DEMLR, 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 Sue White or me at(336) 771-5000. Sincerely, OCT 2 3 2013 Matthew E. Gantt, PE Regional Engineer R, Land Quality Section p T1R - WA .8ran� Enclosures: Annual Self-Recertification Form CC: Debbie Shoffner(City of Greensboro Stormwater Management Division,via email:deborah.shoffner@greensboro-nc.govl Scott Plath (Diebold Inc.,via email:scott.plath@diebold.com) =Stormwater Permittirig�Drlit3 No Exposure Files Central Files - DWR WSRO Files—Land Quality Winston-Salem Regional Office 585 Waughtown Street, Winston-Salem, NC 27107 . Phone: 336-771-50001 FAX:336-771-4631 FOR AGENCY USE ONLY �T ' Division of Water Quality/Surface Water Protection Year Month Dam Month Received Da ��.�w�wrrrr NCDENRNational Pollutant Discharge Elimination System CertiicateofCovemp GHPw CCI�..�.E+1 O. NO EXPOSURE CERTIFICATION for Exclusion.k IM �j F"r ..n .�,o�� NCGNE0000 a � 9 ,� NO EXPOSURE CERTIFICATION JUI 20131 National Pollutant Discharge Elimination System application for exclusion fro a rmwateT-l?ermit based i - WATER 0 ALtTY on NO EXPOSURE: � anndd s nv�t€.8ranc1l 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 DWO Regional Office for your area. (S a . (Please print or type) OCT 2 3 2013 1) Mailing address of owner/operator(address to which all certification corres and nc mailed): Name NC_. Contact _ Er(a _l�l W le T-A N E K Street Address _ 59 9 5 MAY -A T iZ K D City NWT H CAOTOAI State o)f ZIP Code `1172-0 Telephone No. (09�o Fax: Email WE : CoM RECEIVED N.C.Dept.of ENR Page 1 of 7 AUG 0 # 2013 Winston-Salem SW U-NE-12Aug2010 Regional office NCGNE0000 No Exposure Certification 2) Location of facility producing discharge: Facility Name D-rEi3c)Lb,_;QNC — GKE PSOKO Facility Contact 3 C OT Z ?L�T N Facility Street Address i 1 5 h P LEA s AN T -Rz b C I) City r1gra 5MR0 State_ J G ZIP Code 2--7'4 6ID County Z L Fa 12 Telephone No. 33(oL 2 — Fax: Email L Z &et- C I)PI 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). .Yand , + 2-y At on 5akkl R_WLP) RT on W. M1rkej 51. ,, Iff+ on PI'PaSan:t__ id_ae . {2M; en (A copy of a map with the facility clearly located on it should be Vncluded with the certification application.) . 4) Is the facility located on Native American Lands? ❑ Yes )(No 5) Is this a Federal facility? ❑ Yes XNo 6) Latitude %1' 34.5J"r Longitude -79" S8{ 38-S"(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 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. Alqo 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: , 5 10) Provide a brief description of the types of industrial activities and products produced at this facility: L' + jssem Wy and P jaK and s 6, p a era d aidz toa ` i76(_h c n e S and C Drn i)8h eh 4s, 1.1) Does this facility'have any Non-Discharge permits (ex: recycle permits)? y No ❑ Yes 'If yes, list the permit numbers for all current Non-Discharge permits for this facility: Page 2 of 7 SW U-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 l0 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 *10 c. Materials or products from past industrial activity ❑ Yes )(No d. Material handling equipment (except adequately maintained vehicles) ❑ Yes "o e. Materials or products during loading/unloading or transporting activities ❑ Yes l(N0 f. Materials or products stored outdoors (except final products intended for outside ❑ Yes kNo 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 41No 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 A?No j. Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes 10 k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes Lr0 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 ❑ Yes AAO 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 -ki" deterioration, or evidence of leaks? b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No I/A cracks, holes, or evidence of leaks, and are drain valves maintained locked shut? Page 3of7 SWU-NE-12Aug2040 r � 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 *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 */A in close proximity to each other with a combined capacity of more than 1,320- gallons? c. Is secondary containment provided for Title Ill 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 ❑ Yes ❑ No 4-1WA CFR §116? e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No �/A 15) Hazardous Waste: a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes ,(No b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste ❑ Yes 41,10 generated per month) of hazardous waste? c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑ Yes ,�(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 stored: Where is material stored: How many disposal shipments per year: Name of transport/disposal vendor: Vendor address: Footnotes to Ouestions 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 41,10 b. Does your facility have coal piles on site? ❑ Yes ,1No c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes _�No sawdust, etc.? d. Does your facility have air emissions associated with its industrial activity(e.g., ❑ Yes ,I(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? ❑ Yes ❑ No *N/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: Page 5 of 7 5WU-NE-12Aug2010 1 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. 1 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_DkPorson Signing: U4, Title: �tCc. rSr d�c�a- (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($10,000). There is currently no fee for a No Exposure Exclusion. Page 6 of 7 SW U-NE-12Aug2010 } NCGNE0000 No Exposure Certification Final Checklist This a plication should include the following items:. /This completed application and all supporting documentation. C ' A map with the location of the facility clearly marked. If the site currently has an NPDES Stormwater Permit, be sure-to indicate the permit number in Question 8. Mail,the entire package to: Stormwater Permitting Unit Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Note The submission of this document does not guarantee the issuance of a No Exposure Exclusion. For questions, please contact the DWQ Regional Office for your area. DWQ Regional Office Contact Information: R Asheville Office ...... (828) 296-4500 Fayetteville Office ... (910) 433-3300 Mooresville Office ... 704 663-1699 Raleigh Office ........ (919) 791-4200 � Washington Office ...(252) 946-6481 Wilmington Office ... (910) 796-7215 Winston-Salem ...... (336) 771-5000 L .,;• E. Central Office .........(919) 807-6300 ` _�.�.:� W. ngton Page 7 of 7 SWU-NE-42Aug2o10 "Fr `"LfS :Z''�f ;Y. :r• - Y �-C- 1.y ,-r,..rr y..,^ . u :! r- a. --k - r 1--.r::-1 Y r n 17 ,� :.rrt-.: Et"y)! •'� A. .;r• l� ., (+yh',! �r rMr g �s�'31 '•'tivr;.}y/_l c ,•�;_ `I _r1' _ �;^���"�i•r�ofi'"_ f r••.�,,V. 'u-,'�'jr�•2'tS,Y�+�'':•}, ylS•^^ �.r"v r�i ' f -,r•.(, 1V Q.1�' :,li � ..! i}- -.1 fit.- ! M _ { -C� \ �� .'S�' �, L. Si�M1r r ^rrtl.'•.C4,:,• L }, , ,.�'41 �,�� )E.�^S F r,.✓�-�_�, .'N '_�, A .�; rx°'�'u. A'�,///^r2 k.r-...w :I"' 'S•? T r _,= d �• ;�Ir i$ r, r,. ,+rs;; ..y•., .��,kL-,.++`'n..• Yr� ,'4;.,�. .� `c .r .2 s1',�'.:,-J �;:�,'• ��9. /'�1y Yr��f YJ ��� ;y`y�.:''J��"r 'V�• �. ti''k'! �7F r M. ! t'I-i f• .F- '�.� '1.> 4 * "-�°+' �;I:" ',.m:x r 'W'-. r•. -x:/n ?:` F �. --L. :/`/,_1 :,1,' :t !; '+a��. Ir\ y�#►Y�r- •�+ ,i" 'r" _�.,,• � i . �•. �.H' i�;,°Y�;}. . ";;r :�.. !. '�.,�F 4,�.t ,�, a��j:t �d '' r ^ f 7�. .� { r.r, ,'.tt sa' j`* .,,•:c+�k r,.s '�' ' i F'1. r.. .� »�.`�' Jy �-"'� :F r.V .� ' �7 :.$-', .\�+•_ ',S �i� 4M t"_ .+.f` 1�F'•. �•.r{, lyr.\�`!_ .� Ij:�y,:1 I ,'i: '' '- �4 rr.. f°,'s 'Y:^lf� ^ i�.:r,r �. �•�i:�'y.��l1• „� � �P:,�� .+F"-'! ,y �'�' rc•�CF •V i'�^���` .yr, �.:�.,,r.. n ,h��r,. _�: Q,�r _.sr ,ae � yYf-'�: f'. _2 `�p"'"i �''1 }•�v'.�%x k r-�J,. .r�.• z a 'r!`,��".& i �,J�^.':�r�f�„a; >t tZr j���� +. -•-�,.. '�•r r3�\C,, y. 'r®.5 •.ai' Ll�«.. If O�+Y�;-I .-r +'.^..• F "Y° mil;j 1'�� '� ,,,�,-\u:rr�+, '(' �: ,� F I y a 7, si,''-y �`7 .r� �r 4 �'v1 t Jf r' rr' •S =r' r _•`,+ lA. �ti, �'• � „+..z :.�as� . ` J. '•. au� i;�. s, `.r -C'.4;- 'y,.{ ..'�; ,�f•%4`,' i. �a�r,' 1� r.vet. '1 L:'r r � r a i�: Y' ,TT- `r t5% }... lv �..s. 'V ;r: .{ .'. ,•c} �'r'1S Ih r.V -�. #�' -.,�.,1. t.., - ' i .i I. 7 `�.;,i ,t'" y}t fr'�.••�'S•,'+:'.�y �'. �4�1� sr,� �ir�ya�;�r' .},. �,r»r!ti-N'.• �r:''�," .. ,d�*. _i:rF: ,n.' ?�,i� 'fie�'I' .C?'+�.���' .1+�i.`�.� { r r,-`` •1��r�� +' '� •'�i$,• '.t� - - .�!j w��.. r�'I' ".'t:.''13.� ' ' r ;{ .}1._M..,jrl.i-�'' ":e�,1„'� r,•:. SF �r�Y�>` y,.S�.'`•trt*. �' � ill '�°+m.•t.-.��,4' •-/��.V�,�,�.�;r��_aLC� W:�'.xi: ii ��'t� ej!'�•1«•° `fir yn�� k , �r,7,YaSj. ;;i '---.. `':_rir`T3 K ,f;.ry :- 1 I. . ti! •�r4�Y ! _ .� 4,. � c-.. a, R •,, +.. '1'r: •, ,di� - .'a•, r;> . , '•�''�py r .{Y�,f. .ems!<,': � !.1 y"• F.; .:,�}Si,'�{';•SR�-•+ r,� ya� 'r�{ gyp,4;�� •'f�:s IF -w, ``{.r`S"? .s •4 r'i;'^ i. .1.ns*i r"�s. _ ,sT',; fi ':C C Y; '' t: 1'J +titi-/d' t`ji Ar•'i1SC,r/ .• C Imo.:.`.. spp .1 1• r?, �a:'r! ''me F YR .?.' ' i 4•' ,Jr -t;r i'1- fir•��.1..." y •red.•. i.s,�l.,rrr- 'rs.. ,✓tT1 ..: .-' �. � 2 °. �•�,r 4ta> -•�. r.' F: sr�,.� r {{S�` y �, a� yfF h{ �_ r t.•: } _ I' �,, d �'4.'•.r � �; :.i_ �, l,:-, •r'••.I:r•. '';,yam. h 11 :f,C F .�#ras �, {' A.., 't'" ,c-"rV' ,1z d, ':,�� :.�:.In._,r •W -�}4,w�,�, �:flr r xtC x.. a,�.1 = ^'� ! I J rV -i f' :V [ J t`' r L at 1. ..w :I.� aAi `''! ?#-i{ •L` { t.. 3 V -.hl .�i1 • itr- k"Y^ } a. ti„4 c1;Rd,:!M. .t+ c. \:' •, z� '-i � �'�! � y' >T• C'� Y R'',�. '+�-'-'e„^,.+. a.l+�Jf�' 7 n)�1 ,f .S .'r„!1-,i� •Q�• flf }1 I • '•4 1 � �' � �� - .r�.R i .s ,.' 1 s�' c t� •• r'� +*v''` �I� v,,t�s: 14 R+ '�` i>z:r �� �.,' ,�r;� � .c •`�� ff)3,,HR .,� 1, M� �'IY� ne�ia' A$.f]•. .. Fo- ;4 •.L�` _ �•' i- ,q_,. ( •fit,�•.'1.•. ,r..=',f'4]r. f -�-. r:'h1;�'' ;"!�. 7i.'; 1 :Fej � r '. 'i Y: •r ,•� ` '•ly�� l-'i .�•�.�.,1_"'F '�i^� ' -f: • :' ':1 f-'a . � 'f." .'�1�`�• _r{.l�: j�,l '� ` � r., f ))) "'4, '•l,, :V N:� 1 1 Y , ,i :''�i 5�. S 3�� �•' �' ,�,-�ia �' � ! f 1' �. r r`1�:�•:�'' .��,,fic' .tip,. J �Y n�+, r,} t r>.i.I' yf �ti � ''P' :;Jf •�'- 11 ��4 ,r1 t. .,i r �.,' r�.I .r-•,�_/• V. ceF. ,i}. Mar - l 1� e '.kx L °�-.-/ 'F,'p 4: '.if4 T'.'1�t^ �_ I'r,r I'rV1 'r s.� ••+ .i' .if'.mil' �, // a x :�,• r Tilt ytiT �V?I, -.?M' :.-r_ �Tf_a- '! ,t�Er c©v t �n'. tt '3y`r,.: r1 J•r 4� nr, �,,.:i, APE .!M1e„Rra .+_gtjl L ,:s._ fir.#r ; I�L•a .4 "\. .•l. r 1 {{ y. :ryn F�+ ,z� r y .v`!'k:a. .r-t}• ','STsi1. A% 'f't.'Q:, r.T" 'K .y Y ""• $F¢ %/ .�.«.'_>.a' 1. �� tom. N_ '�1` �.� •,11 ly -r "S f ,,, p+2 L -:.!_ 2., >.:�r "s , ��w,'q,`a ,'t, �'�` W � I. y• . � z�lri*,�.,• � •} 'C::, 1.�tv' . �� irk Q r •yn' '"1 , Q�sa� '•'•'R i, r�r i a ! �•y�' 1F.. '�',�l R '+ ]I4p=_ ,. sr _ S�'` V , >•+. r t^ `�,- �'u+�v., F. L'.�•+- tr� P' "�;�` ?Mf-r�.L,}-��ti- �' 'rl ;!f Tr ra"' t � tip• rt t �' r'ri rl 'yia" :`;r, �- b1. /� f- s ,n �7�, t lkp � !3 f�.1�' '., i, yr � l ,�.j,., ; fR:r,�..�.F}_S'Y ,'rY,�. !"a,�t'[.dl„•..y l"�3, S., ,a%y(r.i,W f:LTr'�� .,r✓ ^'Y { � rll ;t,�.`._ 1...,_I �•,:T� ,;#l���L rT� v'� :.'�. �!r, p 3, �7� ,!�y� a s -t�k' I �r � y: # ly,• ,,' . '• �.. i'�.'•, } qy- :=r! 2 .y+Y;^ti!�•r,i�,�-: f.� t q ti �'i�hF, „d;p�-::-� .r L. °' e•rY.�� �+ �s n,' !fi V:,e••�.' .,+a^ !. f e 7y� �i' �_ ,� ,Y f e '�r' a r° •s 1j. , .E � •.•: .}� r;. �r r.'r w. 't' �.:�Ljar ��.-J s' ,�ltw. .:r ��'a'•.+'�1'�'-, 4 -�'k d' a; t •'r' loan ✓3`".r�� ;f g � , ;.4:;'Y. j� ,9• y �'` - ,.•fsr,;. '+gym r�;,,�C° %_ _ � x; o�`:. f .�. ?y f., f r• .! '" ^�A' - _ �,.- e; R'.'1 R'� �6r'� �.•# �� sy, y ff! I rrrrw,� ':'F -ti aUntl ''-• ;�• j�:�. .r' _ ,wa � ,�,iv�' .� l�',t'.. _,.,_�... r �, r � �Y � 4l•t �'.. !' J�T�f? Mi .� /�i�.oi eJ� ,6 j�""4. S. �: }..aWti� .pl� 1�1'�y � Irr.,} IdY6 4�a�' :i^'i'' '�:Yf: �'f}n '4 �`��'✓� � �d� ..�q�a�,i:".'�`•� / 1`��'"1� '� - f i T -4, _(' �1.. �r::1j!i�%. .��; Y� :•qS ., t:lq}� '#t �••��ti:A �'s � *.,t�rn,r.-- T „, .�� :•,�.,.,:,• p .. a �', �,Il:a N -o• ' �-..ta• -y.6 rA,:>£%� '.aT Jr .. t:- i_ :'Fn 'A fIiF,I T' !"i. d"�•' lrti ( �,F". \y;:a is�i7e -1- ;el, '•�• .r7"�. .e ) 1�a x .Y.x .I r1l L f`�3 I, itir �n•i�1•'�a�'V:«""�' {"' :f?.I'�- `'�� F r :t;:f ar `.`C; � ih'.p.�a dti'�.,yr" A' t ; '."1 r, �,w >Sk.+ �,y^r-r,s,'L, � � � i.�°'1 �Lt, i r 'r •�_'HF.k. the v.G• �•�:'• �-� r.�� �ice' ! v',3.�'• i ".'.lfl �ii!•�x''Y,��!,r E 4F; all}- � }�. �':, '!� }� •r• t• r i r h-11 '"� ��;a.�, • 4�:• S, M ""`__ ."*aV ./ -%FY, .I ,t� 1 '4.*y. �, ,#.�+ai :�r., �3<_ ,.r-:+• _ _ 1•_5. L., �/ d, ,lJ .,fJ".'I. L ,i i.w 4•- ii`r •Y� I j' •1. .A� �,, 1:'CI y, �,�"` "F5 i,' �' 1P li `� f°, ,•�� � �� ".R��.. �1. � rya/•.a�.Y � �-h ��� n n5,'!��� P � U `Y �- ��: �[� n�.. f'f _ ''i , :�: ♦'�� '� .y .J;i•, I.0 fit a '�:+,;.;rr '+.,, �• •frz; „r•'r-,7r .{ ,r :a ! qk ;� ,.� �.. .'r' •I- /, �•t�>,aRo.,lr.n.. r,0 _ '.a �`;� =.a\ti �4. �' �' ,1,r r�r� �'r:-,tl ,�",7 ,}^ ,7 r i.�.•�*•�. ry. �>a -�f,.. ?.rs:.;e��,k v �uF�f� � •',, k�t�,, L{r,,�rq" "�``t5� :Ir;,..�'q'I,. •.�: .�r��i: c*`�k,�� -��•-' r� '`��' {.�' c�l ,.s •ti.7,�F L,��?c' ..,�Q �_ -{'r i "f L1 ,,J" _ y �•t.FCr wlle+{'. lam,fr Y1 4�r 1',"' .. 4` F'.. i _'!k:}7✓yy"_'�:V�'f'�,�rF at'3.+u�E�r'.r,,:;""�.;�y.�y. �sy•:-I,"�r•f�.v:,•+�rs:-_:�k'rt'�+'eti.` ��^�„'/` !•rr 'e�w,i^,s_'1 i�.�'."�',r-_1�i#'�Qr��'�T1��i•••��TL 1�li�1.-r',:�r�'�'s'�yfn Vie'3 k.„x:..5F,t��a"�p'-v7`��a�Y_��l D�a'r4'ic•,�r4�1ay�-t�\-I'r,°si��VUk�(*C rij'l.�S'a�`�,i,` "^.r;'ra �i`^u rq rg ck5.�.._�r.!''r-�,t1�4'7`.6,}g ra>A,r.;�e�fr" r t•t�E.}I. Rf�e�h.,�.R�"�sJ•=: atil.I.;"rt+•.�'\1Y- Lt IGJ:I1 1w y Q , `u.r°g•-Ju•r cre, 'n..F s, i.,, <+��+v's � �.,td:n r- r ;•;: ,� �' .�.- �1r7tr�(r;�--� `- - `iT'E 7;;"��tr-. ..�..' �': �� ,,�ry1 .e„ r�l ,lor�u:�ysr'O' -r •;, .•,,w2 ✓';'� (k�'r-'.�"'^y% ',J��r..,! r+r,` t •1r P -C:.•-�. A ei:` L-��' y,�'T, c d .dr:�•r' � .k+ ,, r I..a,�• L; Z;r�i.�:x�: .�� +•ay�� _ ��t[`;;a,�.,-;4.:q ear ,;N';Sj tV'"'s-',.i5t,: µ't,�""�:.- ..t. ,�..� r.tr �4'71�1*y,�°' ;M 7"a n.. .' �'�`'"r-'�i�r.�wg�g �.:+'A•?.�' .� x, , I� �`r S• Imo„ � ,�,` k~., ,_%.•�'''t v{r4 T �i !�j� VxYr i "�t'P� � - r're) !r rt 7,At M>"''• F„ :1 F i.11. t5 ,c "r' I S 4� �+', d, 55�:I ni11 ,�..�k°'+ ;, ..'? t{ fSF> fl:nrn-,.,n �"' �� s- A w, �..• /' aTrl •t:�w I' � �,�ti. ;k5�++� '",r,#r, r"�I ;\ •�•�, y'j ! _'� "4�. X" '�` '.i T'n.a.r'-�-n�{ '�:� ���,i{ --o .�e r :N. �l";--'�'r.'r.C) + ..ty.. �r �jti r,,.' h: t« ``'�'Y t +_,1,;, _ �. � r"'�, t. ! -��!' ''r' �,Y* .L1,.L' - tt n° v,. S�:-i. ,,_,#y ,#-.._.:�.�{� •k r ,i=:"11,4'"'�`} •'L��,-y. rr V ���r.4 r..i� '!�►! a�'L�:rr�t�� � A -•!p�•tM � n «�#� '3d: , ., .. a .K' ?,,. L� .;'�•. 'ri'='�_. Y /s•t-'r,arld�,e k'� _ w. '+f�+i'�� r r•rR ;1 ri r' IJr.. S. { 7'z„ ,,, ��;.;1't,@!v •'Y} ,�-r �.'�'-S _ W r i ,fi y�,,,a.L,. yz ':,A `� �'+ ,✓��rZF' f'I.`t?b C'.rst f��r,t'.r'� +I'." "d. X�•,":f � ;f..=f�L,r,;� ;,•,.. y.��i S.,, x�,z rr. tea m,.:s-_ 4i� . .f .c •,s 7.1 -L '.t�ra-.K ., S ',i^Y� -R p '�":may'{' �! . _ � r f ,!C��rjY. r! ,,- ,� "�' '� 'r :r. .r5' .i 'r '' -`it • ,,.• ,A -- �'.rfel l;i,,>_�,- . • 'r .ft r.,ty I., �%��. -1.'c+'tel��'€1�J t1r T �'• (t v rcn Het !i•' :�, •tlF'.�:,:i .�'rkar,,S�Ti nr� ��. '1!�y{��'.fr' �Qr�`'�``• �ih "[;`y'�L�Q�IkFLr�A..r'''p..-� •.!`�fi i+�+strr... �..r•! * •�� 's3 -'�, Y� ,.•L. v:l,f ,r►R�,n '�+ii....+ll�+ #,..� ra�`!rtir ^;!"r•Y:r..� ;" ,Arty 4' A� b5•i•i -0 ��.M} r1 L. r +3 - r'•i I .l'r'a a� tr .{.- MC' ,�l'I �. R vF'. r•� �. Y,,I.oll� e'ir �� J 1. ''� '! I �l 1I •J' '1{ �. AG 1'4 jr#�] 'I •v�r '"sy,' 'a; J' - sv�h�i}` F �. !14 r� T'/"" 7 .^,'- 7 I. ��:j�. �7..:;t.-.,, La..'t�: F•. ! `!. ti•.,...„ - ' S. .ir gir -I r.. .}�'F ,,k SS5 r'�'T1 rr": � �' :.','•P' •_5 3' , �1 :'l rf.��•�� :..{ ' ,,.�a -QJ j'�.N }r.:".:/'4 y rly' ry,,rG H• 'r 4:1� Ta+•-.I" Ir'i] • �"•r xl'�.1•�t r u. 1 A�4k:.� 17��• w ,1 ulr Y J/ �4 '! I"c m.• •.•.{' ' r H �,y''Gi. d ., !. �� )p 7 l "p7YA•' o-V���e.ar"G Si,;''' .�•. ro p .,t.v i v„ �e :C� ?'• "�'.r•r�k J tw t.r:' tt' �� r�,rlr� u.lr ' `� , •�7��J�' ti [t -P-t•... �• !V .� y, `�• .7 1 It. r• f p./ v ) 1. .: :'r'' �a' .: �`'i•- V -.: ::�4 -,�R^ •:� �1'""• -y,. 5.3iwscay..., 3 � e �� `coot •N%rR t ':7"•ttl• - .+r;�' .�; r! \V' r>a a•CC.- t,�r... ���',i. t"re.rr`Liri Z y �r om F .11.7' f.; y'F{. ±.��r°n ''1;:. ':,1•r,._� ' ':.i rw.er=:�--•-t }�. "� 7tis .� �, `t h t t V, :`x.:n,. '•.a. s;�l r .r. .I:,o,rd. rf: .' ys' -,�,r ''."r"-.-I�f-:: " ,J,� �.a , m�1�:, y�L.:'+Gia,r'r� i+:i `,'_ u'n f..• •.i'. «i t'7� ,I }'• r 'I+. ?' :`.t: - ,i t �. {r :�- . , c ti- ,�t •. _ ..I.r .. .r I,Lk.1 L, r. r:@ Fs, U i. •c+. .. 'ry A g, .1: „� .a t, ,� •.��' ' ..a+-- $ 1 E ,�.r11 r , i"r..1r:;� 4. �..ti'. 'Asr.. _r �r:Ds w1,. rtr7-ur (a,s w�.>t«�+• y:.. ' �• Y� -J � ��I 7.. '...1+.�° :. N" { �_� t': 4'Id;--, ,•-,., :.,,,,¢ !�J ,,�•,r .'^rr r..N-•�-R.114.�.. •+. � 9{ �'+r' tv !dl 1�: i t. '�._ o_ 1�1!1\- i... L' .frr NCDENR North Carolina Department of Environment and Natural Resources Division of Energy, Mineral, and Land Resources Land Quality Section Tracy E. Davis, PE, CPM Pat McCrory, Governor Director John E. Skvarla, III, Secretary October 21, 2013 Megan Weidner Diebold, Inc 5995 Mayfair Road North Canton, OH 44720 Subject: No Exposure Certification NCGNE0959 Diebold, Inc. 1150 Pleasant Ridge Road, Greensboro, NC 27406 Guilford County Dear Ms. Weidner: The Division has reviewed your submittal of the application for No Exposure Certification requesting exclusion from NPDES stormwater permitting for the Diebold facility located at 1150 Pleasant Ridge Road in Greensboro, NC. Based on your submittal of a signed certification of no exposure and on the site visit conducted by Sue White on October 15th, 2013, the Division is granting conditional exclusion from permitting as provided for under 40 CFR 12226(g), which is incorporated by reference in North Carolina regulations. Please note that by our acceptance of your No Exposure Certification, Diebold, Inc. is obligated to maintain no exposure conditions at this facility. If conditions change such that the facility no longer qualifies for no exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for any stormwater discharge. Otherwise, the discharge becomes subject to enforcement as unpermitted discharge. Diebold Inc. must recertify the no exposure status annually using the included form. Any"yes" answer would require that you obtain NPDES permit coverage for stormwater discharge from the facility. The annual self-recertification form does not need to be submitted to DEIVILR, 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 Sue White or me at(336) 771-5000. Sincerely, Matthew E. Gantt, PE Regional Engineer Land Quality Section Enclosures: Annual Self-Recertification Form CC: Debbie Shoffner(City of Greensboro Stormwater Management Division,via emall:deborah.shoffner(d,)greensboro-nc.gov) Scott Plath (Diebold Inc.,via email:scott.plath@diebold.com) Stormwater Permitting Unit—No Exposure Files Central Files - DWR W�SRTQ;FiIes-- Land_Qualit_y_--) Winston-Salem Regional Office 585 Waughtown Street, Winston-Salem, NC 27107 o Phone: 336-771-50001 FAX: 336-771-4631 FOR AGENCY USE ONLY 10 /Surface Water Protection Dacc Received Division of Water Quality Year I Ivianth I Dav ��`"®E�R National Pollutant Dischar-e Elimination System certirtcateofcovcragc low NO EXPOSURE CERTIFICATION for ExclusionLda v E NCGNE0000'' NO EXPOSURE CERTIFICATION:_ 013 National Pollutant Discharge Elimination System application for exclusion frormit b sed on NO EXPOSURE: ��` tn'rs!&anch 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 reguired 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 owner/operator(address to which all certification correspondence will be mailed): Name Z:E3bt-p• TNC.. Contact EraAr4 byET-DNE K Street Address _ 5995 MAY FAT& R D City N09TH CANT&td State Oft ZIP Code "IY720 Telephone No. 11D 410, to!BID7 Fax: Email &E_(*AU, `LVr ANER_�bLD. CDM RE:Salem iV.C.DR Page 1 of 7 AUG� 13 Winst SWU-NE-12Aug201 0 Re To NCGNE0000 No Exposure Certification 2) Location of facility producing discharge: u Facility Name =E f3D L D TNC — E (SOKO Facility Contact' rt'. 5 C bT F�ATH Facility Street Address JISh ?LFAsANT 12zDGE Rb City &gpF-Al 5 M f20 State A7 G ZIP Code 2-HOID County ZL.FORjb Telephone No, 33ID 2 — 0 Fax:., Email- --!5c_t)Tj. PL8Td g bZLISOLI) GOfLj 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). ).ahjv Idete + I- Rfi on 52KA e. M�rkef S-t. )ef+ on PlpaS ei .7r»: cry t2rylZ-# _ (A copy of a map with the facility clearly located on it should be in with the certification application.) 4) Is the facility located on Native American Lands? ❑ Yes WNo 5) Is this a Federal facility? ❑ Yes KNo 2� c � � N 6) Latitude -�10 tD 34,511 o Longitude -2 S� 3S.S (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 Existing Date operation began ❑ Renewal of existing No Exposure Certification Certification No.: NCGNE 6) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes 12 O 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: , 10) Provide a brief description of the types of industrial activities and products produced at this facility: Liak+ assembly aKd pjaK ana ip bpel"a-hn-n ;�rnduce a-k+ptoI-h'C f J)iw mac.h( ne_s attcl. _ctmi9oheh-1s, 11) Does this facility have any Non-Discharge permits(ex: recycle permits)? X No ❑ Yes If yes, list the permit numbers for all current Non-Discharge permits for this facility: Page 2 of 7 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 *0 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 kN0 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 1(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 I1No and similar containers h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ro the discharger i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes Al-No j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes k1lo k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes r0 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 4-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 ly,0 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 VIA deterioration, or evidence of leaks? b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No 1/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 ❑ Yes ❑ No * N/A 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 /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 ❑ Yes ❑ No +N/A Amendments and Reauthorization Act (SARA) water priority chemicals'? d. Is secondary containment provided for hazardous substances"designated in 40 Q Yes ❑ No JO/A CFR §116? e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No Or<IA 15) Hazardous Waste: a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes ,kNo b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes II No generated per month) of hazardous waste? c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes ,�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 stored: Where is material stored: How many disposal shipments per year: Name of transport/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. Page 4 of 7 5WU-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 )(N0 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 ,-'No sawdust, etc.? d. Does your facility have air emissions associated with its industrial activity (e.g., ❑ Yes ArNo 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? ❑ Yes ❑ No h/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: 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 1 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 Person Signing: U,N , Title: ���— CS+dc.•- C,J--� su c�u� 4�?04— U (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 SW U-NE-12Aug2010 NCGNE0000 No Exposure Certification Final Checklist :7his plication should include the following items:. - completed application and all supporting documentation. C5' A map with the location of the facility clearly marked. !w ' 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 ...... (828) 296-45001n taol5cilc.; , 1"` `• �� Fayetteville Office ... (910) 433-3300t- Mooresville Office ... (704) 663-1699 . ► < ' �" ° Raleigh Office ........ (919) 791-4200 t s_- -•Ila Washington Office ...(252) 946-6481 1° �� s Wilmington Office ... (910) 796-7215 Winston-Salem ...... (336) 771-5000 F Central Office ....:..._(919) 807-6300 Wil ngton Page 7 of 7 SW U-NE-12Aug2010 I a"'M 1 AI\F!Xi." R1 INA ap Mll Y.-f-r, Z. '61P I fAj ;oT ,7-Z Mff Vr 1'�, -WIx- P'wy WAL P t If. qt� ALI! 'm'At