NCGNE1022_COMPLETE FILE - HISTORICAL_20140808

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /V CCU Nc I U D�
DOC TYPE IP/HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE Ug��b'
YYYYMMDD

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[1 CDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvada, III
Governor Secretary
August 4, 2014
Steve Wright NO%
High Point Furniture Industries
1104 Bedford Street
High Point, NC 27263
AUG 0 8 2014
Subject: No Exposure Certification NCGNE1022 F I
Rescission of Permit NCG180217
High Point Furniture Industries—Corporation Drive Plant
Randolph County
Dear Mr. Wright:
The Division has reviewed your submittal of the application for No Exposure Certification requesting
exclusion from NPDES stormwater permitting at the High Point Furniture Industries (HPFI) plant on
Corporation Drive. Based on your submittal of a signed certification of no exposure and on inspection by
Aana Taylor-Smith on July 22, 2014, 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.
We are also hereby rescinding your current permit Certificate of Coverage, NCG180217,
Please note that by our acceptance of your No Exposure Certification, HPFI 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.
HPFI must recertify the no exposure status annually using the included form and retain the completed
form on site. 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 Aana Taylor-Smith or me at(336)
771-5000.
Sincerely,
Matthew E. Gantt, PE
Regional Engineer
Land Quality Section
Enclosure: Annual Self-Recertification Form
CC: Stormwater Permitting Unit—No Exposure Files
WSRO Files—Land Quality
Division of Energy, Mineral, and Land Resources
Land Quality Section •Winston-Salem Regional Office
585 Waughtown Street, Winston-Salem, NC 27107• Phone:[phone] FAX: [phone]

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44
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MC®ENR
North Carolina Department of Environment and Natural Resources
} Pat McCrory John E. Skvarla, III
Governor Secretary
August 4, 2014
Steve Wright
High Point Furniture Industries
1104 Bedford Street
High Point, NC 27263
Subject: No Exposure Certification NCGNE1022
Rescission of Permit NCG180217
High Point Furniture Industries —Corporation Drive Plant
Randolph County
Dear Mr. Wright:
The Division has reviewed your submittal of the application for No Exposure Certification requesting
exclusion from NPDES stormwater permitting at the High Point Furniture Industries (HPFI) plant on
Corporation Drive. Based on your submittal of a signed certification of no exposure and on inspection by
Aana Taylor-Smith on July 22, 2014, 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.
We are also hereby rescinding your current permit Certificate of Coverage, NCG180217.
Please note that by our acceptance of your No Exposure Certification, HPFI 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.
HPFI must recertify the no exposure status annually using the included form and retain the completed
form on site. 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 Aana Taylor-Smith or me at(336)
771-5000.
Sincerely,
Matthew E. Gantt, PE
Regional Engineer
Land Quality Section
Enclosure: Annual Self-Recertification Form
CC: Stormwater Permitting Unit— No Exposure Files
WSRO Files--- Land Quality
Division of Energy, Mineral, and Land Resources
Land Quality Section •Winston-Salem Regional Office
585 Waughtown Street,Winston-Salem, NC 27107• Phone: [phone] FAX: [phone]

Taylor-Smith, Aana
From: Steve Wright <[e-mail]>
Sent: Monday, August 04, 2014 10:31 AM
To: Taylor-Smith, Aana
Subject: FW: dock pictures
Will this work?This is the area that the pallets were in.
Steve Wright
Human Resources Manager
(P)336-289-2648
(F)336-431-3070
WWW.HPFI.COM
k
HPFI
From: Susie Bunn
Sent: Monday, August 04, 2014 10:27 AM
To: Steve Wright
Subject: dock pictures
wiiMe.r�
Susie Bunn
Human Resources-Casegoods Division
High Point Furniture Ind.
i

phone: [phone]
fax: [phone]

�6- ns�z�s t� 1—�PsP �V11 S CJJ A,a
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`�' �/ • FOR AGENCY USE ONLY
. Date Received
Division of Energy, Mineral, and Land Resources Year Month Day
NCDENRNational Pollutant Discharge Elimination System Certificate ofCovemge
NO EXPOSURE CERTIFICATION for Exclusion N N E
E aamE�.�oN, � NCGNEOOOO N.0 RECEIVED of E."2
JUL 3t 2014
NO EXPOSURE CERTIFICATION
WINSTON-SALEiv1
National Pollutant Discharge Elimination System application for exclusion from a Storn7viiate�'Peririi 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, DEMLR must approve your application for No
Exposure Certification before this exclusion is effective. Until you are issued a No
Exposure Cfertification 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 DEMLR 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 mailt:
Name High Point Furniture Industries
Contact Steve Wright
Street Address 1104 Bedford St
City High Point State NC ZIP Code 27263
Telephone No_ 336-431-7101 �F�i:E 1X!E.E.Y.-
Email [e-mail] JUL 2 g 2014
Page 1 of 7 ©ENR-LAND QUALITY
STORMWATER PERMITTING
SWU-NE-21 Feb2014

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NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name High Point Furniture Industries
Facility Contact Steve Wright
Facility Street Address1121 Corporation Dr
City High Point State NC ZIP Code 27263
County Randolph
Telephone No. 336-431-7101 Fax:
Email [e-mail]
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). Facility is on Corporation Drive. Corporation Drive is
off of Surrett Dr.
(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 2lu/No
6) Is this a Federal facility? ❑ Yes vl/o
6) Latitude 5 s!` Longitude FP "D--
':�a (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 q
V"Existing Date operation began
❑ Renewal of existing No Exposure Certification No.: NCGNE
8) Was this facility or site ever covered under anN>(�"PIDEES Stormwater Permit? 121' es ❑ No
If yes, what is the NPDES Permit Number? /1 LF/���
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code)that describes the primary industrial
activity at this facility 1
SIC Code: �_ 5 __;� [
10) Prov'de a brie des ription of the type of indu al activit'y s and products produced at this facility:
11) Does his facility have any Non-Discharge permits (ex: recycle permits)?
70
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
Page 2 of 7
5WU-NE-21 Feb2014

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 E�40
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 LWNo
c. Materials or products from past industrial activity ❑ Yes L'hlo
d. Material handling equipment(except adequately maintained vehicles) ❑ Yes e'N0
e. Materials or products during loading/unloading or transporting activities ❑ Yes [�40
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ao
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 12"No
and similar containers h. Materials or products handled/stored on roads or railways owned or maintained by ElYes "/0
the discharger
I. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes DNo
j. Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes M14
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes /No
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes ❑ No
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes VNo
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 ❑ NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any e Yes ❑ No ❑ NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-21 FO2014

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 E7 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 ❑ Yes ❑ No LYNIA
Amendments and Reauthorization Act(SARA) water priority chemicals"?
d. Is secondary containment provided for hazardous substances**designated in 40 ElYes ❑ No ❑'N/A
CFR §116?
e. Are release valves on all secondary containment structures locked? B Yes ❑ No ❑ NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes 2/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 El Yes Cd No
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide a following information:
Type(s) of waste: eA, S©1 "V
How is material stored: rk a Ifj t15 ► CIP,
Where is material stored: 0JJJAI&3
How many disposal shipments per year: r
Name of transport/disposal vendor 0► ;d a.`
Vendor address: �06
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_
i*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-21 Feb2414

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 "0
b. Does your facility have coal piles on site? [:] Yes "o
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes "o
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity(e.g., 2-Yes ❑ No
degreasing operations, plating, pai ing d me I finis 'ng)? If so, d cribp he
industrial activity: �rh� ag ,S L` I
e. If you answered yes to d., are those emissions permitted by a Air Quality Permit? gyres © No ❑ NIA
Please specify:
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier iinr this a22lication (such as Hazardous Waste Permits, etc.).
Permit: ! 3� Program:
Permit: /y G �D3h^ S�?� , Program: veal 34
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5 of 7
SWU-NE-21 Feb2014

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
DEMLR 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 Energy, Mineral, and Land Resources(DEMLR),
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, l 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.
r
Printed Name of Pe on Signing:
Title: vt1YC�� �h
G �Y
(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-21 Feb2014

• P
NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
❑ This completed application and all supporting documentation.
❑ 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 Program
Division of Energy, Mineral, and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information:_
A
Win ale ' -
Asheville Office ...... [phone]
Fayetteville Office ... [phone] - - °t g►+
Mooresville Office ... [phone]
Raleigh Office ......_. 919 791-4200 '
g ( ) the �O°r l°
Washington Office ...[phone] ,af
Wilmington Office ... [phone] •Ile
Winston-Salem ...... [phone] '
Central Office .........[phone] �+
Wit gton
Page 7of7
SWU-NE-21 Feb2014

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-USGS IDENTIFICATION —SCALES
USGS 7.5 MINUTE MAP HIGH POINT EAST/WEST. NC 1/2 0 1
ORIGINAL DATE: 1950/1969 MILES:
PHOTORCVISiON 1982/1987
DATE: 100o 0 2000 4000 6000
FEET: ECE ED
PRIMARY HIGHWAY, HARD SURFACE 1' = 2000'
JUL
SECONDARY HIGHWAY, HARD SURFACE NOTE: TOPOGRAPHICAL CONTOUR INTERVAL a 10 FEET 28 2014
LIGHT-DUTY ROAD HARD OR DENR-L&ND QUALITY
IMPROVED SURFACE COUNTY MAP OF:
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- — UNIMPROVED ROAD MNO�� NORTH CAROLINA R ERMiTTING
U STATE ROAD
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INTERSTATE ROUTE APPROXIMATE SITE LOCATION
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North Carolina Department of Environment and Natural Resources
Rat McCrory John E. Skvarla, HI
Governor Secretary
22 July 2014
Steve Wright
High Point Furniture Industries
1121 Corporation Drive
High Point, NC 27281
Subject: Compliance Evaluation Inspection
NPDES General Stormwater Permit NCG180000
Certificate of Coverage NCG180217
High Point Furniture Industries—Corporation Drive Plant
Randolph County
Dear Mr.Wright:
Aana Taylor-Smith of the Winston-Salem Regional Office of the NC Division of Energy, Mineral, and Land
Resources (DEMLR) conducted a compliance evaluation inspection at the subject facility on 22 July 2014. Your
assistance and cooperation during the inspection were greatly appreciated. An inspection checklist is attached for
your records and the inspection findings are summarized below.
This facility is located at 1121 Corporation Drive in High Point, Randolph County, North Carolina. Stormwater
related to industrial activity is discharged from the site to an unnamed tributary to the Uwharrie River, this
segment of which is currently classified as Class WS-III waters, in the Yadkin-Pee Dee River Basin.
Documentation &Monitoring Review
The facility's Stormwater Pollution Prevention Plan (SPPP) is thorough, up to date, and fully implemented.
Qualitative monitoring has been completed as required. Analytical monitoring is not required because this facility
does not perform on-site vehicle maintenance.The facility has one Stormwater Discharge Outfall (SDO)that
discharges stormwater related to industrial activity.
Site Review
The facility is clean and well-maintained. Secondary containment is implemented as required.The outfall was
inspected and found to be in good order. No evidence of erosion or instability at the SDO was observed.The
receiving stream was free of pollution indicators. During the inspection, it was noted that this facility would only
need to make a few minor adjustments to qualify for No Exposure Certification,which would eliminate the need
for the NCG180000 permit. For more information on No Exposure Certification, please visit our website at the
following link:
http://portal.ncdenr.org/web/lrinpdes-stormwater#tab-5
Division of Energy, Mineral, and Land Resources
Land Quality Section -Winston-Salem Regional Office
585 Waughtown Street, Winston-Salem, NC 27107 •Phone: [phone] FAX: [phone]

High Point Furniture Industries—Corporation Drive Plant `
07/22/2014
Page 2 of 2
We appreciate your efforts to comply with the stormwater permit and the proactive steps taken to identify and
eliminate potential sources of pollution. No additional response to this letter is required. Should you have any
questions regarding the NCGI80000 permit or this inspection, please do not hesitate to contact Ms. Taylor-Smith
or me at [phone].
Sincerely,
Matthew E. Gantt, PE
Regional Engineer
Land Quality Section
Enclosures: RIMS Inspection Checklist
cc: Central Files
WSRO/LQ

Compliance Inspection Report
Permit: NCG180217 Effective: 09101109 Expiration: 08131/14 owner: High Point Furniture Industries
SOC: Effective: Expiration: Facility: High Point Fumiture Industries
t County: Randolph 7127 Corporation Dr
Region: Winston-Salem
}sigh Point NC 27261
Contact Person: Steve Wright Title: Phone: 336A34-5146
I
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 07J2212044 Entry Time: 09:30AM Exit Time: 10:00AM
Primary Inspector: Aana Taylor-Smith Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Furniture and Fixtures Stormwater Discharge COC
Facility Status: ® Compliant Not Compliant
Question Areas:
® Storm Water
(See attachment summary)
Page: 1

Permit: NCGIB0217 Owner-Facility:High Paint Furniture Industries
Inspection Date: 0712212014 Inspection Type:Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Site is in compliance. Records are excellent. No vehicle maintenance is performed,so no analytical monitoring is required.
This site could easily qualify for No Exposure Certification if a small amount of materials were moved indoors.
Page; 2

Permit: NCG180217 Owner-Facility:High Point Furniture Industries
Inspection Date: 07/22/2014 Inspection Type:Compliance Evaluation
Reason for visit: Routine
k .
i Stormwater Pollution Prevention Plan
Yes No NA NE
I
Does the site have a Stormtivater Pollution Prevention Plan? ® ❑ ❑ ❑
#Does the Plan include a General Location(USGS)map? ® ❑ ❑ ❑
#Does the Plan include a"Narrative Description of Practices'? ® ❑ ❑ ❑
#Does the Plan include a detailed site map including outfall locations and drainage areas? ® ❑ ❑ ❑
#Does the Plan include a list of significant spills occurring during the past 3 years? ❑ ❑ ® ❑
#Has the facility evaluated feasible alternatives to current practices? ® ❑ ❑ ❑
#Does the facility provide all necessary secondary containment? IM ❑ ❑ ❑
#Does the Plan include a BMP summary? ® ❑ Cl ❑
#Does the Plan include a Spill Prevention and Response Plan(SPRP)? M ❑ ❑ ❑
#Does the Plan include a Preventative Maintenance and Good Housekeeping Plan? is ❑ ❑ ❑
#Does the facility provide and document Employee Training? ® ❑ ❑ ❑
#Does the Plan include a list of Responsible Party(s)? ® ❑ ❑ ❑
#Is the Plan reviewed and updated annually? ® ❑ ❑ ❑
#Daes the Plan include a Stormtivater Facility Inspection Program? ® ❑ ❑ ❑
Has the Stormwater Pollution Prevention Plan been implemented? ® ❑ ❑ ❑
Comment:
Qualitative Monitoring
Yes No NA NE
Has the facility conducted its Qualitative Monitoring semi-annually? ® ❑ ❑ ❑
Comment:
Permit and Outfalls
Yes No NA NE
#Is a copy of the Permit and the Certificate of Coverage available at the site? ® ❑ ❑ ❑
#Were all outfalls observed during the inspection? M ❑ ❑ ❑
#If the facility has representative outfall status,is it properly documented by the Division? ❑ ❑ ® ❑
+r Has the facility evaluated all illicit(non stormwater)discharges? ® ❑ ❑ ❑
Comment:
Page: 3