NCGNE1048_COMPLETE FILE - HISTORICAL_20150501

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /V N,E I OY K
DOC TYPE 8/'HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑
YYYYMMDD

er
RCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
May 1, 2015
Don Springfield
Artistree, Inc.
1060 Industrial Park Drive
Kernersville, NC 27284
Subject: No-Exposure Certification NCGNE1048
Artistree, Inc.
Dear Mr. Springfield:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater
Permitting form. Based on your submittal and signed certification of no exposure at the above referenced facility,
the Division is granting your conditional exclusion from permitting as provided for under 40 CFR 126.22(g), which
is incorporated by reference in North Carolina regulations.
Please note that by our acceptance of your no-exposure certification, you are obligated to maintain no-
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no-exposure exclusion expires in five years (April 30, 2020). At that time you must re-certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your conditional exclusion from permitting does not affect your facility's legal requirements to obtain
environmental permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact Sue White at 336-776-9661, or at
[e-mail].
Sincerely,
Matthew-E. Gantt, PE
Regional Engineer
Land Quality Section
cc: Winston-Salem Regional Office
Stormwater Permitting Unit, No-Exposure Files
Division of Energy, Mineral, and Land Resources
Energy Section -Geological Survey Section • Land Quality Section
450 West Hanes Mill Road, Suite 300, Winston-Salem, NC 27105 -PHONE: [phone] FAX: [phone]
Internet: http:/Iportal.ncdenr.org/web/Ir/
An Equal Opportunity 1 Affirmative Action Employer—50% Recycled 110% Post Consumer Paper

i
NCGNEOOOO No Exposure Certification RECEIVED
pN.C. Dept. of ENR
Final Checklist
FEB 0 b 2015
Winston-Saiam
This application should include the following items: Regional Office
X This completed application and all supporting documentation.
X A map with the location of the facility clearly marked.
❑ If this is a renewal, indicated current NCGNE number in Question 7.
❑ 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 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:
Asheville Office ...... [phone] } •
Fayetteville Office ... [phone] rl
Mooresville Office ... [phone]
Raleigh Office ........ [phone] e�
Washington Office ...[phone]
Wilmington Office ... 910 796-7215 �-
Winston-Salem ...... [phone]
Central Office .........[phone]
1 ngton
by
Page 7 of 7
SWU-NE-021309 Last revised 6124114

FOR AGENCY USE ONLY
Date Received
�, Division of Energy, Mineral and Land Resources Year Month Da
y.
A���. Land Quality Section
NC® „NR National Pollutant Discharge Elimination System CenificaseofCoverag
NICI
NCrtTM[aRou MA D[WATMEHT O/ NO EXPOSURE CERTIFICATION for Exclusion G N E
ENVIRONMENT A130 NITLJRAL RESOURCCS NCG�TE0.000
Vu r.J
N.C. Dept.of ENR
NO EXPOSURE CERTIFICATION FEB 0 b 2*1ease check here if this is a renewal: ❑
RENEWAL Winston-Salem
Regional Office
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit based
on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notification that your facility does not require a
permit for stormwater discharges associated with industrial activity in the State of North Carolina because
it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means all
industrial materials and activities are protected by a storm resistant shelter(with some exceptions) to
prevent exposure to rain, snow, snowmelt, andlor 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 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 reapply for the No Exposure Exclusion once every five (5) years.
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 mailed):
Name ARTISTREE, INC.
RECEIVED
Contact DON SPRi NGFIELD
Street Address 1060 INDUSTRIAL PARK DRIVE I-LB 0 4 2015
City KERNERSViLLE State NC ZIP Code 27284 DENR-LAND QUALITY
Telephone No. [phone] Fax: [phone]
STORMWATER PERMITTING '
Page 1 of 7
SWU-NE-021309 Last revised 6124114

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name ARTISTREE, INC.
Facility Contact DON SPRINGFIELD
Street Address 1060 INDUSTRIAL PARK DRIVE
City KERNERSVILLE State NC ZIP Code 27284
County FORSYTH
Telephone No. [phone] Fax: [phone]
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). FROM INTERSTATE 1-40 TAKE EXIT#203 NC
HIGHWAY 66, GO 1.4 MILES NORTH AND TURN RIGHT ONTO INDUSTRIAL PARK DRIVE. TRAVEL
APPROXIMATELY 0.7 MILES. THE FACILITY IS ON THE RIGHT SIDE OF TH E ROAD.
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes x No
5) Is this a Federal facility? ❑ Yes x No
6) Latitude 36.103373 Longitude 80.049290 (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
X Existing Date operation began 1996
❑ Renewal of existing No Exposure Certification Certification No.. NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes x No
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2 4 9 9
10) Provide a brief description of the types of industrial activities and products produced at this facility:
MEDIUM DENSITY FIBERBOARD IS MADE INTO CUSTOM WOOD FRAMES FOR MICHAELS. THE
FRAMES ARE SPRAYED WITH WATER BASED PAINTS AND FINISHED FOR CUSTOMER
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.'
ow.
sv l � ^1- 6 qeq3�
Page 2 of 7
SWU-NE-021309 Last revised 6,124114

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 X No ❑ N/A
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 spillsAeaks ❑ Yes X No ❑ N/A
c. Materials or products from past industrial activity ❑ Yes X No ❑ N/A
d. Material handling equipment(except adequately maintained vehicles) ❑ Yes X No ❑ N/A
e. Materials or products during loading/unloading or transporting activities ❑ Yes X No ❑ N/A
f Materials or products stored outdoors (except final products intended for outside ❑ Yes X No ❑ N/A
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 X No ❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes X No ❑ N/A
the discharger
i. Waste material(except waste in covered, non-leaking containers e.g., dumpsters]) ❑ Yes X No ❑ N/A
j. Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes X No ❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes X No ❑ N/A
otherwise regulated(i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes X No ❑ N/A
(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 X No ❑ N/A
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. NO ASTs ON SITE
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or ❑ Yes ❑ No X N/A
deterioration, or evidence of leaks?
b. is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No X N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-021309 Last revised 6124114

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 single above ground storage containers ❑ Yes ❑ No X N/A
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored ❑ Yes ❑ No X N/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 X N/A
Amendments and Reauthorization Act(SARA) water priority chemicals*?
d. Is secondary containment provided for hazardous substances"designated in 40 ❑ Yes ❑ No X N/A
CFR§116?
e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No X N/A
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes X No ❑ N/A
b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste X Yes ❑ No ❑ N/A
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator(1000 kg, or more of hazardous waste ❑ Yes X No ❑ N/A
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: SPENT SOLVENT
How is material stored. INSIDE OF THE MANUFACTURING PLANT IN 55 GALLON DRUMS
Where is material stored. DESIGNATED STORAGE AREAS WITH DIKE OR SPILL CONTROL
How many disposal shipments per year. 12
Name of transport/disposal vendor. GIANT RESOURCES
Vendor address:755 INDUSTRIAL INDUSTRIAL BLVD. SUMTER, SC 29150
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-021309 Last revised 6124114

NCGNE0000 No Exposure Certification
16) Other information: If you answer"Yes"to any of the following items, you might not be eligible for the
no exposure exclusion. A more in-depth evaluation of the site circumstances may be required.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? ❑ Yes X No ❑ N/A
b. Does your facility have coal piles on site? ❑ Yes X No ❑ N/A
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes X No ❑ N/A
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity(e.g., X Yes ❑ No ❑ N/A
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity. PAINT SPRAY BOOTH AND BAGFILTER FOR DUST
CONTROL ON AIR PERMIT
e. If you answered yes to d., are those emissions permitted by an Air Quality X Yes ❑ No ❑ N/A
Permit? Please specify: Forsyth County Environmental Assistance and
Protection issued permit 0990
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--021309 Last revised 6/24/14

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 submit a no exposure certification form once every five(5) years to the North Carolina
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system(MS4)into
which the facility discharges (where applicable). i understand that i must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
in the event that the site no longer qualifies for a No Exposure Exclusion, I understand that 1 must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, 1 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 of Person Signing:DON SPRINGFIELD
Title:P T M
A-2 /
( ignature 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-021309 Last revised 6124114

ARTISTREE, INC.
1060 INDUSTRIAL PARK DRIVE, KERNERSVILLE, NC 27284
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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /V U& N L I OH b
DOC TYPE 0/'HISTORICALFILE
❑ MONITORING REPORTS
DOC DATE ❑ �0�� USD )
YYYYMMDD

�CDEN 9
North Carolina Department of Environment and Natural Resources
Pat McCrory Donald R. van der Vaart
Governor Secretary
May 1, 2015
Leann Welborn
Fleet Painting Service, Inc
4958 Old Marlboro Road
Sophia, NC 27350
Subject: No-Exposure Certification NCGNE1048
Fleet Painting Service, Inc.
Dear Ms. Welborn;
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater
Permitting form. Based on your submittal and signed certification of no exposure at the above referenced facility,
the Division is granting your conditional exclusion from permitting as provided for under 40 CFR 126.22(g), which
is incorporated by reference in North Carolina regulations.
Please note that by our acceptance of your no-exposure certification, you are obligated to maintain no-
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no-exposure exclusion expires in five years (April 30, 2020). At that time you must re-certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your conditional exclusion from permitting does not affect your facility's legal requirements to obtain
environmental permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact Sue White at 336-776-9661, or at
[e-mail].
Sincerely,
Matthew E. Gantt, PE
Regional Engineer
Land Quality Section
cc: Winston-Salem Regional Office
Stormwater Permitting Unit, No-Exposure Files
Division of Energy, Mineral, and Land Resources
Energy Section•Geological Survey Section • Land Quality Section
450 West Hanes Mill Road, Suite 300,Winston-Salem, NC 27105 -PHONE: [phone] FAX: [phone]
Internet: hftp://portal.ncdenr.orgtwebArl
An Equal Opportunity 1 Affirmative Action Employer—50% Recycled 110%Post Consumer Paper

RECEIVEDbV'59D
FOR AGENCY USE ONLY
• O )Res Date Received
Division of Energy, Mineral and Land VVA r;ceQUA %! ,n ,
Land Quality SectionWgrRFERMii j/, crniscateor o1era+
NCDENRNational Pollutant Discharge Elimination System N I C I G IN.E :_
.,.Rr.e NO EXPOSURE CERTIFICATION for I xCILlSion N.U. ae it'Mi _„n
[NVIRON4[4T ar,�Nail.L{a[$O�IRfiE$
RECEIVED NCGNE0000 APR 14 2015
Winston-Salem
j\10 E,VPO SUR,AgtR{fTE7,gT TIOAF .!'lease check here rf this is a rene.wah�i Duce
RENE l FA I
DENR-LAND QUALITY
National PI'ollutantll]i'scharge Elimination System application for exclusion from a Stormwater Permit based
on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notification that your facility does not require a
permit for stormwater discharges associated with industrial activity in the State of North Carolina because
it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means all
industrial materials and activities are protected by a storm resistant shelter(with some exceptions) to
prevent exposure to rain, snow, snowmelt, and/or runoff.
For permitted facilities in North Carolina, DEMLR 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 Teak. "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
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 922.26(g).
You are required to reapply for the No Exposure Exclusion once every five 5 ears.
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 mailed):
a
Name
y40 Af
Contact i
Street Address
City 0 - State ZIP Code
Telephone No. Fax: Q
Page 1 of 7
SVVU-NE-021309 Last revised 61241.14

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility NameFdZA�a4 V
Facility Contact
Street Address
City State C_— ZIP Code
County paaLw
Telephone No. Fax: Lola
3) Physical location information:
Please provide a narrative description of how to get to the facility use street n mes, state road gum ers and
distance and nddirec ion from a oadway i ter ction). u7 to bda, J
(A copy of a map with the facility clearly I ated on it should be included with the certification application.)
4) Is the facility located on Native American Lands?❑ Yes 91�0
5) Is this a Federal facility? ❑ Yes L�'No
6) Latitude Longitude (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 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#ie Vpes pf industrial activities and roducts roduced at this facility:
Q
Yl
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
"o
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
`? . 3g5yq
Page 2 of 7
SWU-NE-021309 Last revised 6124/14

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 D"No ❑ NIA
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 I(No ❑ NIA
c. Materials or products from past industrial activity ❑ Yes O No ❑ NIA
d. Material handling equipment(except adequately maintained vehicles) ❑ Yes D�No ❑ NIA
e. Materials or products during loading/unloading or transporting activities ❑ Yes E�'No ❑ NIA
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ON o ❑ N/A
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 A ❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes 2"No ❑ N/A
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes I"No ❑ N/A
j. Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes Q No ❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes 21'No ❑ N/A
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 eNo ❑ N/A
(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 ❑ 13 Yes No ❑ N/A
stored outside, has the facility had any releases in the past three (3)years?
13) Above Ground Storage Tanks (ASTs): If you answer"No" to any of the following items,you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or /(Yes ❑ No ❑ N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any /'Yes ❑ No ❑ N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
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NCGNE4000 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 single above ground storage containers ❑ Yes ❑ No 2 N/A
(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 214/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 ETIN/A
Amendments and Reauthorization Act(SARA)water priority chemicals"?
d. Is secondary containment provided for hazardous substances— designated in 40 ❑ Yes ❑ No INN/A
CFR §116?
e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No e N/A
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes 21 No ❑ N/A
b. Is this facility a Small Quantity Generator(less than 1000 kg, of hazardous waste ❑ Yes 21 No ❑ N/A
generated per month)of hazardous waste? /
c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑ Yes e No ❑ N/A
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
SWU-NE-021309 Last revised 6/24114

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 Z'No ❑ NIA
b. Does your facility have coal piles on site? ❑ Yes Ao ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes [Ao ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity(e.g., 2' es ❑ No ❑ NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: _-NVL��\4irvR
e. If you answered yes to d., are t o e emissions permitted b an Air Quality Permit? ❑ Yes �'�lo El N/A
Please specify: l r
f. Please list any other environmental program per its (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-021309 Last revised 6/24114

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 submit a no exposure certification form once eve five 5 ears to the North Carolina
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system (MS4)into
which the facility discharges(where applicable). I understand that I must allow the North Carolina Division of Water
Quality or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, i certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information,the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing: � �
Title: IV
I h
(Signature of Applicant) {ba e 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-NF-021309 Last revised 6124/14

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
in/ This completed application and all supporting documentation.
C A map with the location of the facility clearly marked.
❑ If this is a renewal, indicated current NCGNE number in Question 7.
❑ 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 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:
Asheville Office ...... [phone] '� ton6°
Fayetteville Office ... [phone] , °"
Mooresville Office ... [phone] , _ ' o •r
Raleigh Office ........ [phone] , 1e
Washington Office _(252) 946-6481
Wilmington Office ... [phone] +
Winston-Salem ...... [phone] eK wI1°
Central Office .........[phone] "
Wil ngton
Page 7 of 7
SVVU-NE-021309 Last revised 6/24/14

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Driving directions to 8392 Hillsville Rd,Sophia,NC 27350
3226 Gatesville Rd
Greensboro,NC 27405
1, Head south on Gatesville Rd toward Mc Knight Mill Rd
2. Turn left onto Mc Knight Mill Rd
248 fl
3. Turn fight onto 16th St
4. Keep right to continue toward N Ohenry Blvd
- -- -- aim
5. Turn right onto N Ohenry Blvd
6. Continue onto S O Henry Blvd
--- 1.8 M
7. Keep right at the fork,follow signs for 140 WI1-85 BUS SIUS.291US.701US-2201High Point/Charlotte and merge onto 140 WA-85BUS SIUS-220 SIDS-29 VUS-70
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2.2 mi
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9. Continue onto 1-86 S
7.2 rni
10, Take exit 111 for S Main St toward Archdale/High PoinVDowntown
0,2 mi
11. Turn left onto US-311 SIN Main St
Continue to follow US-311 S
1.5IN
12. Turn right onto Tam Hill Rd
13. Turn left onto Archdale Rd
1.9 nti
https.Hmaps.google.con-/maps?hl=en&tab—wl&output=classic&dg=brw 2/9/2015

White, Sue
From: Graznak, Jenny
Sent: Thursday, February 05, 2015 3:48 PM
To: White, Sue
Subject: Fleet Painting - Randolph Co.
Hi Sue!
I went to a complaint site in Randolph County yesterday. Caller was concerned about stormwater runoff from a paint
company next door. I looked up in BIMS and the company does not have a stormwater permit (NCG090000, Paints and
Varnishes). I walked around the outside of the painting company and didn't see anything—it was actually pretty clean.
But the caller said that's a different story during rain events.
Fleet Painting
8392 Hillsville Road
Sophia, NC
Owned by Randal & Christine Welborn
Phone: [phone]
They have two locations—the other larger site is on Old Marlboro Road.This particular complaint is regarding Hillsville
Road, but both probably need SW permits.
Sorry!
Jenny Graznak
NCDENR Division of Water Resources
Winston-Salem Regional Office
450 W. Hanes Mill Road, Suite 300, Winston-Salem, NC 27105
Main Phone: [phone]
Direct Phone: [phone]
www.ncwater.org
Email correspondence to and from this address may be subject to the NC Records Law and may be disclosed to third parties.