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Home My WebLink AboutNCGNE0299_COMPLETE FILE - HISTORICAL_20010921PERMIT NO. DOC TYPE DOC DATE i STORMWATER DIVISION CODING SHEET NCG PERMITS NCGNE n HISTORICAL FILE Cl YYYYMMDD 91OR491067 Tredegar Film Red hpii Tre egir FILM PRODUCTS 10 18 35 a m 00 21 2011 1 14 ®ENR-FR SEP 2 1 2011 ®WQ To Belinda Henderson Hei e 1s Red Springs - Tredegar Corpoi ation 2011 application for re — certification of NPDES Kenneth N Greene Plant Safety and Training WP 910 — 359 — 3074 CP 910 — 257 — 0982 Email Kenneth Greene@tredegar corn Tredegar hilm Products Corporation 1001ndustrial Drive Red Spungs, NC 28377 *Tel eph one 910 843-8343 • Fax 910 843 1067 Corm AE 002 910843106 f 7 a As, A�._►.r. NCDENR Nomm r�wpe,Aa pevakT�K�rr or E-AONMCAT A 7 M4uFA RESOVRcu 7 Tredegar Film Red Spn 10 18 45 a rr 09 21 2011 2 l4 Division of Water Quality / Surface Water Protection National Polkitarit Discharge Elimination System AN TUAL NO EXPOSURE EXCLUSION SELF RE-CER`i [FICA I ION NCGNE0000 Do not submit this form to DWQ unless requested For questions, please contact the DWQ Regional Office for your area or the Central Office (Please print or type) Facility's No Exposure Exclusion No Date Completed (MM/DD/YYYY) N C G N E j 0 2 9 4 0 9 2 1 / 2 0 1 I 1 1) Has the facility name or owner changed? ❑ Yes ® No (if yes please submit a separate Name/Ownership Change Form to DWQ located at http llportal ncdenr orglweblwglwslsu/npdessw#Appllcation_Forms_NPDES) 2) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable futures (Please check either "Yes" or "No ") If you answer "Yes" to any of these items, you are not_ eligible to maintain your no exposure exclusion, and must immediately apply for a permit from DWQ a Using storing or cleaning industrial machinery or equipment, and areas where ❑ Yes ® No 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 ® No 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 ® No f Materials or products stored outdoors (except final products intended for outside ❑ Yes ® No use [e g new cars] where exposure to stormwater does not result in the discharge of pollutants) g Materials contained in open, deteriorated or leaking storage drums, barrels tanks, ❑ Yes ® No and similar containers h Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ® No the discharger i Waste material (except waste in covered non -leaking containers fe g dumpsters]) ❑ Yes ®No l Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes ® No k Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ® No otherwise regulated (i a 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) Page 1 of 3 SWU NESR 29Ju12010 9108411067 Tiedeq ii I ilm Red Spit 10 19 48 a ni 09 21 2011 314 NCGNE0000 No Exposure Self Re -Certification 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? 3) Above Ground Storage Tanks (ASTs) If you answer "No" to any of the following items, you are not eligible to maintain your no exposure exclusion, and must immediately apply for a permit from DWQ a Are exterior ASTs and piping free of rust damaged or weathered coating, pits, or [:]Yes[:] No ® N/A deterioration, or evidence of leaks? b Is secondary containment provided for ail exterior ASTs? If so, is it free of any [:]Yes[—] No ® NIA cracks holes or evidence of leaks, and are drain valves maintained locked shut? 4) Secondary Containment If you answer "No" to any of the following items, you are not eligible to maintain your no exposure exclusion, and must immediately apply for a permit from DWQ a ]s secondary containment provided for all single above ground storage ❑Yes❑ No 0 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 Z 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 VN N/A Amendments and Reauthorization Act (SARA) water priority chemicals'? d Is secondary containment provided for hazardous substances" designated in 40 [—]Yes[—] No � NIA CFR §116? e Are release valves on all secondary containment structures locked? ❑Yes❑ No ® NIA Footnotes to Questions 4) 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 irl 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 5) Other information If you answer "Yes" to any of the following items, and the answer if different from how it was answered when originally applying, you might not be eligible to maintain your no exposure exclusion Please contact the Divlslon If this is the case a Does your facility store used recycled or otherwise reclaimed pallets outside? b Does your Ill have coal piles on site? c Does your facility store other fuel sources outside in piles, such as wood chips, sawdust, etc ? d Does your facility have air emissions associated with its industrial activity (e g , 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? Please specify Page 2 of 3 SWU NESR 29JuI2010 ❑ Yes ® No ❑ Yes ❑ No ❑ Yes ®No ❑ Yes ® No [:]Yes[] No®NIA 910tih31067 liedegal I ilrn Red Spit i NCGNE0000 No Exposure Self Re -Certification 6) Certification 10 20 24 a ni 00 21 )01 1 4 /4 I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of no exposure and obtaininglmaintaining an exclusion from NPDES stormwater permitting t certify under penalty of law that there are no discharges of stormwater contaminated by exposure to Industrial activities or materials from the Industrial facility or site Identified in this document (except as allowed under 40 CFR 122 26(g)(2)) understand that I am obligated to annually self re certify No Exposure and if requested submit this 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 provided Based on my inquiry of the person or persons who manage the system or those persons directly responsible for gathering the information the Information provided is to the best of my knowledge and belief true accurate and complete I am aware that there are significant penalties for providing false information including the possibility of fine and imprisonment for knowing violations I certify that I am familiar with the information contained in this document and that to the best of my knowledge and belief such information is true complete and accurate Printed Name of Person Signing Steven C Hunt Titi Maria r -Tiede ar Film Products Red Springs, NC 28377 (Signature) Pt!t9ned) Please note The Regional Office may 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 ar 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) This completed form must be kept on file at the facility for at least 5 years Do not submit this form to DWQ unless requested Page 3 of 3 SVVU NESR 29Jui2010 Michael F Easley Govemor William G Ross Jr Secretary North Carolina Department of Environment and Natural Resources Alan W Klimek P E Director Division of Water Quality Coleen 17 Sullins Deputy Director Division of Water Quality September 29, 2006 Mr Steven Con Hunt Tredegar Corporation 1100 Boulders Parkway Richmond, VA 23225 Subject No Exposure Certification NCGNE0299 Tredegar Corporation 100 Industrial Drive, Red Springs, NC Robeson County Dear Mr Hunt 0 3 20 ONNO The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES Stormwater Permitting form, which we received on August 8, 2006 Based on your submittal and signed certification of no exposure at the above referenced facility, the Division is granting your certification 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 (September 30, 2011) At that time you must re -certify with the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility Your certification of no exposure does not affect your facility's legal requirements to obtain environmental permits that may be required under other federal, state, or local regulations or ordinances If you have any questions or need further information, please contact Sarah Young at (919) 733-5083, ext 502, or at sarah young@ncmail net cc Fayetteville Regional Office-� Stormwater Permitting Unit Files Sincerely, ORIGINAL SIGNED BY KEN PICKLE for Alan W Klimek, P E Central Files — w/attachments N C Division of Water Quality 1617 Mad Service Center Raleigh North Carolina 27699 1617 (919) 733 7015 VPWI rdEUR Customer Service 1 877 623 6748 1�IA� Michael F Easley Governor k RpG William G Ross Jr Secretary North Carolina Department of Environment and Natural Resources `OHO U? Alan W Klimek P E Director Division of Water Quality -� Coleen H Sullins Deputy Director Division of Water Quality September 29, 2006 Mr Steven Con Hunt Tredegar Corporation 1100 Boulders Parkway Richmond, VA 23225 Subject No Exposure Certification NCGNE0299 Tredegar Corporation 100 Industrial Drive, Red Springs, NC Robeson County Dear Mr Hunt The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES Stormwater Permitting form, which we received on August 8, 2006 Based on your submittal and signed certification of no exposure at the above referenced facility, the Division is granting your certification 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 (September 30, 2011) At that time you must re -certify with the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility Your certification of no exposure does not affect your facility's legal requirements to obtain environmental permits that may be required under other federal, state, or local regulations or ordinances If you have any questions or need further information, please contact Sarah Young at (919) 733-5083, ext 502, or at sarah young@ncmail net Sincerely, for Alan W Klimek, P E cc Fayetteville Regional Office Central Files — wlattachments, Stormwater Permitting Unit Files N C Division of Water Quality 1617 Mail Service Center Raleigh North Carolina 27699 1617 (919) 733 7015 O♦aw. EM Customer Service 1 877 623 6748 Np Exposure for Tredegar Film Products facility Subject No Exposure for Tredegar Film Products facility From Mike Lawyer <Mike Lawyer@ncmail net> Date Fri, 22 Sep 2006 12 59 55 -0400 To Sarah Young <sarah young@ncmail net> CC schunt@tredegar corn, mawestov@tredegar com Sarah, Conducted a site visit to the sub3ect facility on 9/18 and met with Mr Steven Hunt, Plant Manager, and Mr Mike Westover, Safety/Training Coordinator I recommend proceeding with issuance of the No Exposure Certification Thanks, Mike Sarah Young wrote Hi Mike - Here's a no -exposure for your region Please let us know within 30 days if we should issue this Thanks, Sarah Michael Lawyer Environmental Technician NCDENR-Division of Water Quality Surface Water Protection Section Fayetteville Regional Office Direct (910)433-3329 Main (910)433-3300 Fax (910)486-0707 of 1 9/25/2006 5 01 PM Form Approved United States Environmental Protection Agency OMB No 2040 0211 NPDES A Washington DC 20460 FORM `SS 351t] 11 EPA NO EXPOSURE CERTIFICATION for Exclusion from NPDES Storm Water Permitting Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit authorization for its storm water discharges associated with industrial activity in the State identified in Section B under EPA Storm Water Multi Sector General Permit due to the existence of a condition of no exposure A condition of no exposure exists at an industrial facility when all industrial materials and activities are protected by a storm resistant shelter to prevent exposure to rain snow snowmelt and/or runoff 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 without operational taps or valves - adequately maintained vehicles used in material handling and - final products other than products that would be mobilized in storm water 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 the entity in Section A is certifying that a condition of no exposure exists at its facility or site and is obligated to comply with the terms and conditions of 40 CFR 122 26(g) ►_I�i�fYeT ,7�►t�CiIP[►1�b�i li(9:ti1�11�IY�Zi],�r:1�yYi]:�u►' Detailed Instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4 A Facility Operator Information //�� ,//�� //�� 1 Name j li�l!•}(�IFGI IA IC01QII-IQIrU4I:rI 11C1 d I I I I I I I I i 2 Phone jg()ILjj-3j3Ii1.lIQ(JQ) 3 Marling Address a,Srttreet j II !IV1Ca I(WK1._ILI01�1R51LIF'IAMKI(jj1AVI I I I I I 1 1 I I! j b City 11I 1 1 LI 1 fllrf0AA C) I I I I I I I I I I I I I j c State d Zip Code B Facility(Site Location Information /� 1 Facility Name j t Ic-ici li.l�igl:�l_ i6t ii.,im ii4lk �l QIl.11LJ;_, 5, I I I I I I I j 2 a StreetAddress j j 1(20 I-J-ItVj LjL11S 1TiA I1I AI 1 i ijjiK1iVitL I I I I I I b City jet 13 nl I S PI k II IAJI 61 f>l I I I I I I I I I I I c County d Stale I Al & e Zip Code 3 Is the facility located on Indian Lands) Yes ❑ No 4 Is this a Federal facility? Yes ❑ No 5 a Latitude U i rir i LL-1 b Longitude I__L iJ LJ I� ixi 6 a Was the facility or site previously covered under an NPDES storm water permit? Yes ❑ No ❑ b If yes enter NPDES permit number 7 51ClAciroity Codes Primary [Secondary (if applicable) B Total size of site associated with industrial activity & G (. acres p j O n {l f,C�lC.cJaGW �� 9 a Have you paved or roofed over a formerly exposed pervious area in order to qualify for the no exposure exclusion? Yes F� No b If yes please indicate approximately how much area was paved or roofed over Completing this question does not disqualify you for the no exposure exclusion However your permitting authority may use this information in considering whether storm water discharges from your site are likely to have an adverse impact on water quality in which case you could be required to obtain permit coverage Less than one acre ❑ One to five acres ❑ More than five acres ❑ EPA Form 3510 11 (10 99) Pagel of 4 NPDES �► NO EXPOSURE CERTIFICATION for Exclusion from Form Approved FORM ��,EPA OMB No 2040 0211 351011 NPDES Storm Water Permitting C Exposure Checklist Are any of the following materials or activities exposed to precipitation now or in the foreseeable future? (Please check either Yes or No in the appropriate box ) If you answer Yes to any of these questions (1) through (11), you are not eligible for the no exposure exclusion Yes No 1 Using storing or cleaning industrial machinery or equipment and areas where residuals from using storing or cleaning industrial machinery or equipment remain and are exposed to storm water 2 Materials or residuals on the ground or in storm water inlets from spills/leaks 3 Materials or products from past industrial activity 4 Material handling equipment (except adequately maintained vehicles) 5 Materials or products during loadinglunloading or transporting activities 6 Materials or products stored outdoors (except final products intended for outside use [e g new cars] where exposure to storm water does not result in the discharge of pollutants) 7 Materials contained in open deteriorated or leaking storage drums barrels tanks and similar containers ❑ 8 Materials or products handled/stored on roads or railways owned or maintained by the discharger ❑ 60-11, 9 Waste material (except waste in covered non leaking containers [e g dumpsters)) El 52/ 10 Application or disposal of process wastewater (unless otherwise permitted) 11 Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated (i a under an au quality control permit) and evident in the storm water outflow D Certification Statement 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 storm water 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 122 26(g)(2)) understand that I am obligated to submit a no exposure certification form once every five years to the NPDES permitting authority 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 NPDES permitting authority 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 I understand that I must obtain coverage under an NPDES permit prior to any point source discharge of storm water 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 -3 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 1viollations Print Name lskle IV ILAI L_lD lAl ICtI NI I 1 ! ! I ! ! I I I I I I Print Title Signature EPA Form 3510 11 (10 99) Page 2 of 4 \' • /l\ 'l/ae "' �iz� `\ �,�� ar Oy \\ �J \ Ca 113 ry ! 1132 �•�o JJ! p,-. l� —IIIZ (� �, � ;, f- �e / � f _ q 1 CO ESON_t( / — BOB \ \lN.''J + �- --- �ril1 . // \`l.r- 11 0U 7 , »�, �} 1 ,- \ ', _ = till (\A _ lam Allow, ✓% j \� 6I % \ \ �'/ ---�\i r\\1 \ 1377 ' \�\) Cem �ro �r o � _ � N� \'I\,; u e \ \ C\ re � _Y ' -�.a✓ ,-r i '\ i_' -.'"` Os 1� � `�l` \ � ` ♦ y�/yq /�•IA redegar Film Products� cl�r� 1320 v l Nemon Rh 1 k ti� l , / 1 s,[�M1Y ZGS��I, !AA V� , Fdtrahon s // Y,r�7 r r +1i+��--a��\�'/-..�.� 6 � � Phi � �,1 vAv�y��%(��_(\�"'/sv\nt��'�_ v...,,-• �___ 5303 j+\ r — ` \ \- J \ •�>-�' 11 : �I�r zos _�_ ; ,._ r I 1 , PH elnhw / l/- _.��\ 1 ( ! \\��• - �y PC \ 11 \ « '\ r I209 IV Coovnaht (C) 1998 Maote& Inc Form Approved United Stales Environmental Protection Agency OMB No W40 0211 NPDES 2111111111K, S �� Washington DC 20460 FORM 'fir NO EXPOSURE CERTIFICATION for Exclusion from 3510.11 NPDES Storm Water Permitting Submission of this No Exposure Certification constitutes notice that the r.ntity identified in Section A does not require permit authorization for its storm water discharges associated with industrial activity in the State identified in Section B under SPAS Storm Water Multi Sector General Permit due to the existence of a condition of no exposure A condition of no exposure exists at an industrial facility when all industrial materials and activities are protected by a storm resistant shelter to prevent exposure to rain snow snowmelt and/or runoff 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 arovitles 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 contaters that are tightly sealed provided those containers are not doteriorated and do not leak Sealed" means banded or otherwise secured and without operational taps or valves — adequately maintained vehicles used in material handling and -- Rital products other than products that would be mobilized In storm water drscharoes fe g rock Saul A No Exposure Certification musl be provided for each facility qualifying for the no exposure exclusion In addrlron the exclusion trorn NPDES permittling rs 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 exdusiorr By signing anti submitting this No Exposure Certification form the entity, in Section A is cerhlying that a condition of no exposure exists at its facility or site and is obligated to comply with the terms and conditions of 40 CFR 122 26(g) ALL INFORMATION MUST BE PROVIDED ON THIS FORM Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4 A Facility Operator Information 1 !Name I..6 g:1l t 0lfcl�(� 2 Phone 3 Mailing Address `a Street�I ✓f l lip a t Ml 16 I61CALSI I611aLl(.:,,Asil I l l _L _ I _1 1 1 1 J I i b City 16 11 Ll I —I I t .1_..1„_(-I_ I I I I J c State d Zip Code B FacihWSlte Location Information 1 Facility Name l�i� lGIi�ILIi=tPl. l ft li It -AM 2 a StfeetAddress O ll1fl l�IlJiSI� 1�3. I Jdtly I A a t till t"1 1 I L b City 9 ' 1 C lis I W11 r c County d State i A j G e Zip Code i A V3 I A- I I I 1_ I 3 Is the facility located on Indian Lands? Yes ❑ No 4 Is this a Federal facitity'� Yes No 5 a Latitudea[j,,qqj �LA b Longitude a 6 a Was the facility or site previously covered under an NPDES storm water permit? Yes iJ No If yes enter NPDES permit number 7 SIOActivdy Codes Primary ., -,C Secondary (if applicable) LI 1 1 8 Total size of site associated with industrial activity & 4 4, acres l f r ,J11'-'AJOLd J - 9 a Have you paved or roofed over a tormedy exposed pervious area in order to qualify for the no exposure exclu5wnI Yes [:] No b If yes please indicate approximately horn, much area was paved or roofed over ComplPhng this question does not disqualify you far the no exposure exousion However your permitting authority may use this Inform"ilron in considerinct whether storm wafer rischwges Irani your site are likely to have an adverse impact on water quality at wnrcti case you weld be requirW to obtain permit coverage Less than one acre ❑ One to five acres El More than five acres EPA Form 3510 11 (1 D 99) Page 1 of 4 �� s if t NPDES A Form Approved FORM .., NO EXPOSURE CERTIFICATION for Exclusion from OMB No 204"211 3510-11 EPA NPDES Storm Water Permitting C Exposure Checklist Are any of the following materials or activities exposed to precipitation now or in the foreseeable future? (Please check either Yes or No in the appropriate box ) If you answer Yes to any of these questions (1) through (11) you are not eligible forthe no exposure exclusion Yes No 1 Using storing or cleaning industnal machinery or equipment and areas where residuals from using storing or cleaning industrial machinery or equipment remain and are exposed to storm water 2 Materials or residuals on the ground or in storm water inlets from spillsileaks 3 Materials or products from past industrial activity 4 Material handling equipment (except adequately maintained vehicles) 5 Materials or products during loadinglunloading or transporting activities 6 Materials or products stored outdoors (except final products intended for outside use [e g new cars] where ❑ exposure to storm water does not result in the discharge of pollutants) 7 Materials contained in open deteriorated or leaking storage drums barrels tanks and similar containers El I 8 Materials or products handled/stored on roads or railways owned or maintained by the discharger EJ 9 Waste material (except waste in covered non -leaking containers [e g dumpsters]) El 10 Application or disposal of process wastewater (unless otherwise permitted) 11 Particulate matter or vtsible deposits of residuals from roof stacks andlor vents not otherwise regulated (i a under an air quality control permit) and evident in the storm water outflow D Certification Statement 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 storm water 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 122 26(g)(2)) understand that I am obligated to submit a no exposure certification form once every five years to the NPDES permitting authority and tf 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 NPDES permitting authority 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 I understand that t must obtain coverage under an NPDES permit prior to any point source discharge of storm water from the facility Additionally I certify under penalty of law that this document and -III attachments were prepared under my direction or supervision in accordance with a system designed to assure that q jabfied personnel properly gathered and evaluated the nformatton 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 Print Name Eft' l� l�II 1IVi I Itt1J�1-1-1 I I [ I E 11 I I I I�� Print Title Pj lali�T If I 'f 11y1 1TI�I I I I I I I I i I I I I I I I I I I I I Signature Date 161,111,10 yro - geJ3 . J? 37 3 EPA Form 3510 11 (10-95) Page 2 of 4 1 �4 z<t \ r "�q � .-rr -K.... wti 21)�y �},t.. 1 j^�r�" S•\�4 f � it ♦ � ROBE501`1` rC�„ `� r --.ka __— ♦ �_ "be ��{ ye \ate �� + � 1l5 „r,t r �� % i �,; t1�1 .c�.S"-, ,slr�.-�•w..+,�,r.. 'i�i +., `3M �ir� � ro� / �C6'� P110way k l+ u Jul @� / \ (gym , �w-. t k7 ' } 110k aea�ui >eT J if ! � y e f ? , j, ^ R r F Tr!d ar Film Products ti �a r _ i N 1tf 0 to �`, v4 t� !� 11 n9UttI` C it 1[ Ns+ 5 1' �r � cr �}.. r," � _..;,\ ^L�r �3� ,,[{ t~� •r"3� •. 1 ,�� w��_ � I s t�~ t � � � Ftllrilton� '� � � iPlan1 13 I RAC G F h�"��''�- _y/v�. "^" +3•� � I 1 � -� , 4 r�+ � � 6�' t ' { f ry�/�� 2�4 _ �-�'1 :"�.~k-✓,:'Y '"�'I" �. TG "'"��_»^" \* � � �r � �� 7� PC. i 1 7� `� � {�~ t . � ¢M tan `_.-��-�` �'y1` �'/�� t ��r �; x�""':a �`_,..�" -.�4' max, ./ T ��r1�� 't{u� �f �.r� �•' _ y; Copynght(C) 1998 Maptech Inc