NCGNE0014_COMPLETE FILE - HISTORICAL_20090623

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
HISTORICAL FILE
DOC DATE
❑ �d� I� a3
YYYYMMDD

P.O. Box 120
Eaton Aeroquip Inc. 1035 Mecklenburg Highway
Mooresville, NC 28115
October 16, 2000
North Carolina Dept. of Environment & Natural Resources
Division of Water Quality
919 N. Main Street
Mooresville, NC 28115
Dear Mr. Parker;
As an industrial facility, SIC code 3492, we have evaluated our activities to determine the
need for a storm water permit. We have identified our source of exposure as the facilities'
dumpsters which contain scrap parts, and trash. To eliminate the source of exposure we have
installed canopies over the dumpsters, which will prevent storm water from being
contaminated by contact with raw materials. We feel that we have met the requirements for
being permit exempt.
If you should need to contact me on this matter,1 can be reached at 704-660-3736.
Sincerely,
Monte Higgins
Environmental Health & Safety Manager

Mr. Van Walker, President
NuVision Engineering, Inc.
184B Rolling Hill Road
Mooresville, North Carolina 28117
Subject:
Dear Mr. Walker:
Michael F. Easley, Govern.��
William G. Ross Jr., Secret
North Carolina Department of Environment and Natural Resources
February 4, 2008
Stormwater permitting
NuVision Engineering, Inc.
Iredell County
Coleen H. Sullins, Director
Division of Water Quality
The National Pollutant Discharge Elimination System (NPDES) program was established
under the federal Clean Water Act and then delegated to the Division of Water Quality (DWQ)
for implementation in North Carolina. Industrial facilities that fall into one of ten subject
categories are required to obtain permit coverage under a general permit or an individual permit,
depending upon the facilities SIC code and the industrial activity occurring at the facility. There
are currently 19 active general stormwater permits in North Carolina.
Recently Mr. Brian Crutchfield of Southland Associates contacted this Office inquiring
about stormwater permitting at your Mooresville North Carolina facility. Mr. Crutchfield stated
that this facility provides engineering services under Standard Industrial Classification (SIC)
code 8711. SIC code 8711 does not trigger a requirement to obtain a permit under any of the 19
active general stormwater permits.
In addition, Mr. Crutchfield described a 40,000-gallon testing tank on site that has or may
contain various liquids include water, a clay/water slurry, and slightly alkaline water. Please
ensure that any liquids other than pure water contained within the testing tank are properly
disposed of in conjunction with federal, state, and local laws and regulations including any pre-
treatment requirements for the Town of Mooresville POTW and the future Town of Mooresville
Phase II Stormwater permit.
If the Division of Water Quality determines, at some point in the future, that the
NuVision Engineering facility is contributing a significant amount of pollutants to waters of the
State the Division can require your facility to obtain an individual stonnwater permit.
VA
NCDENR
NoiihCarolina
Allatura!!y
Mooresville Regional Office Division of Water Quality Phone [phone] Customer Smice
Internet: www.ncwaterquality.org 610 East Center Ave, suite 301 Mooresville, NC 28115 Fax [phone]
An Equal OpportunitylAffirmative Action Employer — 50% Recycledl10% Post Consumer Paper

Allocco to Walker
February 4, 2008
Page 2
Should you have questions, please do not hesitate to contact me at [phone].
Sincerely,
Marcia Allocco, MS
Environmental Chemist
Surface Water Protection Section
Mooresville Regional Office
cc: Mr. Brian Crutchfield
Southland Associates
255 E. Hebron Street
Charlotte, NC 28273
Ms. Tonya Wemberly, Engineering Department
Town of Mooresville
413 N. Main Street, Suite 1200
Mooresville, NC 28115

W-0
7krAlDivision of Water Quality /Surface Water Protection
�w
NCDENRNational Pollutant Discharge Elimination System
�..��. NO EXPOSURE CERTIFICATION for Exclusion
EAmNa.u.cvr N.D Nnw� ResOln[[s
NCGNE0000
NO EXPOSURE CERTIFICATION
National Pollutant Discharge Elimination System application for exclusio
based on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notice that you
authorization for its stormwater discharges associated with industrial ac
Carolina because it qualifies for a no exposure exclusion. A condition of
facility means all industrial materials and activities are protected by a stc
exceptions) to prevent exposure to rain, snow, snowmelt, and/or runoff.
FOR AGENCY USE ONLY
Date Received'
Year
Month
Day
tt
Cenificate oSCovera
D
E C E � V Lam,
i Stormwater Permit
does not require
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 CH? 122.26(g).
You are required to reappiy for the No Exposure Exclusion once every five 5 ears.
For questions, please contact the DWO Regional Office for your area. (See page 5)
(Please print or type)
1) Mailing address of owner/operator (address to which all certification correspondence _Will _be mailed):
Name I- Ck asa 0, L. -5
Street Address [ 7 3 t\c � e S 5 ie
City 'i S v'` t[ e State C_ ZIP Code -7 9 G 7
Telephone No. ?o y q — F/ 00 Fax: -7 0 ` -7 - (0Z 9
2) Location of facility producing aa discharge: p
Facility Name �2 0 t jc) (2), L(3, key r U r. tic, -V ee6s7 LL ('
Facility Contact
Street Address
City
County
Telephone No.
uy- -
SW U-N E-110607
OCT 2 4 2nnp
Last revised 11/06/07
DWG ��

NCGNE0000 No Exposure Certification
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). 14WQ70 --i' c7 6NC_QeSJ /'�6 .
(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 0(No
5) Is this a Federal facility? ❑ Yes- KNo
6) Latitude Longitude (deg, min, sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
'� Existing Dale operation began
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes E 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 ` r
SIC Code: _z Q 'i 2
10) Provide a brief description of the types of industrial activities and products produced at this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
�[No
Yes
If If yes, list the permit numbers for all current Non -Discharge permits for this facility:
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
)�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 spillslleaks
❑ Yes
I(flo
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)
Page 2 of 5
SWU-NE-110607 Last revised 11/06/07

NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks,
CI Yes
N0
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by
❑ Yes
No
the discharger
L Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes
Q No
j. Application or disposal of process wastewater (unless otherwise permitted)
❑ Yes
(131�No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not
❑ Yes
No
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
1. Empty containers that previously contained materials that are not properly stored
❑ Yes
No
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers
❑ Yes
No
stored outside, has the facility had any releases in the past three (3) years?
l
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
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any Yes ❑ No
cracks, holes, or evidence of leaks, and. are drain valves maintained locked shut?
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
nl Yes
❑ No
(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
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for any amount of Title III Section 3131
Yes
❑ No
Superfund Amendments and Reauthorization Act (SARA) water priority
chemicals?
d. Is secondary containment provided for any amount of hazardous substances?
Yes
❑ No
e. Are release valves on all secondarycontainment structures locked?
Yes
❑ No
Page 3 of 5
SWU-NE-110607 Last revised 11/06/07

NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
© Yes I(No
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
❑ Yes No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
© Yes No
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
16) 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 I 22.26(g) (2)).
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 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. f 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: ty—
Tiitle: r- 1A At:! (A
_ 1i a
(Signature of Applicant) (Date Signed)
Page 4 of 5
SW U-NE-110607 Last revised 11/06/07

NCGNEt]000 No Exposure Certification
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
f 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.
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.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note.
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DWO Regional Office for your area.
DWO Regional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office
... [phone]
Mooresville Office...
[phone]
Raleigh Office ........
[phone]
Washington Office ...[phone]
Wilmington Office
... [phone]
Winston-Salem ......
[phone]
Central Office .........(919)
733-5083
Page 5 of 5
SWUNE-110607 Last revised 11/06/07

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Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000
FOR AGENCY USE ONLY
Date Received
Year
Month Day
Cenificateofcavera e
NICIGI
=9 : t,m
E = t .4 "VL
MAR 2 4 2016
National Pollutant Discharge Elimination System application for exclusion froAlDFv6 t mit.based
trirl-13ci4 LR
on NO EXPOSURE:
MAR1 4- ' c reality Section
Z�f�: , _ ,'1110 Regional Office
Submission of this No Exposure Certification constitutes notification tharf Wdk"PF4,Y >;lfTpt require a
permit for stormwater discharges associated with industrial activity in the State of IVOWN d� 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 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 facilit 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).
If approved, your conditional no -exposure exclusion must be self re -certified at least annually.
Please see information here: http://portal.ncdenr.org/web/ir/npdes-stormwater
For questions, please contact the DEMLR Regional Office for your area. (See page 6)
1) Mailing address of owner/operator
Name
Contact
Street Address
City
Telephone No.
5WU-NCGNE
(Please print or type)
will be
,'SJa. "; ll _ _ State A?. ZIP Code oZ5_
_70-q-_ 973 as `iy
Page 1 of

14

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name CCOSAC_oj.S OOa_'_`nS . _rne _
Facility Contact
Street Address
City
County
Telephone No.
.V : tte State__ ZIP Code-9862A—
__7p'-L_ $7 �"_022 �`� Fax: ?o y _ 97.3 - ` Sag
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).
O A.O Oitc n(^a
(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 IX No
5) Is this a Federal facility? ❑ Yes V( No o O
6) Latitude 36 ,gj%'3q.O"A7 Longitude iSD°,S6' 31.1�J (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
OE New or Proposed Facility Date operation is to begin ^'-S� - Io r{
❑ 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 p( 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: -AL -2- -,5-' --L-
10) Provide a brief description of the types of industrial activities and products produced at this facility:
c v^ w\a­*e
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
ikNo
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SWU-NCGNE Last revised 5l512015

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 K 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 ;K No ❑ NIA
c. Materials or products from past industrial activity ❑ Yes 101 No ❑ NIA
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes 14 No ❑ NIA
e. Materials or products during loading/unloading or transporting activities ❑ Yes [I( No ❑ NIA
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes R No ❑ NIA
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 110 No ❑ NIA
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes $& No ❑ NIA
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes IF No ❑ NIA
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes IV No ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes V No ❑ NIA
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 $rNo ❑ NIA
(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 R No ❑ NIA
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 04 NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No P6 NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NCGNE Last revised 5/5/2015

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
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored
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
Amendments and Reauthorization Act (SARA) water priority chemicals*?
d. Is secondary containment provided for hazardous substances** designated in 40
CFR §116?
e. Are release valves on all secondary containment structures locked?
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
❑ Yes ❑ No R NIA
❑ Yes ❑ No k NIA
❑ Yes ❑ No M NIA
❑ Yes ❑ No K NIA
❑ Yes ❑ No g NIA
❑ Yes X No ❑ NIA
❑ Yes R No ❑ NIA
it Yes ❑No El N/A
Type(s) of waste: . n4 w &A+r- P 1.. pm. Me P"!:)a 3 Foos
How is material stored: a
Where is material stored: i A
How many disposal shipments per year:
Name of transport 1 disposal vendor:
Vendor address: St"w�4-e
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-NCGNE Last revised 5/5/2015

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 5a No ❑ NIA
b. Does your facility have coal piles on site? ❑ Yes 14 No ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes R No ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., K Yes ❑ No ❑ NIA
degreasing operation , 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? k1 Yes ❑ No ❑ NIA
Please specify: rz. e & %r kj
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: NCh o0o 144.974. Program: Re -AA _j_*,, _4u..4 (eA.
Permit: .JO�i`lAdo ac:l,4� y4 Program: /its Pecr++•`+
Permit: Program:
Permit: Program:
Permit:
Program:
Permit: Program:
Permit: Program:
Page 5 of 7
SWU-NCGNE Last revised 5/5/2015

NCGNE0000 No Exposure Certification
17) Certification:
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.
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 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.
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 "ining: ± r W 1
Title: _Q� r ,' ��p�
(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-NCGNE Last revised 5/5/2015

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
❑ This completed application and all supporting documentation.
0 A map with the location of the facility clearly marked.
❑ If the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8.
Mail the entire package to:
Stormwater Permitting Unit 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 Re ional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ...:....
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........[phone]
Page 7 of 7
SWU-NCGNE Last revised 5/5/2015

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Eliminatio.Q �ystem
NO EXPOSURE CERTIFICATION for Excl'26n
NCGNE0000
8
FOR AGENCY USE ONLY
Date Received
Year
Ivlomh
Day
Certificate of Coverage
N16 IN
'0r.. OG� fin.
National Pollutant Discharge Elimination System a pplication:fdrSexsclusion from a Stormwater Permit based
on NO EXPOSURE: f0�,_ �'cx:
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 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 facilit 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).
If approved, your conditional No Exposure Exclusion has no expiration date
BUT MUST BE self re -certified at least annually. o ED
Please look for information about re -certification under the No Exposure section on this pager
r-H
deg. nc.ov/aboutldivisions/ener -mineral-land-resourceslener -mineral-land- ermitslstormwater-
ep rmits/npdes-industrial-sw _U rd
00
For questions, please contact the DEMLR Regional Office for your area. (See page 6)
l�
(Please print or type)
1'
1 j Mailing address of owner/operator
Name
Contact
Street Address
City
Telephone No.
MacLean Curtis LLC
John O'Neill
227 Manufacturers Blvd
Mooresville _
704-940-5535
State NC ZIP Code 28115
Fax:
Page 1 of 7
.SUUI i_Nr'r:NF I tact rauicai gimi?nif;

NCGNEQ000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name MacLean Curtis LLC_
Facility Contact
Street Address
City
County
Telephone No.
John O'Neill
227 Manufacturers Blvd
Mooresville
Iredell
704-940-5535
3) Physical location information:
State NC ZIP Code 28115
Fax:
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). 160 east to 801, turn left onto 801, travel north aprox.
1 mile, turn right onto Manufacturers Blvd
(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 §No
5) Is this a Federal facility? ❑ Yes . No
6) Latitude r35 , 37, 09.5N Longitude _80 , 46, 39.OW (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 811116
❑ 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 , 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: 3 4 5 1
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Machining of metal parts for the automotive (and other) industry. Equipment includes both oil and
water base machines
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
gVV1I_Nr.rNr_ I aer ravicari 00AM)IR

NCGNEQ000 No Exposure Certification
Exposure Checklists 02. - 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 ® 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 , No ❑ NIA
c. Materials or products from past industrial activity ❑.Yes ® No ❑ NIA
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes No ❑ NIA
e. Materials or products during loading/unloading or transporting activities ❑ Yes No ❑ NIA
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes No ❑ NIA
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, ❑ Yes No ❑ NIA
tanks, and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained ❑ Yes 1 No ❑ NIA
by the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., ❑ Yes ® No ❑ NIA
dumpsters])
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes , No ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents ❑ Yes ® No ❑ NIA
not 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 j No ❑ NIA
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes ■ No ❑ NIA
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
deterioration, or evidence of leaks?
b. is secondary containment provided for all exterior ASTs? If so, is it free of any
cracks, holes, or evidence of leaks, and are drain valves maintained locked
shut?
Yes ❑ No ❑ NIA
Yes ❑ No ❑ NIA
Page 3 of 7
lRIAR f_NCr.NF I act rovkofl Q19R/9111F.

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 ❑ NIA
(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 ❑ 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 NIA
Amendments and Reauthorization Act (SARA) water priority chemicals*?
d. Is secondary containment provided for hazardous substances** designated in ❑ Yes ❑ No NIA
40 CFR §116?
e. Are release valves on all secondary containment structures locked? , Yes ❑ No ❑ NIA
15) Hazardous Waste:
a. is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes I No ❑ NIA
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes , No ❑ NIA
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes No ❑ NIA
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of
waste:
vendor:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal
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
.qvvl 1-pdrr:Nr- i :%Q+ ra%AQ.-ri C119AIN)i R

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 No ❑ NIA
b. Does your facility have coal piles on site? ❑ Yes No ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes ® No ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ❑ Yes j No ❑ NIA
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 ❑ Yes ❑ No NIA
Permit? Please specify:
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5 of 7
C1All I_Nr..r;NF I act rwricarl 419R/9r19R

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 maintain no exposure conditions and complete a Self -Recertification form at least once
each year, and if requested, provide this certification 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
Energy, Mineral, and Land Resources, 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 I
must keep a copy of annual re -certifications on file at the facility.
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.
:J-0k!n Ny /
Printed Name of
Title: G-eV11+
of Applicant)
5igni
(Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the NCDEQ
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 6of7
swr i-Nrr;NF i aQr ravicPH Ol?RI7n1R

NCGNEOOOO 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:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 7 of 7
swi I_Nr`r:NF i no r,-%AgPr1 q17Rnmr,

--* Indicates Storm drains
..� Indicates Outfail
Q Indicates Stormwater Management Structures
Dumpsters
� Metal Chips (under roof]

i

u
a .r►. , r � at / � �' ern i
I .

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i
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wus$qu ow
i�r�`
VICINITY 4MAP
il,.Rl � 1*m 9at1

Young, Sarah
From: Allocco, Marcia
Sent: Thursday, July 23, 2009 8:06 AM
To: Young, Sarah
Subject: RE: Same facility for SW permits
Sounds good!
Thanks!
From: Young, Sarah
Sent: Wednesday, July 22, 2009 10:14 AM
To: Allocco, Marcia ,
Subject: RE: Same facility for SW permits
It looks to me like they are, in fact, for the same facility and I think we should eliminate NCGNE0014. I can print out our
email correspondence, put it in the file, and inactivate NCGNE0014. Sound good?..
From: Allocco, Marcia
Sent: Tuesday, July 21, 2009 2:31• PM
To: Young, Sarah
Subject: Same facility for SW permits
Sarah,
Hope all is well with you. I'm going through our expired permits When you have a moment can you research
the following No -Exposure certificates? They appear to be for the same facility at 166 Orbit Road in.
Statesville, NC as per BIMS facility linkage. However, since the effective dates overlap I'm wondering if one of
the No Exposures should be for a separate facility from 166 Orbit Rd?
NCGNE0014 (Expired) — Leggett & Platt, Inc.; Statesville West; Effective 517104-4130109 and Statutory on
411 /04
NCGNE0144 (Active) — Leggett & Platt, Inc.; Statesville West; Effective 511105-4130110 and Statutory on
2/20/04
If they are for the same facility then I guess we can inactivate NCGNE0014.
Thanks,
Marcia
Marcia Allocco, MS - Environmental Chemist
NC Dept. of Env. & Natural Resources (NCDENR)
Division of Water Quality - Surface Water Protection Group
610 East Center Ave., Suite 301, Mooresville, NC 28115
Ph: [phone] Fax: [phone]
Please note: my e-mail address has changed to [e-mail]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties.

COMPACTION TEST REPORT
130.0 -I
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80.0-
0 5 10 15 20 25 30 35 40
Moisture Content, %
Maximum Dry Deni
97.9 pcf
Sample No.:
0.001
Optimum Moisture Content:
25.1 %
Test Method:
ASTM D698
In -situ Moisture Content:
27.T %
Test Date:
02-May-08
Tested B :
RGSIKB
I Reviewed B :
PAMISAS
Material Description:
I Reddish brown silt CLAY
Sample Location:
Borin B-B 0-5'
Project: Proposed Transportation Facili
Project No.: 171075052
Irerracan
521 Clemson Road
Columbia, SC 29229

/\K0
INCORPORATED
STATESVILLE WEST
166 Obit Rd.
Statesville, NC 28677
This is to notify all concerned that Kevin Burnette is no longer
branch manager at this facility. The position has been filled by Lee
Osborne.
Regards,
Loretta Simmerman
Customer Service/Office Manager
CL
CS
Phone: [phone]
Fax: [phone]
0
ao d
So BE ne,N

3r ,

C(T-NE: 0 o / q
Stormwater Permitting_ UnitN��
Attn: Sarah Young
1617 Mail Service Center
Raleigh, NC 27699-1617
November 7, 2005
Sarah,
I am writing on behalf of one of our facilities in Statesville, NC.
In February 2004, Leggett & Platt, Sackner Products located at 166 Orbit Road in
Statesville, NC submitted a No Exposure Certificate form to North Carolina DENR to
formally claim an exemption from storm water permitting. Since the submission of that
form our branch manager has changed and I have been advised to write to you in order to
notify the state of such change.
At the time of submission the manager was Kevin Burnette, the current manager of the
166 Orbit Road facility is now Lee Osborne.
If there is any further information you may need, feel free to contact me at the address or
phone number below.
Thank you in advance,
U UV
Ran ddard .
Leggett & Platt, Inc.
Segment Safety and Environmental Director
1820 Evans Street, NE D IR
Conover, NC 28613 we4ands &
828-459-7064 xt.18

INC-DEFT. OF ENVIROMME 4T
AND NATURAL RESOURCES
�OF W A TF�mAOORESVILI " ' ,a4AL OFFICE
Y
o MAY 1 2 2004
May 7, 2004 Chuck Houchin`VIATE, i i ECTIO g1 �
Sackner Products
166 Orbit Road
Statesville, North Carolina 28677
Dear Mr. Houchins:
�j
Michael F. Easley
Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
Subject: No Exposure Certification
Sackner Products
DWQ Tracking no. NCGNE0014
Iredell County
The Division has reviewed your submittal of the No Exposure Certification for Exclusion
from NPDES Storm Water Permitting form, which we received April 1, 2004. Based on
our review, the Division has determined that the facility qualifies for the conditional no
exposure exclusion 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. 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 Ken Pickle at (919)
733-5083 ext. 584, or at [e-mail].
Sincerely,
Alan W. Klimek, P.E.
cc: Mooresville Regional Office
DWQ Central Files
SGPU Files
NCD- n ENR
Customer Service Division o€ Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
1 800 623-7748

p -rim
n Rw�iCGu�001�{
LI. APR 7 2004
I Form Approved
United States Environmental Protection Agency OMB No. 2040-0211
NPDES t� Washington, DC 20460 —
FORM
3510-11 ` 'Ke'W EPA NO EXPOSURE CERTIFICATION for Exclusion from
NPIDES 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's 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, snowmen, 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).
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 d G�
1. Name: If.-IEa6 6iETITI PI Aril TI I=;'e." _'°_l; �'_I �' _: J 2.Phone: LOxJ18181811151�1✓I
3. MailingAddress: a. Street: 19101 1) 1 #� Ilc.l(Q IG I�rl I-rI Zic:I AiDt 1 1 1 1 1 1 1 1 1 1 1 1 1
b. City: IC�A 5�Ji l i� A 16 if—i I I I I 11 11( I I I I I c. State: ALQ d. Zip code: 1( A 10
B. FacilitylSite Location Information
1. Facility Name: IS A ICI I N I6 IR tRIR 0b I D S IC j T 51 I I t I I I I I I I I I I I
2. a. Street Address: I I=I ®rY
b. City: 15T&-r,�151, iLLILiE1 I I I I I I I l l 11 I c.County: riaIE.1D161LILI I l i
d. State: IN IQ e. Zip Code: IZO 16131�1 - I, I 1 1
3. Is the facility located on Indian Lands? Yes No [r
4. Is this a Federal facility? Yes No
o
5. a. Latitude: L�J �i " b. Longitude:
6. a. Was the facility or site previously covered under an NPDES storm water permit? Yes ❑ No d
b. If yes, enter NPDES permit number:
7. S1ClActivity Codes: Primary: Secondary (if applicable): I I I I I
8. Total size of site associated with industrial activity: 5 acres
9. a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure exclusion? Yes 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) R Page 1 of 4

NPDES
FORM
3510-11
NO EXPOSURE CERTIFICATION for Exclusion from
�7W EPA NPDES Storm Water Permitting
Form Approved
OMB No.2040-0211
C. Exposure Checklist
Are any of the following materials or activities exposed to precipitation, now or in the fcfeseeable 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
d
4. Material handling equipment (except adequately maintained vehicles)
5. Materials or products during loadingfuntoading or transporting activities
r7z
6. Materials or products stored outdoors (except final products intended for outside use (e.g., new cars] where
✓�
exposure to storm water does not resuit in the discharge of pollutants)
7. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers
❑
S. Materials or products handled/stored on roads or railways owned or maintained by the discharger
9. Waste material (except waste in covered, non -leaking containers [e.g,, dumpsters])
❑
10. Appiication 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.e., under an air quality control permit) and evident in the storm water outflow
D. Certification Statement
I certify under penalty of law that t 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)).
I 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. t 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 Ow 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.
Print Name: ICA 10 1 Cl N I I & IUIc I{t I TI P t51 I I I I I I I I I I I I I I i I I I I
Print Title:
Signature:
EPA Form 3510-11 (10-99) Page 2 of 4

F' 1
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
Facsimile transmittal
To: Mike Parker, MRO
Fax: [phone]
From: Ken Pickle, Stormwater and General Date: April 2, 2004
Permits Unit, Division of Water Quality
Phone: [phone] ext. 584 Pages: 4
E-mail: Ken. [e-mail]
Urgent For review Please comment Per your request FYI, no action Please recycle
Subject: No exposure certification
Mike,
I have received the attached No Exposure Certification from Sackner Products at
166 Orbit Road in Statesville. They report an SIC code of 2299, Miscellaneous
Textile Goods.
If we accept their Certification, then they will not have to obtain a stormwater
permit. But they will have to renew the Certification with us after five years (or
obtain a stormwater discharge permit, depending on the physical facts at the
site at that time).
Do you have any comments on whether to accept their Certification? Do you
need to make a site visit to confirm no exposure?
I have attached their Certification (2 pages), plus a copy of the acceptance letter
(1 page) from another Certification so that you can see what we our response
will be if we accept the Certification.
Thanks,
fi'17
Ken

imap://ken.pickle% 40dwq.deer.ncmai1.netCPcros.ncmaiI-net:143/fete...
Subject: Sackner Products
From: Michael Parker <[e-mail]
Date: Mon, 05 Apr 2004 10:55:43 -0400
To: Ken Pickle <[e-mail]>
Ken,
The subject facility also has an NPDES permit with us for a process
water discharge, so if any SW issues arise after we issue the NEC, then
we could address them at that time. Therefore, I don't have any problem
with you issuing the NEC.
Michael Parker - [e-mail]
Environmental Engineer II
North Carolina Dept. of Environment & Natural Resources
Division of Water Quality
919 N. Main Street
Mooresville, NC 28115
Ph: 704.663.1699 Fax: [phone]
Michael Parker <[e-mail]�
e -
Environmental Engineer 11
NC DENR - Mooresville
Division of Water Quality
t of 1 4/5/2004 10: 5 3 A vl

WATF
_OHOF Rwt!i Michael F. Easley
Governor
UJ 7 William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. Director
Division of Water Quality
May 7, 2004
Chuck Houchins
Sackner Products
166 Orbit Road
Statesville, North Carolina 28677
Subject: No Exposure Certification
Sackner Products
DWQ Tracking no. NCGNE0014
iredell County
Dear Mr. Houchins:
The Division has reviewed your submittal of the No Exposure Certification for Exclusion
from NPDES Storm Water Permitting form, which we received April 1, 2004. Based on
our review, the Division has determined that the facility qualifies for the conditional no
exposure exclusion 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. 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 Ken Pickle at (919)
733-5083 ext. 584, or at [e-mail].
Sincerely,
Alan W. Klimek, P.E.
cc: Mooresville Regional Office
DWQ Central Files
SGPU Files
NCDENR
Customer Service Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699.1617 [phone]
1 800 623-7748

-
i __71
LS
APR l 2004
United States Environmental Protection Agency Form Approved
9 Y OMB No. 2040-0211
NPDES ;, ��� Washington, DC 20460
FORM
3510-11 `�' NO EXPOSURE CERTIFICATION for Exclusion from
NP©ES 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's 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).
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
I. Name: 1t-16Icu61ETIT1 I I PLAIT Ti 2.Phone: J6J00I5l Ig151�ICI
3. Mailing Address: a. Street: I��nl I# I ILI�I(eIGI�M-'C1 I&CljAfbI I I f I I f f f t I I 1 I I
b. City. 1i,,_8l_L1ry A t Gi£I 1 1 I 1 I i I I_ 11_ I I I I c. state: Id L..� d. zip Code: Kp I4[ 16131%l - 1 I I I I
B. Facility/Site Location Information
1. Facility Name: LS AL ICI K IE I1� RR IQ1 101c rI51 I I I I I I I I I I# 11 1
2. a. StreetAddress: I I�I�I QI� IIiT lie)AIi I I I I I I ,I I I I I I 4 I I# 1 1
b. City: 1;5T &T1fi5 iV I.1-.ILiL I Ef I i I ►, I J_ I L I I _ I 1 c. County: ZIR Ie. t-DL61 L LLf i- I J
d. State: rr ` t C-r e. Zip Code: 12E I�2 li Q I - II - i , I t 1 1
3. Is the Facility located on Indian Lands? Yes ❑ No
4. Is this a Federal facility? Yes ❑ No
5. a. Latitude: b. Longitude:
6. a. Was the facility or site previously covered under an NPDES storm water permit? Yes ❑ No d
b. if yes, enter NPDES permit number:
7. SIC/Activity Codes: Primary: &J'ZIS1.51 Secondary (if applicable):
8. Total size of site associated with industrial activity: 5 .acres
9. a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure exclusion? Yes ❑ 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 arse ❑ One to five acres ❑ More than five acres ❑
EPA Form 3510-11 (10-99) Page 1 of 4

NPDES �'f Form Approved
FORM �_,EPq NO EXPOSURE 'CERTIFICATION for Exclusion from OMSNo.2040-0211
3510-11 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
d
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 spillslleaks
❑
3. Materials or products from past industrial activity
El
4. Material handling equipment (except adequately maintained vehicles)
❑
5. Materials or products during toadinglunloading 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
9. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
10. Application or disposal of process wastewater (unless otherwise permitted)
El
EJ
11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated
(i.e., 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(9)(2)).
I 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 a
system designed to assure that qualified personnel properly gathered and evaluated the infcrmation 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 awate that there are significant penalties for submitting false information, including the possibility
of fine and imprisonment for knowing violations.
Print Name: icIQ 101Cl�J_L& 10IC I{f ITI0ISI i I 1__A_ 11. 1 _1 _ I A i l I I I I I I
Print Title:
Signature:
EPA Form 3510-11 (10-99) Page 2 of 4

STATE of NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
To:
Mike Parker, MRO
Fax: . [phone]
From: Ken Pickle, stormwater and General Date: April 2, 2004
Permits Unit, Division of Water Quality
Phone: [phone] ext. 584 Pages: 4
E-mail: [e-mail]
Urgent For review Please comment Per your request FYI, no action Please recycle
Subject: No exposure certification
Mike,
I have received the attached No Exposure Certification from Sackner Products at
166 Orbit Road in Statesville. They report an SIC code of 2299, Miscellaneous
Textile Goods.
If we accept their Certification, then they will not have to obtain a stormwater
permit. But they will have to renew the Certification with us after five years (or
obtain a stormwater discharge permit, depending on the physical facts at the
site at that time).
Do you have any comments on whether to accept their Certification? Do you
need to make a site visit to confirm no exposure?
I have attached their Certification (2 pages), plus a copy of the acceptance letter
(1 page) from another Certification so that you can see what we our response
will be if we accept the Certification.
Thanks,
Kl_�
Ken

imap://ken.pickic%40dwq.denr.ncmail.net @cros.ncmail. net: 143/fetc...
Subject: Sackner Products
From: Michael Parker <[e-mail]>
Date: Mon, 05 Apr 2004 10.55:43 -0400
To: Ken Pickle <[e-mail]>
Ken,
The subject facility also has an NPDES permit with us for a process
water discharge, so if any SW issues arise after we issue the NEC, then
we could address them at that time. Therefore, I don't have any problem
with you issuing the NEC.
Michael Parker - [e-mail]
Environmental Engineer II
North Carolina Dept. of Environment & Natural Resources
Division of Water Quality
919 N. Main Street
Mooresville, NC 2B115
Ph: 704.663.1699 Fax: [phone]
Michael Parker [e-mail]>
Environmental Engineer li
NC DENR - Mooresville I
Division of Water Quality
t of 1 4/5/2004 10:58 AM

1.
NG &AJ E D D I `t"
January 17, 2005
N.C. Department of Environment
Storm Water Unit
Attention: Mr. Bradley Bennett
1617 Mail Service Center
Raleigh, NC 27699-1617
Dear Mr. Bennett:
(L
<&
INCORPORATED
9-@--[g 5W 121
[DlrE-
AN 2 0 260-3
N -_WATEROu -ITY6
Attached you will find a newly completed "No Exposure Certification for Exclusion from NPDES Storm
Water Permitting" application for Statesville West (formerly known as Sackner Fibers), located at 166
Orbit Road, Statesville NC 28766.
We originally submitted our no exposure certification application to the US EPA in February 2004. The
plant received a letter from them in March 2004 letting them know that the application needed to be sent
to the NC division. I have attached this letter to the new application. The only reason I am submitting a
new application is that the plant has had a name change and management change from the original
application.
Please process our request and if additional information is needed please feel free to contact me directly
at [phone]. Thank you.
1 Regards,
Andrea Harris Owens
Segment Safety & Environmental Director
cc: Lee Osborne, Branch Manager
Zach Hess, Corporate Environmental
Cumulus Fibers, (a d&kbn of Leggett 8 Platt, Inc), 1101 Tarheel Road, Charlotte, N. C. 28208 [phone]; [phone] fax

"s*R''m' U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA)
(0) 'r NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES} j.
u ..
Z STORM WATER NOTICE OF INTENT CENTER
� Q
' siF�r4l pROSf�'1`O`
'
JOHN KEVIN BURNETT
LEGGETT & PLATT INCORPORATED
166 ORBIT ROAD
STATESVILLE, NC 28677-8623
REFERENCE NUMBER: NCRNEA081
Dear Operator:
FACILITY LOCATI01:
SACKNER FIBERS
166 ORBIT ROAD
STATESVILLE, NC
28677
IN
03/04/2004
Thank you for submitting a "No Exposure Certification for Exclusion from NPDES Storm Water
Permitting" application for the facility noted above. Upon review of your application, it has
been determined that the EPA cannot grant you exclusion from coverage for this facility.
The site location on your form is under the jurisdiction of the State of NC, which has been
authorized by the EPA to implement the NPDES program. Please submit the appropriate
application to the NPDES permitting authority at:
Web Address:
PERIMITTING AUTHORITY
North Carolina Department of Environment
Division of Water Quality
512 N Salisbury St
Raleigh, NC 276991617
Phone:[phone]
Fax:
E-Mail: [e-mail]
Contact Person: Bradley Bennett
Web Address:
If you have any questions regarding this letter, please contact the Storm Water Notice of Intent
Processing Center at [phone], If you have other general questions concerning the storm
water program, please call the EPA Region 04 contact: Floyd Wellborn, [phone].

j
Form Approved
United States Environmental Protection Agency OMB No.204M211
NPDES Washington, DC 20460
FORM 431EPA
351Q-11 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's 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).
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: IldL&11�IEllTl yl I I! I IPI1-IAIf I I 11 INIC101�_l916112lAlil6l61 12.Phone: I7I0ig180I11,12143I
3. Mailing Address: a. Street: 11 I LQJ la .. 1 01,ILI 6 l I r.I... A IQ I A] 61 _1 _ i I L-1 11 1 1 1 1 1 1 1 1 _I 1 J
b. 1S (f l A l l l EI S I U' 1 1 (l,1 (� e 1 l l l l l I l l l l l c. State: �� d. Zip Cade: I I I s+17 171- 13110Z 131
B. Facility/Site Location Information
1. Facility Name: IS if IkIf1C-151V11 ILIL& A&IS``1T1 I I I I I I 1 I I I I 1 1_1
2. a. Street Address: I I I L I U I 10 1 IZ 61 11 r1 I V, 1 01 k 1 y l I I I I I I I I I I I I 1_ 1_ I I I
g b. City: If I A I TI Ct S l V I I I LI Ll f-I i -I I.1 I I I I I I I I I I c. County: I I I Al C-A EI G LI 1 1
d. State: Rb e. Zip Code:
3. Is the facility located on Indian Lands? Yes ❑ No
4. Is this a Federal facility? Yes ❑ No Z
5. a. Latitude: M a I q l tY l I1.1_ 1 . b. Longitude: 101110 ) - L0._l 111'.
6. a. Was the facility or site previously covered under an NPDES storm water permit? Yes ❑ No EZ
b. If yes, enter NPDES permit number:
7. SIC/Activity Codes: Primary: I Z Yi 4 i 7J Secondary (if applicable): 1 I I I
8. Total size of site associated with industrial activity: 3.r25& — acres
9. a. Have you paved or rooted over a formerly exposed, pervious area in order to qualify for the no exposure exclusion? Yes ❑ No Ll
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 fire acres ❑
EPA Form 3510-11 (10-99) Page 1 of 4

j
NPDES NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
FORM ,EPA OMB No. 204M211
3510-11 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
❑
13
4. Material handling equipment (except adequately maintained vehicles)
❑
D'
5. Materials or products during loading/unloading or transporting activities
❑
D-
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
❑
14
8. Materials or products handledlstored on roads or railways owned or maintained by the discharger
❑
❑,
9. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑
a
10. Application or disposal of process wastewater (unless otherwise permitted)
❑
a
11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated
❑
D-
(i.e., 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)).
I 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 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.
Print Name: I U-1 6 1 Q St,!Q_1 121 N l-I L A I I I I I I I I I I I I I I I I I I I
Print Title:
Signature:
Date: loll I III 10I S
EPA Form 3510-11 (10-99) Page 2 of 4

1iCc�li� `
L'7pcSu�c �*•
/ eZ
INCORPORATED
March 16, 2004
N.C. Department of Environment
Storm Water Unit
Attention: Mr. Bradley Bennett
1617 Mail Service Center
Raleigh, NC 27699-1617
Dear Mr. Bennett;
i
n
' }A� 2004
Attached you will find the �No Exposure Certification for Exclusion from NPDES Storm Water Permitting"
application for Sackner Fibers, located at 166 Orbit Road, Statesville NC 28766.
I have to apologize we meticulously went through the guide and followed the directions thereby sending it
to the U.S. EPA office in Washington. As you can see by their cover letter attached they returned the
application back to us requesting that we submit it to our state EPA office.
Please process our request and if additional information is needed please feel free to contact me directly
at [phone]. Thank you.
Regards,
5
+Andas Owens
Segment Safety & Environmental Director
cc: Bill Neal, Branch Manager
Michael Miller, Division Safety Manager
Zach Hess, Corporate Environmental
Cumulus Fibers, (a division of LeggeHFIA4 Inc), 1101 Tateel Road, Ctmik e, N C. 28208 [phone]; (704) 393,5294 fax

^N%v f���. '.._'T✓t.iVV�/ .W�fI/VJ✓�/�.� �N �, �✓'NW��.I ✓vV J'�✓�/`!\ti' ff�/`J`J'�V nMV�/✓�-M��N N✓�J��N✓�V�� P
��seasrgr U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA) ?
o fs
$" 4:TATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
WW
STORM WATER NOTICE OF INTENT CEN"I'ER
PAC),"
JOHN KEVIN BURNETT FACILITY LOCATION:
LEGGETT & PLAYF INCORPORATED SACKNER FIBERS
166 ORBIT ROAD
STATESVILLE, NC 28677-8623
REFERENCE NUMBER: NCRNEA081
Dear Operator:
166 ORBIT ROAD
STA'rESVILLE, NC
28677
03/04/2004
Thank you for submitting a "No Exposure Certification for Exclusion from NPDES Storm Water
Permitting" application for the facility noted above. Upon review of your application, it has
been determined that the EPA;canno't_grant you exclusion from coverage for this facility.
The site location on your form is under the jurisdiction of the State of NC, which has been
authorized by the EPA to implement the NPDES program. Please submit the appropriate
application to the NPDES permitting authority at:
Web Address:
PERMITTING AUTHORITY
North Carolina Department of Environment f fi L
Division of Water Quality 1 Cv
512 N Salisbury St lb I �(i M Jeloy
Raleigh, NC 276991617
Phone: [phone]
Fax:
E-Mail: bradley.bennett r�ncmail.net
Contact Person: Bradley Bennett )e 5Z$'
Web Address:
if you have any questions regarding this letter, please contact the Storm Water Notice of Intent
Processing Center at [phone]. If you have other general questions concerning the storm
water program, please call the EPA Region 04 contact: Floyd Wellborn, [phone].

el d
n off` im�Approved�
United States Environmental Protection Agency OMB No.2040-02ig
NPD? S Ai Washington, DC 20460 u U u
FORM ``�, Epq NO EXPOSURE CERTIFICATION for Exclusion from
3510-11 FEB 2 Q 2004
NPDES Storm Water Permitting lu
Submission of this No Exposure Certification constitutes notice that the entity identified In Section A does not require permit
discharges associated with industrial activity In the State identified In Section B under EPA's Storm Water Multi -Sector Gen
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, andlor 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 arose 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).
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 OperatorInformation
1. Name: C1T141 2. Phone: 1UI�I1 I�6 I�iIJIf1C19��vp 1�1
I
3. Mailing Address: a. Street: G f)Ji A I T D A
b. Clry IS if l A l f l G l s l VI l l Ll II C, I I I I i_ 1_ I I I I i 1 c. State:Vvi C, d. zip Code: I2 l g I G l 7 1-h- 15'I & i Z- 31
B. Facility/Site Location Information
1.Facility Name: I?iAICII`i�ILl�I IFt oliCiP-Isl I I I I I I I i I 1 I I I I I
2. a. Street Address: I l i Wei tP I t 01121 61 11 Ti I Q I0 1 lq I *)1 I I I I I L 1 I I I i 1 I I i I I I
b. City: I S T 1 A 1T 1 E1 Si Vi i I LI L4 6 I I_ I I I I I I t_ I (. 1 c. County: I iP_ 161 h 61 Lt L
d. State: I NI C 1 a. Zip Code: 12 � l tel 71 1 -1 I I _I _
3. Is the facility located on Indian Lands? Yes ❑ No
4. Is this a Federal facility? Yes ❑ No
5. a. Latltude: 17 1 s 1 1- �1 LZ b. Longitude:' �� i y r ��
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. SIC/Activity Codes: Primary: 2 2 fSecondary (if applicable): I I I I
E8!Total size of site associated with industrial activity: �� S� acres
9. a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure exclusion? Yes ❑ 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 qua lily, 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) fi, /age 1 of 4

NPDES n NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
FORM ,EPA OMB No. 2440-0211
3510-11 NPDES Storm Water Permitting
C. Exposure Checklist
Are any of the following materials or acthritles 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 spillslleaks
3. Materials or products from past Industrial activity
4. Material handling equipment (except adequately maintained vehicles)
5. Materials or products during loadingfunloading or transporting activities
6. Materials or products stored outdoors (except final products Intended for outside use [e.g., new cars] where
El
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
❑
I
8. Materials or products handled/stored on roads or railways owned or maintained by the discharger
❑
[W
9. Waste material (except waste In covered, non -leaking containers (e.g., dumpsters])
El
E2'
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.e., 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)).
I understand that I am obligated to submit a no exposure oertiflcation 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.
Addltlonally, 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 property 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.
Print Name: 1:1i,, i b tjl I NEIVI t INi i.0 rimitz�iilrlLl I I I I I I I I I I i I I
Signature:
Date:
EPA Form 3510-11 (10-99) Page 2 of 4

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1 166 Orbit Road, Statesville, NC 28677
EZ-Locate returned a Block Face Match from the Tele Atlas map database.
+ Matched Address I Location (WGS-84) 1 2000 Census
Decimal Degrees Deg:Min:Sec
166 ORBIT RD Lat: 35.772993 35:46:22 _775N
STATESVILLE, NC 28677
Lon:-080.992933 80:59:32.759W
I Standard Address I . Postal I
166 ORBIT RD
STATESVILLE, NC 28677-
8634
Inset
Carrier ................ R022
DPBC................... 66
Lorne cl,
Overview
r1_ Rf6
o`
FIPS County..:
Tract........: NC097
BlockGroup...:NC097C
FIPS Place...:
FIPS MCD.....: N
MSA..........
The red X represents the
matched address.

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