NCGNE0061_COMPLETE FILE - HISTORICAL_20121001

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
�tlo
DOC TYPE
❑HISTORICAL PILE
DOC DATE
❑ �I U U
YYYYMMDD

Division of Water Quality 1 Surface Water Protection
NCDENR
NORn. C No , . ocP.W W— Cc
ENVIRONMCNT UI❑ NAiUR.LL IRESIXlRCl9
National Pollutant Discharge Elimination System
PERMIT NAME/OWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
Date Received
Year Month
pay
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N G 15 10 N G G N I E 10 0 1 6 1 1
1I. Permit status prior to requested change.
a. Permit issued to (company name): FAS Controls Inc.
b. Person legally responsible for permit: James
First
c. Facility name (discharge):
d. Facility address:
e. Facility contact person:.
M Yarboro
M1 last
Director Operations
Title
1100 Airport Road
Permit Holder Mailing Address
Shelby NC 28150
City state Zip
[phone] [phone]
Phone Fax
FAS Controls Inc.
1100 Airport Road
Address
Shelby NC 28150
City State Zip
James M Yarboro [phone]
First 1 MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: X❑ Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit
d. Facility name (di
e. Facility address:
f. Facility contact person:
}
Kendrion FAS Control Inc
Robert Cheatham
First M1 Last
Director Operations
Title
1100 Airport Road
Permit Holder Mailing Address
Shelby NC 28139
City State Zip
[phone] [e-mail]
Phone E-mail Address
Kendrion FAS Controls Inc
1100 Airport Road
Address
Shelby NC 28150
._.._city _ State Zip
Robert Cheatham
First ImI Last
[phone] [e-mail]
Phone E-mail Address
Revised 2012Apr23

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact:
First ImI Last
Title
Mailing Address
City State Zip
Phone E-mail Address
V.
Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
X Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
X This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, Robert Cheatham, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
Signature Date
APPLICANT CERTIFICATION
I, Robert Cheatham, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
U��"1Jc2(,/;2—DI.--
Siunature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 712008

4
0�
NCDENR
North Carolina Department of Environment and
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
September 14, 2010
JANIES 1\1 YARBORO, DIRECTOR OF OPERATIONS
FAS CONTROLS
1100 AIRPORT ROAD
SHELBY NC 28150
Dear Mr. Yarboro:
Natural Resources
Dee Freeman
Secretary
RECEID
DIVISION OF WATER QUALITY
SEP 16 2010
TION
MOORESVILLE REGIONAL OFFICE
Subject: Name/Ownership Change Request
No Exposure Certification NCGNE0061
FAS Controls
Formerly Honeywell Sensing & Control
1100 Airport Road, Shelby, NC
Cleveland County
The Division has reviewed your submittal of the permit name/ownership change form for the subject No -Exposure
Certification, which we received on August 9, 2010. Division personnel have reviewed and approved your request to transfer
the exclusion from NPDES stormwater permitting requirements.
Please note that by our original acceptance of the no exposure certification and by our approval of your request to
transfer it, you are obligated to maintain no exposure conditions at your facility. If conditions change such that your
facility can no longer qualify for the 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.
Annual re -certification is required, and we have enclosed one blank Annual No Exposure Exclusion Self Re -Certification
form for your use. 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 the Stormwater Permitting Unit at [phone].
Sincerely,
ORIGINAL SIGNED BY
KEN PICKLE
for Coleen H. Sullins
cc: Mooresville Regional Office
Stormwater Permitting Unit Files
Wetlands and Stormwater Branch One
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 NorthCarolina
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service:1-877-623-6748 Naturally
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer

No -Exposure Self Re -Certification Information:
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. State statute provides for fines of up to $25,000 per day for un-permitted
discharges. 3„
Your conditional no -exposure exclusion must be self re -certified at least annually as follows:
- Complete the 're,pertification at a minimum of once per year using the included Self Re-
CertificatioriForm.
(additional copies can be downloaded from http://portal.ncdenr.org/web/wgtws/su/npdessw#tab-5 )
- Maintain a record of re -certifications on file at the facility. Do not submit the re -certification to DWQ
unless requested. If requested, submit a copy of the re -certification to the Division and/or the
municipality in which the facility is located.
-During an inspection by DWQ or local government, provide the re -certifications immediately upon
request.
- Notify the Division of any changes in ownership, significant facility and/or activity changes, or if the
facility can no longer maintain no -exposure conditions.
-Allow the NPDES permitting authority or,.if discharging into a municipal separate storm sewer system, the operator
of the system, to: (1) inspect the facility; and (2) make such inspection reports publicly available upon request.
* "No exposure'' means that 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. (40 CFR 122.26(g))
Information and forms related No -Exposure Certifications can be accessed on the website at:
htlp://portal.ncdenr.org/web/wq/ws/su/npdcssw'ttab-5

NC®ENIR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
September 14, 2010
JAMES 1\1 YARBORO, DIRECTOR OF OPERATIONS
FAS CONTROLS
1100 AIRPORT ROAD
SHELBY NC 28150
Dear Mr. Yarboro:
Dee Freeman
Secretary
Subject: Name/Ownership Change Request
No Exposure Certification NCGNE0061
FAS Controls
Formerly Honeywell Sensing & Control
1100 Airport Road, Shelby, NC
Cleveland County
The Division has reviewed your submittal of the permit name/ownership change form for the subject No -Exposure
Certification, which we received on August 9, 2010. Division personnel have reviewed and approved your request to transfer
the exclusion from NPDES stormwater permitting requirements.
Please note that by our original acceptance of the no exposure certification and by our approval of your request to
transfer it, you are obligated to maintain no exposure conditions at your facility. If conditions change such that your
facility can no longer qualify for the 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.
Annual re -certification is required, and we have enclosed one blank Annual No Exposure Exclusion Self Re -Certification
form for your use. 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 the Stormwater Permitting Unit at [phone].
Sincerely,
for Coleen H. Sullins
cc: Mooresville Regional Office
Stormwater Permitting Unit Files
Wetlands and Stmmnwater Branch One
1617 Mail Service Center, Rale�h, North Carolina 27699-1617 NorthCarolina
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 r
Phone; 91 M07-63001 FAX: [phone] Customer Service: 1-877-623-6748 �%tumll i/
Internet: wwncwaterquality.Org ;/ w.
An Equal Opportunity 1 Affirmative Action Employer

No -Exposure Self Re -Certification Information:
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. State statute provides for fines of up to $25,000 per day for un-permitted
discharges.
Your conditional no -exposure exclusion must be self re -certified at least annually as follows:
- Complete the re -certification at a minimum of once per year using the included Self Re -
Certification Form.
(additional copies can be downloaded from http://portal.ncdenr.org/web/wglws/su/npdessw#tab-5 )
- Maintain a record of re -certifications on file at the facility. Do not submit the re -certification to DWQ
unless requested. If requested, submit a copy of the re -certification to the Division and/or the
municipality in which the facility is located.
-During an inspection by DWQ or local government, provide the re -certifications immediately upon
request.
- Notify the Division of any changes in ownership, significant facility and/or activity changes, or if the
facility can no longer maintain no -exposure conditions.
-Allow the NPDES permitting authority or, if discharging into a municipal separate storm sewer system, the operator
of the system, to: (I) inspect the facility; and (2) make such inspection reports publicly available upon request.
* "No exposure" means that 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. (40 CFR 122.26(g))
Information and forms related No -Exposure Certifications can be accessed on the website at:
littp://portal.nedenr.oi,g/web/wq/ws/su/npdessw#tab-7

\o�oF W A rf9p�
' r
a -r
Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C "$ 101 1 1 J= [!0_1G N E 0 0 1 6
11. Permit status prior to requested change.
a. Permit issued to (company name): Honeywell_
b. Person legally responsible for permit: James M Yarboro
First MI Last
a Q� Director Operations
Title
AUG - 9 2010 _ 1100 Airport Rd
Permit Holder Mailing Address
QENfi-HATER QUALI lY Shelby NC 28150
POINT SOURCE BRANCH City State Zip
[phone] 704-487-1429_
Phone Fax
c. Facility name (discharge): Honeywell
d. Facility address: 1100 Airport Rd
Address
Shelby NC 28150
City State Zip
e. Facility contact person: James M Yarboro [phone]
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ® Change in ownership of the facility
❑ Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
FAS Controls
James M Yarboro
First MI Last
Director Operations
Title
_ 1100 Airport Rd
Permit Holder Mailing Address
Shelby NC 28150
City State Zip
[phone] [e-mail]
Phone E-mail Address
FAS Controls
1100 Airport Rd
Address
Shelby NC 28150
City State Zip
James M Yarboro
First MI Last
[phone] [e-mail]
Phone E-mail Address
Revised 812008

PERMIT NAME/OWNERSHIP CHANGE FORM
R Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact:
First MI East
Title
Mailing Address
City State Zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
® This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1, James M Yarboro, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
\M, 7/23/10
Signatu c Date
APPLI(�� CERTIFICA N
I, lames M Yarboro, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
.a.— M-
Signature
7/23/ 10
Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 712008

13 Iaeep Feb 07 2007
03,1W.QQ
Lf�th-%�&x
c v-wt Estate Ex ba Thor
FILM b CI LNUAMD Cetautg, PVC
6D on Feb 07 2007 of IM.J5 PH
Otnoaoafai t 00.lO7 ' FEIRS, or ors
OWK 1511 PAGE 2128
NON -WARRANTY DEED
Exdse T $3,460=
Tax Parcel ID No. _ Verified by County
on the 'day ofof February 20 07--
NmnlBou to�_��oficll' �rl• `f c ltor� _
aaenerrw�'�s�'anA4
This lnstnanentwas piePared .+ngebn.racarn - —
Brief description for ftte Index Deed hm Moneywo l br*rtotl nal Iroc. to FAS controls Inc.
THIS DEED. made ao orthe Ss_ day of February 20 07 by and beMasn
GRANTOR: Honeywell latemadonal Inc-, a Delaware corporation
(herein reierted to collectively as Grantor) and
GRANTEE: FAS Conbxft tree. is Delaware corporation
whose alddrass is:_ 1100 AlMd Road, NC 25150
(herein referred to collactively�as Grantee)
WITNESSETH:
For valuable eonslderation from Grantee to Grantor, the receipt and suf deny of which Is hereby acknowledged.
Grantor hereby gives, giants, qt t Wms and conveys unto Grantee In tee simple, the fo0ovAN described property
located in the City of . County of gmIand Stata of North
Carollna, more particularly described as follows (the'Prtoper":
See �sNhN A' altacfsd useeW and made s prrt hwwL SMECTTD: Al onwrwnm corensnta. eesdfione end rtstr+ttarts. YKltrdirg.
nrtrhout Itrnita4wh, Chase dteradLed lrereh enact an'fxfhElt 6' attached hereto and madf a part Mna ,
Oraotor horsby names nor Ilea land ka wocassors and an** QOremmcrRhi ArIDrorrraa, Other A com Pa Not and cwwuims (as
with terms era daMad h !re Acmes AWwrzu t) nM4x;IVPW commerts (a) of zoom InNron and pm across, wWw and through
(loduAV WooUSan and vMft tar bpro" end epren) the Property dnwbsd an TOM A'sWed hereto and 1=wpontod hmh as
b naoaaaery to stied PerlorasadKe at drs Rapidred FsSrrairmoMal Reraadhdr:r, <: adhYimpfarad oY tf,el tartah recanted Emtranmhrdh>i
Aoo s end Use Apneamerd or own dots herewilh (he'Accass Apmemere) ud (tr) b be the RwwW £nNrannum" Remedtallon
an Me Property, rkdch costo ft re, mro partkafady gtrartled and dhambed h tlsat a d= Fotterris. tt Dad, of awn date herewith,
made by Grandee In favor e[Graaar act rsrmdm Irame&m* 69aahp pis mcodstlon of oft NwWarrawy Dead and s4as ecrtdnrhe
ung rwaro" obop dw m corePicse Ga Raatdrod Ernrimunerrlaf Romeraeatxr hen tarw*wbd The tones and aQrdtenns al ttw Acem
Agreement are hweby Inoo+ponod by m t&mnoe n g My sal ftM rhelah. Said property having been previously conveyed to Granbor by lnsbumcngs) retarded In Book _ 14-e . Page 5 and
being refSected on piat(s) retarded In R&V tat Book . pagefsWe _.
TO HAVE AND TO HOLD unto Gnarttee. foget w w th ail pdviWgm and appurtenances !hereunto belongim. In fee
simple -
Grantor makes no warranty, express or Implied. as to title to Die property herairmbow described.
Revised October 1, 2D06

STATE of L t"-,01S COUNTY of B" IBU PAGE 2M
I certify that the following person(s) personally appeared before me this day', and
(check me of (hefollowing)
I have personal knowledge of the identity of the principal(s); or
1 have seen satisfactory evidence of the principal's identity, by a current state or
federal identification with the principal's photograph in the form of
(check one of the following)
a driver's license, or
in the form of ; or
a credible witness 0) personally known to rue, (H) unaffected by this instrument and
the transaction to which it relates and (iii) who personally knows such principal(s),
has sworn to the ideality of the principal(s).
Each acknowledging to me that he or she voivatarily signed the foregoing ducument for the
purpose stated therein and in tttt capacity indicated: Wert principat(s) names(s) and fFrle(s) below
\,
:3?Ai+r rt r0. as of
Date:-t��i.Sa Z 007
No brie I /
(Offacial seal) Printed Name:
-5Fwj R�oUVP11 SEIkL My commissionexpin�s:,
NoTMYPURZ-STATE of L1JIrrW
My QMWS=N E6[RE8OMM
lLM32R!

\NA 7-F
RQG
Michael F. Easley, Govemor
`OtO
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Ul
Alan W. Klimek, P. E. Director
0 Y
Division of Water Quality
cS&PaF%ifiie,LDeputXe ire tt r'f
AND kpiyision of�VJr3�,¢,tiatij,
April 20, 2005 :-
A
George Smith PR 2 7 2005
Honeywell Sensing & Control
1100 Airport Rd
Shelby, NC 28150
Subject: No Exposure Certification NCGNE0061
Honeywell Sensing & Control - 1100 Airport Rd
Cleveland County
Dear Permittee:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on March 18, 2004. We apologize for the extended period it
has taken us to get back to you on this request and we appreciate your patience as we have worked through
this process. Based on your submittal and signed certification of no exposure at the above referenced facility
the Division is granting your certification as provided for under 40 CFR 126.22(g) which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of your no exposure certification, you are obligated to maintain no
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no -
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no -exposure exclusion expires in five years (April 30, 2010). 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 Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
for Alan W. Klimek, P.E.
cc: Mooresville Regional Office Central Files — wlattachments
Stormwater Permitting Unit Files
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
Ag
NCDENR
Customer Service
1-877-623-6748

Michael F. Easley, Governor
Jr.,
7pG
William G. Ross Secretary
North Carolina Department of Environment and Natural Resources
`O�C'
Alan W. Klimek, P. E. Director
Division of Water Quality
5
Coleen H. Sullins, Deputy Director
Division of Water Quality
April 20,.2005
George Smith
Honeywell Sensing & Control
1100 Airport Rd
Shelby, NC 28150
Subject: No Exposure Certification NCGNE0061
Honeywell Sensing & Control - 1100 Airport Rd
Cleveland County
Dear Permittee:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on March 18, 2004. We apologize for the extended period it
has taken us to get back to you on this request and we appreciate your patience as we have worked through
this process. Based on your submittal and signed certification of no exposure at the above referenced facility
the Division is granting your certification as provided for under 40 CFR 12622(g) which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of your no exposure certification, you are obligated to maintain no
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no -
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no -exposure exclusion expires in five years (April 30, 2010). 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 Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
yet
for Alan W. Klimek, P.E.
cc: Mooresville Regional Office Central Files — wlattachments
Stormwater Permitting Unit Files
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
.ter
NCDENR
Customer Service
1-877-623-6748

Honeywell
Sensing and Control
1100 Airport Road
Shelby, North Carolina 28150
704-482-9582
704481-1741 Fax
NCDENR
WATER QUALITY SECTION
919 NORTH MAIN STREET
MOORESVILLE, NORTH CAROLINA 28115-0950
Attention: Stormwater Section
Subject: No Exposure Certification
Dear Sir:
MAR 1 8 2004
u�
I am submitting this written certification of no exposure for this facility.
This was the former Invensys and Fasco Controls Corp. All industrial materials
and activities are protected from exposure to rain, snow, snow melt, and
runoff. They are either inside the facility or stored in the enclosed storage
building with containment.
Sincerely,
J
George Smith
Environmental & Safety Coord.
Phone: [phone] ext. 326
Fax: [phone]

n'ccrvEoc �l
r
United States Environmental Protection Agency Form Approved
oMe No.2oao-oz11
NPDES a Washington, DC 20460
FORM ` k NO EXPOSURE CERTIFICATION for Exclusion from
3510-11 ®n®
E PA
NPDES Storm Water Permitting
Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit authorization far 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 conditionof 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;
- adequateiy 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 Cenification 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 anv 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 OperatorInformationAB-r
/ r f ry p C L �I
lL1-I � iE614 SI 7iNllrl 41 l��l1t�,11�Ri 01 �1- ! 1 2. Phone: [phone]ig 4 ,5,J l.i"
3. Mailing Address: a.QStreet: ! 10Q D I I I. I I I I I I
d
b- City: [� fi !�1 �1 OI �}I 1 I 1 ! I i ! f I I ! 1 I 1 } I c.State: d. Zip Code: I.�! eI I i_ 101 - 31693 1
B. Facility/Site Location Information
`
1. Facility Name: I�f� ll��i llV I�ILILnn1 f6�ltr Ir�"ISlll�lb' I�I ICI{NI f II�I�€�I I I 1
2. a. Street Address: 1 11 (1 UI,0I IfiITI IU f p16I 11 I I1 riI h I I I I I I I I I I, If IGI�/I I I/1 11,j
b. City: 7 f c. County: I[ . IL IC I V 61-11'fIF `� 1 1
d. State: e. Zip Code: Q-01 115 Ql - I ? 9A.IQ
3. is the facility located on Indian Lands? Yes ❑ No
4. Is this a Federal facility? Yes ❑ No
5. a. Latitude: LK1.51 o L_LSj 3L I b. Longitude: t 1 ,31 f o !L01 SL(J
6. a. Was the facility or site previously covered under an NPDES atorm water permit? Yes FA] p No ❑
b. If yes, enter NPDES permit number: Are Go 30on O CDC NC G,D3 of i4 I
7. SIC/Activity Codes: Primary.- 131(214131 Secondary (if applicable): I I I I 1
6. Total size of site associated with industrial activity: �t_x 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 X
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)
Page 1 of 4
S-32.2 1 Supplement to Environmental Compliance

NPDE
FORM NO EXPOSURE CERTIFICATION for Exclusion from
5Oa11 ®o0�*EPA NPDES Storm Water,Permitting
C. Exposure Checklist
Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future?
(Please check either "Yes" or "No" in the appropriate box.) if you answer "Yes" to any of these questions
(1) through (11), you are not eligible for the no exposure exclusion.
I. Using, storing or cleaning industrial machinery or equipment, and areas where residuals from using,:storing
or cleaning industrial machinery or equipment remain and are exposed to storm water
2. Materials or residuals on the ground or in storm water inlets from spills/leaks
3. Materials or products from past industrial activity
4. Material handling equipment (except adequately maintained vehicles)
5. Materials or products during loadinglunloadmg 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
S. Materials or products handled/stored on roads or raifways 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)
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
I D. Certification Statement
r
Form Approved
OMB No. 2040-0211
Yes No
❑ ®
Elz
❑ EK
❑ L&
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
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 Cr 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 penaities for submitting false information, including the possibility
of fine and imprisonment for knowing violations.
Print Name: C7ilo .rj,7 —i I
Print Title'. I Eft V 1&0 611f `f [.. I F T
Signature:
Date: o 311,7)
-PA Form 9510-11 fln_-9M
Page 2of4
S-32.22 Supplement to Environmental Compliance