NCGNE0141_COMPLETE FILE - HISTORICAL_20080116

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
8'HISTORICAL FILE
DOC DATE
0) I�
YYYYMMDD
9

Mr. Mike Gatch
Flextronics
PO Box 562148
Charlotte, NC 28256
Dear Mr. Gatch.
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen 1-1, Sullins, Director
Division of Water Quality
JA N 18 2008
NC DENR MRO
DM -Surface Water Protection
Subject: Ownership Change
No Exposure Certification NCGNE0141
Flextronics
Formerly: Solectron
6800 Solectron Drive, Charlotte, NC
Mecklenburg County
The Division has reviewed your submittal of the permit name/ownership change form for your No -Exposure
Certification, which we received on October 26, 2007. Division personnel have reviewed and approved your
request to transfer coverage under your Certificate of No -Exposure.
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 on 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 Sarah Young at [phone], ext.
502, or at [e-mail].
cc: Mooresville Regional Office
Stormwater Permitting Unit Files
Sincerely,
for Coleen H. Sullins
Central Files — w/attachments
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
MA
NTDENR
Customer Service
1-877.623-6748

Michael F. Easley, Governor ,j
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E. 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) No Certitpcate of CovCertification
rage i f i c a t i o n
N LOLL I N I C I G
II. Permit status pr1Ur to status change.
a. Permit issued to (company name):
b. rC
res �o]nsible for permit:
26 200?
c. Facility name (discharge):
d. Facility address:
e. Facility contact person:
Solectron
Mike -- -Gatcfi
First / MI / Last
General Manager
Title
P.O. Box 562148
Permit Holder Mailing Address
Charlotte NC _28256
City State Zip
[phone] ( 704)509-8100
TPhone Fax
Solectron
6800 Solectron Dr.
Address
Charlotte NC 28262
City State Zip
�goc Y Do [phone]
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: 13 Change in ownership of the facility
)Q 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:
Flextronics_
Mike Gatch
First / Ml / Last
General Manager
Title
P.O. Box 562148
Permit Holder Mailing Address
--Charlotte NC 28256
city state Zip
[phone] mike _ �atch(�f lextronics .cum
Phone E-mail Ad
T 6800 Solectron Dr.
Address
Charlotte NC 28262
city State Zip
Ngoc Y Do
First / Ml / Last
[phone] ngoc -do(af l extrani rs cam
Phone E-mail Address
Revised 712005

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: N g o c Y Do
First I Ml / Last
Envr. Eng.
Title
P.O. Box 562148
Mailing Address
Charlotte NC 28256
City State Zip
(704_509-8759 ngoc.do@flextronics,com
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior to
this ownership or name change?
b Yes
0 No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE
INCOMPLETE OR MISSING.
93 This completed application is required for both name change and/or ownership change requests.
j7 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.
• • ......... ► .......... a ............................................. • ...............................
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, _Kla t, L'Do , attest that this application for a namelownership
change has been viewed 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.
"nrn,e:z Lo Z---
SiOUAM 0 Date
APPLICANT CERTIFICATION:
I, 1\1_1 lr_- Pv , attest that this application for a name/ownership
change has been revi6wed 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.
"SA= '. 10 115-1
Sigtaprreo Date
a aaaa••••aaaaaa•aaa
PLEASE SEND TFIE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 7/2005

STATE of DELAWARE
LIMITED LIABILITY COMPANY
CERTIFICATE of FORMATION
FIRST: The name of the limited liability company formed hereby is:
SOLECTRON USA LLC
SECOND: The address of the limited liability company's registered office in the State
of Delaware is Corporation Trust Center, 1209 Orange Street, City of Wilmington
19801, County of New Castle, and the name of the registered agent in the State of
Delaware at such address is The Corporation Trust Company.
IN WITNESS WHEREOF, the undersigned has executed this Certificate of Formation
on the 2nd day of October, 2007.
Carrie Schiff, Authorized P
3952192v1

r �
State of Dslawrare
Secretary of State
Division o{ Corporations
Delivered 10:26�! 1010.312007
FILED 08:03 FM 1010312007
SRV 071082576 - 3470237 FILE
STATE OF DELAWARE
CERTIFICATE OF CONVERSION
FROM A CORPORATION TO A
LIMITED LIABILITY COMPANY PURSUANT TO
SECTION 18-214 OF THE LIMITED LIABILITY ACT
1.) The jurisdiction where the Corporation first formed is Delaware.
2.) The jurisdiction immediately prior to filing this Certificate is Delaware.
3.) The date the corporation first formed is December 18, 2001.
4.) The name of the Corporation immediately prior to filing this Certificate is
Solectron USA, Inc.
5.) The name of the Limited Liability Company as set forth in the Certificate of
Formation is Solectron USA LLC.
IN WITNESS WHEREOF, the undersigned has executed this Certificate on the 2nd
day of October 2007.
Carrie i hori;� �_i
3952182vl

r y
Delaware ,.a, ,
The First State
I, HARRIET SMITH WINDSOR, SECRETARY OF STATE OF THE STATE OF
DELAWARE DO HEREBY CERTIFY THAT THE ATTACHED IS A TRUE AND
CORRECT COPY OF CERTIFICATE OF FORMATION OF "SOLECTRON USA LLC"
FILED IN THIS OFFICE ON THE THIRD DAY OF OCTOBER, A.D. 2007, AT
8 : 03 O ' CLOCK P.M.
3470237 8100v
071082576
Harriet Smith Windsor, Secretary of State
AUTHENTICATION: 6050024
DATE: 10-04-07

Delaware PAGE
the First State
I, HARRIET SMITH WINDSOR, SECRETARY OF STATE OF THE STATE OF
DELAWARE DO HEREBY CERTIFY THAT THE ATTACHED IS A TRUE AND
CORRECT COPY OF THE CERTIFICATE OF CONVERSION OF A DELAWARE
CORPORATION UNDER THE NAME OF "SOLECTRON USA, INC_" TO A
DELAWARE LIMITED LIABILITY COMPANY, CHANGING ITS NAME FROM
"SOLECTRON USA, INC." TO "SOLECTRON USA LLC", FILED IN THIS
OFFICE ON THE THIRD DAY OF OCTOBER, A.D. 2007, AT 8:03 O'CLOCK
P.M.
3470237 8100V
071082576
Harriet Smith Windsor, Secretary of State
AUTHENTICATION: 6050024
DATE: 10--04-07

October 25, 2007
Ms. Sarah Young
NC Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Change of Name/Change of Ownership
No Exposure Certification: NCGNE0141
Attached is the Permit Name/Ownership Change Form regarding the change of name and change of
ownership of No Exposure Certification NCGNE0141, located at 6800 Solectron Dr., Charlotte NC 28262.
Also attached is the legal documentation of the transfer of ownership.
Flextronics acquired Solectron on 10/01/2007; consequently, the facility will operate under the legal
intermediate name of Solectron USA, LLC and eventually under the final name of Flextronics. As of
10/01/2007, the common name for this facility is Flextronics.
If you have any questions or need additional information, please contact me at 704-509-8759.
Sincerely,
Ngoc Do
Environmental Engineer

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
ryl. "t,1 . ur 'HNIVIRON 4
14*r11an� Wr Klimek,.P.,E..i)irect
1,�. , � r •wr.
Division of water Qua1iF9
oleen H. Sullins, Deputy Director•10E
Division of Water Quality
April 20, 2005
Massued Behrouzi
Solectron Technology Inc _
PO Box 562148>r...
Charlotte, NC 28256
Dear Permittee:
APR ? 7 200'i
Subject: No Exposure Certification NCGNE0141
Solectron Technology Inc. - 6800 Solectron Dr
Mecklenburg County
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on March 16, 2000. We apologize for the extended period it
has taken us to get hack 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,
Ley
for Alan W. Klimek, P.E.
cc: Mooresville Regional Office Central Files — w/attachments
Stormwater Permitting Unit Files
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
NODE NR
Customer Service
1-877-623-6748

March 14, 2000
Mr. Bradly Bennett
NC Department of Envr. and Natural Resources
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699
Subject: No Exposure Certification
Dear Mr. Bennett:
MAR 1 6 2000
DEER - WATER QUALITY
POINT SOURCE BRANCH
As required by Storm Water Phase 11 Final Rule, please find attached the No Exposure Certifications for
exclusion from NPDES storm water permitting for three facilities of Solectron Technology, Inc., located in
Charlotte, North Carolina. Site locations of these facilities are:
o Bldgs. 1 and 3:
6800 Solectron Dr.
Charlotte, NC 28262
o Bldg. 2:
o Bldg. 4:
5020 West Harris Blvd.
Charlotte, NC 28269
8201 IBM Dr.
Charlotte, NC 28262
If you have any questions or need additional information, please contact Ngoc Do at [phone].
Sincerely,
Randy Grimes
EHS Manager
Solectron Technology, Inc.

03/10/00 11:13-aI51U73d759y (0002/005
NILH--g5.
68808 Federal Rogisler / Vol. 64, No. 235 / Wednesday, December 8, 1999 / Rules and Regulations
App0ndix 4 to that Preamble —No Exposure Certification Form
United Stales Environmental Protection Agency Form Approved
NPOES Washington, DC 20460 OMS No. 20 0-0211
FORM SWEPA NO EXPOSURE CERTIFICATION for Exclusion from
3510-11 NPDES Storm Water Permitting
Submission of INS No Expcsure Carlillcallon constitute& nalloo that I" onliry idenlillod in Section A does not require potmil authorization for its storm water
discharges associated with industrial acuviry In the State Identified In Suclion 5 under EPA's Storm Water µtrlll•SSCIOr General Parmil due to the exictanco
of a Condition of no exposure.
A condition of no exposure exists at an Inoustrial Iscility when as Industrlat materiels and activillas are protected by a storm resistant shelter to prevent
exposure to rain, snow, snowmell, end/ar runoff. Industrial matorlafs or activities Incttidu. but are not limited to, marerlal handling equipment or acCvii-es.
Industrial machinery, raw materials, Intermediate products, by-products, final products, or waste ploducW. Material handling ac!ivilias Include the storage,
loading and unloading. Iramporlailon, or Conveyance of any raw material. Intermediate product, final prddUCI or waste product. A storm resistant shelter Is
not required lot the lotlowing Industrial matertats and activities:
- drums, barrels, Isnks and similar containers that ara tightly sealed, provided those contalners are not dateftaraidd and do net teak. `Sealed'
means banded or olhorwlsa secured and without operational taps or valves:
adequelCly mainlained vehicles used In mafunal handling: and
final products. Other than products M-11 would as mobiltzed In Storm water discharges (e.g.. rack suit).
A No Exposure Cerillication must be provided for OACh lacility qualifying lot the no axposure exclusion In addition, tho exclusion Tram NPOES permitting is
available an a lacli,ly•wide basis only, not lot Indlvidual ouffalls- ll any Industrial acfivilies or malarial: are or will be oxpesod Ia orBapilalion, the facility is
not eligiAie lot the no exposure exclusion.
i
Ely signing ano submitting this No Exposure Certification form. the amity In Sodlon A is cerlilying that a condition of no 6xpo6ura exists at its facility or silo,
and I9 obligated Ia comply with the Ierm5 and conditions of 40 CFR t22.26(gl•
ALL INFORMA710N MUST BE PROv1DED ON Tanis FORM.
Detailed Instructions for completing [hit' larm and obtWning the no axposuro exclusion are provided on pages 3 and 4.
A, Facillty Operator Information
I Name: IS 0 J-I C GI T i Rdt i , t 1 1 f 2. Phane:
3. Mailing Addra5s: a. 511ee1: T101 f r t f 2 141 9-1 1 1 1 1 1 1 1 1
o City: C 141 k 4ZIl-I OfTiTi'Ed I! I - t A I I I I l LJ C Slalo: LCJ d, Zlp Code: JZ�2 151 L-
Fac,tihylSlta Location Information ,�t( /
I. Facillty Nama: 6lot Li IE4 CI Ti R OI 1Y1 ITI El C.1 4KI 31 I-ICIC4 IxF Tl r�l �-1 f , I I I I I
2.a,Street Addres5: 16 1101 6,0A-jE4tT'IR(1 t2 i i I I I
n�,�t
b, Cily: LI ! L 0 T_..JJ e.Counry: IL1FZ1C1 I-1 Ltf-;I I\]II
d. State: 10J e. Zia Code' L2_&Z - }
3 Is the facifiry iocaled an Indian Lands? Yes ❑ No ®
a. Is this a Federal facility? Yes No IR [FM
5. a- Lali[uda: � L1 Sa1 LLU b. Longitude: l 1$ f � l , L 13 10 61
a, Wus tra taciity or silo prev1Ou:)Iy Covered under an NPOES storm water permil7 Ye NoFAR
�1a, a yes, anterNPOES permitrlumborr IVC(i 030321 200
T, SiCtActivlty Codas: Primary: 13 16 IT, 2- Secondary (if apDllcaUel: I I I I
S. Total size of site associated with inauslrral activity: acres DENR - WATER OVAL
POINT SOURCE BRAN
9. a. Have you paved or tooled over a lotMorly exposed, pervlous brow in ardor to quality tor the no bxposure excluslanP Yes ® NO Cl -
b- it yes, plouse indicate approxlmalely how rn=n area wa; paved or fooled over Comploting this Quesftn does not disqually you lot Ina no exposure
exclusion However, your permitting uuthariry may use this information in constgeong whether =rm water dlscnaigos tram your Silo are ftkaly to have
an adverse lmpac! on wafer quality, in which care you could b6 required to oolain permit coveragC.
Less Insn ono acre C Ono to live aces El More than litre scres I]
EPA Form 3510.11 (10.991
Page 1 at 4
�D
,,,rlo , rat ^)arnn 1 1 : 7A 6107367599 ?AGE. 02

1 r.11r rat Rt.-i•sIt! r/ 1•itl, ri4, \r . _'ail/L1"."II-1al.it. I1VI-011111Of' ri I�19!Ii 1::IIr.; .r,lrl It1:l4t1hlIi(III, LiIiHU'!
NPDES �, P NO EXPOSURE CERTIFICATION for. Exclusion from FormApprovea
FORM+� �1 OMB No 2040�211
3510•11 i NPDES Storm Water Permitting
C. Exposure checklist
Are any of the following Materials or activities expasud to pre6'pitalion, now or in Ine foraseeagle future
(Please chock either "Yor' or "No in rile appropriate box ) It you answer "Yet" to any of these quostiorm
(1) through (I I I, you are not eligible for the no oxpocure exclusion.
Yes
No
1, using. storing of cleaning industrial machinery or equipmenl, and areas where residuals from using, storing
or Clearing InduS1631 machinery or aouipmenl rernain end 8ro expoled 10 storm water
2. Materials or residuals on the ground or in storm water inlols from spfllstleaks
3. Materials or products from past industrial activity
4 Material handling equipment (e<cepl adequately maintained vaNclas)
S. Materials or products during loadinglunloadng or transporting activities
❑
Ii. Materiels or products stored outdoors (except linal products intended lot outside use (e.g- new cars) where
exposure 10 storm water does fist result in the discharge of pollurantc)
7. Materials contained In open, dolarioraled or loaking storage drums, barrels, tanks, and similar containers
El
g, Malerlale or products handledrslomd on reads or railways owned or mmnta:med by inn discharger
S. Waste material (except waste In covered, non leaking containers (e,g., dumpstersf)
❑
10, Application or disposal of process wastewater (unless olnerwisa perminaW
11. Particulate maner or visible deposit: of residuals, from roof stacks and/or wenls not otherwisa regulated
1i.e., under an air quality control permit) and ovideni in the storm water ourflow
D. Cartllicatlan Statement.
I coriily under penalty of law that I have read and understand the atiglbilily, requirements for clalming a condition of 'no exposure' and obtaining an
exclusion from NPDES storm water pormitting.
I carlity under penally of law tnat there are no discharges of storm water conlaminalcd by exposure 10 industrlal activities or materials from the industrial
tacifity or site identified in this document (except as allowed under 40 CFR 122.261g)t2)).
I understand that I am obligated In submit a no exposure certification form once every five years to lde NPDES parmining authority and, Wrequestad. 10
the operator of the local municipal separate slcrm,eewer syctem.(MS4) Into which the facIlity discharpes.(whare-appilcablel,. l understand than must
allow the NPOES permltling authority. or.M94 operator.whom.the discharge Is Into the Iocal.MS4, to perform inspecdons lo:confirm the condilianol no
exposure and to make such Inspactton sports pubiltty.availaNe upon request_ 'I understand that I must abtalo coverage under an•NPOES permit prior
to any polni source discharge. of storm wat06from the lacillty.
Additionally. I cartity under penalty of t2wrthat Ihlsdocumenl and elk attachments were prepared under my direction or supervision In accordance wkh a,
system designed toaesura that qualified personnel property galhorad.and'evaluatod the information submined. Based on.my inqufry of the person or
Persons who manage the aystem..orilhose persons directly-reeponslbleior.gathering the information, the Information 4:ubmined Is.fa.lhe best of my
icnowfedge and belief uua; accureia "complete; 4 am aware that here era Wgnifleantpenaidas for furbrrillling Waa information; including the.posalbllily.
of fine land Imprisonment.for knowing violations.
Print Name: I9lkj1 L 0t`1,I I61Rf i A El 51 _ 1 ,1 1 I t 1 I t 1 l 1 1 1 1 1 1 1 I 11 1 ... ..
Print Title: (-El �+1 7 I iMLh19I6I6;llF:j Q. I I I I, I I I I 11 _1 1 _L '1 1 l I i 1�I 1 I
Signature:
Date: Q 131 1141 001
EPA Form 3510.11 (10-99)
Page 2 of 4
MAR 10 2000 11:21
6107387599 PAGE.03

t38808 Federal Register/Vol. 64, No. 235 / Wednesday, 'December 8, 1999 / Rules and Regulations
Appendix 4 to the Preamble —No Exposure Certification Form
United Stales Environmental Protoctlart Agency FOrm Approved
NPDES SWEPA
Washinglon, OC 20460 OMS No. 2a40-0211
FORM NO EXPOSURE CERTIFICATION for Exclusion from
3510-11 NPDES Storm Water Permitting
Submisalon of IRIS No Exposure Cartiftcadori constitutes notice that Ino entity identlllad in Section A does not require parmil au00r17e11on for its storm water
discharges associated with industrial actwily In the Slate Idonlllled In Suclion B under EPA's Storm Water Mulil-Seclor General Permit due to the exislence
al a condition of no oxposura.
A condition of no oxpcsure exists al an Industrial facility whor all Industrial metadals and activillas are pfOtOcted by a Storm resistant shelter to prevent
exposure to rain, snow, snowmelt, in4ior runoff. Industrial materials or activities InC160u, but are not limilad la, materiel handling equipment or activities.
Induarial machinery. raw mafer14115, Intormadialo products, DypraducLs, linel products, or waste producs, Material handling activities inctode the slOm9a,
loading and unloading. transportation, or conveyance of any raw malatfal, Intermediate product. linal product or wattle product. A storm resistant shelter is
not required for the following Industrial materials and activities:
- drums, barrels, Tanks. and similar containers that are lightly seated, provided (hose Containers are not detehoralod and do not leek_ 'Sealed'
means banded of otherwise secured and without Operational taps. or valve.:
Adequdlely malnW8 nad vehicles used In rnaturiel handling; and
Thal product&. diner Iran products INM would oe mobilrzed In Storm water discharge-, te.g., rock 5811J,
A No Exposure Certification must be provided for oath facility qualifying for tno no ax, osure exclusion In addition, Me dxctusion from NPDES permitting is
aveiladla on a laclldywide basis only, not lof Individual ourfalls. 11 any induslrial activities or materlats Oro or wtl be exposed ro precipitation, the facility is
not eligible for the no dxpcsure exclusion
-
Ely signing ono ,uDmitting Ihir No Exposure Cdrtili"hon form. the entity In Section A is cartrlytng fnal a con dillon of no exposure exIsis at its laciliry or silo,
and 15 dbtigetod Id Comply with the terms and conditions of 40 CFR IZ2,28{g).
ALL INFORMATION MUST BE PROVIDED ON THIS FOAM.
Detalled Instrucliony for comptetlng, this form and obtaining the no exposure exclusion are provided an pages 3 and 4.
A. Facility Operator informedonfy
1, Name: ;;, TI R4 ( 01 i Lr�LI I tI ICI �JI � iuI `-{�Y1 I I I I I 1 l 2. Phone: � j() LLB 50 A I S 15 Ali
i_ Mafling Address: r�a.Sliabl: 1 6 B O P Vt I_ t L 1 E_ I _1 I I„ I I I t I I
rY o Ciry: IC I R l�F Li bi 7tTi Fg I I 11 I 1 i I 1 i I f I c Slata: IC d. Zlp Code: 12A&I1 5i fps - l I t I I
S. FactlityrSite Location Information [( 1� +
1_ FecilllY NOM0. 5 QI � Ivl ITi E CIR,L\r IU I LI Q l6zil Ct
2. a. Street Address: z I 0 1 W G SiI I V
b. City: L L- O I _t...lJ c. County: Ll l� G
d. State: L„CJ 0. Zia Code: 1&% 6° 191 - I I I I
3 Is the facility located an Indian Lands? Yes ❑ No
a, Is this a Federal facility? Yes ❑ No cal
Sr a. Lalitude:b. Longitude:�f
8. �. Was It-0 lac➢ky or silo prevlou.ty coverall under an NPDES storm water pernllll YC: ❑ No
o, It yes, onler NFOES permit number:
7. SIC1AcUvily Codes: - Primary 13, 6 Secondary tit appllcablel: I I I I f
A. Total Size of sltc associated with industrial activity: l r 1.7 eere's
9. a, Have you paved or tooled over a lOrmorty oxpasad, pervlou', aeon in order to qualify for file no exposure excluslon7 Yes ❑ Nolink
0, 11 yes, ploase indicate npproxirnately how much area was paved or roofao over Cornploting this question doe: not disqualify you Tor the no exposure
exclusion Howover, your Permitting authority may use this inlormaiion in cortudering whoihor .corm water dlscnargos from your site ere likely to have
an adverse Impact on water quality. In which case you could be required to obtain parmtl eoveragC.
Lass Insn one acre E Ono to five acres ❑ More than lire acres U
EPA Form 3510.1 t 110.99)
Pogo I at 4
MAR 10 2000 11:20 6107367599 PAGE.02

LVjvuJ/u(J5
I'ltrlrraI RuoisIor; 1'Ir(. I ). -N ':l:i! ll', cl r al,,r. I lu,.cnlllr r tl (4);141 r l::llr : .I,Irf I::� ul:llil n., Li1iR[l}(
NPDES ,, NO EXPOSURE CERTIFICATION for.Exclusion from form Approved
FORM I ��� EPA o+�e No za<a�z 1 r
3s1o•1t I NPDES Storm Water Permitting '
C. Exposure Checklist
Are any of the lailowing nlalerlafs or activities exposud io prac,pilalion, now or in the foreseeaule future
(Please chock either -Yuri' or -'No' in Iha appropriate box ) It you answer'•Yar:" to any of these quosfions
(1) through 01), you are not ollglbte for the no oxpocure exclusion.
Yes
No
1. Using, staring or cleaning industrial machinery or equipmenl, and areas whero rosiduals from using, storing
or cfear•ing Induslelal machinery Or equipment remai(1 aAa ara exposed la Storm walor
2. Malerlals or residuals orl tno ground or in storm water Inlets from spfllsdeaks
jQl
3. Materials or products from past industrial activity
O
4 Material` handling equipmenl (except adequately maintained vahfcl641
lAt
S. Materials or products during load inp/unloading or transporting activities
8. 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. Malerlals contained in open, deteriorated or leaking storage drums, barrels, larks, and similar conlainers
a. Malerlala or products hendladlslored on roads or railways owned or maintained by Ina discharger
4, waslo material (except wama In oavored, non -leaking contalnerc (e.g„ dumpslersl)
10. Application OrdlSposal of process wastewater (unless olnerwise permlrtod)
Cl
11, Particulate manor or vrslblo deposits of residuals.from root Stacks and/or rents not ofharwiye regulated
(I.e.. under an air quality control pormil) and ov�denf in the storm water outflow
O, Certification Statement..
I certify under penalty of taw that I have read and understand the oliglbiiity requirements for clalm)ng a condition of 'no exposure"and obtaining an
exclusion Irom NPDES storm water porrnitting,
I certify under penalty of law trial there are no discharges of storm water contaminated by exposuro to indusWM acGvilies or malerials from Ina indu5triat
facility or site identified in this documem (except as allowed under 40 CFA 122.261g)(2)).
I understand Owl I am obligated to submit a no expasure certification form once every Ave years to Ibis NPDES permilting authority and, If requested. to
the operator of the Iota) municipal separate siorim-sawer-syslam (MS4) Into which the feclilty discharges,(whwo.appllcebtel.. I understand that l must
allow the 14POES permitting authority. orM94 operalor.where.the discharge Is Into the Iocal.MS4, to perform Inspections ra.confirm the condition of no
exposure and to make such InspectlOn reporu publkty.aysllab(e upon requa$L 1 understand that I muet obtato coverage under an-NPDES perm(i prior
to any-polnt source discharge. of storm.water.lrom fha iaalllty.
Additionally. I cartty under penalty of law -that lhls$ocumanl and altattachments were prepared under my dlrectian or supervision in accordance wkh a.
system daslgnad to scsura that qualified personnel properly gathorad.and-evaluelod the Information submltted. Based on.my inquiry of the person or
.persons whc manage the aystem,_orlhose persons dleecilyreaponsibte7or.gathering the Information. the Information submilted Is.to,the beat of my
knowtedga and belief,1ruaraaclrrata and comptata-.f am aware lhsl+here are signlficantpertaldas for submtNng frataainlorrnll*n; inciuding tha.posslbltlty.
of fine ­and Imprisonment for knowing vldallons.
Print Name: I �t i�i !� A Yl_-1�i t I�fUV i�t
Print rile: S { 141
Signature: f - - - — -- —
Data: lai3( �`4-t �tOI
EPA Form 3510-11 (10-99)
Page 2 of 4
MAR 10 2000 11:21 6107397599 P.gGE.03

138808 Federal Register/Vol. 64, No. 235 1 Wednesday, December 8, 19991 Rules and Regulations
Appendix 4 to the Preamble —No Exposure Certification Form
— I -
United Stales Environmental Protection Agency Form Approved
NPDES Wa3hinglon, DC 20450 OMB rid. 2040.02n
FORM NWEPA
NO EXPOSURE CERTIFICATION for Exclusion from
3510-11 NPDES Storm Water Permitting
Submiselon of this No Exposure Cer6gratlon conWituteS nOttto teal lna anNty idenlfllad in Section A does riot require permit authorization for its storm water
discharges a9eaclaled with industrial activity In the Slats Identlliod In Suction B under EPA's Storm Water Mulll•Seclor Oenoral Permit due to the exi61ence
oI a condition of no o1po6ure.
A condition of no exposure exists at an Industrial facility whah all Mousirlal materials and aclivilios are protected by a Storm rasisla it %hailer to prevent
exposure to ra}n, snow, snowmell, indror runoff, industrial malanals or activities tnciu00. bul are not limited la, material handling equipment or aclivifies.
IrWuarial machinery, raw materials, Inlarmediaie products. by-products, final producls, or waste products. Malarial handling activities include the storage,
loading and unloading. Iransporteflan, or conveyance or any raw malarial, Intermodlale product, final ProdLCl Or weal@ product A &farm resistant shelter is
not required Ior the following Indu6irla! melarlgl% end activities
- drums, barrels, Tanks. and similar containors that are lightly sealed, provldod those conlalnerS are nor delerlaralod and do not leak. 'Sealed'
means banded or olhorwlso secured and wllhoul operational taps or valve.,;
- adaqual0ly malnWinod vehicfae usso In malunal handling; and
- final proeucls, other Iran products lh3l would be mobilcred In storm water discharges ta,g.. rock said.
A No Exposure Car0fication must be pravid04 lot oath Iaeilfty quallfying for Ina no exposure exclusion In ;addition, trio exclusion from NPDES permitting is
available an a ladblywide bacis only, nol lot lndlvidual curtails. 11 any Indvslrial activities or matenai; era or will be exposed to precipitation, the facifiry is
not eligible for the no oxpasure exclusion.
By signing and submitting tni6 No Exposure Certification lorm. the entity In Socllon A is cerklying tnal a condition of no exposure exists at its facility or site,
and 11 oalgated la comply with the terms and conditions of 40 CFFt 122.26(g).
ALL INFORMATION MUST BE PROVIDED Or+ThIS FORM.
Detailed Instrucllona for completing this form end obtaining the no aapo7uro oxclucion are provlgad on pages ] and 4.
A, Facillry Operator Information1, '` p
1. Name: 6Il iL if 4i lF 10 N I I I iy LC iti 0, of , i tl(-1 1 1 1_ t _1 2. Phone: F {� 5i V [q IS I .
3. mailing Address: a. Straw: It?I Of�, I OI XI I I �(r1 ^ I�I� I I ! t 1�,.L _t ! I 1 1 r I I i/ 4 I
b Ciry: IC4 1-ki TI M t-101TLTi I I 1 _ 1__1__ 1._ I 1 i t 1 1 __l c Slaw IQ d. Zip Code: 2- I'll r -
B. Fac,lityr5ira Locatlon Information
1.Facillty Nama: 1�1{il�IL1Et�-r T1 '�L UI �! IItF-7 Cl %l1lUi���rt�F ZIr1G�� I r ! l {
2. a. Street Address: l 7 21 ,LJ I T 6(A I Pit d 1 f I I I I I t I _ I I r I 1 I I I I 1
b. FY CityC[ itT T ..�J t . caunw: LE�4k I LI i� G
d. Stare: c I a. Zip Code: ��Ill�j - I
3 Is the facility located on Indian Lands? Yes ❑ No
4. t6 this a Federal facility? Yas El No
S. a. Latitude: 13,Til 1 b. Longitude: OJ { I j Of 0,
a. 5, War Ina facility or slle pravrou:ly covered under an NPDES starm water perrn117 Yes ❑ No
b, II yes. anler NPOES permit number' _,
7. SICMctivlfy Codes: Primary t_-3 4, 1-71-,� Satondary(il aapllcahiel: I i i
6. Total size of site associated w+m inaustriel acfivily: _ 3 r Z 'acres
9. a. Have you paved or reoled over a tormorly oxposed, pervious woo in order to quality for the no uxpowra axctuslon7 Yes ❑ No 1K
b, 11 yes, plosss indicate approcmalaly how mum area was paved or roofed over Comploung This question does not disqualify you for the no exposure
exclusion However, your permitting authority may use Ihi; information in consvCering whWhor storm water clscnarge9 Irom your site are likely to have
an advaree imp,1V on water quality, in which case you could be required to oalain permit coverage.
Lass Inan Ono acre 0r10 to We acres ❑ More than live acres
EPA Form 3510.17(I0.991
Ptrgo 1 at 4
MAR 10 2000 11:20 610?38?599 PA5E.02

UJI IU/VU IL: LJ
V Ulu r 00 r J ZP9
VJ003/005
0
l'crlcraI FLV iSIt!1-; l' 11, 64, Nt1 ':I:i l kV,,tIiI alit, it:r• }i [r1r+ hill;flit+n-, GIiREl�1
POE ;��P� NO EXPOSURE CERTIFICATION for. Exclusion from pM9 Form
o 20 a�zeli
3s10 11 I NPDES Storm Water Permitting '
C. Exposure Checklist
Are any 01 the tollowing nlalerials or activities exposed to pf ec-piWion. now or in Int laresee3ple future 7
[Please chock 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 inauslhaf machinery or eQvlpmant, and areas where residuals from using, storing
Of cleaning Industrial machinery or equipment remain and ar0 exposed to storm walor
2.
Materials or residuals on trio ground or in storm water Inlets from spillsrfaaks
3.
Matonais or products from past induslh3t activity
Cl
a
Material handling equipment (except adequately maintained vehicles)
5.
Materials or products during load inglunloading or Vansponing activities
177
8,
materials or products stored ouldoora (except linal products intended br outtldo 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 slorage drums, barrels, tanks, and slmtlercontainers
8•
Materials or products handlaci/rtorad on roads or railways owned or maintained by the discharger
j
YY�ee
9.
Waste materiel (except waste In covered, non -leaking containers [e.g.. dumpslers))
❑ .
10.
Appllealion at disposal of process wsslowaler (unless otnerwise perminod)
11.
Particulate manor or visible deposits of residuals -from roof stacks and/or vents not osherwise regulated
(i.e.. under an air quality control permit) end evident in the storm + alar outflow
o. Certification Statement _
i certify under penalty of law that I have road and understand the eligibility requirements for cialming a condition of 'no exposure"and obtaining en
exclusion tram NPDES storm crater porn-ltting.
I certty under penally of law that there are no discharges of storm water conlaminated by exposuro to industrial activities or materials from the industrial
iacifity or site identified in this documerti (except as allowed under 40 CFA 122.26(g1t2)),
I understand that I am obilgaled to submit a no exposure cenlflravon form once every ttve years to the NPDES porrnanfng authority and,11-requasted. to
the operator of the local municipal separate storm'sower-systam,(MS4)-Into which the facility discharger.(where.apptkabfel.. I understand thet-1 must
allow the NPOES permitting authority, arM94 operalor.where.the discharge is Into the Iocal.MS4, la perform Inspecdans lo.conflral the condition of no
exposure and to make such Irmpecdon ceporls publkfy.avallabie upon request 1 understand that I must obtalo coverage under an-NPOES permit prior
to any point source dischacgaof storm walar,from thelaoilly.
Additionally, I certfy under penalty of tavrtnat lhis-documant and alt att ichrrrants were prepared under my direction or supervision In accordance with a.
system daslgned taessura %hat'qualified personnel property palhorad,and evaluated the lntarmalion submined. Basad on.my inquiry of the person or
persons who manage the syclem,.armase perearrc alrectlyveaponslbfe?or gathering the Inlormaton, the Information Submitted Is-to.lrte best of my
knowledge and betief ilrueraccurate and oomptate.-A am aware theithere era slQnlftcant-penalties for submhng teilnei tformafort: including the.possiblNty.
of linemnd Imprisonment.lor knowing violations.
Print Name: f F t M (A _0�1-161 R( I M F 51 1 1 1 1_ 1 1�1 1, l „1 1 1 1 t I I I i I I I ... ..
Print Tttle: l 1 li4 51 _tM1hNsAt-6n Zt� _1 I I j 1_ I I[ I 1 1 1- 1 1 1 1 1 _t I I
Sipnatura:
Date: ib3iI O
EPA Form 3510-11 0O-G9)
Page 2 of 4
MAR 10 2000 11--21 6107387599 PRGE.03