NCGNE0143_COMPLETE FILE - HISTORICAL_20181105

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. NCGNE DI yj
DOC TYPE HISTORICAL FILE
DOC DATE ❑ D
YYYYMMDD

Riddle, Rick L
From: Bennett, Bradley
Sent: Monday, November 05, 2018 7:49 AM
To: Riddle, Rick L
Cc: Morman, Alaina
Subject: FW: [External] Stormwater no exposure certification application
Attachments: 20181101121317499.pdf; 20181101121249800.pdf
Rick,
NCGNE application below. Let me know if you need any help with this one.
BB
From: Alexander, Laura
Sent: Thursday, November01, 2018 12:20 PM
To: Morman, Alaina <[e-mail]>; Bennett, Bradley <[e-mail]>
Subject: FW: [External] Stormwater no exposure certification application
Fyi... Thanks.
From: Keith Haggerty <[e-mail]>
Sent: Thursday, November 01, 2018 12:09 PM
To: Alexander, Laura <[e-mail]>
Cc: Bill Doerr <[e-mail]>; Michael Fourcand <[e-mail]>; Craig Farley
<Crai .Farle CARAUSTAR.COM>
Subject: [External] Stormwater no exposure certification application
Laura
Good afternoon! Please see the attached application, please let me know if there is any additional information that you
require thanks. I will be sending out the hard copy today.
Keith Haggerty I Reliability Manager
Keith.HaggertyR CARAUSTAR. COM
[phone]
Caraustar's Carolina Carton Plant
8800 Crump Rd
Pineville, NC 28i34
Ocaraustar
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I
.� Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
" NO EXPOSURE CERTIFICATION for Exclusion
Environmental
Quality NCGNE0000
Quality
FOR AGENCY USE ONLY
Data Received
Year Month
Day
conificals of Covcrago
{rational Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit based
on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notification that your facility does not require a
permit for Stormwater discharges associated with industrial activity in the State of North Carolina because
it qualifies for a:no exposure exclusion. A condition of no exposure at an industrial facility means all
industrial materials and activities are protected by a storm resistant shelter (with some exceptions) to
prevent exposure to rain, snow, snowmelt, and/or runoff.
For permitted facilities in North Carolina, DEML.R 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 resclnded, your facility must continue
to abide by the terms and conditions of the current permit.
Industrial materials or activities include, but are not limited to: material handling equipment or activities,
Industrial machinery, raw materials, Intermediate products, by-products, final products, or waste products.
Material handling activities include the storage, loading and unloading, transportation, or conveyance of
any raw material, intermediate product, final product or waste product A storm resistant shelter is not
required for the following Industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed, provided those containers are not deteriorated and do not leak. "Sealed" means
banded or otherwise secured and with locked or non -operational taps or valves; adequately maintained
vehicles used in material handling; and final products, other than products that would be mobilized in
stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no, exposure exclusion. In
addition, the exclusion from NPDES permitting Is available on a facility -wide basis only riot for individual
outfalls. If airy 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 farm, 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-certifled at least annually -
Please look for information about re -certification under the No Exposure section on this page:
https:/Ides nc.4ov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/stormwater-
For questions, please contact the DEMLR Regional Office for your area. (See page 8)
(Please print or type)
1) Mailing address of owner/operator address to which all certification correspondence 'Will be mailed
Name Caraustar Consumer Packaging Group Inc
Contact Henry HaggeTty
Street Address 8800 Crump Road
City Pineville s State NC ,ZIP Code 28134
Telephone No. 704 554-57B6 Pax:
Page 1 of 7
SWU-NCGNE Last revised 9/2812M

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Caraustar Consumer Packaging Group Inc
Facility Contact Henry Haggerty
Street Address s800 Crump Road
City Pineville _ State NC ZIP Code 28134
County Mecklenburg
Telephone No. log 554-5796 Fax:
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). e°uthwIM`ASmith BbL* r4:L M@W Mmti1.rsmks, rwRkftmCmmpR-&TM W07 ft w UM full
(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 C1 No
6) Latitude 35; 07; M5 Longitude 80;53;01.8 (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
V New or Proposed Facility Date operation is to begin
o Existing Date operation began
Cl Renewal of existing No Exposure Certification Certification No.: NCGNE 0143
8) Was this facility or site ever covered under an NPDES Stormwater Permit? li 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: 2 7 5 9
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Diaital and lithociraphic printing on purchased recvc[ed rmr)erboard. The Drinted paverboaal
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
C2 No
® Yes
If yes, list the. permit numbers for all current Non -Discharge permits for this•facility:
. S
i
Page 2 of 7
SWU-NCGNE Lasl revised W8I2016

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 93 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 p Yes B, No o NIA
c. Materials or products from past industrial activity
p Yes El No ® NIA
d. Material handling equipment (except adequately maintained vehicles)
0 Yes El No © NIA
e. Materials or products during loading/unloading or transporting activities
© Yes M No © NIA
f. Materials or products stored outdoors (except final products intended for outside
© Yes el No 13 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 o NIA
tanks, and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained © Yes 13 No © NIA
by the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., 13 Yes ® No 13 NIA
dumpsters])
j. Application or disposal of process wastewater (unless otherwise permitted) 0 Yes ® No K3 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 0 No 0 NIA
(i.e., not closed and stored upside down to prevent precipitation accumulation)
rn. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ® Yes is No D NIA
stoned outside, has the facility had any releases ir) 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 C3 NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No a NIA
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.
ti
Page 3 of 7
aAnn LmrrrmF Last revised 9128/2016

NCGNE0000 No Exposure Certification
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 a No p 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 C2 No ® NIA
Amendments and Reauthorization Act (SARA) water priority chemicals*?
d. Is secondary containment provided for hazardous substances" designated in ® Yes 10 No ® NIA
40 CFR §116?
e. Are release valves on all secondary containment structures locked? ® Yes C No ® NIA
16) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? Mes M No ® NIA
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous ® Yes a No 13 NIA
waste generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste 0 Yes ® No 13 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: Spornrollarmsh
How is material stored: 65 ganon drums
Where is material stored: Enclosed building. Not exposed to stormwater or snow.
How many disposal shipments per year: approximately 2-4 shipments.
Name of transport I disposal t
vendor. Memo solutions Charlotte Plant
Vendor address: 3930 Glenwood Drive, Charfotte NC 28208
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 describedin the exemptions from reporting requirements of Title III SARAi313 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.
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.
Page 4 of 7
SWU-NCGNE Last revised 9/29/2016

NCGNE0000 No Exposure Certification
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside?
® Yes m No 13 NIA
b. Does your facility have coal piles on site?
13 Yes ® No 61 NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips,
a Yes ® No a NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
® Yes 13 No 0 NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: emissions from printlng chemicals
e. If you answered yes to d., are those emissions permitted by an Air Quality
is Yes 0 No ® NIA
Permit? Please specify: Yes- Permit to operate 18-009-068
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:
i
Page 5 of 7
SWU-NCGNE Last revised 9/2812016

NCGNEOOOO 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 g9giRiete a Self -Recertification 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 M84 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 hest of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing: Craig Farley
N
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 13(i) provides that:
Any person who knowingly makes arty false statement, representation, or certification In any application, record, report, plan, or other
document flied or required to be maintained under this Article or a rule Implemerding 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 falsities, 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 C[ass 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
SM-NCGNE Last revised 9n812018

NCGNE0000 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.
Mall the entire package to:
DEMLR - Stormwater Program
Dept. of Environmental Quality
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 ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ....:.
[phone]
Central Office .........(919)
707-9220
Page 7 of 7
SWU-NCGNE Last revised 9/2812016

(� \NA[4s Michael F. Easley, Govenior
`O� ry William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
co Alan W. Klimek, 11. E. Director
> Division of Water Quality_ ,
Q Coleen EiLSullins�Depury` Director" �.li
at Division of Water Quality
MRlt_"
April 20, 2005
Matthew Matheson Demetriades, Coor
Sonoco Carton
8800 S Blvd
Charlotte, NC 28273
Subject: No Exposure Certification NCGNE0143
Sonoco Carton - 8800 S Blvd
Mecklenburg County
Dear Permittee:
APR 'L 7 ?005
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on March 3, 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 TNT
NCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone] Customer Service
1-877-623-6749

Th,
SONOCO
Vul.,y
+ y' A37342004 r�
Mr. Brad Bennett
NC Department of the Environment
Division of Water Quality
512 N. Salisbury Street
Raleigh, North Carolina 27699-1617
Mr. Bennett:
I applied for the following "No Exposure Certification for
Exclusion from NPDES Storm Water Permitting" on January 29,
2004. I received the attached letter stating to send the application
to you, as my site is under the jurisdiction of the State of North
Carolina. Thus, please find the application enclosed.
Please let me know if you have questions. My phone number is
[phone].
Thank you for your consideration.
Mathew Demetriades
Safety and Environmental Coordinator
8800 South Boulevard
Charlotte, North Carolina 28273
www.sonoco.com

y(�'i .. �: �..iin='J.if/'�ii✓ii.�i.�i:::' �i-�: �`-ii✓�ii'::i n�fi it ii. :'i%; iiiii,:-.r'r:.�!��`='�i.ism'-�;`✓✓rJ✓r.•J✓,'✓rJ✓.:i:':�: -✓'; /':;-.F'-'.,:•:.�f/•.
J) I/
U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA) .?
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES); ;, l
STORM WATER NOTICE OF INTENT CENTERN ES
�; PROS�G
MATHEW MATHESON DEMETRIADES FACILITY LOCATION.
>> SONOCO CARTON SONOCO CARTON
8$00 SOUTH BLVD 8800 SOUTH BLVD
l? CHARLOTTE, NC 28273-6930 28 AIt60 0 NC
;S
REFERENCE NUMBER: NCRNEA080
Dear Operator:
02/20/2004
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:
PERNUTTING 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].

INU7 �eO 'lla,4
United States Environmental Protection Agency Form Approved
9 Y OMB Na. 2040-0211
NPDES ;' ��� Washington, DC 20460
FORM '�' NO EXPOSURE CERTIFICATION for Exclusion from
3510-14
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 foltoWng industrial materials and activities:
— drums, barrels, tanks, and similar containers that are tightly seated, 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
}}nformation ((�r pp ,,11 �r}} aa //
1.Name: 1510IN101C101 ICI AlXITI01NJ I I I I I I I 1 I I I I�I 11 1 2.Phone: I i0ill151517Ij1(1lIb
3. Mailing Address: a. Street: 181910101 I S 10 111 1 T I k l 19IO lu l L i 6 i% i A k Di I I I I I i I I I I I I
b. City: C iWiPj&jL IQ irliEic. State: Lt�L d. Zip Code: 1212 I? 13 I — I b I ! 13 I O I
B. Facility/Site Location Information
1. Facility Name: 15,e iri,o tiQ, th Rl"(0 p1�f f_ I I I�,/r Ip I I I I f f f I i i f
2. a. Street Address: 1 9pp 3 I 0 I 0 I I S IQ I U I TI H I I D (D Ili I Z If I V i A M I D I I I I I I I I /� I �/ I I 11j I
b. City: ICIN Ai9iLIQITITIF1 I I I I I I I i i I 1 I I I c.County: IMIEICIr�,��.15iAIglulk
d. State: R-ei e. Zip Code: 12 112 1 7131 — 16 1 q 13 I D I
3. Is the facility located on Indian Lands? Yes ❑ No
4. Is this a Federal facility? Yes ❑ No
5. a. Latitude: 13 15,1 1 1017.1 it 101" b. Longitude: I I �101 a Ibi3l 1011
6. a. Was the facility or site previously covered under an NPDES storm water permit? Yes ® No ❑
b. If yes, enter NPDES permit number: �i7�C�l�}05M
7. SIC/Activity Codes: Primary: 12 4 11,5 ij Secondary (if applicable): 1 I I 1
8. Total size of site associated with industrial activity: 27 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) Page 1 of 4

NPDESEPA NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
FORM �—,OMB No.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
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
ILN
3. Materials or products from past industrial activity
4. Material handling equipment (except adequately maintained vehicles)
5. Materials or products during loading/unloading 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
Lev
9. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
El
N
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 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 Name4d[03�1,0,1/11i
Print Title:
Signature:
Date: 10 13 I O 13 I O #J
EPA Form 3510-11 (10-99) Page 2 of 4

NPDES �, Instructions for the NO EXPOSURE CERTIFICATION for Form Approved
FORM o_,Epp� OMB No.2040-0211
3510-11 Exclusion from NPDES Storm Water Permitting
Who May File a No Exposure Certification Section B. Facility/Site Location Information
Federal law at 40 CFR Part 122.26 prohibits point source discharges of
storm water associated with industrial activity to waters of the U.S. without
a National Pollutant Discharge Elimination System (NPDES) permit. However,
NPDES permit coverage is not required for discharges of storm water
associated with industrial activities identified at 40 CFR 122.26(b)(14)(i)-
(ix) and (A) if the discharger can certify that a condition of "no exposure"
exists at the industrial facility or site.
Storm water discharges from construction activities identified in 40 CFR
122.26(b)(14)(x) and (b)(15) are not eligible for the no exposure exclusion.
Obtaining and Maintaining the No Exposure Exclusion
This form is used to certify that a condition of no exposure exists at the
industrial facility or site described herein. This certification is only applicable
in jurisdictions where EPA is the NPDES permitting authority and must be
re -submitted at least once every five years.
The industrial facility operator must maintain a condition of no exposure at
its facility or site in order for the no exposure exclusion to remain applicable.
If conditions change resulting in the exposure of materials and activities to
storm water, the facility operator must obtain coverage under an NPDES
storm water permit immediately.
Where to File the No Exposure Certification Form
Mail the completed no exposure certification form to:
Storm Water No Exposure Certification (4203)
USEPA
401 M Street, SW
Washington, D.C. 20460
Completing the Form
You must type or print, using uppercase letters, in appropriate areas only.
Enter only one character per space (i.e., between the marks). Abbreviate
if necessary to stay within the number of characters allowed for each item.
Use one space for breaks between words. One form must be completed
for each facility or sito for which you are seeking to certify a condition of no
-exposure. Additional guidance an completing this form can be accessed
through EPA's web site at www.epa.gov/owmtsw. Please make sure you
have addressed all applicable questions and have made a photocopy for
your records before sending the completed form to the above address.
Section A. Facility Operator Information
1. Provide the legal name of the person, firm, public organization, or, any
other entity that operates the facility or site described in this certification.
The name of the operator may or may not be the same as the name of
the facility. The operator is the legal entity that controls the facility's
operation, rather than the plant or site manager.
2. Provide the telephone number of the facility operator.
3. Provide the mailing address of the operator (P.O. Box numbers may be
used). Include the city, state, and zip code. All correspondence will
be sent to this address.
1. Enter the official or legal name of the facility or site.
2. Enter the complete street address (if no street address exists, provide
a geographic description [e.g., Intersection of Routes 9 and 55)), city,
county, state, and zip code. Do not use a P.Q. Box number.
3. Indicate whether the facility is located on Indian Lands.
4. Indicate whether the industrial facility is operated by a department or
agency of the Federal Government (see also Section 313 of the Clean
Water Act).
5. Enter the latitude and longitude of the approximate center of the facility
or site in degreeslminuteslseconds. Latitude and longitude can
be obtained from United States Geological Survey (USGS) quadrangle
or topographic maps, by calling 1-(888) ASK-USGS, or by accessing
EPA's web site at httpJ/www.epa.gov/owm/sw/industry/index.htm and
selecting Latitude and Longitude Finders under the Resources/Permit
section.
Latitude and longitude for a facility in decimal form must be converted
to degrees (0), minutes ('), and seconds (") for proper entry on
the certification form. To convert decimal latitude or longitude to
degrees/minutes/seconds, follow the steps in the following example.
Example: Convert decimal latitude 45.1234567 to degrees (°), minutes
('), and seconds (").
a) The numbers to the left of the decimal paint are the degrees: 451,
b) To obtain minutes, multiply the first four numbers to the right of the
decimal point by 0.006: 1234 x 0.006 = 7.404.
c) The numbers to the left of the decimal point in the result obtained
in (b) are the minutes: 7'.
d) To obtain seconds, multiply the remaining three numbers to the
right of the decimal from the result obtained in (b) by 0.06:
404 x 0.06 = 24.24. Since the numbers to the right of the decimal
point are not used, the result is 24".
e) The conversion for 45.1234567 = 45' 7' 24".
6. Indicate whether the facility was previously covered under an NPDES
storm water permit. If so, include the permit number,
7. Enter the 4-digit SIC code which identifies the facility's primary activity,
and second 4-digit SIC code identifying the facility's secondary activity,
if applicable. SIC codes can be obtained from the Standard Industrial
Classification Manual, 1987.
8. Enter the total size of the site associated with industrial activity in acres.
Acreage may be determined by dividing square footage by 43,560, as
demonstrated in the following example.
Example: Convert 54,450 ft2 to acres
Divide 54,450 ft2 by 43,560 square feet per acre:
54,450 ft2 - 43,560 ft2/acre = 1.25 acres.
9. Check "Yes" or "No" as appropriate to indicate whether you have paved
or roofed over a formerly exposed, pervious area (i.e., lawn, meadow,
dirt or gravel roadiparking lot) in order to qualify for no exposure. If yes,
also indicate approximately how much area was paved or roofed over
and is now impervious area.
EPA Form 3510-11 (10-99) Page 3 of 4

NPDES n instructions for the NO EXPOSURE CERTIFICATION for Form Approved
FORM o-,EPA OMB No.2040-0211
3510-11 Exclusion from NPDES Storm Water Permitting
Section C. Exposure Checklist authority to sign documents has been assigned or delegated to
the manager in accordance with corporate procedures;
Check "Yes" or "No" as appropriate to describe the exposure conditions at
your facility. If you answer "Yes" to ANY of the questions (1) through (11) For a partnership or sole proprietorship: by a general partner or the
in this section, a potential for exposure exists at your site and you cannot proprietor; or
certify to a condition of no exposure. You must obtain (or already have)
coverage under an NPDES storm water permit. After obtaining permit For a municipal, State, Federal, or other public facility: by either a
coverage, you can institute modifications to eliminate the potential for a principal executive or ranking elected official,
discharge of storm water exposed to industrial activity, and then certify to
a condition of no exposure. Paperwork Reduction Act Notice
Section D. Certification Statement
Federal statutes provide for severe penalties for submitting false information
on this application form. Federal regulations require this application to be
signed as follows:
For a corporation: by a responsible corporate officer, which means:
(i) president, secretary, treasurer, or vice-president of the corporation
in charge of a principal business function, or any other person
who performs similar policy or decision making functions for the
corporation, or
(ii) the manager of one or more manufacturing, production, or
operating facilities, provided the manager is authorized to make
management decisions which govern the operation of the
regulated facility including having the explicit or implicit duty of
making major capital investment recommendations, and initiating
and directing other comprehensive measures to assure long
term environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary systems
are established or actions taken to gather complete and accurate
information for permit application requirements; and where
Public reporting burden for this certification is estimated to average 1.0 hour
per certification, including time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Burden means the total time,
effort, or financial resources expended by persons to generate, maintain,
retain, or disclose to provide information to or for a Federal agency. This
includes the time needed to review instructions; develop, acquire, install,
and utilize technology and systems for the purposes of collecting, validating,
and verifying information, processing and maintaining information, and
disclosing and providing information; adjust the existing ways to comply with
any previously applicable instructions and requirements; train personnel to
be able to respond to a collection of information; search data sources;
complete and review the collection of information; and transmit or otherwise
disclose the information. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it
displays a currently valid OMB control number. Send comments regarding
the burden estimate, any other aspect of the collection of information, or
suggestions for improving this form, including any suggestions which may
increase or reduce this burden to: Director, OPPE Regulatory Information
Division (2137), USEPA, 401 M Street, SW, Washington, D.C. 20460,
Include the OMB control number of this form on any correspondence. Do
not send the completed No Exposure Certification form to this address.
EPA Form 3510-11 (10-99) Page 4 of 4