NCGNE0299_COMPLETE FILE - HISTORICAL_20110921

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

9108431067 Tredegar Film Fed Spii 10:18:35 a.m. 09-21-2011 1 14
DENR-FRC
sEP 2 1 2011
®WQ
Tredega
FILM PRODUCTS
To: Belinda Henderson
- Here is Red Springs - Tredegar Corporation 2011 application for re —
certification of NPDES.
Kenneth N Greene
Plant Safety and Training
WP: 910 — 359 — 3074
CP: 910 — 257 — 0982
Email: Kenneth. [e-mail]
Tredegar Film Products Corporation
100 Industrial Drive, Red Springs, NC 28377 • Telephone [phone] • Fax [phone]
Form: AF-002

9108431067 Tredegar Film Red Spri
10:18:45 a.m. 09-21-2011 214 _.�.
YMAI.
NCDENR
++oars+ c.aO w Co+wrr , w
[ir.�aOw MCH' —� N-W. R'ES C"
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
ANNUAL INTO EXPOSURE EXCLUSION SELF RE -CERTIFICATION
NCGNE0000
Do not submit this form to DWQ unless requested.
For questions, please contact the DWQ Regional Office for your area or the Central Office.
(Please print or type)
Facility's No Exposure Exclusion No. Date Completed (MM/DD/YYYY)
N I C I G I N I E 1 0 1 2 1 9 9 (} 9 /I2 1/ 210I1 1
1) Has the facility name or owner changed? ❑ Yes ® No
(if yes, please submit a separate Name/Ownership Change Form to DWQ located at
http:llportal.ncdenr.orglweblwq/ws/sutnpdessw#Application_Forms_NPDES)
2) 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 to maintain your no exposure exclusion, and must immediately apply for a permit from DWQ.
a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes ® No
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ]Yes ®No
c. Materials or products from past industrial activity
❑ Yes
® No
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
® No
e. Materials or products during loadinglun loading or transporting activities -
0 Yes
®No- -
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes
® No
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks,
❑ Yes
M No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by
❑ Yes
® No
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes
® No
j. Application or disposal of process wastewater (unless otherwise permitted)
❑ Yes
® No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not
[:]Yes
® No
otherwise regulated (i.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
® No
(i.e., not closed and stored upside down to prevent precipitation accumulation)
Page 1 of 3
SWU-NESR-29M2010

9108431067 Tredegar Film Red Spn 10:19-48 a_rn. 09-21-2011 314
�r
NCGNE0000 No Exposure Self Re -Certification
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes ® No
stored outside, has the facility had any releases in the past three (3) years?
3) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible to maintain your no exposure exclusion, and must immediately apply for a permit from DWQ.
a. Are exterior ASTs and piping free of rust, damaged or weathered coating, pits, or ❑Yes❑ No ® NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑Yes❑ No ® NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
4) Secondary Containment: If you answer "No" to any of the following items, you are not eligible to
maintain your no exposure exclusion, and must immediately apply for a permit from DWQ.
a. Is secondary containment provided for all single above ground storage ❑Yes❑ No NIA
containers (including drums, barrels, etc.) with a capacity of more than 660-
gailons?
b. Is secondary containment provided for above ground storage containers stored Dyes[] No ® NIA
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund ❑Yes❑ No X NIA
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40 ❑Yes❑ Nc ® NIA
CFR §116?
e. Are release valves on all secondary containment structures locked? [:]Yes[] No ® NIA
Footnotes to Questions 4) c. & d.
"Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require secondary containment.
However, some exceptions may be made for de minimis amounts of certain substances, an0or other qualifiers, as described in the
- exemptions from reporting requirements of Title III SARA 313 in 40 CFR §372.38. _
"Note that amounts below the 660-gallon (single) and 1,320-gallon (cornbined) bulk storage minimums require secondary containment.
However, some exceptions may he made for amounts less than the Reportable Quantities of the hazardous substances listed in 40 CFR
§117,3.
5) Other information: If you answer "Yes" to any of the following items, and the answer if different from
how it was answered when originally applying, you might not be eligible to maintain your no exposure
exclusion. Please contact the Division If this is the case.
a, Does your facility store used, recycled, or otherwise reclaimed pallets outside?
b. Does your facility have coal piles on site?
c. Does your facility store other fuel sources outside in piles, such as wood chips,
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit?
Please specify:
Page 2 of 3
SWU-NESR-29Ju12010
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ® No
[:]yes[:] No®N1A

910,9431067 Tredegai Film Red Spri 10:20:24 a.m_ 09-21-2011 41-1
i
NCGNE0000 No Exposure Self Re -Certification
6) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no
exposure" and obtainingimaintaining 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 CF€t 122.26(g)(2)).
I understand that I am obligated to annually self re -certify No Exposure and, if requested, submit this re, -certification to
DWQ or the operator of the local municipal separate storm sewer system (MS4) into which the facility discharges (where
applicable). I understand that I must allow the North Carolina Division of Water Quality, or MS4 operator where the
discharge is into the local MS4, to perform inspections to confirm the condition of no exposure and to make such
inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information provided. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information provided is to the best of my knowledge and belief true, accurate and complete. I am -aware
that there are significant penalties for providing false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that i am familiar with the information contained in this document and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing: Steven C. Hunt
Till Mana r - Tiede ar i=ilrin Products, Red Springs, NC 2$377
(Signature) ( to igned)
Please note: The Regional Office may Inspect your facility at any time in the future for
compliance with the No Exposure Exclusion -
North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders Inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
lEnvirenmental Management) Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000).
This completed form must be kept on file at the facility for at least 5 years. Do not submit this
form to DWQ unless requested.
Page 3 of 3
SWU-NESR-29Ju120i0

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
September 29, 2006
Mr. Steven Con Hunt
Tredegar Corporation
1100 Boulders Parkway
Richmond, VA 23225
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
OFNFI—r—RO
100 0 3 20
Subject: No Exposure Certification NCGNE0299
Tredegar Corporation
100 Industrial Drive, Red Springs, NC
Robeson County
Dear Mr. Hunt:
DVVQ
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on August 8, 2006. Based on your submittal and signed
certification of no exposure at the above referenced facility, the Division is granting your certification as
provided for under 40 CFR 126.22(g), which is incorporated by reference in North Carolina regulations.
Please note that by our acceptance of your no exposure certification, you are obligated to maintain no
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no -
exposure exclusion, you are obligated to immediately -obtain NPDES permit coverage for your stormwater - -
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no -exposure exclusion expires in Five years (September 30, 2011), At that time you must re -certify
with the Division, or obtain NPDES permit coverage for any Stormwater discharges from your facility.
Your certification of no exposure does not affect your facility's legal requirements to obtain environmental
permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact Sarah Young at [phone], ext.
502, or at [e-mail]. . .
Sincerely,
ORIGINAL SIGNED BY
KEN PICKLE
for Alan W. Klimek, P.E.
cc: Fayetteville Regional Office Central Files — wlattachments
Stormwater Permitting Unit Files .
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
10A
�D OR
Customer Service
1-877-623-6748

Michael F. Easley, Govemor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P. E. Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
September 29, 2006
Mr. Steven Con Hunt
Tredegar Corporation
1100 Boulders Parkway
Richmond, VA 23225
Subject: No Exposure Certification NCGNE0299
Tredegar Corporation
100 Industrial Drive, Red Springs, NC
Robeson County
Dear Mr. Hunt:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on August 8, 2006. Based on your submittal and signed
certification of no exposure at the above referenced facility, the. Division is granting your certification as
provided for under 40 CFR 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 (September 30, 2011). At that time you must re -certify
with the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility
Your certification of no exposure does not affect your facility's legal requirements to obtain environmental
permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact Sarah Young at [phone], ext.
502, or at [e-mail].
cc: Fayetteville Regional Office
Stormwater Permitting Unit Files
Sincerely,
,� /Pe_4�
for Alan W. Klimek, P.E.
,Central Files — wlattachments
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
NLiSENR
Customer Service
1-877-623-6748

N;) Exposure for Tredegar Film Products facility
Subject: No Exposure for Tredegar Film Products facility
From: Mike Lawyer <Mike. Lawyer@ncmai 1. net>
Date: Fri, 22 Sep 2006 12:59:55 -0400
To: Sarah Young <[e-mail]>
CC: [e-mail], [e-mail]
Sarah,
Conducted a site visit to the subject facility on 9/18 and met with Mr. Steven Hunt,
Plant Manager, and Mr. Mike Westover, Safety/Training Coordinator. T recommend
proceeding with issuance of the No Exposure Certification.
Thanks,
Mike
Sarah Young wrote:
Hi Mike -
Here's a no -exposure for your region. Please let us know within 30 days if we
should issue this. Thanks, Sarah
Michael Lawyer.
Environmental Technician
NCDENR-Division of Water Quality
Surface Water Protection Section
Fayetteville Regional. Office
Direct: (910)433--3329
Main: [phone]
Fax: [phone]
1 of 1 9/25/2006 5:01 PM

United States Environmental Protection Agency Form Approved
g Y OMB No. 2040-0211
NPDES A Washington, DC 20460
3510-11
FORM 18Y EPA NO EXPOSURE CERTIFICATION for Exclusion from
NPDES Storm Water Permitting
Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit authorization for its storm water
discharges associated with industrial activity in the State identified in Section B under EPA's Storm Water Multi -Sector General Permit due to the existence
of a condition of no exposure.
A condition of no exposure exists at an industrial facility when all industrial materials and activities are protected by a storm resistant shelter to prevent
exposure to rain, snow, snowmelt, and/or runoff. Industrial materials or activities include, but are not limited to, material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste products. Material handling activities include the storage,
loading and unloading, transportation, or conveyance of any raw material, intermediate product, final product or waste product. A storm resistant shelter is
not required for the following industrial materials and activities:
— drums, barrels, tanks, and similar containers that are tightly 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 fe.a., 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 /y /� � / , 1
1. Name: I r i/i ri j)i FA A A I C Q 124 `/� I ()IkA:rI f I c1 M I I l 1 1 I I I 12. Phone:
3. Mailing Address: a.Street: I111/LL1I IVIr-h L1hLl/1tyI I I I 1 1 1 1 1 1� 1 1
b. City: c. State: Lt�_l!�I d. Zip Code:
B. Facility/Site Location Information
1, Facility Name: T1CFl LNtS T1AlA t`I I IL•II1V l�pl R10i QIIbC' I jLSi I I I _I I— I— I-
2. a. Street Address: i l l tliy[ _1_Pii'1f11]It.1 SiTCWt ili Al L1 11JILqUVICI I I I I IDI I I I I I �/I
b. city: kl i7 �1 I� PI R j IA11 & p_SI 71�]1 1 1 I 1 1 1 1 I I I c. county: Il i O I�r SIOI/tr! I
d. State: L nL 0 e. Zip Code: 12 ICI /1-7— 1 1 1
3. Is the facility located on Indian Lands? Yes ❑ No ❑
4. Is this a Federal facility? Yes ❑ No
5. a. Latitude: b. Longitude:
6. a. Was the facility or site previously covered under an NPDES storm water permit? Yes ❑ No ❑ t/j/,6.,JOLAV'
b. If yes, enter NPDES permit number:
7. SIC/Activity Codes: Primary: 3018if# Secondary (if applicable): I I I I
8. Total size of site associated with industrial activity: & L ( 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. It 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

NPDES �, NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
FORM ��,EPA 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 El OZ/
or cleaning industrial machinery or equipment remain and are exposed to storm water
2. Materials or residuals on the ground or in storm water inlets from spillslleaks ❑ IV
3. Materials or products from past industrial activity
4. Material handling equipment (except adequately maintained vehicles)
5. Materials or products during loadingluntoading or transporting activities
6. Materials or products stored outdoors (except final products intended for outside use [e.g., new cars] where EZ
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 handledlstored on roads or railways owned or maintained by the discharger
9. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
10. Application or disposal of process wastewater (unless otherwise permitted)
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. r -�+
Print Name: ISkie—AiPlAi CL161 14ALN111 I I 1 I I L I _I I I I I I I I I I �
Print Title:
Signature:
EPA Form 3510-11 (10-99) Page 2 of 4

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7//0 le
United States Environmental Protection Agency Form Approved
9 Y OMB No. 2040-021 t
NPDES �is ��� Washington, DC 20460
510-1 `1� NO EXPOSURE CERTIFICATION for Exclusion from
3510-11
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 13 under EPA's Storm Water Mufti -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, snowmeft, 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 laps or valves;
— adequately maintained vehicles used in material handling; and
— final Products. other than products that would be mobilized in storm water discharges fe.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. It any industrial activities or materials are or will be exposed to precipitation, the facility is
not eligible for the no exposure exclusion.
By signing and submitting this No Exposure Certification form. the entity in Section A is certifying that a condition of no exposure exists at its facility or site,
and is obligated to comply with the terms and conditions of 40 CFR 122.26(g).
ALL INFORMATION MUST BE PROVIDED ON THIS FORM.
Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4.
A_ Facility Operator Information
1. Name: f ,IlCik< It'I��IiI If��Ir�J'iryl�lilll itL1 I t 1 1 k I l 1
3. Mailing Address: a. Street: 1f 0in I& tt I? I tilf_' I/Z I&I• IAI)ttQr l!JIPtt VI
Stale
1 2.Phone: (..� fS�j�
I I I i I I i I I �I �
d. Zip Code:
8_ Facility/Site Location Information
t. Facility Name: IiL'I[ 1 i�iL�l zi�i�ti ly::I i IL.10A III)I IQ101 iDil(A.I Ti15 1 1 1
1 1 1 I i � �j;'�
2. a. Street Address: i ji t )idi JIB' I {NISI I i t f C_� I t11 J i il�'I i t E 11 1
I I I I I I I E_ :F
b. city: 1] l l- I I u I L ?I.._I —I_._I I I I I I I! I c_ County
ALAI I IC?l I
d. State: [AL0 e. Zip Code: LI LEI 2 —1 I I
3. Is the facility located on Indian Lands? Yes ❑ No U
4. is this a Federal Facility? Yes ❑ Now
; irFi
5. a. Latitude:] " b. Longitude: I eLLJ
6. a. Was the facility or site previously covered under an NPDES storm water permit? Yes ❑
y
No ❑ U� j�1 �tl _-
b. If yes, enter NPDES permit number'
7. SIUAcbvity Codes: Primary: bQ611 Secondary (if applicable): I I I
8. Total size of site associated with industrial activity: , L 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, kr which rase you could be required to obtain permit coverage.
Less than one acre ❑ One to five acres ❑ More than five acres ❑
EPA Form 351C-11 ((10-99)9) /L
e-
as� afJ�c1 pal �l5
,tr 'j
Page 1 of 4

NPDES rm Approve
FORM „EPA NO EXPOSURE CERTIFICATION for Exclusion from 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 spillslleaks El
3. Materials or products from past industrial activity El
4. Material handling equipment (except adequately maintained vehicles)
5. Materials or products during loadinglunloading or transporting activities
6. Materials or products stored outdoors (except Final products intended for outside use (e.g.. new cars) where Ldd
exposure to storm water does not result in the discharge of pollutants)
7. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers
8. Materials or products handled/stored on roads or railways owned or maintained by the discharger
9. Waste material (except waste in covered, non -leaking containers (e.g., dumpsters))
10. Application or disposal of process wastewater (unless otherwise permitted) ❑
11. Particulate matter or visible deposits of residuals from roof stacks andfor vents not otherwise regulated
(i.e., under an air quality control permit) and evident in the storm water outflow
0. 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 1122.26(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 NPDFS 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 nformation 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. '-rf
Print Name: U-1t,v ICIAl CkI/titl
Print Title: �L -1 li'Ul ! I li'i ll�'I ineig L.L I I I I i I I I I I I I I I i I I G
Signature:
Date: 7/D — Fi`13 - � 3113
EPA Form 3510-11 (10-99) Page 2 of 4

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