NCGNE0487_COMPLETE FILE - HISTORICAL_20090220

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. NCGNE c>- Ll K7
DOC TYPE C HISTORICAL FILE
DOC DATE ❑
YYYYM M DD

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality '!� � .
Beverly Eaves Perdue Coleen H. Sullins ef reer� n
Governor Director F1e
'Secretary .
February 20, 2009 FEB 2 4 2008
Mr. David P. Risley . idl'V6' fkk:
Gough Econ, Inc. t� �,
PO Box 668583 DVVQ-3L1-rfQCe fter prof - f-
Charlotte, NC 28266-8583
Subject: No -Exposure Certification NCGNE0487
Gough Econ, Inc.
9400 N. Lakebrook Rd., Charlotte, NC 28214
Mecklenburg County
Dear Mr. Risley:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES Stormwater
Permitting form. Based on your submittal and signed certification of no exposure at the above referenced facility, the
Division is granting your conditional exclusion from permitting 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 (February 19, 2014). At that time you must re -certify with the Division, or
obtain NPDES permit coverage for any stormwater discharges from your facility.
Your conditional exclusion from permitting 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 Robert Patterson at [phone], or at
robert. patterson@ncmail, net.
Sincerely,
for Coleen H. Sullins
cc: Mooresville Regional Office -Michael Parker
Stormwater Permitting Unit No- Exposure Files
Wetlands and Stormwater Branch One 7 1617 Mai; Service Center, Raleigh, North Carolina 27699-1617 NorthCarol in
Location: 512 N. Salisbury St. Ralegh, North Carolina 27604
Phone: [phone] FAX: 91H07-54941 Customer Service; 1-877-623-6748 �tltil�r�l��lf
Internet: www.ncwaterquality.org v ;/
An Equal Opportunity l Affirmative Action Employer

(4
1 FOR AGENCY USE ONLY
Date Received
Division of Water Quality /Surface Water Protection Year Month Da
FqCDENRNational Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion t
NVnM CanOli.Y �ISYRTKM O/g `
E I.VIRpNNCMT ANO NRIR+L RLSOURC[S
NCGNE0000
NO EXPOSURE CERTIFICATION OCT 2 4
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit
based on NO EXPOSURE: P.
Submission of this No Exposure Certification constitutes notice that your facilitj'd6esft7ot�requir
authorization for its stormwater discharges'associated with industrial activity in the State of Nan
Carolina because it qualifies for a no exposure exclusion. A condition of no exposure at an indu:
facility means all industrial materials and activities are protected by a storm resistant shelter (wil
exceptions) to prevent exposure to rain, snow, snowmelt, and/or runoff.
Industrial materials or activities include, but are not limited to: material handling equipment or a
industrial machinery, raw materials, intermediate products, by-products, final products,.or waste
products. Material handling activities include the storage, loading and unloading, transportation
conveyance of any raw material, intermediate product, final product or waste product. A storm r,
shelter is not required for the following industrial materials and activities: drums, barrels, tanks,
similar containers that are tightly sealed, provided those containers are not deteriorated and do i
"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 produce
would be mobilized in stormwater discharges (e.g., rock salt).
permit lion
lF
ILWQa
W t CQ
ad
i.ad
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion.
In addition, the exclusion from. NPDES permitting is available on a facility -wide basis only —not for
individual outfalls. If any industrial activities or materials are, or will be, exposed to precipitation, the
facility is not eligible for the no exposure exclusion. By signing and submitting this No Exposure
Certification form, you certify that a condition of no exposure exists at this facility or site and are
obligated to comply with the terms and conditions of 40 CFR 122-26(g).
You are required to reaePly for the No Exposure Exclusion once every five (5) years.
For questions, please contact the DWO Regional Office for your area. (See page 5)
(Please print or type)
1) Mailing address of owner/operator (address to which all certification correspondence will be mailed :
Name Lo % GQu &A QcgKi , t-4
Street Address a (66 55
City _ State Q. C. ZIP Code 29Z(k- �553
Telephone No. 7e4 _ 39 9 - 4501 Fax: -To 39 2 - g70(n
2) Location of facility producing discharge:
Facility Name Gou64 E ON
Facility Contact b ', i�5 P. : SW\(
Street Address cOrCID R.
City C4,--,? Lcfi-c— State QC , ZIP Code 23z.1
County Ce` I A C-
Telephone No. '7oq 39q -'- cc )1 _ Fax: Toy Y92- - 9-10
Page 1 of 5
SWU-NE-I IM7 Last revised 1 1l06107

NCGNE0000 No Exposure Certification
3) Physical location information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection)..Z S5 Soo-N -rc SA^ L,!', Ls ct�f 0-6' , �i r. To � o E �AY4t'
ruza (.e-pT CInsS � ,1 Q Inter Sim isr QOAN P—'c,tkT AT -
(A copy of a reap with the facility clearly located on it should be included with the cerlification application.)���.
4) Is the facility located on Native American Lands? ❑ Yes pD No
5)' Is this a Federal facility? ❑ Yes Z No
6) Latitude 35° l5' 22-" Longitude S6' 54I` 27 " (deg, min, sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
N Existing Date operation began iaa4
S) Was this facility or site ever covered under an NPDES Stormwater Permit? 0 Yes X No
If yes, what is the NPDES Permit Number? N /A
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 3 5 3 5
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Mom, N -.Lc��2c r3U ctc T E 4-vn tpKz , CIAZ_ Lt cuu Qs .Yok A A,,3 a V g t2,,Toey (3y
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility: N/A
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
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
c. Materials or products from past industrial activity
d. Material handling equipment (except adequately maintained vehicles)
e. Materials or products during loading/unloading or transporting activities
f. Materials or products stored outdoors (except final products intended for outside
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
❑ Yes X No
❑ Yes No
❑ Yes No
• Yes No
❑ Yes No
❑ Yes i No
Page 2 of 5
SWU-NE-110607 Last revised 11/06/07

NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes M No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes 14 No
the discharger
i. Waste material (except waste in covered, non -leaking containers je.g., dumpsters]) 0 Yes No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes 114 No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ' V 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 X No
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes l No
stored outside, has the facility had any releases in the past three (3) years? .
13) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or )I Yes ❑ No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? It so, is it free of any Yes ❑ No
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
14) Secondary Containment: If you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for single above ground storage containers b4 Yes ❑ No
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored Yes ❑ No
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for an
I amount of Title III Section 313 is f,, ❑ Yes ❑ No
Superfund Amendments and Reauthorization Act (SARA) water priority
chemicals?
d. Is secondary containment provided for any amount of hazardous substances? t Yes ❑ No
e. Are release valves on all secondary containment structures locked? 34'Yes ❑ No
Page 3 of 5
5W U-NE-110607 Last revised 11/06/07

i
NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes No
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste 0 Yes No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste 0 Yes No
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
16) Certification:
certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no
exposure" and obtaining an exclusionfrom 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)).
1 understand that I am obligated to submit a no exl2osure certification form once every five 5 ears to the North Carolina
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system (MS4) into
which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4, to perform inspections_ to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty
of law that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based
on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. t 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:y,� C!� -P ! ; 5 cy
Title: — p = s, ilEkir e CEO ti+nr;) C'`)t - OwNv-z-'1e
(Signature of Applicant)
Id-3 O
(Date Signed)
Page 4of5
S W U-N E-110607 Last revised 11/06/07

Tmlwt,Aougn j:con; inc. ai ine; ena~or r ,uaKeuroOK,IIU-'
fi you experience any problem fincing`us', caI1�7D9} 399=4'50f

3
N
ROAD CLASSIFICATION
PRIMARY HIGHWAY LIGHT -DUTY ROAD, HARD OR
HARD SURFACE IMPROVED SURFACE
SECONDARY HIGKWAY
HARD SURFACE =31111111111111=3 LUMPROVED ROAD ...._
Latitude 35015'22"
Longitude 80°59127"
Map # F15SW
Sub -basin 030834
Stream Class
WS-IV �6 CA
Discharge Class bo- M Gs
Receiving Stream
Catawba River
Design Q o.oa12 M(3
Permit.expires 8/31/01
SCALE 1 :24 000
i
x .�nsx-zs:r+e.-:emsaxa +x•�
� Ili
• f
QUAD LOCATION Gough Econ, Inc.
NCO058084
% Mecklenburg County
WWTP

NCGNE0000 No Exposure Certification
Please note; This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules.of.the
(Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.
Final Checklist
This application should include the following items:
d This completed application and all supporting documentation.
d A map with the location of the facility clearly marked.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office
... [phone]
Mooresville Office
... [phone]
Raleigh Office ........
[phone]
Washington Office
...[phone]
Wilmington Office
... [phone]
Winston-Salem ...... [phone]
Central Office .........(919)
733-5083
Page 5 of 5
5WU-NE-110607 Last revised 11/06/07

Dimension
Wood Products
NCGNE0488
Inc - Dimension
Wood Products
Incorporated
2884 Kelly Blvd
Claremont
No -(Wes Be!!)
Gough Econ Inc
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NCGNE0487
Gough Econ
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kC,,WeS,BelI
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9400 N Lakebr
Charlotte
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Mbm Inc - Fast
Food
NCGNE0514
Merchandiser -
Rowan
40 Cir M Dr
Salisbury
No-(J L)
Indian Head
4=
NCGNE0507
Industries -
MGM Brakes
8535 Cliff CamgCharlotte
Jcurnalbocksrri
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Charlotte
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NC Division-
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NC Division
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Norcross Safety
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2349 13th Ave .
Hickory
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�' • Division of Water Quality 1 Surface Water Protection
NCDENRNational Pollutant Discharge Elimination System
,.Io—C., -Dr ­ or NO EXPOSURE CERTIFICATION for Exclusion
EIMgWMEM IND Nauru RE]OU.+GES
NCGNE0000
NO EXPOSURE CERTIFICATION
FOR AGENCY USE ONLY
Date Received
Year
I Month
Da
b
0
Certificate of Coverage
NICIGINFEWMbff
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit
based on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notice that your facility does not require permit
authorization for its 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 indusrM
facility means all industrial materials and activities are protected by a storm resistant shelter (wit
exceptions) to prevent exposure to rain, snow, snowmelt, and/or runoff.
industrial materials or activities include, but are not limited to: material handling equipment or ad
industrial machinery, raw materials, intermediate products, by-products, final products, or waste [�
products. Material handling activities include the storage, loading and unloading, transportation,
conveyance of any raw material, intermediate product, final product or waste product. A storm rt�
shelter is not required for the following industrial materials and activities: drums, barrels, tanks,
similar containers that are tightly sealed, provided those containers are not deteriorated and do99
"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 produc s
would be mobilized in stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion.
In addition, the exclusion from NPDES permitting is available on a facility -wide basis only —not for
individual outfalls. If any industrial activities or materials are, or will be, exposed to precipitation, the
facility is not eligible for the no exposure exclusion. By signing and submitting this No Exposure
Certification form, you certify that a condition of no exposure exists at this facility or site and are
obligated to comply with the terms and conditions of 40 CFR 122.26(g).
You are required to reapply for the No Exposure Exclusion once every five (5) years.
For questions, please contact the DWQ Regional Office for your area. (See page 5)
(Please print or type)
1) Mailing address of owner/operator (address to which all certification correspondence will be mailed):
Name
17.�v � � T')• K- s Lc.`I
Street Address
Pa o &DIB5
City
C Na,tZLO to State Q. C . ZIP Code 28ZW - 95 5 3
Telephone No.
'70 -99 - 451) 1 Fax: --ro4 39 2 - A 70(p
2) Location of facility producing discharge:
Facility Name
GOuCA E ohl , .z+��' ,
Facility Contact
l�A.v D P. iz " SUE"I
Street Address
q,,- R- L,!"kL= 13120NC 2� _
City
CAS 1.n� State 0' c . ZIP Code 2521
County
Telephone No.
7o4 399 -4501 Fax: -704 39L - 9-10&
Page 1 of 5
cc
S W U-NE-110607 Last revised 1 1 /06/07

NCGNEOOOO No Exposure Certification
3) Physical location information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). Z g5 Soo-_-o_S�an% LW Lsa,j Qb � T._ ]Mp oF_1 AMP
Tuow L.e`-r. cuss IhLTir SD9 - u iLr t2-o,,6 a Z&r q c_-2� vt 34R_c= 12:�e{r qr
(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 X No
5)' Is this a Federal facility? ❑ Yes (gl No
6) Latitude 650 IS' 22" Longitude $O° 5q' 2.7 (deg, min, sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
N Existing Date operation began IqB
8) Was this facility or site ever covered under an NPDES Slormwater Permit? O Yes X No
If yes, what is the NPDES Permit Number? N/.4
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code-. 3 5 3 5
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Mo,N�1`Ac�v C 3uc -T EItVAYo,2s Cunt = olz.d V�3 YD�Y - �25 4Y
h.c4uS CN_ fn2�u; k1e A.�.N We[W 013 tO of MErQL
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility: N/.n
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
residuals from using, staring 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
c. Materials or products from past industrial activity
d. Material handling equipment (except adequately maintained vehicles)
e. Materials or products during loading/unloading or transporting activities
f. Materials or products stored outdoors (except final products intended for outside
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
❑ Yes X No
❑ Yes U. No
0 Yes N No
❑ Yes 14 No
❑ Yes DO No
© Yes tid No
Page 2 of 5
S W U-N L-1 10607
Last revised 11/06/07

NCGNE0000 No Exposure Certification
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 i No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ' 14 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)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes l No
stored outside, has the facility had any releases in the past three (3) years? .
13) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or X Yes ❑ No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any Yes ❑ No
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
14) Secondary Containment: If you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion -
a. Is secondary containment provided for single above ground storage containers
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for any amount of Title III Section 313 MIA\
Superfund Amendments and Reauthorization Act (SARA) water priority
chemicals?
d. Is secondary containment provided for 2ny amount of hazardous substances?
e. Are release valves on all secondary containment structures locked?
N Yes ❑ No
4 Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
Yes ❑ No
Page 3 of 5
SWU-NE-110607 Last revised 11/06/07

NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes No
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste 0 Yes No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes( No
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport 1 disposal vendor:
Vendor address:
16) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no
exposure" and obtaining an exclusion from NPDES stormwater permitting.
i certify under penalty of law that there are no discharges of stormwater contaminated by exposure to industrial activities
or materials from the industrial facility or site identified in this document (except as allowed under 40 CFR 122.26(g)(2)).
understand that I am obligated to submit a no exposure certification form once every five (5) years to the North Carolina
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system (MS4) into
which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty
of law that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and evaluated the information submitted- Based
on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. 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:.yt l�; 5 �i
Title: = Si bt_l tr f CE'O anti Cc - c7WNL
r
(Signature of Applicant)
Id-3-o7
(Date Signed)
Pogo 4 of 5
SWU-NE-110607 Last revised 11/06/07

,South- Go4gli Econ Inc.
Interstate 85
Gastonia Al. t akebroai<
Center Grow
US'74
Sam Wilsnn
Little Ruck Rd.
Sam wilsbn Rd.
Exit 29
Holliday Inn"
From Ch.ariatte/Douglas International Airport, take the airport
expressway to Billy Graham Parkway. Take Evilly Graham
Parkway North to Interstate 85. Take" .Interstate 85 South to
Sam Nilson Rd, exit #29. Turn left, ,across the Interstate
bridge. Fake first right after crossinc.1-95, which is Canter
Gr6ve Road. Bear right onto N. Lakeblrook Road and you will
firid Gough Icon, Inc. at the end of N. Lakebrook.Rd.
If y6u experience any problems finding us, call (704) 399=4501
and,we'll be glad to help.
Mon*
North
Int®rstate "85 j'�
Greensboro
US 74
Billy Graham Parkway
Gough Econ, Inc.
9400 N. Lakebrook Rd.
Charlotte, NC 28214
[phone]

3!
N
ROAD CLASSIFICATION
PRIMARY HIGHWAY UGHT•DUTY ROAD. HARD OR
HARD SURFACE CAP! IMPROVED SURFACE
SECONDARY H OMWAY
HARD SURFACE LHMPRDVED ROAD .,
Latitude 35115'22"
Longitude 80°59'27a
Map # F15SW
Sub -basin 030834
Stream Class
WS-IV k 8 CA
Discharge Class 1�^M Gsr
Receiving Stream
Catawba River
Design Q .OX012 MG
Permit.expires 8/31/01
SCALE 1:24 000
1 7DOO FEET
:09amuar.-: xsrss�
/ 1 KILOMETER'
CONTOURr FEET
QUAD LOCATION Gough Econ, Inc.
NCO058084
Mecklenburg County
WWTP

NCGNE0000 No Exposure Certification
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 B(i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.
Final Checklist
This application should include the following items:
Cd This completed application and all supporting documentation.
t( A map with the location of the facility clearly marked.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DWQ Regional Office for your area.
DWQ Reqional Office Contact_ Information:
Asheville Office ...... [phone]
Fayetteville Office ... [phone]
Mooresville Office ... [phone]
Raleigh Office ........ [phone]
Washington Office ...[phone]
Wilmington Office ... [phone]
Winston-Salem ....:. [phone]
Central Office .........[phone]
Page 5 of 5
SWU-NE-110607
Last revised 11/06/07