NCGNE0725_COMPLETE FILE - HISTORICAL_20170208

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE v�a�
DOC TYPE
HISTORICAL FILE
DOC DATE
❑ G I �/u(,
YYYYMMDD

Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
Energy, Mineral NCGNE0000
and Land Resources
ENVIRONMENTAL, GUAUTY
FOR AGENCY USE ONLY
Dais Received
YOU Month
Day,
Cell lilcale o C ovuragc
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TJ7
National 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, andlor runoff.
For permitted facilities in North Carolina, DEMLR 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Exposure Certification and your NPDES permit is rescinded, your facility must continue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
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, 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 -certified at least annually.
Please look for information about re -certification under the No Exposure section on this page:
https:iideg.nc.gov/abouUdivisions/energy-mineral-land-resources/energy-mineral-land-permitslstormwater-
For questions, please contact the DEMLR Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of owner/operator (address to which all certification corres oridence'wiII-be,mailed):
Name Actega North America-Lincolnton Facility FE8 7
Contact Scott Welsh ���r
Street Address 125 Technology Drive OENrj_ AfLf) f)Lj,.tyry
City Lincolnton State NC ZIP Code 28092 STORMU'VNFEt,r�.;,;�,1T?1�t0
Telephone No. 704-735-8282 Fax: [phone]
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NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Actega North America Lincolnton
Facility Contact Scott Welsh
Street Address 125 Technology Drive
City Lincolnton NC ZIP Code 28092
County Lincoln
Telephone No. 704-735-8282 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). Highway 321 to Lincolnton (exit 24). West on Highway
150 (27) approximately 1.5 miles. Make a right on Lithia inn Rd and a left on technology. Facility is at end of
street.
(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? X Yes ❑ No
6) Latitude 32° 28' 29.6" Longitude 811 12' 52.2'_ (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility
X Existing
Date operation is to begin
Date operation began 1995
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes X 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 $ 9 3
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Manufactures water based ink and coatings used for packaging and labels.
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
X No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
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NCGNEOOOO 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 X 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 ❑ Yes X No ❑ NIA
c. Materials or products from past industrial activity ❑ Yes X No ❑ NIA
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes X No ❑ NIA
e. Materials or products during loading/unloading or transporting activities ❑ Yes X No ❑ NIA
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes X No ❑ 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, tanks, ❑ Yes X No ❑ NIA
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes X No ❑ NIA
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes X No ❑ NIA
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes X No ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes X No ❑ NIA
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 ❑ NIA
(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 X No ❑ NIA
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 ❑ NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No X 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.
a. Is secondary containment provided for single above ground storage containers
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
❑ Yes ❑ No X NIA
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NCGNE0000 No Exposure Certification
b. Is secondary containment provided for above ground storage containers stored ❑ Yes ❑ No X 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 CJ No X NIA
Amendments and Reauthorization Act (SARA) water priority chemicals"?
d. Is secondary containment provided for hazardous substances" designated in 40 ❑ Yes 0 No X NIA
CFR §116?
e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No X NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? C7 Yes X No ❑ NIA
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes X No ❑ NIA
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes X No ❑ 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: waste inks and coatings,
How is material stored: Totes and drums, finished products in drum and 5 and 1 gallon containers
Where is material stored: On racks in warehouse
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
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 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 (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.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? X Yes ❑ No ❑ NIA
b. Does your facility have coal piles on site? ❑ Yes X No ❑ NIA
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NCGNE0000 No Exposure Certification
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes X No ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., X Yes ❑ No ❑ NIA
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 ❑ Yes X No ❑ NIA
Permit? Please specify:
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:
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NCGNE0000 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)).
understand that I am obligated to maintain no exposure conditions and complete a Self -Recertification form 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 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 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, 1 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: Scott We]
Title: 0W of EHS —7 �
(SignatM-e of Applicant)
1 /30/17_
(Date Signed)
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 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 rutemaking 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.
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NCGNEOOOO No Exposure Certification
Final Checklist
This application should include the following items:
X This completed application and all supporting documentation.
X A map with the location of the facility clearly marked.
0 If the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8.
Mail the entire package to:
Stormwater Permitting Program
Division of Energy, Mineral and Land Resources
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 .........
[phone]
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DAT1_7--: 03.06-09 RF"VISION NO: 0
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I

North Cara
Beverly Eaves Perdue
Governor
4�
na Department of Environment and
Division of Water Quality
Coleen H, Sullins
Director
October 28, 2010
Mr. Tony Blakley, Technical Manager
ACTEGA WIT, Inc.
125 Technology Drive
Lincolnton, N.C. 28092
11211LIEN.
Natural Resources
Subject: No -Exposure Certification NCGNE0725
ACTEGA WIT, Inc.
125 Technology Drive
Lincointon, NC 28092
Lincoln County
Dear Mr. Blakley:
Dee Freeman
Secretary
The Division has reviewed your submittal of the No -Exposure Certification form for exclusion from NPDES
Stormwater Permitting. Based on your submittal and signed certification of no -exposure at the above referenced
facility, and a site visit on October 8, 2010, by Mr. Samar Bou-Ghazale with this Office, the Division is granting your
conditional exclusion from stormwater permitting as provided for under 40 CFR 122.26(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. Faiiure
to obtain a No -Exposure exclusion could also subject you to enforcement for an unpermitted stormwater discharge.
You must self re -certify your No -Exposure status annually using the included form or obtain NPDES permit
coverage for any stormwater discharges from your facility. The annual self re -certification does not need to be
submitted to DWQ unless requested. Please note that 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
focal regulations or ordinances.
If you have any questions or need further information, please contact Mr. Bou-Ghazale at [phone] or by email at
[e-mail].
Sincerely,
for Coleen H, Sullins
cc: Stormwater Permitting Unit No- Exposure Files (Cory Larsen)
Mooresville regional Office One
Location: 610 East Center Ave., Suite301 Mooresville, NC 28115 North Qtro liria
Phone: [phone] Fax [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org . / � wit ally/
An Eeual opoorturity'i AYrmative Action Employer — 3056 Recycled'10% Post Consumes paper Y '/

M (i1
Division of Water Quality / Surface Water Protection
NC®ENR National Pollutant Discharge Elimination System
V., NO EXPOSURE CERTIFICATiON for Exclusion
xsw•G[; N C G N E 0 0 00
FOR AGENCY USE ONLY
Due Rcekked
Year
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NO EXPOSURE CERTIFICATION Please check here if this is a renewal_ ❑ RENEWAL
National 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, andlor runoff.
For permitted facilities in North Carolina, DWQ 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 rescinded, 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 —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 reappy-for the No Exposure Exclusion once every five (5) Years.
For questions, please contact the DWQ Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of ownerloperator (address to which all certification correspondence will be mailed):
Name ACTEGA WIT, Inc.
Contact Mr. Tony Blakley
Street Address 126 Technology Drive
City Lincolnton State NC ZIP Code 28092
Telephone No, 704-735-8282 Fax: [phone] RECEIVED
DIVISIOI) t?E WA3�-R QUALITY
SEP 27 2010
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NCGNEOOOO No Exposure Certification
2) Location of facility producing discharge:
Facility Name
ACTEGA WIT Water Ink Facility
Facility Contact
Tony Blakley (Technical Manager)
Street Address
125 Technology Drive
City
Lincolnton State NC ZIP Code 28092
County
Lincoln Co.
Telephone No.
704-735-8282 Fax: [phone]
3) Physical location information:
Please provide a narrative description of flow to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). Highway 321 to Lincolnton (exit 24). West on Highway
150 and go 0.8-mile. Right on Lithia Inn Rd and go 0.3-mile. Left on Technology Dr. Facility is 0.1-mile
on left
(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? 0 Yes X No
6) Latitude 350 28' 29.6" Longitude 81° 12' 52.2" (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
X Existing Date operation began 1995
❑ Renewal of existing No Exposure Certification Certification No.. NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes X No
If yes, what is the NPDES Permit Number? NA
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: 2893
10) Provide a brief description of the types of industrial activities and products produced at this facility:
ACTEGA WIT produces water -based inks and coatings at the Lincolnton facility used for packaging
printing and labels.
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
X No
Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
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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 X 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 ❑ Yes X No ❑ N/A
c. Materials or products from past industrial activity ❑ Yes X No ❑ NIA
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes X No ❑ NIA
e. Materials or products during loadingluntoading or transporting activities ❑ Yes x No ❑ NIA
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes X No ❑ 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, tanks, ❑ Yes X No ❑ NIA
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes i No ❑ NIA
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters)) ❑ Yes i No ❑ NIA
j. Application or disposal of process wastewater (unless otherwise permitted) ID Yes x No ❑ NIA
k_ Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes X No ❑ NIA
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 ❑ NIA
(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 i No ❑ NIA
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 ❑ NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No i NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
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NCGNE0000 No Exposure Certification
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 Title III Section 313 Superfund
Amendments and Reauthorization Act (SARA) water riori chemicals'?
d. is secondary containment provided for hazardous substances" designated in 40
CFR §116?
e. Are release valves on all secondary containment structures locked?
IS) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
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:
Footnotes to Questions 14) c. S d.
❑ Yes ❑ No X NIA
❑ Yes ❑ No X NIA
❑ Yes ❑ No X NIA
❑ Yes ❑ No X NIA
❑ Yes ❑ No X NIA
❑ Yes X No ❑ NIA
❑ Yes X No ❑ NIA
❑ Yes X No ❑ NIA
'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 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 (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,
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• 4 ,
NCGNE0000 No Exposure Certification
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.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? X Yes ❑ No ❑ NIA
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. Air permitting activities are currently under assessment.
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:
❑ Yes X No ❑ NIA
❑ Yes X No ❑ NIA
x Yes 0 No ❑ NIA
❑ Yes X No ❑ N/A
Page 5 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 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.
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 submit a no exposure certification form once every five (5) years to the North Carolina
Division of V11ater 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: /'i� i 99K
Title: cmirEr eWje
(Signature of
% o
(Date Signed)
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 8(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 Anicie; 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 (510,000).
There is currently no fee for a No Exposure Exclusion.
Page & of 7
SVJU-NE-021309 Last revised 211312009

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
X This completed application and all supporting documentation.
X A map with the location of the facility clearly marked.
❑ If this is a renewal, indicated current NCGNE number in Question 7.
❑ If the site currently has an NPOES Stormwater Permit, be sure to indicate the permit number in Question 8.
Mail the entire package to:
Stormwater Permitting knit
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.
DWg 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 .........
[phone]
Page 7 of 7
SWu-NE-021309 Last revised 2113/2009

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NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Tony Blakley, Technical Manager
ACTEGA WIT, Inc.
125 Technology Drive
Lincolnton, N.C. 28092
Dear Mr. Blakley:
Division of Water Quality
Coleen H. Sullins
Director
October 28, 2010
Subject: No -Exposure Certification NCGNE0725
ACTEGA WIT, Inc.
125 Technology Drive
Lincolnton, NC 28092
Lincoin County
Dee Freeman
Secretary
The Division has reviewed your submittal of the No -Exposure Certification form for exclusion from NPDES
Stormwater Permitting. Based on your submittal and signed certification of no -exposure at the above referenced
facility, and a site visit on October 8, 2010, by Mr. Samar Bou-Ghazale with this Office, the Division is granting your
conditiona4 exclusion from stormwater permitting as provided for under 40 C>=R 122.26(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. Failure
to obtain a No -Exposure exclusion could also subject you to enforcement for an unpermitted stormwater discharge.
You must self re -certify your No -Exposure status annually using the included form or obtain NPDES permit
coverage for any stormwater discharges from your facility. The annual self re -certification does not need to be
submitted to DWQ unless requested. Please note that 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
iocal regulations or ordinances.
If you have any questions or need further information, please contact Mr. Bou-Ghazale at [phone] or by email at
Samar. [e-mail].
Sincerely,
for Coleen H. Sullins
cc: Stormwater Permitting Unit No- Exposure Files (Cory Larsen)
Mooresville Regional Office One
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115 NorthCarolina
Phone: [phone] Fax: [phone] Customer Service: 1.877-623-6748
Internet: www.ncwaterqualiy.org Xa is -ally
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