NCGNE0765_COMPLETE FILE - HISTORICAL_20110328

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
❑HISTORICAL FILE
DOC DATE
❑ 3oi) 03 c� 0
YYYYMMUD

Nuth Carolina
Beverly E:eves Perdue
Governor
Mr. Jim Sipe
Carolina Foam, LLC
2377 Penny Road
Claremont, North Carolina 28610
Dear Mr. Sipe:
NDNR
Decartment of Environment and Natura
C,ivisicn of Water QuAty
G-Dleen K Sullins
Lifectcr
March 28, 201 i
Resources
Dee Freeman
SIcret?ri
Subject. No -Exposure Certification NCGNE0765
Carolina Foam, LLC -- Claremont Plant
2377 Penny Road, Claremont, NC 28610
Catawba County
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, the site
visit of March, 10, 2011, and the photo documentation of the covered waste dumpster (with drain plug) the Division is
granting your conditional exclusion from 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.
Otherwise, the discharge becomes subject to enforcement as an un-permitted 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.
Your conditionaf exc#usion 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 Marcia Allocco at [phone], or at [e-mail].
Sincerely,
—1�2!s -�A k/__�
for Coleen H. Sullins
cc:
Stormwater Permitting Unit No- Exposure Files (Brian Lowther)
Mooresville Regional Of ice
Location: 610 East Cenier Ave.. Suite 301 Mooresville, NC 26115
Phone: [phone] Fax: [phone] Customer Service: 1-877-623-6746
Internet: v"jv.ncwaterquality.org
IL9@00MR,
APR 0.. 4 2011
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Permit: NCGNE0765
SOC:
County: Catawba
Region: Mooresville
Contact Person: Jim Sipe
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Compliance Inspection Report
Effective: Expiration: Cwner: C2rclina Foam LLC Claremont Plant
Effective: Expiration: Facility: Carolina Foam LLC Claremont Plant
2377 Penny Rd
Inspection Date: 0311012011
Primary Inspector: Marcia Allocco
Secondary Inspector(s):
Title:
Entry. Time: 10:00 AM
Claremont NC 28610
Phone: [phone]
Certification:
Exit Time: 10:15 AM
Phone:
Phone: [phone]
Exi.22C4
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ® Compliant n Not Compliant
Question Areas:
® Miscellaneous Questions
(See attachment summary)
Page 1

Permit: NCGNE0765 Owner - Facility: Carolina Foam LLC Claremont Plant
Inspection Date: 03/10/2011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
The facility was visited through a new No -Exposure Certification request and marufactures foam for the furniture industry.
From the Catawba County GIS system it was ascertained that the facility discharges to an unnamed tributary to Long
Creek along the northwestern side of the facility.
The facility had the following exposure of industrial materials outside and exposed to stormwater:
• One uncovered waste dumpster without a drain plug
Facility personnel forwarded photo documentation of the installation of a-covereddumpster with a drain plug on March 28,
2011, to qualify for No-Expoasure.
Page: 2

No -Exposure Self Re -Certification Informatfon:
You are obligated to maintain no -exposure" conditions at your facility. 1€ 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. State statute provides for fines of up to 525,000 per day for
un-permitted discharges.
Your conditional no -exposure exclusion must be self re -certified at least annually as follows:
- Complete the re -certification at a minimum of once per year using the included Self Re -
Certification Form.
(additional copies can be downloaded from ht,p://per,al.ncdenr.org/web/tivq/,,vs/su/npdessw#No_Exposure_NPDES )
- Maintain a record of re -certifications on file at the facility. Do not submit the re -certification to
DWO unless requested. If requested, submit a copy of the re -certification to the Division and/or
the municipality in which the facility is located.
-During an inspection by DWO or local government, provide the re -certifications immediately
upon request.
- Notify the Division of any changes in ownership, significant facility and/or activity changes, or if
the facility can no longer maintain no -exposure.
-Allow the NPDES permitting authority or, it discharging into a municipal separate storm sewer
system, the operator of the system, to: (1) inspect the facility-, and (2) make such inspection reports
publicly available upon request.
* "No exposure" means that 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. (40 CFR 122.26(g))
Information and forms related No -Exposure Certifications can be accessed on the website at:
httpa/portal. ncdenr.org/web/wq/ws/su/npdessw#No_Exposure_N P DES
Rev. 2BJul2010

9FE
NC®ENR
�HVP „ra e.. —NAN...AF�i�.-N-5
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
ANNUAL NO EXPOSURE EXCLUSION SELF RE -CERTIFICATION
tiCGNEOOOO
Do not submit this form to DWO 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 ((VIl l/DD/YYYY)
N C G N E/ /
1) Has the facility name or owner changed? ❑ Yes ❑ No
(if yes, please submit a separate Namelownership Change Form to DWQ located at
h ttp://portal. n cd e n r. org/web/wq/ws/s uln pdessw# Ap pl icat i on_Fo rm s_N P D ES)
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 cldaning 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 loading/unloading or transporting activities ❑ Yes ❑ No
I. 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 ❑ 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
SVJU-NESR-29Jut2010

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 DWO.
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-
gallons?
b. Is secondary containment provided for above ground storage containers stored ❑Yes❑ No ❑ NIA
in close proximity to each other with a combined capacity of more than 1,320-
gallans?
c. Is secondary containment provided for Title Ilk Section 313 Superfund []Yes[:]No ❑NIA
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances— designated in 40 ❑Yes❑ No ❑ NIA
CFR §116?
e. Are release valves on all secondary containment structures locked? ❑Yes❑ Nc ❑ 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 minlmis 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 (singte) and 1,320-gallon (combined) bulk storage minimums require secondary containment.
However, some exceptions may be made for amounts less than the Reportable Quantifies of the hazardous substances fisted in 40 CFR
§ 1 17.3.
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:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑No
❑ Yes ❑ No
[:]Yes[:] No❑NIA
Page 2 of 3
SWU-NESR-29M2010

NCGNEOOOO No Exposure Self Re -Certification
6) Certification:
I certify under penalty of law that I have read and understand the eligibFity requirements far claiming a condition of "no
exposure" and obtaining/maintaining 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 CFn 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 focal municipal separate storm sever system (MS4) into which the facility discharges (where
applicable). I understand that I must aflow the North Carolina Division of Water Quality, or NIS4 operator �.vhere 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 Qoint 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. eased 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.
1 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:
TWe-
(Signature)
(Date Signed)
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 rulema'King 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 o; a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars ($io,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-29JU2010

Nofh
Beverly Baves Perdue
Governor
Aga
NCDENR
Carolina Department or Environment and Natura
Division ct'Nater Quality
Coleen H. Sullins
Drectcr
Mr. ,Jim Sipe
Carolina Foam, LLC
2377 Penny Road
Claremont, North Carolina 28610
Dear Mr, Sipe:
March 28, 2011
Resources
Dee Freeman
Secretary
Subject: No -Exposure Certification NCGNE0765
Carolina Foam, LLC — Claremont Plant
2377 Penny Road, Claremont, NC 28610
Catawba County
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, the site
visit of March, 10, 2011, and the photo documentation of the covered waste dumpster (with drain plug) the Division is
granting your conditional exclusion from 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.
Otherwise, the discharge becomes subject to enforcement as an un-permitted 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 se€f re -certification does not need to be
submitted to DWQ un€ess requested.
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 Marcia Allocco at [phone], or at [e-mail].
Sincerely,
---Kcs --A� <__�
tot Caleen H. Sullins
cc:
Stormwater Permitting Unit No- Exposure Files (Brian Lowther)
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville; NC 281 15
Phone: [phone] Fax: [phone] [ Customer Service: 1-877-623-6748
Internet: www,navaterquality.org
An Eaual 0coortunily % At irmalive Action Emelover - Post Consumer pacer
NOne
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Compliance Inspection Report
Permit: NCGNE0765 Effective: Expiration: Cwner: Carolina Foam L! C Claremont Plant
SOC: Effective: Expiration: Facility: Carolina Foam I_LC Claremont Plant
County: Catawba 2377 Penny Rd
Region: Mooresville
Claremont NC 28610
Contact Person: Jim Sipe Title: Phone: 828-45�--1036
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 03110/2011 Entry. Time: 10:00 AM Exit Time: 10:15 AM
Primary Inspector: Marcia Allocco Phone: [phone]
Ext.2204
Secondary Inspector(s).
Reason for Inspection: Routine - Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ® Compliant Q Not Compliant
Question Areas:
® Miscellaneous Questions
(See attachment summary)
Page: 1

Permit: NCGNF0765 Owner . Facility: Carolina Foam LLC Claremont Plant
Inspection Date: 03/10/2011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
The facility was visited through a new No -Exposure Certification request and manufactures foam for the furniture industry.
From the Catawba County GiS system it was ascertained that the facility discharges to an unnamed tributary to Long
Creek along the northwestern side of the facility.
The facility had the following exposure of industrial materials outside and exposed to stormwater:
One uncovered waste dumpster without a drain plug
Facility personnel forwarded photo documentation of the installation of a -covered dumpster with a drain plug on March'28,
2011, to qualify for No-Expoasure
Page: 2

No -Exposure Self Re -Certification Information:
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. State statute provides for fines of up to $25,000 per day for
un-permitted discharges.
Your conditional no -exposure exclusion must be seif re -certified at least annually as follows:
- Complete the re -certification at a minimum of once per year using the included Self Re -
Certification Form.
(additional copies can be downloaded from http://porkal.ncdenr.org/web/wq/%vs/su/npdessw„No_Exposure_NPDES }
- Maintain a record of re -certifications on file at the facility. Do not submit the re -certification to
DWQ unless requested. If requested, submit a copy of the re -certification to the Division and/or
the municipality in which the facility is located.
-During an inspection by DWQ or local government, provide the re -certifications immediately
upon request.
- Notify the Division of any changes in ownership, significant facility and/or activity changes, or if
the facility can no longer maintain no -exposure.
-Allow the NPDES permitting authority or, if discharging into a municipal separate storm sewer
system, the operator of the system, to: (1) inspect the facility-, and (2) make such inspection reports
publicly available upon request.
"No exposure" means that 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. (40 CFR 122.26(g))
Information and forms related No -Exposure Certifications can be accessed on the website at:
httpalportal.ncdenr.org/web/wqlws/su/npdessw#No_Exposure_NPDES
Rev. 28Ju12010

a
NCDENR
Ynv-v_rv�+•.t awp N rt+•u. :Ir�•Lar-t.
Division of Water Quality / Surface Water Protection
National Pollutant Discl-targe Elimination S✓stern
AN".,NiUAL NO EXPOSURE EXCLUSION SELF RE -CERTIFICATION
N CGtiEOOOO
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 (NIM/DD/YYYY)
N C G N E I I 1/1 1 /
1) Has the facility name or owner changed? ❑ Yes ❑ No
(if yes, please submit a separate NamelOwnership Change Form to DWQ located at
http://portal. ncdenr.erglweb/wq/wslsc/npdessw#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 adequateiy maintained vehicles)
❑ Yes
❑ No
e. Materials or products during loading/unloading or transporting activities
❑ 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
❑ 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
SW U-NESR-29Ju12010

NCGNE0000 No Exposure Self Re -Certification
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers L ❑ 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-.
gallons?
b. Is secondary containment provided for above ground storage containers stored ❑Yes❑ 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 ❑ NIA
Amendments and Reauthorization Act (SARA) water priority chemicals"?
d. Is secondary containment provided for hazardous substances" designated in 40 ❑Yes❑ No ❑ 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, 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.
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:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑No
❑ Yes ❑ No
❑Yes❑ No❑NIA
Page 2 of 3
SWU-NIESR-29Ju12010

NCGNEQ000 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 cf "no
exposure" and obtaAinglmaintaining an exdusion from NFDES stormwater permitting.
I certify under penalty of ia,.v that there are no discharges of stormwater contaminated lay exposure to incustrial activities
or materials from the industrial facility or site identified in this document (except as allowed under 4C CFR 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
DWC or the operator of the local municipal separate storm Sewer system (1`054) 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
dscharge 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 evacuated 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:
Title:
(Signature)
(Date Signed)
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 faise 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 vender this Article or rules of the
[Environmental Managementj Commission implementing this Article shall be guiily of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars (S10,000).
This completed form must be kept on file at the facility for at least 5 years. Do not submit this
form to DWO unless requested.
Page 3 of 3
s�vu-Iv�st�-zQ�rrizal a

S.a Division of Water Quality / Surface Water Protection A
n
,;2�
National Pollutant Dischar-c 131ii11inatlon Svstein
NC®ENR
NO EXPOSURE CER,r[FICATIQN f'ot- EEXClusjon
NCGNF.'000 )
FnR AGENCY USF ONLY
Daw Rc ci,ed
Yeal I Month D..,V
get, 2
Ccl liti='rae. u; l;pccm ge
NO EXPOSURE CERTIFICATION
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, and/or 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, fanks, 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 mobili2ed in
stormwater discharges (e,g., rock salt).
A No Exposure Certification most 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 CI'R 122.26(g),
You are required to self re -certify your No Exposure Exclusion_annuall_y.
For questions, please contact the DWQ Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of owne operator ddress to which all certification correspondence will be mailed):
Name CQ�d lJ.sou:.y, LUC
Contact
Street Address
City
Telephone No.
Ernail
SN!U4t•:E-12Aug2010
J-e,.-r Si p
2-'A'77 Pe o
C(a.-eoft0 �" r State NG ZIP Code 2-$410
8 2-8 V 5`9-- 10 34 Fax: 8 28 ' { s-"9— !!a `f
Page 1 of 7
FFg z 12D1j

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name _ C^,o-o /J.t a Fa a ..7 LL C -- C 1-t-,e ,,o
Facility Contact W_T_ /!?:j _ Sip t
Facility Street Address _ 2-3
City C[Az--eO...aState N L ZIP Code
County Ca. w'04t _
Telephone No. _y2$ `i S-11r— to Fax: S �
Email
z-g 6 / a
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). 5e e A-/� c b,-,, e, ¢--
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes (&No
5) Is this a Federal facility? ❑ Yes 90
6) Latitude �S'Y�� °3- 45' "f l Longitude 81. °T e29. 36W (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
I, New or Proposed Facility Date operation is to begin
Existing Date operation began _3 S 1J2.000
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes ONO
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: 3 0 S G
10) Provide a brief description of the typ s of industrial activities and products pro uced at this facility:
A, r-4-4 r t r v rr Aa b"'-edL 41-a% ZO %.I " , � Vr-'4 a r. '0 A"
0
r
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
Page 2 of 7
SVVU-NE-12Aug2O 10
AIC ©,4
/Ud. O '07` A01

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 VA
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 "o
c. Materials or products from past industrial activity ❑ Yes WINO
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes VAO
e. Materials or products during loading/unloading or transporting activities ❑ Yes ry o
f. Materials or products stared outdoors (except final products intended for outside ❑ Yes 5140
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
t3,40
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by
❑ Yes
ff
�'No
the discharger
/
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes
S No
j. Application or disposal of process wastewater (unless otherwise permitted)
❑ Yes
Li'No
k. Particulate matter o; visible deposits of residuals from roof stacks and/Or vents not
G Yes
I"o
otherwise regulated (i.e.. under an air quality control permit) and evident in the
stormwater outflow
1. Fmpty containers that previously contained materials that are not properly stored
© Yes
(Le,, not closed and stored upside down to prevent precipitation accumulation)
ni. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers
❑ Yes
F 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 and piping free of rust, damaged or weathered coating, pits, or ❑ Yes El No M IA
deterioration. or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? if so, is it free of any
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SI dU-NE-iMug26;6
Yes ❑ No v- NIA

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 all single above ground storage
❑ Yes
❑ No I] N/A
containers (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 W 1A
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 Supertund
❑ Yes
❑ No EV, 6A
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40
❑ Yes
❑ No V N/A
CFR §116?
e. Are release valves on all secondary containment structures locked?
❑ Yes
❑ No (YN/A
15) 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 / disposal vendor:
Vendor address:
Footnotes to Questions 14) c. & d.
❑ Yes V'N//o''
Q Yes vf`lo
❑ Yes - 10
-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
§3 7 2.38.
"'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.
Page 4 of 7
s';Vu-NIE-12ALV010

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? ❑ Yes �/o
b. Does your facility have coal piles on site? 0 Yes i_tvo
c. Does your facility store other fuel sources outside in piles, such as wood chips, © Yes V<O
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: 5p-4,y
A-d hes3 ve oP-era., -"a t
e. If you answered yes to d., are those
emissions permitted by an Air Quality Permit?
Please specify: NC Z>A-Q
P4 e," 1 t Nd ; 0 90 7 9Rcl/
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:
Page 5 of 7
SW U-NE-12An2C 10
Q'Yes ❑ No
V Yes © No ❑ NIA

NCGNEOOOO No Exposure Certification
17) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no
exposure" and obtaining an exclusion from NPDES stounwaier 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 annually -,eEf re-curCify No ExpgIure and, if requested, submit the re certiflCalion to
DWO or the operator of the local municipal separate stonn sewer system (MS4) into which the facility discharges (where
applicable). I understand that 1 must allow fhe North Carolina DMsfon of Water ©uality, 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 dis har e of stormwater from the facilit . 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 famflfar 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: T% _S_t P-e
Title: It'x a 1%4,4r r
(Sign fare of Applicant)
1-'F-//
(Date Signed)
Please mote: 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 13(1) provides that:
Any poison who knowingly makes arty false sinlement, ropreseniaLion, or ccrtiiication in any application, record, rcpofl, plan, or other
ducurnew filed or required to be maintained under this Article or a rule implementing this Article: or who knowingly makes a lalse
s':atemcni of a material fact in a rulemakinC proceeding or contested case under this Article: or wlio 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 l,Aanacementf Commission implementing this Articte shall be guilty of a Class 2 misdemeanor which may include a fine
nol to exceed ton thousand dollars (S10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SVRrU-NE-12Au92010

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
L This completed application and all supporting documentation.
V A map vAth the location of the facility clearly marked.
❑ If the sire currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 6.
Mail the entire package to:
Storin:vater 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]
FayettevJle Office
... [phone]
Mooresville Office
... [phone]
Raleigh Office ........
[phone]
Washington Office ...[phone]
Wilmington Office
... [phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 7 of 7
SWU-NE-12Atig2010

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Claremont Plant
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