NCGNE0825_COMPLETE FILE - HISTORICAL_20120216

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE O&U
DOC TYPE
❑HISTORICAL FILE
DOC DATE
❑ a012 VGi I
YYYYMMDD

North Carolina
Beverly Eaves Perdue
Governor
Ms, Marilyn Diaz
Zylem, Inc.
14125 South Bridge Circle
Charlotte, North Carolina 28273
x1a
NC®ENR
Department of Environment and
Division of Water Quality
Charles Wakild, P.E.
Director
January 5, 2012
Natural Resources
Subject.- Return of No -Exposure Certification NCGNE0825
Zylem, Inc. (formerly ITT AWT-Wedeco Division)
14125 South Bridge Circle, Charlotte, NC
Mecklenburg County
Dear Ms. Diaz:
Dee Freeman
Secretary
RECEIVED
FEB I s 2012
CENTRAL FILES
DWQ/BOG
The Division has reviewed your submittal of the No Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on November 22, 2011. As part of the review process an
inspection of your facility was performed on December 20, 2011, by Ms. Marcia Allocco of this Office. The
inspection found that there are two stormwater outfalls on site and that no industrial activities or materials
are exposed to stormwater. Your site would qualify for a No -Exposure Certification. However, it was
learned that manufacturing no longer occurs at the Zylem, Inc. facility.
G.S. 143-215.1 requires that certain industrial facilities must obtain and operate under a National Pollutant
Discharge Elimination System (NPDES) permit for industrial stormwater discharges. NPDES general permit
NCG030000 has been established pursuant to G.S. 143-215.1(b) for discharges of industrial stormwater to
surface waters. This general permit is applicable to owners or operators of stormwater point -source
discharges associated with activities classified as establishments primarily engaged in the rolling, drawing,
and extruding of nonferrous metals [standard industrial classification (SIC) 3351, heat treating of metal (SIC
3398), fabricating of metal products (SIC 34), manufacturing of industrial and commercial machinery (SIC
35), manufacturing of electronic equipment (SIC 36), manufacturing of transportation equipment (SIC 37),
and the manufacturing of measuring and analyzing instruments (SIC 38).
Although the Division concurs with your certification of No -Exposure, we are "returning" your application
since your facility does not engage in any of the above activities (no manufacturing). In addition, the Division
would support recession of your coverage under General permit NCG030000 (Certificate of Coverage
NCG030551) and asks that you complete the enclosed Rescission Request form.
If conditions change such that your facility initiates manufacturing activities you are obligated to immediately
obtain NPDES permit coverage for your stormwater discharges or to reapply for No Exposure Certification.
Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge.
Mooresville Regional Office One
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115 North C arol i na
Phone: [phone] Fax: [phone] Customer Service: 1�77-623-6748 Naturally
lntemet www.ncwaterquality.org
An Equal Opportunity 4 Afirmatve Action Employer - 30% Recydedll01 Post Consumer paper

Marilyn Diaz, Zylem, Inc.
NCGNE0825, Page 2
January 5, 2012
If you have any questions or need further information, please contact Ms. Marcia Allocco at [phone],
or at marcia.alloccoC7ncdenr.gov.
Sincerely,
for Charles-Wakild, P.E.
Enclosure! Rescission Request form
NCGNE0825 Inspection Report
Cc: Stormwater Permitting Unit Files
Rusty Rozzelle, MCWQP

Compliance Inspection Report
Permit: NCGNE0825 Effective: Expiration: Owner: Xylem Inc Was Itt Wedeco
SOC: Effective: Expiration: Facility: Xylem Inc (was ITT Wedeco)
County: Mecklenburg 14125 S Bridge Cir
Region: Mooresville
Charlotte NC 28273
Contact Person: Marilyn Diaz Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 12/20/2011 Entry Time. 01:30 PM
Primary Inspector: Marcia Allocco
Secondary Inspector(s):
Certification: Phone:
Exit Time: 02:00 PM
Phone: [phone]
Ext.2204
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ■ Compliant 0 Not Compliant
Question Areas:
■ Miscellaneous Questions N Misc
(See attachment summary)
Page: 1

Permit: NCGNE0825 Owner - Facility: Xylem Inc Was Itt Wedeco
Inspection Date: 12/2012011 Inspection Type: Compliance Evaluation
Reason for Visit: Routine
Inspection Summary:
The facility was visited through a No Exposure request. The facility currently holds Certificate of Coverage (COG)
NCG030551.
From the Mecklenburg County GIS system and MRO topographic maps it was determined that the facility discharges to
an unnamed tributary to Steele Creek through two stormwater outfalls.
The facility has the following outside:
• General waste dumpster - covered - -- `—
• Two self-contained metal storage containers-_-�_----
• Trash compactor; no signs of discharge
Inspector agrees with No -Exposure Certification request by permittee. However, there is manufacturing (metal
fabrication) occurring at the facility and therefore coverage under a permit is not required and neither is the No Exposure
Certification. Will forward permit rescission form for COC NCG030551.
Mlsc
Is the facility compliant?
Comment:
Yes No NA NE
n n n n
Page: 2

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor Director
January 5, 2012
Ms. Marilyn Diaz
Zylem, Inc.
14125 South Bridge Circle
Charlotte, North Carolina 28273
Subject: Return of No -Exposure Certification NCGNE0825
Zylem, Inc. (formerly ITT AWT-Wedeco Division)
14125 South Bridge Circle, Charlotte, NC
Mecklenburg County
Dear Ms. Diaz:
Dee Freeman
Secretary
The Division has reviewed your submittal of the No Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on November 22, 2011. As part of the review process an
inspection of your facility was performed on December 20, 2011, by Ms. Marcia Allocco of this Office. The
inspection found that there are two stormwater outfalls on site and that no industrial activities or materials
are exposed to stormwater. Your site would qualify for a No -Exposure Certification. However, it was
learned that manufacturing no longer occurs at the Zylem, Inc. facility.
G.S. 143-215.1 requires that certain industrial facilities must obtain and operate under a National Pollutant
Discharge Elimination System (NODES) permit for industrial stormwater.discharges. NPDES general permit
NCG030000 has been established pursuant to G.S. 143-215.1(b) for discharges of industrial stormwater to
surface waters. This general permit is applicable to owners or operators of stormwater point -source
discharges associated with activities classified as establishments primarily engaged in the rolling, drawing,
and extruding of nonferrous metals [standard industrial classification (SIC) 335], heat treating of metal (SIC
3398), fabricating of metal products (SIC 34), manufacturing of industrial and commercial machinery (SIC
35), manufacturing of electronic equipment (SIC 36), manufacturing of transportation equipment (SIC 37),
and the manufacturing of measuring and analyzing instruments (SIC 38).
Although the Division concurs with your certification of No -Exposure, we are "returning" your application
since your facility does not engage in any of the above activities (no manufacturing). In addition, the Division
would support recession of your coverage under General permit NCG030000 (Certificate of Coverage
NCG030551) and asks that you complete the enclosed Rescission Request form.
If conditions change such that your facility initiates manufacturing activities you are obligated to immediately
obtain NPDES permit coverage for your stormwater discharges or to reapply for No Exposure Certification.
Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge.
Mooresville Regional Office One
Location; 610 East Center Ave., suite 301 Mooresville, NC 28115 NorthCarolina
Phone: [phone] Fax: [phone]fi401 Customer Service: 1-877.623-6748
lntemet: www.ncwaterquality,org ;Vatul' lly
An Equal Opportunity t Af irmatiive Action Employer - 30% Recycled/10 ro Post Consumer paper �`//

Marilyn Diaz, Zylem, Inc.
NCGNE0825, Page 2_."1
January-5! 2012
If you have any questions or need further information, please contact Ms.. Marcia Allocco at [phone],
or at marcia.allocco(cb-ncdenr.gov.
Sincerely,
n
for Charles Wakild, P.E.
Enclosure: Rescission Request form
NCGNE0825 Inspection Report
cc: Stormwater Permitting Unit Files
Rusty Rozzelle, MCWQP

Compliance Inspection Report
Permit: NCGNE0825 Effective: Expiration: Owner: Xylem Inc Was Itt Wedeco
SOC: Effective: Expiration: Facility: Xylem Inc (was ITT Wedeco)
County: Mecklenburg 14125 S Bridge Cir
Region: Mooresville
Charlotte NC 28273
Contact Person: Marilyn Diaz Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 12120/2011 Entry Time: 01:30 PM Exit Time: 02:00 PM
Primary Inspector: Marcia All occo . Phone: [phone]
Ext.2204
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: 5tormwater Discharge, No Exposure Certificate
Facility Status: ■ Compliant Q Not Compliant
Question Areas:
N Miscellaneous Questions E Misc
(See attachment summary)
Page: 1

Permit: NCGNE0825 owner - Facility: Xylem Inc Was Itt Wedeco
Inspection Date: 12/2012011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
The facility was visited through a No Exposure request. The facility currently holds Certificate of Coverage (COC)
N CG030551.
From the Mecklenburg County GIS system and MRO topographic maps it was determined that the facility discharges to
an unnamed tributary to Steele Creek through two stormwater outfalls.
The facility has the following outside:
• General waste dumpster - covered
• Two self-contained metal storage containers---
• Trash compactor; no signs of discharge
Inspector agrees with No -Exposure Certification request by permittee. However, there is manufacturing (metal
fabrication) occurring at the facility and therefore coverage under a permit is not required and neither is the No Exposure
Certification. Will forward permit rescission form for COC NCG030551.
Misc.
Is the facility compliant?
Comment:
n n n n
Page: 2

No Exposure Certification Questions
Permit No.:
NCG
NCSO
Facility Name:
G\�l � 6A S -- -T-
NCGNE nD
Permit Effective:
NA
Discharges to:
7
Inspection Date:
yaPZJD
Inspection Type
CEI CSI Complaint Other
Inspector(s):
tL1
�,� , r-�1DC_CAE::�
Agency:
MRO MCWQP
Entry Time:
Exit Time
�`�Q'�/�
Facility Contact (s)
Work Days
,
Facility Status:
Compliant Non -Compliant Neither
-�-A
-_
�
YMA
ill re-m Y10-0)+
M
Page 1 of 3
Rev, 1, 6109

No Exposure Certification Questions
If you answer "Yes" to any of these questions the facility is not eligible for No Exposure (or for question #10
might not be eligible)
Yes
I No
NA
1. Does the facility/site use, store, or clean industrial machinery or equipment and are those areas,
where residuals from using, storing, or cleaning industrial machinery or equipment remain exposed to
❑
M
❑
stormwater?
2. Is there any evidence of materials or residuals on the ground or in stormwater inlets from spills or
❑
rs/
❑
leaks?
3. Is there any evidence of materials, residuals, or products from past industrial activity (past sources of
❑
❑
contamination that have remained on'site which could -cause a condition of exposure)?
4. Are any materials or final products (including improperly -maintained material handling equipment,
transformers, cooling towers, and air compressors) exposed to precipitation during material handling,
loading/unloading. or transporting activities, now or in the foreseeable future? [The containers, racks,
❑
❑
and other transport platforms (e.g., wooden pallets) used for the storage or conveyance of these
final products can also be stored outside, providing the containers, racks, and platforms are
pollutant -free].
5. Are any materials or products contained in open, deteriorated or leaking storage drums, barrels,
❑
❑
tanks, and similar containers exposed to precipitation, now or in the foreseeable future?
B. Are any materials or products exposed to precipitation handled or stored on roads or railways owned
ElEl
or maintained by the discharger?
7. is any waste material (except waste in covered, non -leaking containers, e.g., dumpsters)
❑
❑
exposed to precipitation, now or in the foreseeable future?
S. Is there application or disposal of process wastewater (unless otherwise permitted) exposed to
❑
❑
precipitation, now or in the foreseeable future?
9. Is there particulate matter or visible deposits of residuals from roof stacks/vents not otherwise
❑
❑
regulated, i.e., under an air quality control permit, exposed to precipitation?
10. Does the facility have an Emissions permit with the Division of Air Quality? What pollutants does it
❑
❑
cover? Does the facility file a TRI report? What chemicals are released?
Comments:
8% G f s
Page 2 of 3 Rev. 1, 6/09

No Exposure Certification Questions
If you answer "No" to any of these questions the facility is not eligible for No Exposure
Yes
No
NA
11. Are drums, barrels, tanks, and similar containers exposed to precipitation labeled, tightly sealed, in
good condition, free of, leaks and any deterioration, and properly stored?
❑
❑
12. Are materials stored in original containers with original labels?
❑
❑
13. Are incompatible materials stored separately?
❑
❑
14. Do drums, barrels, tanks, and similar containers exposed to precipitation meet DOT specifications,
including compatibility?
❑
❑
15. If empty containers that previously contained materials are exposed to precipitation are they
properly stored (i.e., closed and stored upside down to prevent precipitation from accumulating on top of
the drums around the bung)?
❑
❑
16. For facilities or sites with exterior ASTs and drums, barrels, tanks, and similar containers stored
outside, has the facility been free of any releases in the past 3 years?
❑
17. Is the storage area secured to prevent unauthorized entrances?
❑
❑
18. Are exterior ASTs physically separated from and not associated with vehicle maintenance?
❑
❑
SY
19. Are piping, flanges, valves, pumps or other equipment exposed to precipitation free of any evidence
of leaks and spills?
❑
❑
20. Are exterior ASTs and piping exposed to precipitation protected from traffic lanes to minimize
exposure?
❑
❑
21. Are exterior AST coatings free of signs of bubbled, cracked, damaged, or weathered coating?
❑
❑
22. Are exterior ASTs or piping/supports free of rust, pits or deterioration or evidence of leaks?
❑
❑
23. Are exterior AST leak detection systems operating properly?
❑
❑
24. Are exterior AST capacity indicating equipment operating properly?
❑
❑
25. Is secondary containment provided for all exterior ASTs? Is secondary containment free of any
cracks, holes, or evidence of leaks?
❑
❑
26. Is exterior AST secondary containment enclosure free of accumulated water?
❑
❑
27. Are exterior AST secondary containment drain valves maintained locked shut?
❑
❑
28. Are drain logs being maintained for all exterior AST secondary containment?
❑
❑
29. Are spill kits available and adequate?
❑
❑
❑
30. For facilities or sites with exterior ASTs and drums, barrels, tanks, and similar containers stored
outside, has the facility developed and implemented an SPCC plan, an inspection and maintenance
program, material handling procedures, and site specific loading and unloading procedures?
❑
❑
31. For facilities or sites with ASTs and drums, barrels, tanks, and similar containers stored outside, has
the facility developed and implemented an employee training program addressing spill prevention control
and countermeasures, inspection and maintenance, material handling procedures, and site specific
loading and unloading procedures?
❑
❑
Comments:
Page 3 of 3 Rev. 1, 6/09

ApT�
NCDENR
Vie_ nH c+na C-Fvr O.
fN V RJrvNF,yY .wn N6lRN. Fa-�o.�xFs
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000
NO EXPOSURE CERTIFICATION
FOR AGENCY USE ONLY
Date Received
Year
Ni
Dav
Ccr[ir[ca[c o$cFw - /prl
NV C Gi- 1H S •i
QUALITY
NOV 3 0 2011
SWP SF=QTinN-,
Please check here if this is al renewal:iLIDERENEIIVA
-- -- ---- . _ W .,."., OFFICE
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, 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 facalty qualifying for the no exposure exclusion. M
addition, the exclusion from NPDES permitting is available on a facility -wide basis only —not for individual
outfalis. 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 r5ears.
1)
For questions, please contact the DWQ Regional Office for your area. (See page 6)
(Please print or type)
Mailing address of owner/operator (address to which all certification correspondence will be mailed):
Name )(�j i C' m -!_ C - C U� �S TT wG'd.e-CO�)
Contact M rt,r, kw _-T) i n 2:�
Street Address
City
Telephone No.
S W U-NE-021309
you - 90q--G3a9 1@@[RflWq[#N
Page � of 7
NOV 2 2 2011
Last reWEUVbEA?4M09
.�sprras1011M TER aWCH

1

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name rn 1Yl
d 1 L 1
Facility Contact
Street Address
City
County
Telephone No.
3) Physical location information:
Please provide a narrative description of how to get to the facility (use st t nimes, state road numbers, and
distance and direction from a roadway intersection). We 1 j 1i? _ ��� i✓I G4 S � � �Gi
A-1;7iQ r , `7T5 YVi i1X W RrQ no w$ cm -Kn P 1`
(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?`kl Yes ❑ No
5) Is this a Federal facility? ❑ Yes 1i No
O r rl 0 f
6) Latitude :95- ttb 0.54 Longitude SO 57 Qza.35v/(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
7 Existing Date operation began
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered underanN/P�DES Stormwralteer{ Permit? 'yirl Yes ❑ No
�,
If yes, what is the NPDES Permit Number? I`� Q l5 n�t �e_vteirc)L -PQ-r'�=� �
9) Standard Industrial Classification: N C w OS�j 1 '(fir rCct 1e of Coverp,ge
Provide the 4 digit Standard Industrial. Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: Ci
10) Provide a brief description of the types of industrial activitie and products produced at this facility:
Wo- nn 6)CA1P,- m qr,►��� o i urr� CYy—�4�,�C ae 11't—'V . We- re,n-9tir n1 mnS
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
.
�•� Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Pft k10 : N CGE-SQGb3805
Fva- 1J0 - D aU i
�E P A -'Id- N () Ij C uE SQ G 0000 o'L
EPP, wts-je< No: D OO i
Page 2 of 7
SWU-NE-021309 Last revised 2/1312009

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 ?� 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 Cl Yes No El NIA
c. Materials or products from past industrial activity
❑ Yes
No
❑ NIA
d. Material handling equipment (except adequately maintained vehicles)
Cl Yes
1 No
❑ NIA
e. Materials or products during loading/unloading or transporting activities
❑ Yes
No
❑ NIA
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes
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
1 No
❑ NIA
and similar containers
`
h, Materials or products handled/stored on roads or railways owned or maintained by
© Yes
No
❑ NIA
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes
No
❑ NIA
j. Application or disposal of process wastewater (unless otherwise permitted)
❑ Ye
I No
❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not
❑ Yes
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
NXNo
© N/A
(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
❑ to
0 N/A
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 ❑ Yes ❑ No IkN/A
' �' tAle �p Gn 0 / '
deterioration, or evidence of leaks. Xy�}rYl J-'Rr]tC.MtYL C>oD���rIG, IC+t� r—
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No i N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-021309 Last revises{ 2/13/2009

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 Super -fund
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40
CFR §116?
e. Are release valves on all secondary containment structures locked?
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: Mur)Clnc cSewe(- 1 Me-rc�-'r')
How is material stored: q ra Ll n c-L-n U-vNA`A (2t cXe d- C
Where is material stored: �+
How many disposal shipments per year: 1 O
Name of transport / disposal vendor: U eX [J cLg-nu ri �rtir
Vendor address: .5rZ- CO (3 i q 7_e r R1,,I(u7Qk4 .4�4*s 3kkb" -% r)
Footnotes to Questions 14) c. & d.
❑ Yes ❑ No NIA
❑ Yes ❑ No I NIA
❑ Yes ❑ No '$N/A
❑ Yes ❑ No - N/A
❑ Yes ❑ No I N/A
❑ Yes 1�eNo ❑ NIA
X Yes ❑ No ❑ NIA
Cl Yes Nt No ❑ N/A
O rn 5►� + drs T� u al
;QIfLkjg 0 .-Iec,-f
'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.
Page 4 of 7
SWU-NE-021309 Last revised 2/13/2009

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 ail No
b. Does your facility have coal piles on site?
❑ Yes )I No
c. Does your facility store other fuel sources outside in piles, such as wood chips,
❑ Yes le No
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
❑ Yes 'y No
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: No-t-e ' v>e- c�o som e- So rTn l; nc� ; r► Sr �)
�tjre{Zg; So) Can.S�
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit?
❑ Yes No ❑ NIA
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:
Page 5 of 7
SW U-NE-12Aug2010

NCGNE0000 No Exposure Certification
17) 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 exclusion from NPDES stormwater permitting.
I certify under penalty of law that there are no discharges of stormwater contaminated by exposure to industrial activities
or materials from the industrial facility or site identified in this document (except as allowed under 40 CFR 122.26(g)(2)).
I understand that I am obligated to submit a no exposure certification form once every five U vears to the North Carolina
Division of Water Quality and, if requested, to the operator of the focal municipal separate storm sewer system (MS4) into
which the facility discharges (where applicable). l 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 Mth 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: _ MIJ(i �J&) lfla7
Title:.:—:5�A Coora;r)q )Or— r-M "". -, 1, ) I- it
(Sign ure of A pficant) (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 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
[l;nvironmental 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.
Page 6 of 7
SWU-NE-021309 Last revised 2113)2009

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