NCGNE0873_COMPLETE FILE - HISTORICAL_20121126

i
i
PERMIT NO.
DOC TYPE
STORMWATER DIVISION CODING SHEET
NCG PERMITS
❑ HISTORICAL FILE
n MONITORING REPORTS
DOC DATE i
YYYYMMDD

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. NCGNE CA � 3
DOC TYPE 'HISTORICAL FILE
DOC DATE
YYYYMMDD

A LA
NCDENR
--P�-- --- North Carolina Department•of Environment-and
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor Director
November 26, 2012
Ms. Rhonda Grady
Director of Environmental Protection, Health and Safety
Electronic Recyclers International —North Carolina, Inc.
2860 S. East Avenue
Fresno, CA 93725
Subject: No -Exposure Certification NCGNE0873
Electronic Recyclers International
Badin, NC 28009
Stanly County
Dear Ms. Grady:
Natural Resources
12=7--m
2 1OMN
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 the site visit of
August 27, 2012 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. Failure to obtain a No -Exposure exclusion
could also subject you to enforcement for an un-permitted discharge.
You must self re -certify your No -Exposure status annually using the enclosed fora► 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 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 Barbara Sifford at [phone], or me at
[e-mail].
Sincerely,
A
for Charles Wakild, P.E.
Enclosure: No -Exposure Self Re -certification Information sheet/ Annual No -Exposure Exclusion Self Recertification form
Site inspection report
cc: Stormwater Permitting Unit No- Exposure Files (Brian Lowther)
Pam.
Mooresville Regional Office
Location: 610 last Center Ave., Suite 301 Mooresville, NC 26115
Phone: [phone] Fax: [phone] Customer Service: 1-877.623-6748
Internet: www.ncvvaterquality,org
One
NorthCarohna
Naturally
An Equal Opportunity ! Affirmative Action Employer — 30% Recyclodll0% F'osf Consumer paper

•• +e _ r
Permit: NCGNE0873
SOC:
County: Stanly
Region: Mooresville
Compliance Inspection Report
Effective: Expiration:
.,r • Owner: Electronic Recyclers International North
Carolina Inc
Effective: Expiration: Facility: Electronic Recyclers International North
Carolina Inc
293 NC 740 Hwy Bldg 134
Badin NC 28009
Contact Person: Adam Ellis Title: Phone: [phone]
Directions to Facility:
from intersectin of 740 Hwy N & raleigh Hwy (E Main St) continue on 740 Hwy N - 740 & Wood St on the left
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 08/27/2012 Entry Time: 03:30 PM Exit Time: 04:30 PM
Primary Inspector: Barbara Sifford Phone: [phone]
Ext.2196
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ® Compliant ❑ Not Compliant
Question Areas:
■ Miscellaneous Questions ® Misc
(See attachment summary)
r
Page: 1

i
Permit: NCGNE0873 Owner - Facility: Electronic Recyclers International North Carolina Inc
Inspection Date: dk712012` Inspection Type: Compliance Evaluation Reason`tor \hsiti Routine
Inspection Summary:
Annual certification is required to be kept on file at the facility.
Misc Yes No NA NE
Is the facility compliant? ■ Q n n
Comment: NCGNE0794 rescind. Changed building locations at old Alcoa site to
larger square footage more shipping and receiving area. All outside dumpsters were
covered with a tarp, spill kits for dock areas if needed due to truck fuel leaks.
Page: 2

NCDENR
- -- ,.-Nort�;-C'aro ina-Derartl�;;^t et LEnvironment-and
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E.
Governor Director
November 26, 2012
Ms. Rhonda Grady
Director of Environmental Protection, Health and Safety
Electronic Recyclers International — North Carolina, Inc.
2860 S. East Avenue
Fresno, CA 93725
Subject: No -Exposure Certification NCGNE0873
Electronic Recyclers International
Badin, NC 28009
Stanly County
Dear Ms. Grady:
Natural Remirt es —
Dee Freeman
Secretary
REUIVEm-
DEC 111012
CENTRALFILEs
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 the site visit of
August 27, 2012 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 stortnwater discharge. Failure to obtain a No -Exposure exclusion
could also subject you to enforcement for an un-permitted discharge.
You must self re -certify your No -Exposure status annually using the enclosed 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 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 Barbara Sifford at [phone], or me at
[e-mail].
Sincerely,
for Charles Wakild, P.E.
Enclosure: No -Exposure Self Re -certification Information sheet/ Annual No -Exposure Exclusion Self Recertification form
Site inspection report
cc: Stormwater Permitting Unit No- Exposure Files (Brian Lowther)
Adam Ellis- Badin Facility
Mooresville Regional Office
Location: 610 East Center Ave., Suite 301 Mooresville, NC 28115
Phone: [phone] Fax: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwatergoality.org
One
NorthCarolina
An Equal opportunity! A5mahve Action Employer — 30% Recyclod?10 o Pest Consumer paper

Permit: NCGNE0873
SOC:
County: Stanly
Region: Mooresville
Compliance Inspection Report
. _.., •V- ------------ _ Electronic Rec'yclers International North
Effective: Expiration: Owner: Carolina Inc
Effective: Expiration: Facility: Electronic Recyclers International North
Carolina Inc
293 NC 740 Hwy Bldg 134
Badin NC 28009
Contact Person: Adam Ellis Title: Phone: [phone]
Directions to Facility:
from intersectin of 740 Hwy N & raleigh Hwy (E Main St) continue on 740 Hwy N - 740 & Wood St on the left
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 08/27/2012
Primary Inspector: Barbara Sifford
Secondary Inspector(s):
Entry Time: 03:30 PM
Exit Time: 04:30 PM
Phone: [phone]
Ext.2196
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: 0 Compliant Q Not Compliant
Question Areas:
® Miscellaneous Questions ■ Misc
(See attachment summary)
Page: 1

Permit: NCGNE0873 Owner - Facility: Electronic Recyclers International North Carolina Inc
ssN��t;ca Date: t}812712012 Inspection Type: Complioace EVelu ion Reason for Viz—;!!- FTc;j ine
Inspection Summary:
Annual certification is required to be kept on file at the facility.
Misc Yes No NA NE
Is the facility compliant.
■nnn
Comment: NCGNE0794 rescind. Changed building locations at old Alcoa site to
larger square footage more shipping and receiving area. All outside dumpsters were
covered with a tarp, spill kits for dock areas if needed due to truck fuel leaks.
Page: 2

,0
.4mja
NC®ENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Division of Water Quality
Charles Wakild, P.E.
Director
November 16, 2012
Ms. Rhonda Grady
Director of Environmental Protection, Health and Safety
Electronic Recyclers International -- North Carolina, Inc.
2860 S. East Avenue
Fresno, CA 93725
Subject: No -Exposure Certification NCGNE0873
Electronic Recyclers International
Badin, NC 28009
Stanly County
Dear Ms. Grady:
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 the site visit of August 27, 2012 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 enclosed 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 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.
Mooresville Regional Office
Location. 610 East Center Ave., Suite 301 Mooresville, NC 28115
Phone: [phone] i Fax: [phone] Customer Service: 1-877-623.6748
Internet: www.ncwaterquality.org
NorthCarolina
Naturally(
An Equal Opportunity1 Aflirmativo Action Employer — 3V* Recycled1101Y. Post Consumer paper

Rhonda Grady
Facility — NCGNE087,3
Nov. 2012 j
If you have any questions or need further information, please contact Barbara Sifford at (704) 235-
2196, or me at [e-mail].
Sincerely,
for, Charles Wakild, P.E.
Enclosure: No -Exposure Self Re -certification Information sheet
Annual No -Exposure Exclusion Self Recertification form
Site inspection report
CC' Stormwater Permitting Unit No- Exposure Files (Brian Lowther)
Adam Ellis- Badin Facility

Permit: NCGNE0873 Effective:
SOC: Effective:
County: Stanly
Region: Mooresville
Compliance Inspection Report
Expiration: Owner: Electronic Recyclers International North
Carolina Inc
Expiration: Facility: Electronic Recyclers International North
Carolina Inc
293 NC 740 Hwy Bldg 134
Badin NC 28009
Contact Person: Adam Ellis Title: Phone: [phone]
Directions to Facility:
from intersectin of 740 Hwy N & raleigh Hwy (E Main St) continue on 740 Hwy N - 740 & Wood St on the left
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 0812712012 Entry Time: 03:30 PM Exit Time: 04:30 PM
Primary Inspector: Barbara Sifford Phone: [phone]
Ext2196
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
Miscellaneous Questions O Misc
(See attachment summary)
Page: 1

Permit: NCGNE0873 Owner - Facility. Electronic Recyclers International North Carolina Inc
Inspection Date: 08127/2012 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Annual certification is required to be kept on file at the facility.
Misc
Is the facility compliant?
Comment: NCGNE0794 rescind. Changed building locations at old Alcoa site to
larger square footage more shipping and receiving area. All outside dumpsters were
covered with a tarp, spill kits for dock areas if needed due to truck fuel leaks.
Yes No NA NE
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 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 httpl/portal.ncdenr.org/web/wq/ws/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:
http://portal.ncdenr.org/web/wq/ws/su/npdessw#No—Exposure—NPDES
Rev. 28J02010

RMENR
Division of Water Quality / Surface Water Protection
FOR AGLNCY USE ONLY
[late Received
Year
Month
Day
Certificate of Coverage
NC
N E � `�
National Pollutant Discharge Elimination System
12
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000 DIVISION OF WATER QUALITY
JUL 13 2012
NO EXPOSURE CERTIFICATION
Skirt'',3 ,-,T;0N
National Pollutant Discharge Elimination System application for exclusion i�6MV' tormw"ater=`t'�@1.r�t'� �i� ed
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, DWO 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
For questions, please contact the DWO Regional Office for your area. (See page 6)
1) Mailing address of owner/operator
Name
Contact
Street Address
City
Telephone No.
Email
SW U-N E-12Aug2010
0 h ►�
(Please print or type)
r,
no
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NCGNE0000 No Exposure Certification
2) Location of facility producing dischE
Facility Name 41e-e,+ ro h Ic
Facility Contact o(aK,.
Facility Street Address R q 3 NC'�
City
County S
Telephone No. !Ty— 9 74
Email a e.11f;t" 0 PJi
3) Physical location information:
ers -T-Kje'V- I7<A dYld— Alar4t Cav`o lt+1.Vv, Inc ,
Please provide a narrative description of how to get to the fac,iSity (use street names, state road numbe s, and
distance and direction f om a roadway inters ction). 7�i'iJ7K �f'�iL In]
n]e+�se.c i" , `]'�O 11t ft�o�
'Kaie�' w �E s �e- vtu e. a� '740 w - a.�. 6 s fry �
(A cop f a map Ah the facility clearly loca ed on it should be included with A certification application.)
4) Is the facility located on Native American Lands? 0 Yesrnlo
5) Is this a Federal facility? ❑ Yes 8Jo f�
6) Latitude4 1 q-quail Longitude' gpU 7 L 411 d (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the folio ing:
[ 'New or Proposed Facility Date operation is to begin fo 1
CIP-
0 Existing
Date operation began
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? '(s
If yes, what is the NPDES Permit Number?N C. 000 410
9) Standard Industrial Classification:
❑ No
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: ._61__�Q
10) Provide a brief description of the t%pes of industr'aI activities and products produced at this/facili y:
eC aG (n/ Gi �S' awl I iYLvac't�7L� u 'en:.y Alhi
Q o ,,I- e.,K a S A- r4+c.r a A
+Vj
11) toes this facility have any Non-Discharger
on Di charger6efmits (ex: recycle p rmits)?4
2'No
© Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SWU-NE-12Aug2010

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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
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 P1110
c. Materials or products from past industrial activity ❑ Yes 2<01
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes i4�0
e. Materials or products during loading/unloading or transporting activities ❑ Yes V<O-
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes 0401
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 e o
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by
❑ Yes
VNo
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes
t'No
Application disposal
Wfio
j. or of process wastewater (unless otherwise permitted)
❑ Yes
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
1. Empty containers that previously contained materials that are not properly stored
❑ Yes
Qlo
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers
❑ Yes
L'1Vo
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 ❑ No PIV/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No "/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
S W U-N E-12AAug2010

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 II1/A
containers (including drums, barrels, etc.) with a capacity of more than 660-
gailons?
b. Is secondary containment provided for above ground storage containers stored
❑ Yes
❑ No VN/A
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 �-fQ1A
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 �A
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
❑ Yes �No
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
❑ Yes Flo
generated per month) of hazardous waste? Cl— s Q Q
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
❑ Yes W O
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. & 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.
Page 4 of 7
SWU-NE-12Aug2010

NCGNE000O 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
b. Does your facility have coal piles on site? ❑ Yes k
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes �IVo
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ❑ Yes 911_0
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? ❑ Yes ❑ No [+HIV/A
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 5of7
SVVU-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)).
understand that I am obligated to annually self re -certify No Exposure and, if requested, submit the re -certification to
DWQ or the operator of the local municipal separate storm sewer system (MS4) into which the facility discharges (where
applicable). I understand that I must allow the North Carolina Division of Water Quality, or MS4 operator where the
discharge is into the local MS4, to perform inspections to confirm the condition of no exposure and to make such
inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information 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 N e of Person Si nin , C 4
Title:�SWmr / G!'
(ure of Appli n) (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
[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.
Page 6 of 7
SW U-NE-12Aug2010

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
This completed application and all supporting documentation.
l3' A map with the location of the facility clearly marked.
I" 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 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.
DWO Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office
... [phone]
Mooresville Office
... [phone]
Raleigh Office ........
[phone]
Washington Office
...[phone]
Wilmington Office
... [phone]
Winston-Salem ......
[phone]
Central Office .........(919)
807-6300
Page 7 of 7
SWU-NE-12Aug2010

28009 Zip Code Map I MapQuest
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28009 Zip Code Map j MapQuest Page 1 of 1
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conditions or route usability You assume all risk of use.View Terms of Use
https://www.mapquest.com/print?a=app.core.a7d7Oa81 a3aa7d8a29fh7241
6/29/20 i 2

Driving Directions from Charlotte/Douglas International Airport (CL"I) in Charlotte, Nort... Page 1 of 1
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hqs://www.mapquest.com/print?a=app.core.a7d7Oa8I a3aa7d8aNW241 6/29/2012