NCGNE0947_COMPLETE FILE - HISTORICAL_20130606

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
p HISTORICAL FILE
DOC DATE
O (/►UI 3A 06
YYYYMMDD

Aa�lILFIWA
NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, P.E. John E. Skvarla, III
Governor Director Secretary
R May 30, 2013
Ms. Katie Chapman, Sustainability Specialist JUN Q 6 2013 �
Haworth Health Environments
1 Haworth Center CENTRAL FILES
Holland, MI 49423 DWQl30G
Subject: No -Exposure Certification NCGNE0947 /
Haworth Health Environments/Legacy Plant
Catawba County
Dear Ms. Chapman:
The Division has reviewed your submittal of the No -Exposure Certification form for exclusion from NPDES Stormwater
Permitting. Based on your submittal and signed certification of no -exposure at the above referenced facility, and a site
visit on May 30, 2013, 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 unpermitted stormwater discharge.
You must self re -certify your No -Exposure status annually using the form that is available at this link:
http://portal.ncdenr.org/web/wg/ws/su/npdessw#tab-5 If you are unable to recertify your No -exposure status, you must
obtain NPDES permit coverage for any stormwater discharges from your facility. The annual self re -certification does
not need to be submitted to DWQ unless requested. Please note that your conditional exclusion from permitting does
not affect your facility's legal requirements to obtain environmental permits that may be required under other federal,
state, or local regulations or ordinances.
If you have any questions or need further information, please contact me at [phone] or by email at
Michael. [e-mail].
Sincerely,
w
for Charles Wakild, PE
Enclosure
cc: Stormwater Permitting Unit No- Exposure Files
Mooresville Regional Office
Location: 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Phone: [phone] k Pax: [phone]
Internet: http://portal,ncdenr.org/weblwq
0Ile
NorthCarolina
Naturally
An Equal Opportunity 1 Affirmative Action Employer - 50% Recycted110°/ Post Consumer paper

LIE
NC®ENP
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Ms. Katie Chapman, Sustainability Specialist
Haworth Health Environments
1 Haworth Center
Holland, MI 49423
Dear Ms. Chapman:
Division of Water Quality
Charles Wakild, P.E.
Director
May 30, 2013
John E. Skvarla, III
Secretary
Subject: No -Exposure Certification NCGNE0947
Haworth Health Environments/Legacy Plant
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, and a site
visit on May 30, 2013, 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 unpermitted stormwater discharge.
You must self re -certify your No -Exposure status annually using the form that is available at this link:
http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-5 If you are unable to recertify your No -exposure status, you must
obtain NPDES permit coverage for any stormwater discharges from your facility. The annual self re -certification does
not need to be submitted to DWQ unless requested. Please note that your conditional exclusion from permitting does
not affect your facility's legal requirements to obtain environmental permits that may be required under other federal,
state, or local regulations or ordinances.
If you have any questions or need further information, please contact me at [phone] or by email at
Michael. [e-mail].
Sincerely,
C
for Charles Wakild, PE
Enclosure
cc: Stormwater Permitting Unit No- Exposure Files
Mooresville Regional Office
Location: 610 East Center Avenue, suite 301, Mooresville, NC 26115
Phone: [phone] \ Fax: [phone]
Internet: http://portal.ncdenr.org/web/wq
One
NorthCarolina
Naturally
An Equal Opportunity 1 A€firmative Action Employer — 54% Recyded110% Post Consumer paper

^'Zk�l iP&_�
��' IFA
• Division of Water Quality / Surface Water Protection
RCDENRNational Pollutant Discharge Elimination System •
NO EXPOSURE CERTIFICATION for Exclusion
F�.�•»...'�• ���.t� u� NCGNE0000 •
NO EXPOSURE CERTIFICATION
FOR AGENCY USF ONLY
Date Received
Year
month
Day
Certificate aYCov e ,
NICIGINIE
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 storm water discharges associated with industrial activity in the State of North Carolina because
it qualifies fora 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, andfor runoff.
For permitted facilities in North Carolina, DWQ must approve your application for No
Exposure Certification before this exclusion is effective. Until you are issued a No
Exposure Certification and your NPDES permit is rescinded, your facility must continue
to abide by the terms and conditions of the current permit.
Industrial materials or activities include, but are not limited to: material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste products.
Material handling activities include the storage, loading and unloading, transportation, or conveyance of
any raw material, intermediate product, final product or waste product. A storm resistant shelter is not
required for the following industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed, provided those containers are not deteriorated and do not leak. "Sealed" means
banded or otherwise secured and with locked or non -operational taps or valves; adequately maintained
vehicles used in material handling; and final products, other than products that would be mobilized in
stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In
addition, the exclusion from NPDES permitting is available on a facility -wide basis only —not for individual
outfalls. If any industrial activities or materials are, or will be, exposed to precipitation, the facility is not
eligible for the no exposure exclusion. By signing and submitting this No Exposure Certification form, you
certify that a condition of no exposure exists at this facility or site and are obligated to comply with the
terms and conditions of 40 CFR 122.26(g).
For questions, please contact the DWO Regional Office for your area. (See page 6)
1) Mailing address of owner/operator (adds
Name ' lIrn vo-7 lot
(Please print or type)
is vjp rT'T-k 14 ecc l i-Y) jfrn vt -rc) n m ea')f 5
Contact r
Street Address
City ho la,1d State M I ZIP Code 4g42-9
Telephone No. tfltt4- $G13 -1533 Fax: t_olto- 3q3 -1570
Email Jim.��ozvY.'�nski @hawor•�w� f�
RECEIVED � f �( n;o
DIViSION OF WATER QUALITY2 4 Page 1 of 7M MAY 2�13 AY 2 2
SWU-NE-12Aug2{3100 SECTION
MUORE;,dILLE REGIOI14AL O; iCE

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name o• -l-h,, `_RZA vl A 44 G- a
Facility Contact g06
Facility Street Address ILQ I O t PeAn"" Her_ryy)ah Rood_
City Cpyt c\ eA— State _ ZIP Code V&Dk 3
County Cast- A W 6e;
Telephone No. S23 32$ - SWO b Fax:
Email bda. ty1ClQ1,J$ _---hGlyJcr�-�, • (��v,
3) Physical location information:
Please provide a narrative description of how to get to the facility use street names, state road numbers, a
distance and direction from a roadway intersection), TCO�q_ I - 4� _ �U btd US-1 o
(A co0y of a map with the facility clearly located on it should be included with the certifica'Wn application.)
4) Is the facility located on Native American Lands? ❑ Yes f No
5) Is this a Federal facility? ❑ Yes IgNo
6) Latitude25'42�52`' Longitudetl't5�1_2' (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
V Existing Date operation began OLD 1 OI J 7At
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes �XN0
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 2- 5 2
10) Provide a brief description of the types of industrial activities and products produced at this facility:
t� 00 d -�UV-n itc tYe ; St� <jCXY- i Y_)a I-P, 4e�►r� : Unl IC&jj �, ,�,_ .g�5
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
XNo
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this.facility:-.•_
�t
Page 2 of 7
SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
Ex osure Checklists (1Z - 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 9(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 tXNo
c. Materials or products from past industrial activity ❑ Yes XNo
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes X No
e. Materials or products during loading/unloading or transporting activities ❑ Yes kNo
f• Materials or products stored outdoors (except final products intended for outside ❑ Yes tkNo
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 kNo
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes kNo
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes VNo
j., Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes Od No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes k 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 1<No
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes kNo
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 a No �r,N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? It so, is it free of any ❑ Yes ❑ No NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU NE-12Aug2010

h
2
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
containers (including drums, barrels, etc.) with a capacity of more than 660-
gallons?
b. Is secondary containment provided for above ground storage containers stored
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund
Amendments and Reauthorization Act (SARA) water 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:
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 ❑ No K NIA
❑ Yes ❑ No $� NIA
❑ Yes ❑ No K NIA
❑ Yes ❑ No X NIA
❑ Yes ❑ No RCN/A
❑ Yes K No
❑ Yes 'tR-No
[-]Yes N(No
'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
SW U-NE-12Aug2010

NCGNEOOOO 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? 0 Yes )� No
b. Does your facility have coal piles on site? ❑ Yes P�No
c. Does your facility store other fuel sources outside in piles, such as wood chips, El Yes "o
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., D( Yes o No
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: S� 54�,kio i ✓Z a
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? Yes D No D NIA
Please specify: � QO"3�IP-D D rho GciSS Dhi�-,'�-}DrLA SMOLT, I
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
SWU-NE•12Aug2010

N
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 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). 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 orior to any goint source discharge of stormwater from the facility, Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for, gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing: l4bz�j e CIA 1 — �}0
Title: I� r 1a6l i 41„ YL
(Signature of Applicant) (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
SWU-NE-12Au92010

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