NCGNE1056_COMPLETE FILE - HISTORICAL_20150407

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
HISTORICAL FILE
DOC DATE
❑ � I S � y C) f
YYYYMMDD

A
A
�� p.�T+A_H
North Carolina Depa4ment of Environment and Natural Resources
Pat McCrory Donald van der Vaart
Governor Secretary
April 7, 2015
ABF Freight System, Incorporated
Attention: Shaun McCaffrey
3801 Old Greenwood Road
Fort Smith, Arkansas 72903
Subject: No -Exposure Certification NCGNE1056
ABF Freight System -Charlotte
325 Peach Orchard Road
Belmont, North Carolina, 28012
Gaston County
Dear Mr. McCaffrey:
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 18, 2015, 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 restart NPDES permit
coverage under NCGO80257 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 DEMLR 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.
Division of Energy, Mineral, and Land Resources
Energy Section - Geological Survey Section - Land Quality Section
Mooresville Regional Office
610 East Center Avenue, Suite 301, Mooresville, North Carolina 28115
Telephone: [phone] FAX: [phone] • Internet: http:llportal.nodenr.org/web/Inland-quality
An Equal Opportunity ! Affirmative Action Employer — 50% Recycled / 10% Post Consumer Paper

ABF No Exposure Approval
NCGNE1056
April 7, 2015
Page 2 of 2
If you have any questions or need further information, please contact Donna Hood at [phone], .
or at [e-mail].
Sincerely,
Zahid S. Khan, CPM, CPESC, CPSWQ
Regional Engineer
Land Quality Section
cc:
Stormwater Permitting File NCGNE1056

Permit: NCGO80257
SOC:
County: Gaston
Region: Mooresville
Contact Person: Chris Brown
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Compliance Inspection Report
Effective: 11/01/12 Expiration: 10/31/17 Owner: ABF Freight System Inc
Effective: Expiration: Facility: ABF Freight System, Inc. -Charlotte
325 Peach Orchard Rd
Belmont NC 28012
Title: Phone: [phone]
Inspection Date: 0311912015
Primary Inspector; Donna Hood
Secondary Inspector(s):
Certification: Phone:
Entry Time: 12:OOPM Exit Time: 12:15PM
Phone: [phone] Ext.2193
Reason for inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Transportation wNehicle Maintenance/Petroleum Bulk/Oil Water Separator Stormwater Discharge COC
Facility Status: Ej Compliant Not Compliant
Question Areas:
M Storm Water
(See attachment summary)
Page: 1

/! [a
permit: NCG080257 Owner - Facility: ABF Freight System Inc
Inspection Date: 0311912015 Inspection Type : Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Site inspection was performed for dual paperwork requests. The permittee requested rescission of the permit as well as No
Exposure exclusion from the permit. Because the facility is still in business as a freight company the rescission is denied-
-however, the site was very clean and well -kept so the no -exposure request is granted.
Page: 2

NCG
Ela
N FOR AGENCY L'SE ONLY
Date Received
Division of Energy, Mineral and Land Resources Year I Month Day
Land Quality Section DIVISION OF LAND RE
+ AKID 011ALI 'Y SE ; I i( Certificate ovof
NCDENR National Pollutant Discharge Elimination System..„ orNICIGI
-
r7owm.Gnauw.0enurnewrar NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000 MAR 2 4 zQ�� 9 r'
� iDEPAr,...,_.. , �O
NO EXPOSURE CERTIFICATION Please NeRd lherefif thisfis M4 " ©
RENEWAL TF�p
7�
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit • A
on NO EXPOSURE: 1114G
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, DEMLR must approve your application for No
Exposure Certification before this exclusion is effective. Until you are issued a No
Exposure Certification and your NPDES permit is rescinded, your facility must continue
to abide by the terms and conditions of the current permit.
Industrial materials or activities include, but are not limited to: material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste products.
Material handling activities include the storage, loading and unloading, transportation, or conveyance of
any raw material, intermediate product, final product or waste product A storm resistant shelter is not
required for the following industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed, provided those containers are not deteriorated and do not leak. "Sealed' means
banded or otherwise secured and with locked or non -operational taps or valves; adequately maintained
vehicles used in material handling; and final products, other than products that would be mobilized in
stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. M
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 12Z.26(g).
You are required to reapply for the No Exposure Exclusion once every five ( ears.
For questions, please contact the DEMLR Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of ownerloperator (address to which all certification correspondence will be_mailedl:
Name
Contact
Street Address
City
Telephone No.
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NCGNE0000 No Exposure Certification
2) Location of facility 1
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
3) Physical location information:
Please provide a narrative description of how to get to the facility R(u2""44
street names, state road numbers, and
distance and direction frorq a roadway intersection). 7fLe f .,h M g&"J1`1je N
&h tin led 4ris� `ee'tL or(u"j f4 4 1-4 "i"Ja-
(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 KNo
6) Latitude 'W i� � p� Longitude
g' 91') 3 1 W (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
,4 Existing Date operation began C3 i
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? IX Yes J2 No
If yes, what is the NPDES Permit Number? W &
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: _�L S
10) Provide! a brief descriptionofthe types of industrial activities and products produced at this facility:
Y �`i�1 � f �, 5 T .tfk i2. n^ t +JT•�2 r �i' I'(R, � D. tf1'
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
SWU-NE-021309 Last revised 6/24/14

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 V. No ❑ NIA
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes b No ❑ NIA
c. Materials or products from past industrial activity
❑ Yes
No
❑ NIA
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes]
No
❑ NIA
e. Materials or products during loading/unloading or transporting activities
❑ Yes
gL No
❑ NIA
f. Materials or products stored outdoors (except final products intended for outside o Yes CO 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, 0 Yes N No ❑ NIA
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes 50 No ❑ NIA
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes q No ❑ NIA
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes N No ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes M 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 11 No ❑ 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 0 No ❑ NIA
stored outside, has the facility had any releases in the past three (3) years?
13) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or []Yes ❑ No N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any _OYes ❑ No C N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut? I`
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NCGNE0000 No Exposure Certification
14) Secondary Containment: If you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for single above ground storage containers
Yes
❑ No C NIA
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored
11 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
C Yes
❑ No NIA
Amendments and Reauthorization Act (SARA) water priority chemicals"?
d. Is secondary containment provided for hazardous substances" designated in 40
.El Yes
❑ No 1 NIA
CFR §116?
e. Are release valves on all secondary containment structures locked?
Yes
❑ No NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes No ❑ NIA
b, Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes 9 No ❑ NIA
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑.Yes Ej No ❑ N/A
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,
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t
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 % No ❑ NIA
b. Does your facility have coal piles on site? ❑ Yes t$t No ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips,
❑ Yes 14 No ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
❑ Yes No ❑ NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality 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:
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SVVU-NE-021309 Last revised 6124114

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 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 (5) years to the North Carolina
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system (MS4) into
which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
l 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: - �G
—... . Fr' 'Y_ I 1 —.cam l
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.
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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.
❑ If this is a renewal, indicated current NCGNE number in Question 7.
❑ 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 Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
(919) 7914200
Washington Office...
[phone]
Wilmington Office...
[phone]
Winston-Salem ......
[phone]
Central Office ......... [phone]
Page 7 of 7
SWU-NE-021309 Last revised 6124114

Google Map Maker
Page I of I
325 Peach Orchard Road, Belmont, NC
ADD NEW Edit Browse
https://www.google.com/mapmaker?11=35.249658,-81.064056&spn=0,006694,0.008465&t... 3/3/2015

� , XX
A,
Division of Energy, Mineral and Land Resources
Land Quality Section
NC®ENi
National Pollutant' Discharge Elimination System .
NO EXPOSURE CERTIFICATION For Exclusion
.
E.mrouwrt w.o Mm-„ti Ruo�w[u
NCGNE0004
FOR AGENCY USE ONLY
Date Received
Year _ Month
EJa
Certifiweofcoiera e
NO EXPOSURE CERTIFICATION Please check here if this isa 414& 0 �1���
RENEWAL � q FRV V. 'S
National Pollutant Discharge Elimi.riation System application for exclusion from a Stormwater Permit
on NO EXPOSURE: /NG
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 activltles are protected by a storm resistant shelter (with some exceptions) to
prevent exposure to rain, snow, snowmen, and/or runoff.
For permitted facilities in North Carolina, DEMLR must approve your -application for No
Exposure Certification before this exclusion is effective. Until you.ar6 issued a No
Exposure Certification and your NPDES permttns rescinded, your facility must continue
to abide by the terms and conditions of the current permit.
Industrial materials or activities Include, but are riot limited to: material handling equipmenfor activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste products.
Material handling activities -include 11 the storage, loading and pnloadingi 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 NPDFS 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 f 22.26(g).
You are required to reapply for the No Exposure Exclusion once.every five (5) years.
For questions, please contact the DEMLR Regional Office for your area. (See page 6)
(Please print -or type)
1) Mailing address of ownerloperator (address to which all certification correspondence will be mailed);
Name
Contact
Street Address
City
Telephone No,
Page 1 of 7
SWU-NE-021309
last revises U24114

NCGNE0000 No Exposure Certification
2) Location of facility 1
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
3) Physical location information:
Please provide.a narrative description of how to get to the facility (us street names, state oadnumber , and
distance an direction fro a roadway interse tion). 'f'r 1z &g 117 r,i44 v-i�� /i'�( Y-9"111, _r1��fg�
(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? 0 Yes. No
5) Is.this a Federal fa.cility7 0 Yes KNo
6) Latitude ° V� Longitude I (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
o: New or Proposed Facility' Date operation is to begin
A Existing Date operation began 5h 11aa1
0 Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? Yes fj No
If yes, what is the NPDES Permit Number? r
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: 'S
10) Provide a brief description of the types of `industrial activities and products produced. at this facility:,
11) Does this facility have any Non -Discharge pe►mits'(ex: recycle permits)?
0 No
0 Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
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Last revised 6124714

NCGNEOOOO No Exposure Certification
Exposure Checklists (12. - 14.)
12) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable
future? (Please'check either "Yes" or "No.") If you answer "Yes" to any of these items,.y.ou are not
eligible for the no exposure exclusion.
.a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes 1 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/ieaks ❑ Yes .021 No '❑ NIA
c. Materials or products from past industrial activity
❑ Yes
P No
El NIA
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes,
M No
❑ NIA
e. Materials or products during loadinglunloading or transporting activities
❑ Yes
r 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.
0 No
❑ NIA
and similar containers
h. Materials or products handled/stored on roads or railways'owned or maintained by ❑ Yes q No ❑ N/A
the discharger
i. Waste material (except waste in covered, non -leaking containers (e.g:, dumpslers]) ❑ Yes .�4 No 0 NIA
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes I� No' o NIA.
k: Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑' Yes 0 No ❑ NIA
otherwise regulated (i.e., under an airquality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not property stored ❑ Yes KI No ❑ NIA
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels,1anks, and similar containers ❑ Yes A No ❑ NIA
stored outside, has the facility had any releases in the past three (3) years?
13) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items, you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered, coating, pits, or
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.6f leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE•021309
ElYes ❑ No NIA
Yes ❑ No XN/A
Last revised 6124114

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 exclusions.
a. Is secondary containment provided for single above ground storage containers n Yes 0 No N/A
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored p Yes ❑ No NIA
in close proximity.to each other with a combined capacity of more than 1,a2o-
gallons?
c. Is secondary containment.provided for Title III Section 313 Superfund Yes ❑ No N/A
Arneradments and Reauthorization Act (SARA) water pflority chemicals`,?
d. Is secondary containment provided for hazardous substances" designated in 40 E3 Yes ❑ No � NIA
CFR §116?
e. Are release valves on all secondary containment structures locked? 0 Yes 0 No � NIA
IS) Hazardous Waste:
a. Is this facility a Hazardous Waste;Treatment, Storage, or Disposal Facility? D Yes �, No ❑ NIA
b. Is this facility a Small Quantity Generator (less than 1000 kg: of hazardous waste ❑ Yes (hl No ❑ NIA
generated per month] of hazardous waste?,
c. Is this facility a Large'Quantity'Gerierator (1000 kg. or more of hazardous waste d Yes No ,❑ WA
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.
"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 111 SARA 313 in 40 CFR
§372.38.
"Note that amounts below the 660-gallon (single) and 1,3Mgallon (combined) bulk storage minimums require
secondary containment.. However, some exceptions may be made for amounts less than the Reportable Quantities
of the hazardous substances listed in 40 CFR §117.3.
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NCGNE0000 No Expos We. Certification
16) Other Information: If you answer "Yes" to any of the following Items, you might not be eligible for the
no "exposuPe exclusion. Amore in-depth evaluation of the site circumstances rrlay be required.
a. Does your facility store used, recycled,'or otherwise reclaimed pallets outside? ❑ Yes % No l3 NIA
b. Does your facility have coal piles on site? ❑ Yes % No 0 NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips,
lD Yes 10 No 0 NIA
sawdust, etc.?
d. Does your facility have ail• emissions..associated with its industrial'activity (e.g.,
0 Yes No 0 NIA
degreasing operations, plating, painting and metal finishing)? If's%-describe the.
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit?
© Yes No 0 N/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 5 of 7
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NCGNE0000 No Exposure Certification
17) Certification:
('certify under penaltyof 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 siteldentified in this document (except as allowed under 40 CFR 122.26(g)(2)).
I understand that I am obligated to submij a no exposure certification form once every fiye.(5) years to the North Carolina
Division of Water Quality and, if requested, to the operator of the local. municipal separate storm sewer system (MS4) into
which the facility discharges (where applicable), !,understand that l must allow the North Carolina Division of Water
Quality; or MS4 operator where the discharge is into the local MS4, to perform inspections to confirrr_i 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 ttfis document and all attachments were prepared under mydirection 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 into 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:1 am farniliar 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: ^lXtt GPI �G�D _
. in Y_ 1 -rr 1"
Please note: This application for the No Exposure Exclusion Is subject id. 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'ahr time in the future for compliance with the No Ex osure 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 riled or required to be maintained under this Articfe 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 Articfe: or who falsifies, tampers with, or knowingty
renders inaccurate any recording or monitoring device or method required to be, operated or maintained under this Article or rules of the
(Environmental Managements Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a ripe
not to exceed ten thousand dollars ($10,000),
There Is currently no fee for a No Exposure Exclusion.
Page fi af7
SWU•NE•021309 Last revised 6124114'

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
❑ This completed application and all supporting,documentation.
❑ A map with the location of the facility clearly marred.
© if this is a renewal, indicated current NCGNE number in=Question 7:
0 If the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in.Ciuestion 8.
Mail the entire package to:
Stormwater Permitting Unit Program
Division of Energy. Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please coniact the Dt±MLR Regional Office for your area..
DEMLR Regional Office Contact Information_
Asheville. Office ...... (828) 296=4500
Fayetteville Office ... [phone]
Mooresville Office ... [phone]
Raleigh Office ........ (919) 79.1.4200
Washington.Office ... [phone]
Wilmington Office ... [phone]
Winston -'Salem ...... [phone]
Central Office.— —;. (9 19) 807=6300
Page 7 of 7
5WU-NE•021309
Last revised 6124114

asks,

FOR AGENCY USE ONLY
Ali 0 Division of Energy, Mineral & Land Resources I Date Rawi�d
FAA
Year Month Da
Land Quality Se'cti6nJSt0rMW2ter Permitting Progrnm
RCD01 PE 1IL42 R National Pollutant Discharge Elimination System
.,. c...o.... D� e
RESCISSION REQUEST FORM
Please flli out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
2) Owner/Facility Information: • Final correspondence will be rnalled to the address noted below
Owner/Facility Nam
Facility Contact
Street Address `
City
County
Telephone No.
E-mail Address tAq%A;n14A rak.tic.h{.tOrn_
Fax: � d - 214
3) Reason for rescission request (This is mui information. Attach. separate. sheet IF necessary):
❑ Facility closed or is closing on All indusirial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
C3 Facility sold to M on 9EM. . If the facility will continue operaEions under the new owner it
may be more appropriate to request an ownershia change too reissue to permitlto the new owner.
Other: ' S ch;Itte(t 5sfnif/ __� M lfii� �t l 4 { f i1+ eQS p �1e 1,(l�inc�.
t -- --
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained.in this request and to the best of my knowledge and belief
such information is true, complete and accurate.
Signature Date Z! ;14 �t s
Print or type name -of person signing above Title
Please return this completed rescission request form to: NPDES Permit Coverage Rescission
Stormwater Permitting Program
16i2 Mail Service Center
Raleigh, North Carolina 27699-1612
1612 Mail Service Center, 3alei h, North Carolina 27%9.1612 RECEIVED
Phone: [phone] FAX: 9 iMO7-6492
An Equa[ Opportunity 1 Affirmative Action Employer HAR 0. 4: 2015
DENR-LAND QUALITY
STORMWATER PERMITTING
f
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