NCGNE1185_COMPLETE FILE - HISTORICAL_20170512

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
NCGNE
DOC TYPE
❑ HISTORICAL FILE
DDC DATE
0 wj� U�
YYYYMMDD

6
1
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Energy, Mineral
and Land Resources
ENWRONMENTAL QUALITY
May 12, 2017
Caraustar Recovered Fiber Group; Inc.
Attention: Mr. Tim Richter
4915 Hovis Road
Charlotte, North Carolina 28208
ROY COOPER
(( Governor
MICHAEL S. REGAN
Secretary
TRACY E. DAVIS
Direcrar
Subject: No -Exposure Certification NCGNE1185
Caraustar Recovered Fiber Group, Inc.
4915 Hovis Road
Charlotte, North Carolina 28208
Dear Mr. Richter,
The Division has reviewed your submittal of the No Exposure Certification for Exclusion from NPDES Stormwater
Permitting form, which we. received on April 24, 2017. The Division is unable to concur with your certification of
No -Exposure.
Based on an inspection of your facility on May 2, 2017, Mooresville Regional Office staff found that industrial
activities or materials on your site either are exposed, or have the potential to be exposed. DEMLR cannot grant
your requested exemption from permit coverage when industrial activities or materials are exposed or have the
potential to be exposed. Please see attached inspection report.
If you have any questions or need further information,, please contact Isaiah Reed at [phone], or at
[e-mail].
Sincerely,
Zahid S. Khan, CPM, CPESC, CPSWQ
Regional Engineer
Land .Quality Section' '.
Enclosure: Inspection Report
cc: Stormwater Permitting Program, No- Exposure Files NCGNEI 185
State of North Carolina I Environmental Quality I Energy, Mineral and land Resources
Mooresville Regional Office 1 610 East Center Ave Ste 301 1 Mooresville, NC 28115
704 663 1699 T

Compliance Inspection Report
Parrrri1:rrN1CGNE1185" Effective: Expiration: "Owner :" Caraustar-Recovered Fiber Group Inc ,y
SOC: Effective: Expiration: Facility: 'Caraustar
County:' Mecklenburg 4915 Hovis Rd
Region: Mooresville
Charlotte NC 28208
Contact Person: Tim Richter Title: Phone: [phone]
Directions to Facility:
North on Brookshire Blvd, left North Hoskins Rd, right on Hovis Road on left:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 05/02/2017 Entry Time: 02:OOPM Exit Time: 02:30PM
Primary Inspector: Isaiah 4 Reed Phone: [phone]
Secondary Inspector(s):
Ousmane Sidibe Phone
Reason for Inspection: Routine Inspection Type: Technical Assistance
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: Compliant ❑ Not Compliant
Question Areas:
Miscellaneous Questions Misc
.(See attachment summary)
Page: 1

Permit; NCGNE1185 Owner - Facility: Caraustar Recovered Fiber Group Inc
Inspection Date: 05/02/2017 Inspection Type : Technical Assistance Reason for Visit: Routine
..-rV..
Misc
Yes No NA NE
Is the facility compliant? ❑ ❑ 1111
Comment:
Page: 3

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
March 20, 2017
Caraustar Recovered Fiber Group, Inc.
Attention: Mr. Tim Richter
4915 Hovis Road
Charlotte, North Carolina 28208'
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY E. DAVIS
Director
Subject: No -Exposure Certification NCGNE1185
Caraustar Recovered Fiber Group, Inc.
4915 Hovis Road
Charlotte, North Carolina 28208
Mecklenburg County
Dear Mr. Richter,
The Division has reviewed your submittal of the No Exposure Certification for Exclusion from NPDES Stormwater
Permitting form, which we received on February 21, 2017. The Division is unable to concur with your certification
of No -Exposure.
Based on an inspection of your facility on March 9, 2017, Mooresville Regional Office staff found that industrial
activities or materials on your site either are exposed, or have the potential to be exposed. DEMLR cannot grant
your requested exemption from permit coverage when industrial activities or materials are exposed or have the
potential to be exposed. Please see attached inspection report.
If you have any questions or need further information, please contact Isaiah Reed at [phone], or at
[e-mail].
Sincerely,
Zahid S. Khan; CPM, CPESC, CPSWQ
Regional Engineer
Land Quality Section
Enclosure: Inspection Report
cc: Stormwater Pe5-mitting-P.rogrm-n Raleigh central Office, No- Exposure Files NCGNE1185
State of'North Carolina I Environmental Quality I Energy, Mineral and Land Resources
Mooresville Regional Office 1 610 East Center Ave Ste 301 1 Mooresville, NC 28115
704 663 1699 T

Compliance inspection Report
Permit: NCGNE1185 Effective: Expiration
SOC: Effective: Expiration
county: Mecklenburg
Region: Mooresville
Contact Person: Tim Richter Title: -
Directions to Facility:
North on Brookshire Blvd, left North Hoskins Rd, right on Hovis Road on Lett.
System Classifications:
Primary ORC: Certification:
Secondary ORC(s):
On -Site Representative(s);
Related Permits:
Owner : Caraustar Recovered Fiber Group Inc
Facility: Caraustar
4915 Hovis Rd
Charlotte NC 28208
Phone; 704-972-7170
Phone:
Inspection Date: 03/09/2017 EntryTime: 11:30AM Exit Time: 12:OOPM
Primary Inspector: Isaiah L Reed Phone: [phone]
Secondary lnspector(s):
Holliday Keen Phone :
Reason for Inspection: Other Inspection Type: Technical Assistance
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ❑ Compliant ❑ Not Compliant
Question Areas:
® Miscellaneous Questions
(See attachment summary)
Page: i

R,'
permit; NCGNE1185 Owner - Facility: Caraustar Recovered Fiber Group Inc
Inspection Date: 0310912017 Inspection Type : Technical Assistance Reason for Visit: Other
Inspection Summary:
This inspection was conducted per the No Exposure Certification application submitted by Caraustar Recovered Fiber
Group INC. Upon inspection, we found that materials from the site would be exposed to and had the potential to affect
stormwater runoff from the site. Prior to recieving a No Exposre Certification, all materials exposed to stormwater must be
removed from the site.
Page: 2

permit: NCGNE1185 Owner -Facility; Caraustar Recovered Fiber Group Inc
Inspection Date; 03/0912017 Inspection Type ; Technicai Assistance Reason for Visit: Other
Page: 3

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
March 20, 2017
Caraustar Recovered Fiber Group, Inc.
Attention: Mr. Tim Richter
4915 Hovis Road
Charlotte, North Carolina 28208
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY E. DAVIS
Director
Subject: No -Exposure Certification NCGNE1185
Caraustar Recovered Fiber Group, Inc.
4915 Hovis Road
Charlotte, North Carolina 28208
Mecklenburg County
Dear Mr. Richter,
The Division has reviewed your submittal of the No Exposure Certification for Exclusion from NPDES Stormwater
Permitting form, which we received on February 21, 2017. The Division is unable to concur with your certification
of No -Exposure.
Based on an inspection of your facility on March 9, 2017, Mooresville Regional Office staff found that industrial
activities or materials on your site either are exposed, or have the potential to be exposed. DEMLR cannot grant
your requested exemption from permit coverage when industrial activities or materials are exposed or have the
potential to be exposed. Please see attached inspection report.
If you have any questions or need further information, please contact Isaiah Reed at [phone], or at
[e-mail].
Sincerely,
�3�_ -'s-_ X_'
Zahid S. Khan, CPM, CPESC, CPSWQ
Regional Engineer
Land Quality Section
Enclosure: Inspection Report
cc: Stormwater Permitting Program, Raleigh central Office, No- Exposure Files NCGNEI 185
Stale of North Carolina I l;nvlrOnlnental Quality I Energy, Mineral and Land Resources
Mooresvilie Regional Office 1 610 Fast Center Ave Ste 30I j Mooresville, NC 28115
704 663 1699 T

Permit: NCGNE1185
SOC:
County: Mecklenburg
Region: Mooresville
Compliance Inspection Report
Effective: Expiration: Owner: Caraustar Recovered Fiber Group Inc
Effective: Expiration: Facility: Caraustar
4915 Hovis Rd
Contact Person: Tim Richter Title:
Directions to Facility:
North on Brookshire Blvd, left North Hoskins Rd, right on Hovis Road on left.
System Classifications:
Primary ORC: Certification:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 03/09/2017
Primary Inspector: Isaiah L Reed
Secondary Inspectors):
Charlofte NC 28208
Phone: [phone]
Phone:
Entry Time: 11:30AM Exit Time: 12:OOPM
Phone: [phone]
Holliday Keen Phone
Reason for Inspection: Other Inspection Type: Technical Assistance
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ❑ Compliant ❑ Not Compliant
Question Areas:
E Miscellaneous Questions
(See attachment summary)
Page: 1

permit: NCGNE1185 Owner - Facility:Caraustar Recovered Fiber Group Inc
Inspection Date: 03/09/2017 Inspection Type; Technical Assistance Reason for Visit: Other
Inspection Summary:
This inspection was conducted per the No Exposure Certification application submitted by Caraustar Recovered Fiber
Group INC. Upon inspection, we found that materials from the site would be exposed to and had the potential to affect
stormwater runoff from the site. Prior to recieving a No Exposre Certification, all materials exposed to stormwater must be
removed from the site.
Page: 2

Permit NCGNE1185 Owner - Facility: Caraustar Recovered Fiber Group Inc
Inspection Date: 03/09/2017 Inspection Type : Technical Assistance Reason for Visit: Other
Page: 3

Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
March 20, 2017
Caraustar Recovered Fiber Group, Inc.
Attention: Mr. Tim Richter
4915 Hovis Road
Charlotte, North Carolina 28208
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY E. DAVIS
Director
Subject: No -Exposure Certification NCONE1185
Caraustar Recovered Fiber Group, Inc.
4915 Hovis Road
Charlotte, North Carolina 28208
Mecklenburg County
Dear Mr, Richter,
The Division has reviewed your submittal of the No Exposure Certification for Exclusion from NPDES Stormwater
Permitting form, which we received on February 21, 2017. The Division is unable to concur with your certification
of No -Exposure.
Based on an inspection of your facility on March 9, 2017, Mooresville Regional Office staff found that industrial
activities or materials on your site either are exposed, or have the potential to be exposed. DEMLR cannot grant
your requested exemption from permit coverage when industrial activities or materials are exposed or have the
potential to be exposed. Please see attached inspection report.
If you have any questions or need further information, please contact Isaiah Reed at [phone], or at
[e-mail].
Sincerely,
Zahid S. Khan,. CPM, CPESC, CPSWQ
Regional Engineer
Land Quality Section
Enclosure: Inspection Report
cc: Stormwater Permitting Program, Raleigh central Office, No- Exposure Files NCGNE1185
State of North Carolina j Environmental Quality I Energy, Mineral and Land Resources
Mooresville Regional Office 1 610 East Center Ave Ste 301 j Mooresville, NC 29115
704 663 1699 T

Permit: NCGNE1185 Effective:
SOC: Effective:
County: Mecklenburg
Region: Mooresville
Compliance Inspection Report
Expiration
Expiration
Contact Person: Tim Richter Title:
Directions to Facility:
North on Brookshire Blvd, left North Hoskins Rd, right on Hovis Road on left.
System Classifications: .
Primary ORC: Certification:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Owner : Caraustar Recovered Fiber Group Inc
Facility: Caraustar
4915 Hovis Rd
Charlotte NC 28208
Inspection Date: 0310912017 EntryTime: 11:30AM Exit Time: 12:OOPM
Primary Inspector: Isaiah L Reed
Secondary Inspector(s):
Phone: [phone]
Phone:
Phone: [phone]
Holliday Keen Phone :
Reason for Inspection: Other Inspection Type: Technical Assistance
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: Compliant Not Compliant
Question Areas:
N Miscellaneous Questions
(See attachment summary)
Page: 1

Permit: NCGNE1185 owner - Facility: Caraustar Recovered Fiber Group Inc
Inspection Date: 03109/2017 Inspection Type : Technical Assistance Reason for Visit: Other
Inspection Summary:
This inspection was conducted per the No Exposure Certification application submitted by Caraustar Recovered Fiber
Group INC. Upon inspection, we found that materials from the site would be exposed to and had the potential to affect
stormwater runoff from the site. Prior to recieving a No Exposre Certification, all materials exposed to stormwater must be
removed from the site.
Page: 2

permit: NCGNE1185 Owner - Facility: Caraustar Recovered Fiber Group Inc
Inspection Date: 0310812017 Inspection Type : Technical Assistance Reason for Visit: Other
Page: 3

Division of Energy, Mineral and Land Resources
Land Quality Section a
National Pollutant Discharge Elimination Systerr%
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NO EXPOSURE CERTIFICATION for Exclusi6,p ,9,
Energy, Mineral J Co
and Lon d Resources NCGNEOOOO V ED
ENVIRONMENTAL QUALITY � �AN 2017
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National Pollutant Discharge Elimination System application fp clu$i� froRPa`�9t6biiWMer PermiCbased
on NO EXPOSURE-7`ytnsmr.a, �...-
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If Submission of this No Exposure Certification constitutes notifica at your facility does not require a
permit for stormwater discharges associated with industrial activit rn a State of North Carolina because
it qualifies for a no exposure exclusion. A condition of no exposure 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. 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).
If approved, your conditional No Exposure Exclusion has no expiration date
BUT MUST BE self re -certified at least annually.
Please look for information about re -certification under the No Exposure section on this page:
https://deg. nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/stormwater-
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 Caraustar Recovered Fiber Group, Inc.
Contact Tim Richter
Street Address 4915 Hovis Road
City Charlotte State: NC ZIP Code: 28208
Telephone No. 704-972-7170
Page 1 of 7
SWU-NCGNE Last revised 912812016

i
NCGNEQ000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Caraustar
Facility Contact
Tim Richter
Street Address
4915 Hovis Road
City
Charlotte State NC ZIP Code 28208
County
Mecklenburg
Telephone No.
704-972-7170
3) Physical location information:
Please provide a narrative description of how to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). North on Brookshire Blvd, Left North Hoskins Road, Right
on Hovis Road, on Left
(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 //�✓Nro� � f
O
5) Is this a Federal facility? ❑ Yes ✓ No 3-T, 9 13 9 �, r 81, C1 90/
6) Latitude 35°16'02.7"N Longitude 80°53'57.0"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
✓ Existing Date operation began November 2016
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes ✓ No
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: 5093
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Facility collects waste paper and sorts grades of paper in order to sale to vendors and paper mills
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-NCGNE Last revised 9/2812016

NCGNE0000 No Exposure Certification
Exposure Checklists (12. - 14.)
11) 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 ❑ Yes ✓ 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 ✓ 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, ❑ Yes ✓ No ❑ NIA
tanks, and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained ❑ Yes ✓ No ❑ NIA
by the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., ❑ Yes ✓ No ❑ NIA
dumpsters])
j. Application or disposal of process wastewater (unless otherwise permitted) Q Yes ✓ No 0 NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents ❑ Yes ✓ No ❑ NIA
not 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 ✓ 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 ✓ No D NIA
stored outside, has the facility had any releases in the past three (3) years?
12) 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 ❑ NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ✓ Yes ❑ No ❑ NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked
shut?
13) Secondary Containment: If you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion.
Page 3 of 7
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'NCGNE0000 No Exposure Certification
a. Is secondary containment provided for single above ground storage containers
✓ Yes ❑ No ❑ NIA
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored
✓ Yes ❑ No ❑ NIA
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund
✓ Yes ❑ No ❑ NIA
Amendments and Reauthorization Act (SARA) water priority chemicals*?
d. Is secondary containment provided for hazardous substances— designated in 40
✓ Yes ❑ No ❑ NIA
CFR §116?
e. Are release valves on all secondary containment structures locked?
✓ Yes ❑ No ❑ NIA
14) 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 ✓ No CIN/A
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes ✓ No CI 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
§372.3&
**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.
15) 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
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NCGNE0000 No Exposure Certification
b. Does your facility have coal piles on site?
❑ Yes ✓ No ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips,
❑ Yes ✓ 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:
Page 5 of 7
SWU-NCGNE Last revised 912812016

NCGNE0000 No Exposure Certification
16) 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 maintain no exposure conditions and complete a Self -Recertification form at least once
each year, and if requested, provide this certification 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
Energy, Mineral, and Land Resources, 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. I understand I
must keep a copy of annual re -certifications on file at the facility.
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 Name of Person Signing: Tim Richter
Title: Plant Manager
— a ?r� I A
(Signature of Applicant) (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the NCDEQ
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.
lJ A map with the location of the facility clearly marked.
ID 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 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 ........
[phone]
Washington Office ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
707-9220
Page 7 of 7
5WU-NCGNE Last revised 9/28/2016