NCGNE0114_COMPLETE FILE - HISTORICAL_20081105

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
L' HISTORICAL FILE
DOC DATE
❑ apoK I I CS
YYYYMMDD

S
DIV OF WATER OUALITV Fax:[phone]
:+::+: T ransm i t Conf_ Repo rt +:,+,
P. 1
Nov 5 20118 15:15
Fax/Phone Number
Mode
Start
Time
Page
Result
Note
919204943598
NORMAL
5,15:15
1'45"
9
4 t., K
To: Mark Batchelor
From: Julie — NC Division of Water Quality
Becton Dickinson — Durham County — NCGNE0114
9 pages faxed

To: Marls Batchelor
From: Julie — NC Division of Water Quality
Becton Dickinson — Durham County — NCGNE0114
9 pages faxed

F W A Michael F. Easley, Governor
\O\O ' 7oG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
r Alan W. Klimek, 1'. E. Director
CO
3 Division of Water Quality
Q Coleco H. Sullins, Deputy Director
— Division of Water Quality
April 20, 2005
Wayne Baker, Coordinator Faciliti
Becton Dickinson
1 Becton Dr
Franklin Lakes, NJ 07417
Subject: No Exposure Certification NCGNE0114
Becton Dickinson - 1 Becton Cir
Durham County
Dear Permittee:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on June 4, 2002. We apologize for the extended period it has
taken us to get back to you on this request and we appreciate your patience as we have worked through this
process. Based on your submittal and signed certification of no exposure at the above referenced facility the
Division is granting your certification as provided for under 40 CFR 126.22(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. Your
conditional no -exposure exclusion expires in five years (April 30, 2010). At that time you must re -certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your certification of no exposure 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 Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
�71
for Alan W. Klimek, P.E.
cc: Raleigh Regional Office Central Files —w/attachments
Stormwater Permitting Unit Files
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
© `y
.ENR
a
NCD
Customer Service
1-877-623-6748

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April 20, 2005
Wayne Baker, Coordinator Faciliti
Becton Dickinson
1 Becton Dr
Franklin Lakes, NJ 07417
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, 1'. F. Director
Division of Water Quality
Coleen It. Sullins, Deputy Director
Division of Water Quality
Subject: No Exposure Certification NCGNE0114
Becton Dickinson - 1 Becton Cir
Durham County
Dear Permittee:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on June 4, 2002. We apologize for the extended period it has
taken us to get back to you on this request and we appreciate your patience as we have worked through this
process. Based on your submittal and signed certification of no exposure at the above referenced facility the
Division is granting your certification as provided for under 40 CFR 126.22(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. Your
conditional no -exposure exclusion expires in five years (April 30, 2010). At that time you must re -certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your certification of no exposure 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 Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
for Alan W. Klimek, P.E.
cc: Raleigh Regional Office Central Files —w/attachments
Stormwater Permitting Unit Files
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
N%
1JCDEPVR
Customer Service
1-877-623-6748

15
_ Ju , E U u G NS oilf
N 4 2002 J
Form Approved
"ed Cates Environmental Protection Agency OMB No. 2040-0211
NPDES A R -WATER OLITY Washington, DC 20460
FORM a'r1►/ �� T SouRCE "O_ SU E CERTIFICATION for Exclusion from
3510.11
NPDES Storm Water Permitting
Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit authorization for its storm water
discharges associated with industrial activity in the State identified in Section B under EPA's Storm Water Multi -Sector General Permit due to the existence
of a condition of no exposure.
A condition of no exposure exists at an industrial facility when 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. A storm resistant shelter is
not required for the following industrial materials and activities:
- drums, barrels, tanks, and similar containers that are lightly sealed, provided those containers are not deteriorated and do not leak. "Sealed"
means banded or otherwise secured and without operational laps or valves;
- adequately maintained vehicles used in material handling; and
- final products, other than products that would be mobilized in storm water discharges (e.g., rock sail).
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 facilily-wide basis only, not for individual oulfalls. If any industrial activities or malerials 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, the entity in Section A is certifying that a condition of no exposure exists at its facility or site,
and is obligated to comply with the terms and conditions of 40 CFR 122.26(g).
ALL INFORMATION MUST BE PROVIDED ON THIS FORM
Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4
A. Facility Operator Information
1. Name: t0i.0 .CLZt�N�1PD�.IIClK1r�NJilQl�1_7 'I J�-'I I I I IJ--1_J 2. Phone: �u11g1�f.Lj_l6lit n
3. Mailing Address: a. Street: Ill AT- �- 1 /�k11L-Q V✓LEI II I I l l I l l l
b. City: IF!pjAN r
k I I zIN I 1 K1C i5 I I I I I I 1� c. Stale: LNL-i d. Zip Code: ' J''fj1 L%1=!_I-1_I-1
B. Facility/Site Locations Information
1. Facility Name: Ild lf'. 10' ITlo lh/I Ipl i1c•Ii1ILY151o1A/I I I
2. a. Street Address: 1 19 1 e, 1 C 1 L1J;j_1 IGI L LCLI 11 el I II I I I I I I
b. City: A -au UIA I I—i I I I 1-1—j I I I I I I c. County: ID I u I ohI 1/I IM I
d. State: UC I e. Zip Code: IZ I�17111.21-I I I I I
3. Is the facility located on Indian Lands? Yes No
4. Is this a Federal facility? ��'�Yes No I�
5. a. Latitude: �J Lj� i 1,;; IT. Longitude: I I% suJ 1/ I r 1 La L/J
6. a. Was the facility or site previously covered under an NPDES storm water permit? Yes No
b. If yes, enter NPDES permit number:
7_SIC/Activity Codes: Primary: I 1 1
& Total size of site associated with industrial activity:
Secondary (if applicable): I I
acres - - -
9. a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure exclusion? Yes El No P/
b. If yes, please indicate approximately how much area was paved or roofed over. Completing this question does not disqualify you for the no exposure
exclusion. However, your permitting authority may use this information in considering whether storm water discharges from your site are likely to have
an adverse impact on water quality, in which case you could be required to obtain permit coverage.
Less Than one acre One to five aces More than five acres
EPA Form 3510-11 (10.99) Page 1 of 4

NPDES NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
FORM OMB OMB No. 2040-0211
3510-11 NPDES Storm Water Permitting
C. Exposure Checklist
Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future?
(Please check either "Yes" or "No" in the appropriate box.) If you answer"Yes" to any of these questions
(1) through (11), you are not eligible for the no exposure exclusion.
Yes
No
1. Using, storing or cleaning industrial machinery or equipment, and areas where residuals from using, storing
❑
or cleaning industrial machinery or equipment remain and are exposed to storm water
2. Materials or residuals on the ground or in storm water inlets from spills/leaks
❑
3. Materials or products from past industrial activity
❑
4. Material handling equipment (except adequately maintained vehicles)
❑
5. Materials or products during loading/unloading or transporting activities
❑
P'
6. Materials or products stored outdoors (except final products intended for outside use [e.g., new cars] where
❑
�"
exposure to storm water does not result in the discharge of pollutants)
7. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers
❑
Lf
8. Materials or products handled/stored on roads or railways owned or maintained by the discharger
9. Waste material (except waste in covered, non -leaking containers [e.g., dumpstersl)
❑
LVI
10. Application or disposal of process wastewater (unless otherwise permitted)
❑
11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated
❑
2�
(i.e., under an air quality control permit) and evident in the storm water outflow
D. Certification Statement
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 storm water permitting.
I certify under penally of law that there are no discharges of storm water 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)).
1 understand that I am obligated to submit a no exposure certification form once every five years to the NPDES permitting authority 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 NPDES permitting authority, or MS4 operotor 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 that I must obtain coverage under an NPDES permit prior
to any point source discharge of storm water from the facility.
Addilionally, 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 One and imprisonment for knowing violations.
Print Name:IYIf Xi,VZ iV kiE'iR-t_1 I I I I I I I ILI 1 I I I I I I
Print Title:
Signature:
Date: 10 12,ID 1 `71 D 1�.
EPA Form 3510-11 (10-99) Page 2 of 4

United States Office of Water EPA 833-F-00-015
Environmental Protection (4203) January 2000
Agency Fact Sheet 4.0
=0EPA
Storm Water Phase II
Final Rule
Fact Sheet Series
Overview
1.0 - Storm Water Phase II Final
Rule: An Overview
Small MS4 Program
2.0 - Small MS4 Storm Water
Program Overview
2.1 - Who's Covered? Designation
and Waivers of Regulated Small
MS4s
2.2 - Urbanized Areas: Definition
and Description
Minimum Control Measures
2.3 - Public Education and
Outreach
2.4 - Public Participation)
Involvement
2.5 - Illicit Discharge Detection
and Elimination
2.6 - Construction Site Runoff
Control
2.7 - Post -Construction Runoff
Control
2.8 - Pollution Prevention/Good
Housekeeping
2.9 - Permitting and Reporting:
The Process and Requirements
2.10 - Federal and State -Operated
MS4s: Program Implementation
Construction Program
3.0 - Construction Program
Overview
3.1 - Construction Rainfall
Erosivity Waiver
Industrial "No Exposure"
1.0 - Conditional No Expposure
Exclusion for Industrial Aclivity
Storm Water Phase II
Final Rule
Conditional No Exposure
Exclusion for Industrial Activi
Why Is the Phase I No Exposure Exclusion Addressed in the Phase 11 Final
Rule?
The 1990 storm water regulations for Phase I of the federal storm water program identify
eleven categories of industrial activities that must obtain a National Pollutant Discharge
Elimination System (NPDES ) permit. Operators of certain facilities within category eleven
(xi), commonly referred to as `light industry," were exempted from the definition of "storm
water discharge associated with industrial activity," and the subsequent requirement to obtain
an NPDES permit, provided their industrial materials or activities were not "exposed" to storm
water. This Phase I exemption from permitting was limited to those facilities identified in
category (xi), and (lid not require category (xi) facility operators to submit any information
supporting their no exposure claim.
In 1992, the Ninth Circuit court remanded to EPA for further rulemaking the no exposure
exemption for light industry after making a determination that the exemption was arbitrary
and capricious for two reasons. First, the court found that EPA had not established a record
to support its assumption that light industrial activity that is not exposed to storm water (as
opposed to all other regulated iudesir:al activity rot exposed) is not a "stems vatcr discharge
associated with industrial activity." Second, the court concluded that the exemption
impermissibly relied on the unsubstantiated judgment of the light industrial facility operator to
determine the applicability of the exemption. ''his fact sheet describes the revised conditional
no exposure exclusion as presented in the Phase 11 Final Rule.
Who is Eligible to Claim No Exposure?
As revised in the Phase II Final Rule, the conditional no exposure exclusion applies to ALL
industrial categories listed in the 1990 storm water regulations, except for construction
activities disturbing 5 or more acres (category (x)).
What Is The Regulatory Definition of "No Exposure"?
The intent of the no exposure provision is to provide facilities with industrial materials and
aciivilies that are entirely sheltered from storm water a simplified way of complying with the
storm water permitting provisions of the Clean Water Act (CWA). This includes facilities that
are located within a larger office building, or facilities at which the only items permanently
exposed to precipitation are roofs, parking lots, vegetated areas, and other non -industrial areas
or activities. 'Ilre Phase 11 regulatory definition of "no exposure" follows.
No exposure means all industrial materials and activities are protected by a
storm resistant shelter to prevent exposure to rain, snow, snowmch, and/or
runoff. Industrial materials or activities include, but are not linuted to, material
handling equipment or activities, industrial machinery, raw materials,
intermediate products, by -produces, final products, or waste products.

Fact Sheet 4.0 — Conditional No Exposure Exclusion for Industrial Activity Pa Le 2
A storm resistant shelter is not required for the following onsite. General refuse and trash, not of an industrial nature,
industrial materials and activities: is not considered exposed as long as the container is
completely covered and nothing can drain out holes in the
O Drums, barrels, tanks, and similar containers that are bottom, or is lost in loading onto a garbage truck. Industrial
tightly sealed, provided those containers are not refuse and trash that is left uncovered, however, is considered
deteriorated and do not leak. "Sealed" means banded exposed.
or otherwise secured and without operational taps or
valves; What is Required Under the No Exposure
O Adequately maintained vehicles used in materials
handling; and
❑ Final products, other than products that would be
mobilized in storm water discharges (e.g., rock salt).
'11te term "storm -resistant shelter," as used in the no exposure
definition, includes completely roofed and walled buildings
or structures, as well as structures with only a top cover but
no side coverings, provided material under the structure is not
otherwise subject to any run-on and subsequent runoff of
storm water. While the intent of the no exposure provision is
to promote a condition of permanent no exposure, EPA
understands certain vehicles could become temporarily
exposed to rain and snow while passing between buildings.
Adequately maintained mobile equipment (e.g., trucks,
automobiles, forklifts, trailers, or other such general purpose
vehicles found at the industrial site that are not industrial
machinery, and that are not leaking contaminants or are not
otherwise a source of industrial pollutants) can be exposed to
precipitation or runoff. Such activities alone would not
prevent a facility from certifying to no exposure. Similarly,
trucks or other vehicles awaiting maintenance at vehicle
maintenance facilities that are not leaking contaminants or are
not otherwise a source of industrial pollutants, are not
considered "exposed."
In addition, I -IPA recognizes that there are circumstances
where permanent no exposure of industrial activities or
materials is not possible and, therefore, under such
conditions, materials and activities can be sheltered with
temporary covers (e.g., tarps) between periods of permanent
enclosure. The no exposure provision does not specify every
such situation, but NPDES permitting authorities can address
this issue on a case -by -case basis.
The Phase 11 Final Rule also addresses particulate matter
emissions from roof stacks/vents than are regulated by, and in
compliance with, other environmental protection programs
(i.e., air quality control programs) and that do not cause storm
water contamination are considered not exposed. Particulate
matter or visible deposits of residuals from roof stacks ancVor
vents not otherwise regulated (i.e., under an air quality
control program) and evident in storm water outflow are
considered exposed Likewise, visible "track out" (i.e.,
pollutants carried on the tires of vehicles) or windblown raw
materials is considered exposed. Leaking pipes containing
contaminants exposed to smrnl water are deemed exposed,
as are past sources of storm water contamination that remain
Provision?
The Phase II Final Rule represents a significant expansion
in the scope of the original no exposure provision in
terms of eligibility (as noted above) and responsibilities
for facilities claiming the exclusion. Under the original no
exposure provision, a light industry operator was expected
to make an independent determination of whether there was
"exposure" of industrial materials and activities to storm
water and, if not, simply not submit a permit application.
An operator seeking to qualify for the revised conditional
no exposure exclusion, including light industry operators
(i.e., category (xi) facilities), must:
❑ Submit written certification that the facility meets the
definition of "no exposure" to the NPDES permitting
authority once every 5 years.
The Phase II Final Rule includes a four -page
No Exposure Certification form that uses a series
of yes/no questions to aid facility operators in
determining whether they have a condition of
no exposure. It also serves as the necessary
certification of no exposure provided the operator
is able to answer all the questions in the negative.
EPA's Certification is for use only by operators of
industrial activity located in areas where EPA is the
NPDES permitting authority.
• A copy of the Certification can be obtained from
the U.S. EPA Office of Wastewater Management
(OWM) web site, the Storm Water Phase 11 Final
Rule published in the Federal Register (Appendix
4), or by contacting OWM.
❑ Submit a copy, upon request, of the Certification to the
municipality in which the facility is located.
❑ Allow the NPDES permitting authority or, if
discharging into a municipal separate storm sewer
system, the operator of the system, to: (I ) inspect the
facility; and (2) make such inspection reports publicly
available upon request.
Regulated industrial operators need to either apply for a
permit or submit a no exposure certification form in order to
be in compliance with the NPDES storm water regulations.
Any permit held becomes null and void once a certification
form is submitted.

Fact Sheet 4.0 — Conditional No Exposure Exclusion for Industrial Activity Page 3
Even when an industrial operator certifies to no exposure,
the NPDES permitting authority still retains the authority to
require the operator to apply for an individual or general
permit if the NPDES permitting authority has deternuned that
the discharge is contributing to the violation of, or interfering
with the attainment or maintenance of, water quality
standards, including designated uses.
Are There Any Concerns Related to Water
Quality Standards?
Yes. An operator certifying that its facility qualifies for
the conditional no exposure exclusion may, nonetheless,
be required by the NPDES permitting authority to obtain
pennit authorization. Such a requirement would follow
the permitting authority's determination that the discharge
causes, has a reasonable potential to cause, or contributes to
a violation of an applicable water quality standard, including
designated uses. Designated uses can include use as a
drinking water supply or for recreational purposes.
Many efforts to achieve no exposure can employ simple
good housekeeping and contaminant cleanup activities such
as moving materials and activities indoors into existing
buildings or structures. In limited cases, however, industrial
operators may make major changes at a site to achieve no
exposure. "These efforts may include constructing a new
building or cover to eliminate exposure or constructing
structures to prevent run-on and storm water contact with
industrial materials and activities. Major changes undertaken
to achieve no exposure, however, can increase the impervious
area of the site, such as when a building with a smooth roof is
placed in a formerly vegetated area. Increased impervious
area can lead to an increase in the volume and velocity of
storm water runoff, which, in turn, can result in a higher
concentration of pollutants in the discharge, since fewer
pollutants are naturally filtered out.
The concern of increased impervious area is addressed in one
of the questions on the Certification form, which asks, "Have
you paved or roofed over a formerly exposed, pervious area
in order to qualify for the no exposure exclusion'? If yes,
please indicate approximately how much area was paved or
roofed over." This question has no affect on an operator's
eligibility for the exclusion. It is intended only to aid the
NPDES permitting authority in assessing the likelihood
of such actions interfering with water quality standards.
Where this is a concern, the facility operator and its NPDES
permitting authority should take appropriate actions to ensure
that water quality standards can be achieved.
What Happens if the Condition of No Exposure
Is Not Maintained?
Under the Phase H Final Rule, the no exposure exclusion
is conditional and not an outright exemption. Therefore,
if there is a change in circumstances that causes exposure of
industrial activities or materials to storm water, the operator is
required to comply immediately with all the requirements of
the NPDES Stortn Water Program, including applying for and
obtaining a permit.
Failure to maintain the condition of no exposure or obtain
coverage under an NPDES storm water permit can lead to
the unauthorized discharge of pollutants to waters of the
United States, resulting in penalties under the CWA. Where
a facility operator determines that exposure is likely to occur
in the future due to some anticipated change at the facility,
the operator should submit an application and acquire storm
water permit coverage prior to the exposed discharge to avoid
such penalties.
For Additional Information
Contact
aT U.S. EPA Office of Wastewater Management
• Phone: [phone]
• I mail: [e-mail]
• Internet: www.epa.gov/own,/swlphase2
Wy Your NPDES Permitting Authority. (A list of names
and phone numbers for each U.S. EPA Region is
included in Fact Sheet 2.9. Additional contact
names, addresses, :in(] numbers for each State can be
obtained from the U.S. EPA Office of Wastewater
Management)
Reference Documents
ua" Storm Water Phase II Final Rule Fact Sheet Series
• Internet: www.epa.gov/owndsw/phase2
Storm Water Phase It Final Rule (64 FR 68722)
• Internet: www.epa.gov/owndsw/phase2
• Contact the U.S. EPA Water Resource Center
— Phone: [phone]
— E-mail: [e-mail]

NPDES Instructions for the NO EXPOSURE CERTIFICATION for
FORM I-OEPA
aslo-11 Exclusion from NPDES Storm Water Permitting
Who May File a No Exposure Certification Section B. Facility/Site Location Information
Federal law at 40 CFR Part 122.26 prohibits point source discharges of
storm water associated with industrial activity to waters of the U.S. without
a National Pollutant Discharge Elimination System (NPDES) permit. However,
NPDES permit coverage is not required for discharges of storm water
associated with industrial activities identified at 40 CFR 122.26(b)(14)(i)-
(ix) and (xi) if the discharger can certify that a condition of 'no exposure'
exists at the industrial facility or site.
Storm water discharges from construction activities identified in 40 CFR
122.26(b)(14)(x) and (b)(15) are not eligible for the no exposure exclusion.
Obtaining and Maintaining the No Exposure Exclusion
This form is used to certify that a condition of no exposure exists at the
industrial facility or site described herein. This certification is only applicable
in jurisdictions where EPA is the NPDES permitting authority and must be
re -submitted at least once every five years.
The industrial facility operator must maintain a condition of no exposure at
its facility or site in order for the no exposure exclusion to remain applicable.
If conditions change resulting in the exposure of materials and activities to
storm water, the facility operator must obtain coverage under an NPDES
storm water permit immediately.
Where to File the No Exposure Certification Form
Mail the completed no exposure certification form to:
Storm Water No Exposure Certification (4203)
USEPA
401 M Street, SW
Washington, D.C. 20460
Completing the Form
You must type or print, using uppercase letters, in appropriate areas only.
Enter only one character per space (i.e., between the marks). Abbreviate
if necessary to stay within the number of characters allowed for each item.
Use one space for breaks between words. One form must be completed
for each facility or site for which you are seeking to certify a condition of no
exposure. Additional guidance on completing this form can be accessed
through EPA's web site at www.epa.gov/owm/sw. Please make sure you
have addressed all applicable questions and have made a photocopy for
your records before sending the completed form to the above address.
Section A. Facility Operator Information
1. Provide the legal name of the person, firm, public organization, or any
other entity that operates the facility or site described in this certification.
The name of the operator may or may not be the same as the name of
the facility. The operator is the legal entity that controls the facility's
operation, rather than the plant or site manager.
2. Provide the telephone number of the facility operator.
3. Provide the mailing address of the operator (P.O. Box numbers may be
used). Include the city, state, and zip code. All correspondence will
be sent to this address.
Form Approved
OMB No. 2040-0211
1. Enter the official or legal name of the facility or site.
2. Enter the complete street address (if no street address exists, provide
a geographic description [e.g., Intersection of Routes 9 and 55)), city,
county, state, and zip code. Do not use a P.O. Box number.
3. Indicate whether the facility is located on Indian Lands.
4. Indicate whether the industrial facility is operated by a department or
agency of the Federal Government (see also Section 313 of the Clean
Water Act).
5. Enter the latitude and longitude of the approximate center of the facility
or site in degrees/minutes/seconds. Latitude and longitude can
be obtained from United Slates Geological Survey (USGS) quadrangle
or topographic maps, by calling 1-(88B) ASK-USGS, or by accessing
EPA's web site at http://www.epa.gov/owm/sw/industryrindex.htm and
selecting Latitude and Longitude Finders under the Resources/Permit
section.
Latitude and longitude for a facility in decimal form must be converted
to degrees (1), minutes ('), and seconds (") for proper entry on
the certification form. To convert decimal latitude or longitude to
degrees/minutes/seconds, follow the steps in the following example.
Exam: Convert decimal latitude 45.1234567 to degrees ("), minutes
('), and seconds (").
a) The numbers to the left of the decimal point are the degrees: 450.
b) To obtain minutes, multiply the first four numbers to the right of the
decimal point by 0.006: 1234 x 0.006 = 7.404.
c) The numbers to the left of the decimal point in the result obtained
in (b) are the minutes: 7'.
d) To obtain seconds, multiply the remaining three numbers to the
right of the decimal from the result obtained in (b) by 0.06:
404 x 0.06 = 24.24. Since the numbers to the right of the decimal
point are not used, the result is 24".
e) The conversion for 45.1234567 = 45' 7' 24".
6. Indicate whether the facility was previously covered under an NPDES
storm water permit. If so, include the permit number.
7. Enter the 4-digit SIC code which identifies the facility's primary activity,
and second 4-digit SIC code identifying the facility's secondary activity,
if applicable. SIC codes can be obtained from the Standard Industrial
Classification Manual, 1987.
8. Enter the total size of the site associated with industrial activity in acres.
Acreage may be determined by dividing square footage by 43,560, as
demonstrated in the following example.
Example: Convert 54,450 f12 to acres
Divide 54,450 ft2 by 43,560 square feet per acre:
54,450 ft2. 43,560 ft2/acre = 1.25 acres.
9. Check 'Yes' or 'No' as appropriate to indicate whether you have paved
or roofed over a formerly exposed, pervious area (i.e., lawn, meadow,
dirt or gravel road/parking lot) in order to qualify for no exposure. If yes,
also indicate approximately how much area was paved or roofed over
and is now impervious area.
EPA Form 3510-11 (10-99) Page 3 of 4

NPDES Instructions for the NO EXPOSURE CERTIFICATION for Form Approved
FORM *-EPA OMB No. 2040-0211
3510-11 Exclusion from NPDES Storm Water Permitting
Section C. Exposure Checklist
Check "Yes" or "No" as appropriate to describe the exposure conditions at
your facility. If you answer "Yes" to ANY of the questions (1) through (11)
in this section, a potential for exposure exists at your site and you cannot
certify to a condition of no exposure. You must obtain (or already have)
coverage under an NPDES storm water permit. After obtaining permit
coverage, you can institute modifications to eliminate the potential for a
discharge of storm water exposed to industrial activity, and then certify to
a condition of no exposure.
Section D. Certification Statement
Federal statutes provide for severe penalties for submitting false information
on this application form. Federal regulations require this application to be
signed as follows:
For a corporation: by a responsible corporate officer, which means
(i) president, secretary, treasurer, or vice-president of the corporation
in charge of a principal business function. or any other person
who performs similar policy or decision making functions for the
corporation, or
(ii) the manager of one or more manufacturing, production, or
operating facilities, provided the manager is authorized to make
management decisions which govern the operation of the
regulated facility including having the explicit or implicit duty of
making major capital investment recommendations, and initiating
and directing other comprehensive measures to assure long
term environmental compliance with environmental laws and
regulations; the manager can ensure that the necessary systems
are established or actions taken to gather complete and accurate
information for permit application requirements; and where
authority to sign documents has been assigned or delegated to
the manager in accordance with corporate procedures;
For a partnership or sole proprietorship: by a general partner or the
proprietor; or
For a municipal, State, Federal, or other public facility: by either a
principal executive or ranking elected official.
Paperwork Reduction Act Notice
Public reporting burden for this certification is estimated to average 1.0 hour
per certification, including time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information. Burden means the total time,
effort, or financial resources expended by persons to generate, maintain,
retain, or disclose to provide information to or for a Federal agency. This
includes the time needed to review instructions; develop, acquire, install,
and utilize technology and systems for the purposes of collecting, validating,
and verifying information, processing and maintaining information, and
disclosing and providing information; adjust the existing ways to comply with
any previously applicable instructions and requirements; train personnel to
be able to respond to a collection of information; search data sources;
complete and review the collection of information; and transmit or otherwise
disclose the information. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it
displays a currently valid OMB control number. Send comments regarding
the burden estimate, any other aspect of the collection of information, or
suggestions for improving this form, including any suggestions which may
increase or reduce this burden to: Director, OPPE Regulatory Information
Division (2137), USEPA, 401 M Street, SW, Washington, D.C. 20460.
Include the OMB control number of this form on any correspondence. Do
not send the completed No Exposure Certification form to this address.
EPA Form 3510-11 (10-99) Page 4 of 4