NCGNE0483_COMPLETE FILE - HISTORICAL_20150413

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE (7
DOC TYPE
EKHISTORICAL FILE
DOC DATE
❑ a0)5 Dy 13
YYYYMMDD

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGja
DOC TYPE
❑ HISTORICAL FILE
DOC DATE
❑
YYYY M M DD

AIA
Division of Energy, Mineral and Land Resources
���, Land Quality Section / Stormwater Permitting Program
NCDENR National Pollutant Discharge Elimination System (NPDES)
NORTH L FOLII 0VJ ICMi or
°°N °P4RCBO RO°° PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USI? ONLY
Date Received
Year
Month
Uav
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
W
What does "legally responsible individual' mean?
The person is either: IUp(U
• the responsible corporate officer (for a corporation); K�ro�ther�publilc Z05
• the principle executive officer or ranking elected official (for a municipality, state, de
agency); DENR •WATER RESOURCES
• the general partner or proprietor (for a partnership or sole proprietorship); 401 & BUFFER PERMITTING
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation')
applies:
Individual Permit
N I C I S
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(ot) Certificate of Coverage
N C G N E 0 4 8 3
Chloride
Chloride, a Division of the Genlyte Group, owned by
272 West Stag Park Service Road
Address
Burgaw NC 28425
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
ham'//Vortal.iicdeiir.orUweb/Ir/sw-permit-contacts and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual:
Dick McLaul
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this pennit:
Nancy Bourdeau
First MI Last
SW U-OW NERAFFI L-25July2014
Page I of

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
5), ,Reason for -this change:
l
A result of:
:-."jf61her please explain:
Plant Mai
Title
272 West StaE Park Service Road
Mailing Address
Burgaw NC 28425
City State Zip
10) 259-1065
Telephone E-mail Address
[phone] [e-mail]
philips.com
Fax Number
X Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
1, Nancy Bourdeau, attest that this application for this change in Owner Affiliation (person legally
responsible for the pen -nit) has been reviewed and is accurate and complete to the best of my knowledge. I
understand that if all required parts of this form are not completed, this change may not be processed.
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call 919-707-9220 or visit the website at:
http://portal. ncdenr.ore/web/Ir/storinwater
Page 2 of 2
S W ll-OW NERAFFI L-25July2014

NC®ENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Curtis M. Dail
Chloride a Genlyte Company
272 W Stag Park Service Road
Burgaw, North Carolina 28245
Dear Mr. Dail:
Division of Water Quality
Coleen H. Sullins
Director
February 27, 2009
Subject: No -Exposure Certification NCGNE0483
Chloride Systems
272 W Stag Park Service Road
Fender County
Dee Freeman
Secretary
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES Stormwater
Permitting form. Based on your submittal and signed certification of no exposure at the above referenced facility, the
Division is granting your conditional exclusion from permitting 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 (February 28, 2014). At that time you must re -certify with the Division, or obtain NPDES permit
coverage for any stormwater discharges from your facility.
Your conditional exclusion from permitting does not affect your facility's legal requirements to obtain environmental
permits that may be required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact Cory Larsen at [phone], or at
[e-mail].
Sincerely,
for Coleen H. Sullins
cc: Wilmington Regional Office
Stormwater Permitting Unit No Exposure Files
Wetlands and Stormwater Branch t.T n t 1617 Mail Service Center, Raleigh, North Carolina 27699-1617 1� OCthl-,aCO1] I7 �1
One
Location: 512 -8 N. Salisbury St. Raleigh, North Carolina r Sewi Natura��I,�
Phone: [phone] \ FAX: [phone] \Customer Service: 1-877-623-6748 - it
Internet: www.ncwaterquality.org
An Fnnal OnmennitO AI(irmetivn Artim Fmdnvar

✓S Y
QL Division of Water Quality / Surface Water Protection
NCDENRNational Pollutant Discharge Elimination System
«.,-CAROU-rrc�,..e„, o. NO EXPOSURE CERTIFICATION for Exclusion
E DO.N,..ND� RESWRCES NCGNE0000
NO EXPOSURE CERTIFICATION
National Pollutant Discharge Elimination System application for exclusion from a
based on NO EXPOSURE:
I -OR AGENCY USE. ONLY
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N N'O S
Submission of this No Exposure Certification constitutes notice that your facility does not re
authorization for its stormwater discharges associated with industrial activity in the State of
Carolina because it qualifies for a no exposure exclusion. A condition of no exposure at an ij
facility means all industrial materials and activities are protected by a storm resistant shelte/
exceptions) to prevent exposure to rain, snow, snowmelt, and/or runoff.
ON
Industrial materials or activities include, but are not limited to: material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste
products. Material handling activities include the storage, loading and unloading, transportation, or
conveyance of any raw material, intermediate product, final product or waste product. A storm resistant
shelter is not required for the following industrial materials and activities: drums, barrels, tanks, and
similar containers that are tightly sealed, provided those containers are not deteriorated and do not leak.
"Sealed" means banded or otherwise secured and with locked or non -operational taps or valves;
adequately maintained vehicles used in material handling; and final products, other than products that
would be mobilized in stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion.
In addition, the exclusion from NPDES permitting is available on a facility -wide basis only —not for
individual outfalls. If any industrial activities or materials are, or will be, exposed to precipitation, the
facility is not eligible for the no exposure exclusion. By signing and submitting this No Exposure
Certification form, you certify that a condition of no exposure exists at this facility or site and are
obligated to comply with the terms and conditions of 40 CFR 122.26(g).
You are required to reapply for the No Exposure Exclusion once every five (5) years.
For questions, please contact the DWO Regional Office for your area. (See page 5)
(Please print or type)
1) Mailing address of owner/operator (address to which all certification correspondence will be mailed):
Name Chloride a Genlyte Co (operator) Owner information is provided on attached sheet.
Street Address 272 W. Stag Park Service Rd.
City Burgaw State NC ZIP Code 28425
Telephone No. 910 259-1000 Fax: [phone]
2) Location of facility producing discharge:
Facility Name Chloride
Facility Contact Dick McLaughlin
Street Address 272 W. Stag Park Service Rd
City Burgaw State NC ZIP Code 28425
County Pender
Telephone No. 910 259-1000 Fax: [phone]
Page 1 of 5
SWU-NE-110607 Last revised 11/06/07

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NCGNE0000 No Exposure Certification
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). Exit #396 off 1-40. E. on Hwy 53 (1) mile.
S. on Stag Park Rd. (2) miles. Rt. on Stag Park Service Rd.
(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 IZ No
5) Is this a Federal facility? ❑ Yes V1 No
6) Latitude 34' 33' 47.56" N Longitude 77" 53' 53.03" W (deg, min, sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
p Existing Date operation began December 1990
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes 0 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: 3 6 4 8
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Primary activity = Emergency Lighting assembly (i.e. EXITS signs)
Secondary activity = Printed Circuit Board, Wire Harness & Ballast assembly. Also have Shipping & Receiving Dept.s
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
V No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
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
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
c. Materials or products from past industrial activity
d. Material handling equipment (except adequately maintained vehicles)
e. Materials or products during loading/unloading or transporting activities
f. Materials or products stored outdoors (except final products intended for outside
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
❑ Yes m No
❑ Yes 0 No
❑ Yes ® No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes ® No
Page 2 of 5
SWU-NE-110607 Last revised 11/06/07

NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks,
❑ Yes 0 No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by
❑ Yes WJ No
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes 0 No
j. Application or disposal of process wastewater (unless otherwise permitted)
❑ Yes 0 No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not
❑ Yes A No
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored Cl Yes m No
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes IZI No
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
n19�
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or
❑ Yes ❑ No
deterioration, or evidence of leaks?
1 1
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any
❑ Yes ❑ No
R(1C
D
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
14)
Secondary Containment: If you answer "No" to any of the following items, you are not eligible for the
no exposure exclusion.
5
a. Is secondary containment provided for single above ground storage containers
❑ Yes ❑ No
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
Vp!1
b. Is secondary containment provided for above ground storage containers stored
❑ Yes ❑ No
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in close proximity to each other with a combined capacity of more than 1,320-
1�
gallons?
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c. Is secondary containment provided for any amount of Title III Section 313
❑ Yes ❑ No
`
Superfund Amendments and Reauthorization Act (SARA) water priority
chemicals?
d. Is secondary containment provided for any amount of hazardous substances?
❑ Yes ❑ No
e. Are release valves on all secondary containment structures locked?
❑ Yes ❑ No
Page 3 of 5
SWU-NE-110607 Last revised 11/06/07

NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes 0 No
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste IZ Yes ❑ No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes m No
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: Flourescent Bulbs, Printed Circuit Boards, Silk Screen rags, Solder Dross, Lead Acid batteries.
How Is material stored: In locked weather-proof Haz Material shed; in lined / 55 gallon drums & boxes for Bulbs
Where Is material stored: Hazardous Material shed
How many disposal shipments per year: 24 on average; required every 180 days
Name of transport / disposal vendor:,ECOFLO, Inc. 2750 Patterson St, Greensboro, NC 27407
vazl�: Electrum, 827 Martin St., Rahway, NJ. 07065
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 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.
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: Dick McLaughlin
Title: / H.R. Manager / Safety Coordinator
(Sig atureofAp ant) (Date igned)
Page 4 of 5
S W U-NE-110607 Last revised 11 /06/07

NCGNE0000 No Exposure Certification
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, of 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.
Final Checklist
This application should include the following items:
R This completed application and all supporting documentation.
V A map with the location of the facility clearly marked.
Mail the entire package to: ✓
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DWQ Regional Office for your area.
DWO Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........(919)
733-5083
Page 5 of 5
SWU-NE-110607 Last revised 11/06/07

Ownership Information:
Mr. Dail (listed below) is the owner of the building & property on which Chloride operates.
It is owned for investment purposes only.
Mr. Dail does not have anything to do with the operation or maintenance of this facility.
Chloride is responsible for the operation and all related compliance issues.
Mr. Curtis M. Dail (919) 779 - 7707 Wk
1976 Benson Rd, (919) 779 - 3547 Hm
Gamer, NC. 27529

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