NCGNE0554_COMPLETE FILE - HISTORICAL_20090223

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE U
DOC TYPE
VHISTORICAL FILE
DOC DATE
❑ Ulu) ��
YYYYMMDD

NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Jeff Weatherspoon
Colliers Pinkard
3110 Edwards Mill Road Suite 210
Raleigh, NC 27612
Dear Mr. Weatherspoon:
Division of Water Quality
Coleen H. Sullins
Director
February 23, 2009
Subject: No -Exposure Certification NCGNE0554
Clayton Distribution Center
1003 Shotwell Road, Clayton, NC
Johnston County
Dee Freeman
Secretary
���
MAR — Q
f tU
�DEPIR RALEIGH C„
1R_-,_ rF1Cf
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 23, 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 Brian Lowther at [phone], or at
[e-mail].
4k67.63Le'
cc: Raleigh Regional Office
Sincerely,
/,/., /Z� --� 9G7, � 3 7 6
for Coleen H. Sullins
Stormwater Permitting Unit No- Exposure Files
Wetlands and Stormwater Branch 1�r
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 One
1 Une l.al-Of 1 nd
Location: 512 N. Salisbury St. Raleigh, North Carolina 27664 l
qturl it `)�
n//
Phone: [phone] \ FAX: [phone] \ Customer Service: 1-877-623-6748 �b(
Internet: www.ncwaterquality.org p
An Enual Onnoeun,N \ Alfrmalive Action Emnlover

North Carolina
Beverly Eaves Perdue
Governor
Mr. Jeff Weatherspoon
Colliers Pinkard
3110 Edwards Mill Road Suite 210
Raleigh, NC 27612
Dear Mr. Weatherspoon:
®j®
NC®ENR
Department of Environment and
Division of Water Quality
Coleen H. Sullins
Director
February 23, 2009
Natural Resources
Subject: No -Exposure Certification NCGNE0554
Clayton Distribution Center
1003 Shotwell Road, Clayton, NC
Johnston 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 23, 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 Brian Lowther at [phone], or at
[e-mail].
Sincerely,
ORIGINAL SIGNED BY
for Coleen H. 9EINRICKLE
cc: Raleigh Regional Office
Stormwater Permitting Unit No- Exposure Files
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] \ FAX: [phone] \ Customer Service: 1.877-623-6748
Internet: www.ncwaterquality.org
An Enual Onnortunitv \ Affirmative Action Emnlwer
NorthCarolina
Naturally

Re: [I--wd: IFxvd: Re: Pending No hXposuresI]
Subject: Re: [Fwd: [Fwd: Re: Pending No [Exposures]]
From: Danny Smith <danny.smith@ncmail:net>--- -------
Date: Mon; 16 Feb 2009-1"1:42•:08 -0500
To:'Sa-ah Young <Sarah.Younga ncmai1.net>
e thanks! we will be on to of these from this y p. p point forward.
thanks!
danny
Sarah Young wrote:
we're planning on issuing these this week. cool?
Subject:
[Fwd: Re: Pending No Exposures]
From:
Sarah Young <[e-mail]>
Date:
Thu, 12 Feb 2009 13:25:39 -0500
To:
Roger Edwards <[e-mail]>, Belinda Henson
<[e-mail]>, Rob Krebs <[e-mail]>, Danny Smith
<[e-mail]>, Al Hodge <[e-mail]>, Belinda Henson
<[e-mail]>, [e-mail]
To:
Roger Edwards <[e-mail]>, Belinda Henson
<[e-mail]>, Rob Krebs <[e-mail]>, Danny Smith
<[e-mail]>, Al Hodge <[e-mail]>, Belinda Henson
<[e-mail]>, [e-mail]
Sorry. No, just sheet 1.
------------------------------
Subject:
Re: Pending No Exposures
From:
Rob Krebs <[e-mail]->
Date:
Thu, 12 Feb 2009 13:23:33 -0500
To:
Sarah Young <[e-mail]>
To:
Sarah Young <[e-mail]>
Sarah,
You have two sheets on the excel handout. I'm assuming we need to look at both?
M.
Sarah Young wrote:
Here's another updated no exposure back log list from the last time I sent it
out. I said I would issue these if I still hadn't heard from you by the end of
the week, but some of you indicated you wanted more time. Please let me know
ASAP if you need additional time. The rest of the backlog will be distributed
I oft 2/16/2009 12:58 PM

Hayes, Mitch
From: Young, Sarah
Sent: Thursday, July 23, 2009 4:11 PM
To: [e-mail]
Cc: Hayes, Mitch
Subject: No exposure app. and letter
Attachments: 07-23-2009(4).pdf, 07-23-2009(2).pdf
Mr. Phillips -
Attached are the no exposure certificate for your facility and the No Exposure Application that we got from your facility.
As you will note, the facility address is listed as 1003 on the application, so that's what it says on the letter. Furthermore,
the facility address we had listed for NCG060289 was 833 Shotwell Road, so we didn't know to rescind the permit when
we issued the NE. Only when Mitch Hayes did an inspection did he find that the facility had an No Exposure and we
could rescind the permit at that time. If you are certain of it, I will change the facility address to the correct address
(1053 Shotwell Road). Correct?
Sarah M. Young
DENR/DWQ/Wetlands and Stormwater Branch
1617 Mail Service Center
Raleigh, NC 27699-1619
phone:[phone]
fax:[phone]
http://h2o.enr.state.nc.us/ws/home.htm
Please note: my e-mail address has changed to sarah.vouna a.ncdenr.y
F-inail correspondence to and front this address may be subject to the
North Carolina Public Records Law and nrcry he disclosed to third parties.
"In the end, we will conserve only what we love.
We will love only what we understand.
We will understand only what we have been taught."
Baba Dioum -- Senegalese Conservationist

1
�r
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
February 23, 2009
Mr. Jeff Weatherspoon
Colliers Pinkard
3110 Edwards Mill Road Suite 210
Raleigh, NC 27612
Dee Freeman
Secretary
N L 61o662�S%
Subject: No -Exposure Certification NCGNE0554
Clayton Distribution Center
1003 Shotwell Road, Clayton, NC
Johnston County
Dear Mr. Weatherspoon:
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 23, 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 Brian Lowther at [phone], or at
b r i a n. l o wt h e r@ n c m a i l. n e 1.
Sincerely,
ORIGINAL SIGNED BY
for Colleen H. aMICKLE
cc: Raleigh Regional Office
Stormwater Permitting Unit No- Exposure Files
Wetlands and Stormwater Branch �0E
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 NOTthCarohl]a
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604 Phone: 919-807-M \ FAX: [phone] \ Customer Service: 1-877-623-6748 Naturally
Internet: www.ncwaterquality.org
An Enual OnnnrtuniN \ Affirmative Aclinn Emnlnver

NCDENR
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE00011
f fz_o
roe nchNcv usr; oul.v
Ilmc Received
Your Month
nu)'
Cenifcme or Coverage
N C G N E O c
NO EXPOSURE CERTIFICATION Please check here if this is a renewal: O RENEWAL
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit
based on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notice that your facility does not require permit
authorization for its 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.
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 II
"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 th z
would be mobilized in stormwater discharges (e.g., rock salt). 0.
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusi
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 Exposurey
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 must re -apply for the No Exposure Exclusion once every five
For questions, please contact the DWQ Regional Office for your area. (See page 5)
(Please print or type)
1) Mailing address of owner/operator
Name C&We
Contact -)09 k- F W rt r � r"
Street Address -- -� t�_retL}1 5 Z.l0
City State N L ZIP Code LX(P t 2-
Telephone No. _j.L k_ _] r1-I ^ ZI o q Fax: Esc'_..
2) Location of facility producing discharge:
Facility Name C A, i"o N
Facility Contact CrJ
Street Address ( O
City G
County
Telephone No. (I IS1
Page 1 of 5
State IV G ZIP Code _>-7,52,0
Fax: 4119
SWU-NE-071408 Last revised 7/14/2008

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). t-� w i 70 C Sf -to C144 +v- ArG
rd&SL Omoerl :: 4Da;e ✓r. eA A eN !-<i f
(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 1?KO
5) Is this a Federal facility? ❑ Yes R IVo
6) Latitude 35 30I 54 Longitude -79 2.8 `F x (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility
CV Existing
Date operation is to begin
Date operation began t 9 -7 7
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes 2"No
If yes, what is the NPDES Permit Number? ✓-F 9
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: q Z L
10) Provide a brief description of the types of industrial activities and products produced at this facet
n_r. � .—^ 4= t-O,- �i:4-11. SoN�4 /'dnOR ) A MA 14A.t1 m4r14 a A-rdc /dealt )—e
YZ2 )
Rd
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
IaTlo
❑ 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
I. 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 l3'No
❑ Yes
9-No
❑ Yes
171-No
❑ Yes
C!RIo
❑ Yes
la -No
❑ Yes
la -No
Page 2 of 5
SWU-NE-071408 Last revised 771412008

NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks,
❑ Yes 1VNo
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by
Cl Yes [?No
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes dNo
j. Application or disposal of process wastewater (unless otherwise permitted)
❑ Yes EVNo
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not
❑ Yes VNo
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 YNo
(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 t!rNo
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 C3'Yes Cl No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any [.?Yes ❑ No
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.
a. Is secondary containment provided for single above ground storage containers
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored
In close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for any amount of Title III Section 313
Superfund Amendments and Reauthorization Act (SARA) water priority
chemicals?
d. Is secondary containment provided for any amount of hazardous substances?
e. Are release valves on all secondary containment structures locked?
15) Hazardous Waste:
:;;'Yes ❑ No
GYYes ❑ No
WYes ❑ No
Gales ❑ No
dyes ❑ No
Page 3 of 5
SWU-NE-071408 Last revised 7/14/2008

NCGNE0000 No Exposure Certification
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: _
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:_
Vendor address:
16) Certification:
❑Yes Cho
❑ Yes 1,No
❑ Yes IlAo
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 qualities 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 systern, 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: _ GFF {�JCA f 9pQaN
Title: _. P r-"e-( {,n M A-M
Applicant)
b-D li
(Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion
Page 4 of 5
SWU-NE-071408 Last revised 7/14/2008

NCGNE0000 No Exposure Certification
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 Anicle 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:
❑ This completed application and all supporting documentation.
❑ A map with the location of the facility clearly marked.
❑ If this is a renewal, indicated current NCGNE number in Question 7.
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.
DWQ Regional Office Contact Information:
Asheville Office ....
Fayetteville Office .
Mooresville Office .
Raleigh Office ......
Washington Office
Wilmington Office.
Winston-Salem ....
Central Office ......
.. [phone]
..[phone]
..[phone]
.. [phone]
...[phone]
[phone]
[phone]
...[phone]
Page 5 of 5
SWU-NE-071408 Last revised 7/14/2008

Gqpsle-
C,:.

Hayes, Mitch
From:
Young, Sarah
Sent:
Monday, July 06, 2009 1:04 PM
To:
Hayes, Mitch; Nisely, Myrl
Cc:
Smith, Danny
Subject:
RE: NCG060273 - Smithfield Packing Company Inc.
If you all are comfortable with that then it's fine by me. I would suggest that someone let them know if they need to
apply for an NCG08 if, in fact, that is the case. I'll use this email as confirmation that the permit can be rescinded.
From: Hayes, Mitch
Sent: Monday, July 06, 2009 12:21 PM
To: Nisely, Myrl
Cc: Young, Sarah; Smith, Danny
Subject: NCG060273 - Smithfield Packing Company Inc.
Sarah, Myrl,
A Google search has confirmed that a new business, Burris Refrigerated Logistics, is now operating at 444 Gilbert Road,
the former address for Smithfield Packing Company Inc, in Benson, NC. httpf/www.burrislogistics.com/
I could do a site visit to confirm if you would like, but I think this may be sufficient. I recommend that the permit
NCG060273 for Smithfield Packing Company, Inc. be rescinded.
Mitch Hayes
Please note my email address has changed to mitch.haves(@ncdenr.Rov
Mitch Hayes, Environmental Specialist
NCDENR, Division of Water quality, Raleigh Regional Office
1628 MSC, Raleigh, NC 27699-1699
Voice: 919.791.4261-- Fax: [phone]
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties.
From: Nisely, Myrl
Sent: Monday, July 06, 2009 11:20 AM
To: Hayes, Mitch
Cc: Young, Sarah
Subject: Please Recon For Us
NCG060273 Smithfield Packing Company Inc —
Benson
Mitch, this company in Benson has
appealed for a rescission of this permit.
However, we need to know the status of
that building. If it has new owners, and
if they are carrying out the same kind of
industrial activity, the permit should just
have a change of ownership. Can you
take a look before long?
Thanks,
Myrl

Michael F. Easley, Govemor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director u
Y
August 22, 2008
Mr. Mike Teston
Raleigh Warhouse Facility
833 Shotwell Road
Clayton, NC 27520
Subject: Rescission of NPDES General Permit
Certificate of Coverage Number NCG060250
Raleigh Warehouse Facility
Johnston County
Dear Mr. Teston:
On February 8, 2007, the Division of Water Quality received you request to rescind your coverage under
stormwater discharge Certificate of Coverage Number NCG060250. In accordance with your request,
NPDES General Permit NCG060250 is rescinded, effective immediately.
Operating a treatment facility, discharging wastewater or discharging specific types of stonmwater to
waters of the State without valid coverage under an NPDES permit will subject the responsible party to a
civil penalty of up to $25,000 per day.
If the facility is in the process of being sold, you will be performing a public service if you would inform
the new or prospective owners of their potential need for NPDES permit coverage.
If you have questions about this matter, please contact Sarah Young at [phone], or the Water
Quality staff in our Raleigh Regional Office at [phone].
Sincerely,
P
Coleen H. Sullins
cc: Raleigh Regional Office w/attachments
Stormwater Permitting Unit
DWQ Central Files - w/attachments
Fran McPherson, DWQ Budget Office
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 [phone]
e ��A
`M
Wc—bENR
Customer Service
1-877-623-6749

r F'�V /1TF Michael F. Easley, Governor
oho R pG William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
1 Division of Water Quality
O 'C
August 23. 2002
DON BENNETT
RALEIGH WAREHOUSE FACILITY
833 SHOTWELL ROAD
CLAYTON. NC 27520
Subject: NPDES Stormwater Permit Renewal
Raleigh Warehouse Facility
COC Number NCG060250
Johnston County
Dear Permittee:
In response to your renewal application for continued coverage under general permit NCG060000. the Division of
Water Quality (DWQ) is forwarding herewith the reissued Stormwater general permit. This permit is reissued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between the state of North Carolina and the U.S. Environmental Protection Agency, dated December 6, 1983.
The following information is included with your permit package:
A new Certificate of Coverage
A copy of General Stormwater Permit NCG060000
A copy of a Technical Bulletin for the general permit
Your coverage under this general permit is not transferable except after notice to DWQ. The Division may require
modification or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law, rule, standard, ordinance, order, judgment, or
decree.
If you have any questions regarding this permit package please contact Aisha Lau of the Central Office Stormwater
and General Permits Unit at [phone], ext. 578
Sincerely,
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Stormwater & General Permits Unit Files
Raleigh Regional Office
ern
NCDERR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1- 800-623-7748

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
December 27, 2001
DON BFNNI 17
RALIIGH WARL"HOUSH RACII.,ITI'
833 SI-10'FW6LL ROAD
CLAYTON. NC 27520
Suhjecl: NPDIS Slonnwater Pcrnlit Renewal
RAI-E.IGH WARG1-I0US6 FACILITY
COC Numhet NCG060250
Johnston County
Dcar Pcnniucc:
Your LlCilitq is currently covered lot slonnwater discharge under Genend Permit NCG060000. "Phis permit cxpircs
off Au,list 31, 2002. 'Pile Division staff is currently in the process of rewi itin, this permit and is scheduled to have
the Per reissued by talc sumuner of-2002. Once the per is reissued, your facility would be efigiblu for
cuntinucd coverage under file rcissucd permit.
In order 10 assure your continued arverugc under file general permit, you must apply to file Division of Water
011olity (DWQ) for rcncwal of vuur permit coverage. To make this runewal process Casio, we arc informing you in
advance that your permit will be expiring. Hnclosed you will find a General Permit Coverage Renewal
Application Form. The applicaliun must be cunlplUcd and I-Clm'ned by March 4, 2002 in order to assure continued
coverage under the general permit.
I'ailurc to rcquesl IbnCwnl within this lime period 11MV result in n civil JSSCSSn1en1 Oftit Icast `F250.00. L:u'gcr
Penalties may be assessed depending un the delinquency of the request. Discharge of stnnmwalcr lions your I;icility
without coverage under ❑ valid slornlwalcr NPDBS pu'11111 would constitute a violation of NCGS 143-215.1 and
could result in asscssmmlIts of civil pcnallics of up 10 S 10.000 per day.
Please note that recent lCdcr:l legislation has extended the "no exposure exclusion" 10 all operators of industrial
facilities in ally of file I I categories of "storm water dischat es assucialed with industrial activity." (Cxcept
construction activilics). If you [CC[ your hIcilily can cmtily it condition of "no cxposurc", i.e. file I;Icihy industrial
nmteriols and operations arc not exposed to sturmwatcr, you can apply For file no cxposurc exclusion. For additional
infornlalion convect the Central Office Stormwatcr Still[ Incmher listed below or check the Slornlwatci & Gcnclal
1'enoits Unit Web Site in htlp://h2o.enr.stale.iic.tis/sti/slormwzitei.litiiil
II the subject sturmwatcr discharge to waters of the state has hccn tCI"11111MICd, please cOut pluc the enclosed
Rescission Request Form Mailing instructions arc listed un the bolloul of lot Ill. You will be notified when Ihu
rescission process has been completed.
]['You have any questions regarding the permit renewal procedures please contact Joe Alhislon of the Raleigh
Regional Office at 919-571-4700 ur Aisha Lau of the Ccntrul Office Sturmwatci Unit at [phone]. ext. 578
Sincerely.
Bradley Bonnet. Supervisor
Sh llowalel and Gencr:d Permits Unit
CC : Cenll-A Piles
Ralcil,h Rgnonal O ice
�°g A
NCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1647 [phone] Customer Service
1- 800-623-7748

r�F ?NATF/t Michael F. Easley, Governor
�• 0 /y�1 �� William G. Ross Jr., secretary
North Carolina Department of Environment and Natural Resources
r/ Gregory J. Thorpe, Ph.D.
L —I Acting Director
O C Division of Water Quality
AUG 2 7 2001 D °gust 24, 2001
Mr. Patrick Ross
Winn -Dixie Stores, I uirINR RALEIGH REGIONAL OFFICE(
5050 Edgewood Court ---
Jacksonville, FL 32254
Subject: General Permit No. NCG060000
Raleigh, North Carolina, Warehouse Facility
COC NCG060250
Johnston County
Dear Mr. Ross:
In accordance with your application for a discharge permit received on May 23, 2001 we are forwarding
herewith the subject certificate of coverage to discharge under the subject state — NPDES general permit. This
permit is issued pursuant to the requirements of North Carolina General Statute 143-215 .1 and the
Memorandum of Agreement between North Carolina and the US Environmental Protection agency dated May
9, 1994 (or as subsequently amended).
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division
of Water Quality. The Division of Water Quality may require modification or revocation and reissuance of the
certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Water Quality or permits required by the Division of Land Resources, Coastal Area Management
Act or any other Federal or Local governmental permit that may be required.
If you have any questions concerning this permit, please contact Aisha Lau at telephone number (919)
733-5083 ext. 578.
- �pilrtt�nt�irgr�
YLI F--77tb�r N. I'h r.�
Gregory J.-Thorpe, Ph.D.
cc: Raleigh Regional Office
Central Files
Stormwater and General Permits Unit Files
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
pw
FB
Customer service
1 800 623-7748

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER -QUALITY
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060250
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Winn -Dixie Stores, Inc.
is hereby authorized to discharge stormwater from a facility located at
Raleigh, North Carolina, Warehouse Facility
833 Shotwell Road
Clayton
Johnston County
to receiving waters designated as the Neuse River, a class WS V NSW stream in the Neuse River Basin in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III, IV,
V, and VI of General Permit No. NCG060000 as attached.
This Certificate of Coverage shall become effective August 24, 2001.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day August 24, 2001.
C7'3- W,,LT4- w
Gregory J. Thorpe, Ph.D., Acting Director
Division of Water Quality
By Authority of the Environmental Management Commission

STATE
0
0

A7 r
N�DENR
„�uw. r
frimx✓iH ua� Nma^��PiV1�a!nv
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000
FOR AGENCY USF ONLY
lu R ,6,,j
Year
Numh
I My
I
Ccnil ianc of Couiagc
N FCTGFNTFTCT574� It
NO EXPOSURE CERTIFICATION Please check here if this is a renewal. ❑ RENEWAL
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit
based on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notice that your facility does not require permit
authorization for its 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.
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 I S
"Sealed" means banded or otherwise secured and with locked or non -operational taps or valves; 5
adequately maintained vehicles used in material handling; and final products, other than products th a
would be mobilized in stormwater discharges (e.g., rock salt). P
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusif
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 must re -apply for the No Exposure Exclusion once every five
For questions, please contact the DWQ Regional Office for your area. (See page 5)
(Please print or type)
1) Mailing address of owner/operator
Name CD I I e
Contact R r 5 P 00 N
Street Address Ip LQwA_t Ls (A:t1 A 5w.�� Z10
City fife :Sh State Ne. ZIP Code L i(o /Z
Telephone No. 91 15 -2 - ZI o q Fax: 5119 �- o Lb a
2) Location of facility producing discharge:
Facility Name C(A��oN b:5�'rabu�Ao, 6:_ A_-r
Facility Contact
Street Address
City
County
Telephone No.
Page 1 of 5
SWU-NE-071408 Last revised 7/14/2008

3

e
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). fi er y 70 CA-Sf -fo CI A-1 iv . Af 6
-f rrN leifoni ShaTwct rarrdt, r'oQcr{ ;s rk ra?C. }'zn�:le arr Lift
(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 14I_Ko
5) Is this a Federal facility? ❑ Yes iiiAo
6) Latitude 35 501 54 Longitude 7$ 2-9 4 K (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
LV Existing Date operation began / 9 -7 7
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE_
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes E-rNo
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: `_f L L `fL21
10) Provide a brief description of the types of industrial activities and products produced at ' this fa ity:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
D,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 ❑ Yes e3"No
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks
❑ Yes
D§ No
c. Materials or products from past industrial activity
❑ Yes
C3-No
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
A qo
e. Materials or products during loading/unloading or transporting activities
❑ Yes
19-No
I. Materials or products stored outdoors (except final products intended for outside
❑ Yes
Iallo
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
Page 2 of 5
SWU-NE-071408
Last revised 7/14/2008

NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes 5/No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes EeNo
the discharger
Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes f�(No
Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes 13'No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes IVNo
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 Q 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 [!(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
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or E;?"Yes El No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any [Yes ❑ No
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.
a. Is secondary containment provided for single above ground storage containers
GYYes ❑ No
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored
GYYes ❑ No
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for any amount of Title III Section 313
[e'i'es ❑ No
Superfund Amendments and Reauthorization Act (SARA) water priority
chemicals?
d. Is secondary, containment provided for any amount of hazardous substances?
Ur'Yes ❑ No
e. Are release valves on all secondary containment structures locked?
15) Hazardous Waste:
R(Yes ❑ No
Page 3 of 5
SWU-NE-071408 Last revised 7/14/2008

NCGNE0000 No Exposure Certification
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste:
How is material stored:_
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
16) Certification:
❑ Yes 1-9,No
❑ Yes GYNo
❑ Yes L4'No
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: SG(:F WCA R-e 15f!6a1\1
Title: P r "e f +H M" Acw r
Si tv e 1 Applicant) (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
Page 4 of 5
SWU-NE-071408 Last revised 7/14/2008

NCGNE0000 No Exposure Certification
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.
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 marked.
❑ If this is a renewal, indicated current NCGNE number in Question 7.
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 DWO Regional Office for your area.
DWQ 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)
807-6300
Page 5 of 5
SWU-NE-071408 Last revised 7/14/2008

Ggg8le-
Maps

Re: National Guard No exposures
Subject: Re: National Guard No exposures
From: Samar Bou-Ghazale <[e-mail]>
Date: Thu, 22 May 2008 16:58:03 -0400
To: Sarah Young <[e-mail]>
Sarah,
I inspected today The NC National Guard in Taylorsville(NCG080569), Newton
(NCG080504), Kings Mountain (NCG080554), Lincolnton (NCG080494), and
Monroe(NCG080499). All of the above facilities have no exposure to Stromwater. I
did not inspect Albemarle (NCG080531) because it have seen enough of these facilities
and I believe that Albemarle facility is similar to all other facilities. On the
other hand, Mooresville, Gastonia and Belmont facilities have been inspected by Alan
Johnson previously and these facilities have no exposure to stormwater as well.
Sorry for the delay, but we have a lot on our plate.
Take Care
Thanks
samar
Sarah Young wrote:
Please respond on the remaining National Guard No Exposures by the end of this
week if possible. Thanks for all your help! -Sarah
Samar Bou-Ghazale - [e-mail]
Environmental Engineer II
North Carolina Dept. of Environment & Natural Resources
Div. of Water Quality
610 E. Center Ave.,. Suite 301
Mooresville, NC 28115
Ph: [phone] Fax: [phone]
I of 1 6/19/2008 10:31 AM

Wo� Permit Coverage
Rescission Request Form Certificate of Coverage Number
National Pollutant Discharge Elimination System NCGO80554
General Permit NCG080000
Please fill out.and return this form only if you no longer need to maintain your NPDES stormwater permit.
The following is the information currently in our database for your facility. Please review this information carefully and
make all corrections as necessary in the space provided to the right of the current information.
Facility Information
Facility Name: NC Nat Gd- Kings Mountain
Facility Physical Address: 200 Phifer Rd
Kings Mountain, NC 28086
Facility Contact:
Mailing Address:
Phone Number:
Fax Number
Email Address
Permit Information
Permit Contact: Vickie A Dudick
Mailing Address:* 4105 Reedy Creek Rd
Raleigh, NC 27607
Phone Number: 919-664-6n4v Ext.
Fax Number:
Email Address
* This is the address to which the permit rescission notice will be mailed
Reason for rescission request (this is required information):
REQUEST AND CERTIFICATION
I, as an authorized representative, hereby request rescission of certificate of coverage NCG080554 under NPDES
Stormwater General Permit NCG080000 for the subject facility. I am familiar with the information contained in this
request and to the best of of my knowled and belief such information is true, complete and accurate.
Signature t/1 Cam--✓ � Date FEB 2 8 2007
Print or type name of person signing above
Please return this completed rescission request form to:
VICKIE A. DUDICK
Director of Environment &
Natural Resources
Title
SW General Permit Coverage Rescission
Stormwater Permitting Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

.i ,
I-!/t—elarr z
United States Environmental Protection Agency Form Approved
9 Y OMB No. 2040-0211
NPDES ;/ ��� Washington, TI N 60
fo
FORM `r►' NO EXPOSURE 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 tightly sealed, provided those containers are not deteriorated and do not leak. 'Sealed'
means banded or otherwise secured and without operational taps 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 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, 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 Informations 1� /� �] // ww
1. Name: IVI IC Yj I IEI V 11)1P It jr, kj II I I�/ I IOI I I r�I r�I 12. Phone: RI i 191 b6I711AI A�
3. Mailing Address: a. Street: ��Ail Ifl15i RE F-DlrI �tIZ661 - iV4P I I I I I 1 1 1 1_ 1_I-_lI 1 �/ ryf
b. City le�J FI 161 {ir c. Slate: 1�-6 d. Zip Code: LLI%1(.01 r 1- 16141 t 1 `�I
B. Facility/Site Location Information
1. Facility Name: IKII N 0I51 nnIIl!I01 01MI T'IAI 1011ITTNI VIT11 IDI0JIAt Ll 1G1u1AI rV 0
2. a. Street Address: A Q'0 IrIRI( IFIEIRI 1A01A4 NI 1 11 1 1 1 1 1 1 1 1 1 1 1 1 1 I -
b. City: III ifINl GISI 144 of M N I TIAI I II�/A)I I I I I I I I I I c. County: CIt I t I ✓l t I t-I �t k I
d.State: INC] e. Zip Code: ZIIaIah6I-I I I I
3. Is the facility located on Indian Lands? Yes No
4. Is this a Federal facility? ��Yes �. No fA
5. a. Latitude: I3J r A � 1 b. Longitude: II Lq `t r I lops
6. a. Was the facility or site previously covered under anNPDES storm water permit? Yes ® No
b. If yes, enter NPDES permit number: KC1709000 0
7. SIC/Activity Codes: Primary: 17151 31 9 Secondary (if applicable): I
8. Total size of site associated with industrial activity: -7. I li acres
9. a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure exclusion? Yes ❑ No
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 rase you could be required to obtain permit coverage.
Less than one acre ❑ One to two acres Q More than five acres ❑
EPA Form 3510-11 (10-99) Page 1 of 4

NPDES /� Form Approved
FORM \�A/E�/`1 NO EXPOSURE CERTIFICATION for Exclusion from - 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
❑
0
3. Materials or products from past industrial activity
❑
sa
4. Material handling equipment (except adequately maintained vehicles)
El
54
5. Materials or products during loading/unloading or transporting activities
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
8. Materials or products handled/stored on roads or railways owned or maintained by the discharger
❑
9
9. Waste material (except waste In covered, non -leaking containers [e.g.. dumpsters])
❑
V
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
❑
tz
(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 penalty 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)).
I 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 1 must
allow the NPDES permitting authority, 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 that I must obtain coverage under an NPDES permit prior
to any point source discharge of storm water 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.
Print Name:
Print Title:
Signature:
Date: 07(�
EPA Form 3510-11 (10-99) Page 2 of 4