HomeMy WebLinkAboutNCGNE0670_COMPLETE FILE - HISTORICAL_20100114STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
O HISTORICAL FILE
DOC DATE
❑ aDl U U I I
YYYYMMDD
�r
NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Mr. Steve Brown
Director of Public Works and Utilities
400 James Jackson Ave.
Cary, NC 27513
Dear Mr. Brown:
Division of Water Quality
Coleen H. Sullins
Director
January 12, 2010
Subject: No -Exposure Certification
Cary Fleet Maintenance F
Cary
Wake County
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 and a
facility inspection made with Ms. Carolyn Lewis on 1/11/2010, 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.
We are also hereby rescinding your current permit Certificate of Coverage, NCG080798.
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 unpermitted discharge (subject to civil penalties of
up to $25,000 per day). Your conditional no -exposure exclusion does not expire. You will receive another letter in
coming weeks that explains this change in policy from a permit that expired every five years.
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,
myri.nisely@ncdenr.gov
please contact Myrl Nisely at (919) 791-4200 or at
Since ly, 1
for Coleen H. ullins
cc: RRO Stormwater Permitting File NCG080798
Stormwater Permitting Unit No -Exposure -Files Fran McPherson -Budget Office
City of Raleigh Stormwater Unit Wake County Stormwater Unit
North Carolina Division of Water Quality 1628 Mail Service Center Raleigh, NC 27699-1628 Phone (919) 791-4200
Internet: www.ncwatercualiN.ora Location: 3800 Barrett Drive Raleigh, NC 27609 Fax (919) 788-7159
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper
ne
N( hCarolina
�l alima!!y
Customer Service
1-877-623-6748
Z Division of Water Quality
Division of Soil and Water Conservation
❑ Other Agency
Facility; Number : Facility Status: Active Permit: NCGNE0670 ❑Denied Access
Inspection Type: Reconnaissance Inactive or Closed Date:
Reason for Visit: Routine County: Wake Region: Raleigh
' Date of Visit: 01/11/2010 Entry Time: 10:00 AM Exit Time: 10A0 AM
JFarm Name: Fleet Maintenance Facility
Owner: Iown of Cary
Incident #:
Mailing Address: 400 James a k on AveCary NC 275128005
Physical Address: 400 James Jackson Ave Cary NC 275128005
Facility Status: ® Compliant ❑ Not Compliant Integrator:
Location of Farm:
, Latitude:
Longitude:
From Raleigh-C 54 West Chapel Hill Road. Left on NW Maynard Road Right on James Jackson Avenue Facity is on the right.
Question Areas:
Certified Operator: Operator Certification Number:
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
Primary Inspector: Myrl Nisely Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
This inspection was carried out with the help of Ms. Carolyn Lewis to determine whether the facility qualifies for No Exposure
certification. A roofed fueling station is well cared for, with absorbant products on the island for emergencies. The outsides of the
pumps are washed down 2x per year. The curb drain has petroleum absorbant filter material in it, as do all the drains on this site. The
stormwater flow is joined by runoff from the street, and it all goes to a retention pond. Samples taken in June showed very low TSS
(10 vs benchmark 100) and Oil and Grease (3 vs benchmark 30). Most of the vehicles in the lot are police cars, with few garbage
trucks. Garbage trucks are washed out before entering this site for repairs. Repaired vehicles are rinsed in an outdoors wash bay
with a drain and containment, then parked on a pervious concrete area until picked up. If a vehicle arrives with known fluid leakage, an
absorbent pad is placed under the drip before the keys are accepted by the maintenance crew. Batteries are stored in ametal\
cabinet. Oil filters are diposed of in special containers. All chemicals are stored in the building. There is a special shed for small
impliments such as weed cutters. Employee training is given at least annually, and Ms. Lewis makes random weekly inspections of
the facility to check on the stormwater protection program.
Page:1
North Carolina
Beverly Eaves Perdue
Governor
e��I.
NCDENR
Department of Environment and
Division of Water Quality
Coleen H. Sullins
Director
January 12, 2010
Mr. Steve Brown
Director of Public Works and Utilities
400 James Jackson Ave.
Cary, NC 27513
Natural Resources
Subject: �No=ExExposure Certification NCGNE06703
Cary Fleet Maintenance Facility
Cary
Wake County
Dear Mr. Brown:
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 and a
facility inspection made with Ms. Carolyn Lewis on 1/11/2010, 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.
We are also hereby rescinding your current permit Certificate of Coverage NCG080798.
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 unpermitted discharge (subject to civil penalties of
up to $25,000 per day). Your conditional no -exposure exclusion does not expire. You will receive another letter in
coming weeks that explains this change in policy from a permit that expired every five years.
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 Myrl Nisely at (919).791-4200 or at
myrl.nisely@ncdenr.gov
Since ly, 1
for Coleen H. ullins
cc: RRO Stormwater Permitting File NCG080798
Stormwater Permitting Unit No -Exposure Files Fran McPherson -Budget Office
City of Raleigh Stormwater Unit Wake County Stormwater Unit
North Carolina Division of Water Quality 1628 Mail service Center Raleigh, NC 27699-1628 Phone (919) 791-4200
Internet: www.ncwateroualitv.or i Location: 3800 Barrett Drive Raleigh, NC 27609 Fax (919) 788-7159
An Equal Opportunity/Affirmative Action Employer— 50°/ Recycled/10% Post Consumer Paper
One
No Carolina
Wffra!!il
Customer Service
1-877-623-6748
Division of Water Quality
❑ Division of Soil and Water Conservation
❑ Other Agency
Facility Number: Facility Status: Active Permit: NCGNE0670 ❑ Denied Access
Inspection Type: Reconnaissance Inactive or Closed Date:
Reason for Visit: Routine County: Wake Region: Raleigh
Date of Visit: 01111/2010 Entry Time: 10:00 AM Exit Time: 10:40 AM Incident #:
Farm Name: Fleet Maintenance Facility Owner Email: kim.fishe(atownofcary
Owner: Town of Cary Phone: 919-469-4092
Mailing Address: 400 James Jackson Ave Cary NC 275128005
Physical Address: 400 James Jackson Av Cary NC 275128005
Facility Status: E Compliant ❑ Not Compliant Integrator:
Location of Farm:
Latitude:
Longitude:
From Raleigh-C 54 West Chapel Hill Road. Left on NW Maynard Road Right on James Jackson Avenue Facity is on the right.
Question Areas:
Certified Operator:
Secondary OIC(s):
On -Site Representative(s): Name
Operator Certification Number:
Title
Primary Inspector: Myrl Nisely Phone:
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
Date:
Phone
This inspection was carried out with the help of Ms. Carolyn Lewis to determine whether the facility qualifies for No Exposure
certification. A roofed fueling station is well cared for, with absorbant products on the island for emergencies. The outsides of the
pumps are washed down 2x per year. The curb drain has petroleum absorbant filter material in it, as do all the drains on this site. The
stormwater flow is joined by runoff from the street, and it all goes to a retention pond. Samples taken in June showed very low TSS
(10 vs benchmark 100) and Oil and Grease (3 vs benchmark 30). Most of the vehicles in the lot are police cars, with few garbage
trucks. Garbage trucks are washed out before entering this site for repairs. Repaired vehicles are rinsed in an outdoors wash bay
with a drain and containment, then parked on a pervious concrete area until picked up. If a vehicle arrives with known fluid leakage, an
absorbent pad is placed under the drip before the keys are accepted by the maintenance crew. Batteries are stored in a metal
cabinet. Oil filters are diposed of in special containers. All chemicals are stored in the building. There is a special shed for small
impliments such as weed cutters. Employee training is given at least annually, and Ms. Lewis makes random weekly inspections of
the facility to check on the stormwater protection program.
Page:1
0
✓SK
F-EMA Division of Water Quality If Surface Water Protection
w�
NC®ENR National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000
FOR AGENCY USE ONLY
Date Received
Year I Month
I Da
O 11 12-12
Certificate oNICIGINf Coves e
NO EXPOSURE CERTIFICATION Please check here it 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 notification that your facility does not require a
permit for stormwater discharges associated with industrial activity in the State of North Carolina because
it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means all
industrial materials and activities are protected by a storm resistant shelter (with some exceptions) to
prevent exposure to rain, snow, snowmelt, and/or runoff.
For permitted facilities in North Carolina, DWO must approve your application for No
Exposure Certification before this exclusion is effective. Until you are issued a No
Exposure Certification and your NPDES permit is rescinded, your facility must continue
to abide by the terms and conditions of the current permit. 17 —
Industrial materials or activities include, but are not limited to: material handling equipment or ac iH
t w1l
industrial machinery, raw materials, intermediate products, by-products, final products, or waste ct
1
Material handling activities include the storage, loading and unloading, transportation, or conveys e f
l�V
any raw material, intermediate product, final product or waste product. A storm resistant shelter i
required for the following industrial materials and activities: drums, barrels, tanks, and similar co rs
p
that are tightly sealed, provided those containers are not deteriorated and do not leak. "Sealed" m '
banded or otherwise secured and with locked or non -operational taps or valves; adequately maint
vehicles used in material handling; and final products, other than products that would be mobiliz
stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each /acility 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 6)
(Please print or type)
1) Mailing address of owner/operator
Contact
Street Address
City
Telephone No.
SW U-NE-021309
�►L�iT��l�'�
Page 15of,,7 r
I
i
JM � 4 2016
Last revised 2/13/2009
MR) A - IIAL
NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name 54657 Ml///Jr,-'5& A1C6 154UL/%il
Facility Contact
Street Address
City
County
Telephone No.
3) Physical location information:
State-&r_ZIPCode oZ7S/3
Please provide a narrative description of how to get to the facility (use street
distance and direction from a roadway intersection). T il/YAi1�_
(A copy of a map with
on it should be included with the
4) Is the facility located on Native American Lands? ❑ Yes RNo
state oad num ers, and
9
ific
PL< ih�D FCf,ETG
ation application.)„
5) Is this a Federal facility? ❑ Yes VNo
6) Latitude 35'47 1,5!!iLongitude ° 'I $ �� (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
VK Existing Date operation began /
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? OeYes ❑ No
If yes, what is the NPDES Permit Number? &6 4M M
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: 0 Q Q
10) Provide a brief description of the types of industrial activities and products produced at this facility:
G!dGT, GGEETAf/1wa2st�" iyEU.UEi
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
f3'No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SWU-NE-021309 Last revised 2/13/2009
-•—f
�.� e
.�
,;
. k:'
:�
r•'
<5�
:r . '
IN
or
R: fJ Fir �,�Y �•,�t�y�l� •S I � a •y w� Ly
y `�r frj' � r t•C [A�. � + �, �' `` i . i..._: '`^�\ fl .' � p � � � �+
q=`
��"'�"'-tom` ,. \ '� �i 9 ✓: .a �� - 5\11�.
+
.-.
NCGNE0000 No Exposure Certification
Exposure Checklists (11- 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 "o ❑ N/A
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 ii(No O N/A
c. Materials or products from past industrial activity ❑ Yes eNo ❑ N/A
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes W'No ❑ N/A
e. Materials or products during loading/unloading or transporting activities ❑ Yes 16 No ❑ N/A
I. Materials or products stored outdoors (except final products intended for outside ❑ Yes fi (No ❑ N/A
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes VNo ❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes "o ❑ WA
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes 93'No o N/A
j. Application or disposal of process wastewater (unless otherwise permitted) O Yes "o ❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ❑ No "/A
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 EfNo O N/A
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes R No ❑ WA
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 no
eligible for the no exposure exclusion.
a. Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or ❑ Yes ❑ No HUA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No M ITA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-021309 Last revised 2/13/2009
1 \<
��' �.. r •• ..
...
\..
..
NCGNE0000 No Exposure Certification
14) Secondary Containment: 11 you answer "No" to any of the following Items, you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for single above ground storage containers ❑ Yes []No @'N/A
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored ❑ Yes O No 59'N/A
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund ❑ Yes ❑ No VN/A
Amendments and Reauthorization Act (SARA) water Priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40 ❑ Yes ❑'No L9*A
CFR §116?
e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No a'N/A
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
❑ Yes KNo ❑ N/A
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste
t"Yes ❑ No ❑ N/A
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
❑ Yes "o ❑ N/A
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: ?t LEA56 SEE a bi i Ti1(x1ED
S+IEE TS
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport / disposal vendor:
Vendor address:
Footnotes to Questions 14) c. & d.
'Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for de minimis amounts of certain substances,
and/or other qualifiers, as described in the exemptions from reporting requirements of Title III SARA 313 in 40 CFR
§372.38.
"Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for amounts less than the Reportable Quantities
of the hazardous substances listed in 40 CFR §117.3.
Page 4 of 7
SWU-NE-021309 Last revised 2/13/2009
._ -
_
_ _.
.
_1
..
�
.
_T
_
�
..
?
_
_
s .
"i
�
_
_
15) Hazardous Waste:
b) Small Quantity Generator (Everything is recycled)
Type of waste: Used Battery cores
How it is stored: Hazmat cabinet on shelves, limit 24
Where it is stored: secondary containment, on pallet, outside
How many disposal shipments per year: every 6 weeks
Name of transport/ disposal vendor & address: NAPA (space is leased from
Town of Cary) 420 James Jackson Ave, Cary, NC 27513
Type of chemical: New Brake Fluid
How it is stored: 55 gal. drum w/secondary containment
Where it is stored: Indoors, chemical supply room
How many disposal shipments per year: quarterly
Name of transport/ disposal vendor & address: NAPA
Type of chemical: New Transmission Fluid
How it is stored: 55 gal. drum w/secondary containment
Where it is stored: Indoors, chemical supply room
How many disposal shipments per.year: quarterly
Name of transport/ disposal vendor & address: Safety Kleen
5360 Legacy Drive, Plano, Texas 75024
Type of chemical: New Antifreeze
How it is stored: 55 gal. drum w/secondary containment
Where it is stored: Indoors, chemical supply room
How many disposal shipments per year: quarterly
Name of transport/ disposal vendor & address: Safety Kleen
Type of waste: Used Tires
How it is stored: Tire recycling container
Where it is stored: Outside
How many disposal shipments per year: 3 to 6 months
Name of transport/ disposal vendor & address: Waste Management
10411 Globe Road, Morrisville, 27560
Type of chemical: Biodegradable Hydraulic Oil
How it is stored: 500 gal cylinder
Where it is stored: Indoors, chemical supply room
How many disposal shipments per year: quarterly
Name of transport/ disposal vendor & address: Safety Kleen
Type of chemical: 10W40 Oil
How it is stored: 500 gal cylinder
Where it is stored: Indoors, chemical supply room
How many disposal shipments per year: 3 months
Name of transport/ disposal vendor & address: Safety.Kleen
S
_�� , ,.... .Y, I � ..: !_ <(•,.S' .'i'., .. ,fir i _ C._ ..
?' <. °.7ir •a',.. �... !_ •! C. .: 1�a,rl is '. .�' r :S;
Type of waste: Used Antifreeze
How it is stored: Plastic drum with lock and label
Where it is stored: Outdoors
How many disposal shipments per year: quarterly
Name of transport/ disposal vendor & address: Safety Kleen
Type of waste: Used Oil Filters (crushed and drained)
How it is stored: Metal and plastic bin with lock and label
Where it is stored: Outside
How many disposal shipments per year: quarterly
Name of transport/ disposal vendor & address: Safety Kleen
Type of waste: Mix of all oils and fluids
How it is stored: underground storage tank
Where it is stored: "
How many disposal shipments per year: 4-5 time per year
Name of transport/ disposal vendor & address: Safety Kleen
'C:: � h
. 1 . � � . ..
IJL •A ..� � :�lYl l.I 11 ��'.. .. r i.�'�r, t. .r .`��.
! 1 •rr. 'iL '.�II'1�
_. �
�
�
� t ,
1
-. .�. P
NCGNE0000 No Exposure Certification
16) Other information: If you answer "Yes" to any of the following items, you might not be eligible for the
no exposure exclusion. A more in-depth evaluation of the site circumstances may be required.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? ❑ Yes 6,'No ❑ N/A
b. Does your facility have coal piles on site?
❑ Yes M/No ❑ N/A
c. Does your facility store other fuel sources outside in piles, such as wood chips,
❑ Yes KrNo ❑ N/A
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
❑ Yes VNo 0 N/A
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit?
❑ Yes ❑ No q(N/A
Please specify:
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5 of 7
SWU-NE-021309 Last revised 2/13/2009
NCGNE0000 No Exposure Certification
17) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no
exposure' and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that there are no discharges of stormwater contaminated by exposure to industrial activities
or materials from the industrial facility or site identified in this document (except as allowed under 40 CFR 12226(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 Si niing: e 1 eVi J . E r o W V�
Title: -DI ��tar a
IZ•IS-O
(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.
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.
Page 6 of 7
SWU-NE-021309 Last revised 2/13/2009
NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
❑ This completed application and all supporting documentation.
❑ A map with the location of the facility clearly marked.
❑ If this is a renewal, indicated current NCGNE number in Question 7.
❑ If the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8.
Mail the entire package to:
Stormwater Permitting Unit
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.
DWO Regional Office Contact Information:
Asheville Office ......
(828) 296-4500
Fayetteville Office ...
(910) 433-3300
Mooresville Office ...
(704) 663-1699
Raleigh Office ........
(919) 791-4200
Washington Office ...(252)
946-6481
Wilmington Office ...
(910) 796-7215
Winston-Salem ......
(336) 771-5000
Central Office .........(919)
807-6300
Page 7 of 7
SWU-NE-021309 last revised 2/13/2009