NCGNE0927_COMPLETE FILE - HISTORICAL_20131014

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE��
DOC TYPE
VHISTORICAL FILE
DOC DATE
❑ LLLLL_L_�1
YYYYMMDD

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
Land Quality Section Pat McCrory, Governor
Tracy E. Davis, PE, CPM " " ` John E. Skvarla, III, Secretary
Director
October 14, 2013
Mr. Steven Snyder
Reser's Fine Foods - Don Pancho Authentic Mexican Foods
11075 Highway 903
Halifax, NC 27839
Subject: Approval of No -Exposure Certification
Don Pancho Authentic Mexican Foods
NCGNE0927
Halifax County
Dear Mr. Snyder:
The Division of Energy, Mineral and Land Resources (DEMLR) has reviewed your submittal of the No -
Exposure Certification for Exclusion from the NPDES Stormwater Permitting form and made a site visit to
assess the potential for stormwater pollution. Based on our observations and 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 (subject to civil penalties of up to $25,000 per day). Your conditional no -exposure exclusion
does not expire. However, you must self re -certify annually, or obtain NPDES permit coverage for any
stormwater discharges from your facility. Please retain the completed re -certification forms to have
them available during future inspections by DEMLR.
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Drive, Raleigh, North Carolina 27609 nrOne
Phone: [phone] FAX: 919-571 A718 NorthCarolina
Internet http:pnity\Acdmative Action
rl ;Vat1 lly
An Equal Opportunity l Affumative Action Employer K s� Kl bts

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 Dave Parnell at [phone] or at
[e-mail].
Sincerely,
J n L. Holley, Jr., PE, CPESC
egional Engineer
Raleigh Regional Office
cc: DEMLR Central Files - with attachment
Stormwater Permitting Program Files - with attachment
Raleigh Regional Office DEMLR No Exposure Files - with attachment
1628 Mail service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Drive, Raleigh, North Carolina 27609 �rOne
Phone: [phone] FAX: [phone] v orth Caro f I na
Internet: ht!pOpportunity
nA denr mati,e coon rl Nafu"al�b
An Equal Opportunity \ Affumative Action Employer [ `

Permit: NCGNE0927 Effective:
SOC: Effective:
County: Halifax
Region: Raleigh
Compliance Inspection Report
Expiration: Owner: Resets Fine Foods
Expiration: Facility: Don Pancho Authentic Mexican Foods
11075 Highway 903
Contact Person: Steven Snyder Title:
Directions to Facility:
from 195 exit on to exit 168 rt 903 head east 1 mi on left
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 10/01/2013 Entry Time: 12:00 PM
Primary Inspector: David R Parnell
Secondary Inspector(s):
Halifax NC 27839
Phone: [phone]
Certification:
Exit Time: 01:00 PM
Phone:
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ■ Compliant O Not Compliant
Question Areas:
Miscellaneous Questions . Misc
(See attachment summary)
Page: 1

Permit: NCGNE0927
Inspection Date: 10/01/2013
Inspection Summary:
Misc
Is the facility compliant?
Owner - Facility: Resets Fine Foods
Inspection Type: compliance Evaluation
Reason for Visit: Routine
Yes No NA NE
■ O ❑ ❑
Comment: Housekeeping and cleanup have been significant and a No Exposure can
now be permitted.
Page:2

Q= r NNR
North Carolina Department of Environment and Natural Resources,
Division of Energy Mineral and Land Resources
i Land Quality. Section Pat McCrory, Governor
Tracy E. Davis PE,.CPM John'E.•Skvarla, III, Secretary
- Director
.October 14, 2013 -
Mr Steven Snyder
Reser•'s-Fine Foods- Don Pancho Authentic Mexican Foods
11075 Highway 903 -'
Halifax, NC 27839
a .
Subject:. Approval of No -Exposure Certification
Don Pancho Authentic Mexican Foods ; r:
NCGNE0927'`''
Halifax County..
Dear Mh Snyder:,.. ,
The Division of Energy, Mineral andi,Land Resources (DEMLR) has reviewed your -submittal of the No- ,
Exposure Certification for Exclusion from -the NPDES.Stormwater;PermittingI form and made a site visit to
assess the otentiai p fo'r.'stormwaterpollufion. Based on ou'r observations and your submittal and signed.
certification'of.no exposure at the above referenced facility, the Division is granting your conditional,,
exclusion from,permitting-as providedrforunder 40 CFR 126'22(g), which is incorporated by reference int
North Carolina regulations. .
Please note that by our acceptance of your no,exposure certification, you are obligated to maintainno=
exposure conditions atyour 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 (subject to civil'penalties'of up to $25,000 per.day). Your conditional'no-exposure exclusion
-does not expire. However, you must self re -certify annually, or obtain NPDES permit coverage for any
stormwater discharges from your facility.' Please retain the completed're-certification forms to have
them available during future inspections by DEMLR.
1628 Mail Service Center, Ralegh, North Carolina 27699-1628
Location: 3800 Barrett Drive, Ra fth, North Carolina 27609 One
Phone: 919-791A2001 FAX: 919-571A718 NorthCarolina
Internet http:portalAffir active ctionE 1atunall
An Equal OppoMnirylAffirrnative Action Employer [i/�/ s[t

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 Dave Parnell at [phone] or at
david.parnellPricdenr gov.
Sincerely,
J n L. Holley, Jr., PE, CPESC
egional Engineer
Raleigh Regional Office
cc: DEMLR Central Files - with attachment
Stormwater Permitting Program Files - with attachment
Raleigh Regional Office DEMLR No Exposure Files - with attachment
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Drive, Ralegh, North Carolina 27609 One
Phone: [phone] FAX: [phone] NOrthCaT'Olina
Internet http:portaLnchmative M1tionEl Natulally
An Equal Opportunity 1 Affirmative Action Employer K l

Permit: NCGNE0927 Effective:
SOC: Effective:
County: Halifax
Region: Raleigh
Compliance Inspection Report
Expiration: Owner: Reser's Fine Foods
Expiration: Facility: Don Pancho Authentic Mexican Foods
11075 Highway 903
Contact Person: Steven Snyder Title:
Directions to Facility:
from 195 exit on to exit 168 rt 903 head east 1 mi on left
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 1010112013 Entry Time: 12:00 PM
Primary Inspector: David R Parnell
Secondary Inspector(s):
Halifax NC 27839
Phone: [phone]
Certification:
Exit Time: 01:00 PM
Phone:
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
0 Miscellaneous Questions E Misc
(See attachment summary)
Page:1

Permit: NCGNE0927 Owner -Facility: Resets Fine Foods
Inspection Dale: 10/01/2013 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Mist;
Is the facility compliant?
Comment: Housekeeping and cleanup have been significant and a No Exposure can
now be permitted.
Yes No NA NE
Page: 2

Permit: NCGNE0927 Effective:
SOC: Effective:
County: Halifax
Region: Raleigh
Compliance Inspection Report
Expiration: Owner: Reser's'Fine Foods
Expiration: Facility: Don Pancho Authentic Mexican Foods
11075 Highway 903
Contact Person: Steven Snyder Title:
Directions to Facility:
from 195 exit on to exit 168 rt 903 head east 1 mi on left
System Classifications:
Primary ORC: Certification:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Halifax NC 27839
Phone: [phone]
Phone:
Inspection Date: 0311812013 Entry Time: 01:00 PM Exit Time: 02:00 PM
Primary Inspector: David R Parnell Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: 0 Compliant ■ Not Compliant
Question Areas:
Miscellaneous Questions E Misc
(See attachment summary)
Page: 1

b v N
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Charles Wakild, PE
Governor . Director
March 18, 2013
Mr. Steven Snyder
Reser's Fine Foods - Don Pancho Authentic Mexican Foods
11075 Highway 903
Halifax, NC 27839
Subject: Denial of No -Exposure Certification
Don Pancho Authentic Mexican Foods
NCGNE0927
Halifax County
Dear Mr. Snyder:
John E. Skvada III
Secretary
The Raleigh Regional Office (RRO) of the Division of Water Quality has reviewed your
submitted request for No Exposure Certification for Exclusion from NPDES Stormwater
Permitting. The Division is unable to concur with your checkbox certification of no exposure
for your facility. Based on an inspection of your facility on March 11, 2013, conducted by Dave
Parnell, it was found that materials on your sites were exposed. No exposure literally means
that no materials having a potential to pollute, are exposed. This includes materials that may
be directly exposed to stormwater, either from precipitation or as stormwater that runs/Flows
across the surface of the facility.
DWQ cannot grant your requested exemptions from permit coverage as follows:
This facility had food materials collecting around a storm grate, and dumpsters - containing
food production materials and food products - were exposed to precipitation.
North Carolina Division of Water Qua ity 1628 Mail Service Center Ra Ieigh, NC 27699-1628 Phone [phone] Customer Service
Internet: mm rimatemuality or Location: 3800 Barrett Drive Raleigh, NC 27609 Fax [phone] I-877-623-674
Nn(ihCarolin�
An Rqual Opponunily/A innalive Action Employer —50% Rccycicvl/10%Post Consumer Paper

I
1 i
Please make arrangements to apply for the NCG06000 NPDES Stormwater Permit by
contacting Ken Pickle at 919 807-6376.
If you have any questions or need further information, please contact Dave Parnell at (919)
791-4200.
Cl
If
I
j Danny Smjt ,Supervisor
Raleigh Regional Office
Surface Water Protection Section
I
Enclosure
�I cc: Raleigh Regional Office File
Stormwater Permitting Unit Files
DWQ Central Files
,i
i�
,I
North Carolina Division of Water Quality 1628 MaiI Service Ccrad Raleigh, NC 27699-1628 Phone [phone] Customer Service
Internet: ww,v.nocatere¢Iality.org Location: 3800 Barren Drive Raleigh, NC 27609 Fax [phone]-623-674
1 No ffiCarolina
AnEqual Opportunity/Atfumauvc Action Employer— 50%Recyclttlll0% Post Consumer Paper Aii&rally

Permit: NCGNE0927 Effective:
SOC: Effective:
County: Halifax
Region: Raleigh
Compliance Inspection Report
Expiration: Owner: Resers Fine Foods
Expiration: Facility: Don Pancho Authentic Mexican Foods
11075 Highway 903
Contact Person: Steven Snyder Title:
Directions to Facility:
from 195 exit on to exit 168 rt 903 head east 1 mi on left
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 03/1812013 Entry Time: 01:00 PM
Primary Inspector: David R Parnell
Secondary Inspector(s):
Halifax NC 27839
Phone: [phone]
Certification:
Exit Time: 02:00 PM
Phone:
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ❑ Compliant ■ Not Compliant
Question Areas:
E Miscellaneous Questions E Misc
(See attachment summary)
Page:1

'I Permit: NCGNE0927 Owner -Facility: Reser's Fine Foods
Inspection Date: 03/18/2013 Inspection Type: compliance Evaluation Reason for Visit: Routine
Inspection Summary:
I
Mist; Yes No NA NE
P
Is the facility compliant? ❑ ■ ❑ ❑
Comment: This inspection was for determinining the approval for a No Exposure
Certification. The certification was denied for the following reasons: open dumpsters
contained food materials and products, there was food materials deposited around a
stormdrain grate by the docks. The material had been swept from a dock onto the
pavement below and then collected around the grate.
li
I
Page: 2

4 �r
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral and Land Resources
Land Quality Section Pat McCrory, Governor
Tracy E. Davis, PE, CPM John E. Skvarla, III, Secretary
Director
October 14, 2013
Mr. Steven Snyder
Reser's Fine Foods - Don Pancho Authentic Mexican Foods
11075 Highway 903
Halifax, NC 27839
Subject: Approval of No -Exposure Certification
Don Pancho Authentic Mexican Foods
NCGNE0927
Halifax County
Dear Mr. Snyder:
The Division of Energy, Mineral and Land Resources (DEMLR) has reviewed your submittal of the No -
Exposure Certification for Exclusion from the NPDES Stormwater Permitting form and made a site visit to
assess the potential for stormwater pollution. Based on our observations and 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 (subject to civil penalties of up to $25,000 per day). Your conditional no -exposure exclusion
does not expire. However, you must self re -certify annually, or obtain NPDES permit coverage for any
stormwater discharges from your facility. Please retain the completed re -certification forms to have
them available during future inspections by DEMLR.
1628 Mail service Center, Ralegh, North Carolina 27699-1628
Location: 3800 Barrett Drive, Raleigh, North Carolina 27609 7�rOne !� 1
Phone. 919-791A2001 FAX: [phone] ortlL, iCarolini
Internet http:portal.ncdenr mativeActionE Naturally An Equal Opportunity 1 Affirmative Action Employer ` c "]✓,/

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 Dave Parnell at [phone] or at
david.parnellgricderingov.
Sincerely,
J n L. Holley, Jr., PE, CPESC
egional Engineer
Raleigh Regional Office
cc: DEMLR Central Files - with attachment
Stormwater Permitting Program Files - with attachment
Raleigh Regional Office DEMLR No Exposure Files - with attachment
1628 Mail Service Center, Raleigh, North Carolina 27699-1628
Location: 3800 Barrett Drive, Raleigh, North Carolina 27609 One
Phone: [phone] FAX: 919-57I A718 North Carolina
Internet'. http:portal.ncdeative then rl Naturally
An Equal Opportunity Affirmative Action Employer Naturally L

Compliance Inspection Report
Permit: NCGNE0927 Effective: Expiration: Owner: Resets Fine Foods
SOC: Effective: Expiration: Facility: Don Pancho Authentic Mexican Foods
County: Halifax 11075 Highway 903
Region: Raleigh
Contact Person: Steven Snyder Title:
Directions to Facility:
from 195 exit on to exit 168 rt 903 head east 1 mi on left
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 10/01/2013 Entry Time: 12:00 PM
Primary Inspector: David R Parnell
Secondary Inspector(s):
Halifax NC 27839
Phone: [phone]
Certification
Exit Time: 01:00 PM
Phone:
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: IN Compliant ❑ Not Compliant
Question Areas:
E Miscellaneous Questions E Misc
(See attachment summary)
Page:1

Permit: NCGNE0927 Owner -Facility: Reser's Fine Foods
Inspection Date: 10/01/2013 Inspection Type: Compliance Evaluation
Inspection Summary:
Misc
Is the facility compliant?
Reason for Visit: Routine
Comment: Housekeeping and cleanup have been significant and a No Exposure can
now be permitted.
Yes No NA NE
M ❑ ❑ ❑
Page:2

I
NCDENR
North Carolina Department of Environment and
Division of Water Quality
Pat McCrory Charles Wakild, PE
Governor . Director
March 18, 2013
Mr. Steven Snyder
Reser's Fine Foods - Don Pancho Authentic Mexican Foods
11075 Highway 903
Halifax, NC 27839
Dear Mr. Snyder:
Natural Resources
Subject: Denial of No -Exposure Certification
Don Pancho Authentic Mexican Foods
NCGNE0927
Halifax County
John E. Skvarla III
Secretary
The Raleigh Regional Office (RRO) of the Division of Water Quality has reviewed your
submitted request for No Exposure Certification for Exclusion from NPDES Stormwater
Permitting. The Division is unable to concur with your checkbox certification of no exposure
for your facility. Based on an inspection of your facility on March 11, 2013, conducted by Dave
Parnell, it was found that materials on your sites were exposed. No exposure literally means
that no materials having a potential to pollute, are exposed. This includes materials that may
be directly exposed to stormwater, either from precipitation or as stormwater that runs/flows
across the surface of the facility.
DWQ cannot grant your requested exemptions from permit coverage as follows:
This facility had food materials collecting around a storm grate, and dumpsters - containing
food production materials and food products - were exposed to precipitation.
North Carolina Division of Water Qual it) 1628 Mail Service Center Raleigh, NC 27699-1628 Phone [phone] Customer Service
Internet: wv tvnewbtentualitv.o, Location. 3800 Barrett Drive Raleigh Location 3800 Bartell Drive Raleigh, NC 27609 Fix [phone] 1-977-623-674
No0�hCarolina
An Equal Opporumity/Affirmative Action Employer— 50% Recycled/10 % Post Consumer Paper J�

1
1.
;Please make arrangements to apply for the NCG06000 NPDES Stormwater Permit by
',contacting Ken Pickle at 919 807-6376.
If you have any questions or need further information, please contact Dave Parnell at (919)
791-4200.
jinIy,
l
Danny Sm t`hi Supervisor
Raleigh Regional Office
Surface Water Protection Section
Enclosure
r;
cc: Raleigh Regional Office File
Stormwater Permitting Unit Files
DWQ Central Files
I
I
I
I
North Carolina Division of Water Quality 1628 Mail Service Center ;Raleigh, NC 27699-1628 Phone [phone] Customer Service
Internet: wivAv.nc, ateraualitv.ore Location: 3800 Barreu Drive Raleigh, NC 27609 Fax [phone]-623-674
vhCamliva
An Equal Opportunity/Affirmative Action Employer— 50%Recycled/10% Post Consumer Paper A�,#urally

Permit: NCGNE0927 Effective:
SOC: Effective:
County: Halifax
Region: Raleigh
Compliance Inspection Report
Expiration: Owner: Reser's Fine Foods
Expiration: Facility: Don Pancho Authentic Mexican Foods
11075 Highway 903
Contact Person: Steven Snyder Title:
Directions to Facility:
from 195 exit on to exit 168 rt 903 head east 1 mi on left
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 0311812013 Entry Time: 01:00 PM
Primary Inspector: David R Parnell
Secondary Inspector(s):
Halifax NC 27839
Phone: [phone]
Certification:
Exit Time: 02:00 PM
Phone:
Phone: [phone]
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ❑ Compliant ■ Not Compliant
Question Areas:
■ Miscellaneous Questions Q Misc
(See attachment summary)
Page:1

Permit: NCGNE0927 Owner - Facility: Reser's Fine Foods
Inspection Date: 03/18/2013 Inspection Type: Complian ce Evaluation Reason for Visit: Routine
I
Inspection Summary:
I
Misc - Yes No NA NE
Is the facility compliant? , ❑ ■ ❑ ❑
Comment: This inspection was for determininin the approval for a No Exposure
Certification. The certification was denied for the following reasons: open dumpsters
contained food materials and products, there wa' food materials deposited around a
stormdrain grate by the docks. The material had been swept from a dock onto the
pavement below and then collected around the g ate.
i
Page:2

A974
Division orWater Quality I Surface Water Protection
NC®ENR
National Pollutant Discharge Elimination System
Ftl VIpNWM NW MA4W. R?ryJ1p[.0
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000
NO EXPOSURE CERTIFICATION
FOR AGENCY USE ONLY
Unm Re..ivW
Year Modh
Da
cerormtaorc.v Mp
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 qualities 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, DWQ must approve your application for No
Exposure Certification before this exclusion Is effective. Until you are Issued a No
Exposure Certification and your NPDES permit is rescinded, your facility must continue
to abide by the terms and conditions of the current permit.
industrial materials or activities Include, but are not limited to., material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste products.
Material handling activities include the storage, loading and unloading, transportation, or conveyance of
any raw material, intermediate product, final product or waste product. A storm resistant shelter is not
required for the following industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed, provided those containers are not deteriorated and do not leak. "Sealed" means
banded or otherwise secured and with locked or non -operational taps or valves; adequately maintained
vehicles used in material handling; and final products, other than products that would be mobilized in
stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In
addition, the exclusion from NPDES permitting Is available on a facility -wide basis only --not for individual
outfalls. N 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).
For questions, please contact the DWQ Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of owner/operator (address to which all certification correspondence will be mailed):
Name ?e4dr o t ,ue, R op 7 /A -paw l"/�f -
Contact
fT>myevl J_nyp c r
Street Address
/ a f He cfibu-f
City
/ AG r Qup
Telephone No.
2= 2 S
Email
�Teupt C c1e✓S.
l
Pagel of7
f=CE 2 0 2013
SWU-NE-12Aug2010 _
L r ^r
StateQ/L _ZIP Code
Fax: AJA
1A
FES 1 8 2013

N
1

NCGNEO000 No Exposure Certification
2) Location of facility producing discharge: ^/�� Facility Name Name �h P14PUr 4o F"Y/�N ek lc�t /�Jf/�/(gyp ✓ / �e�+
Facility Contact �1 i_c_L�! _ Aje7'/PoeI,
Facility Street Address //a7 r 6r0h'k !z 9a
City lilt L i AAK- State JJ C- ZIP Code
County i
Telephone No. Z �? 7 32 Fax:
Email snr'edPS e-
- GSClS , cwc r
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). AArn y9,f le'hOr1,_6 �s _L'4o� 4-
/6
R 4- 7,) 3 — G4P4-0 & `:'i / six i k- 41-1 L[
(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 XIo
5) Is this a Federal facility? a ❑ Yes VNo 6G4 0 3 9 0
6) Latttude' Longitude - 71 . -3 (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation Is to begin
Existing Date operation began / IS Z a s O
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
0) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes No
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Coder
10) Provide a brief description of the types of industrial activities and products produced at this facility:
/Gs27-( ///� - O" e)/Jv /�f %fin
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
X No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SWU-NE-12AOg2010
III 11� FEB 2 B 2013
I •p

n e� t

NCGNE0000 No Exposure Certification 20 2013
J'
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 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 1` No
c. Materials or products from past industrial activity
❑ Yes
jNo
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
i� No
e. Materials or products during loading/unloading or transporting activities
❑ Yes
No
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes
No
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
No
and similar containers
rr
h. Materials or products handled/stored on roads or railways owned or maintained by
❑ Yes
No
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes f No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes 61 No
otherwise regulated (i.e., under an air quality control permit) and evident in the J
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes X 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 Xi 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 and piping free of rust, damaged or weathered coating, pits, or ❑ Yes ❑ No X N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No X N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
S W U-N E-12Aug2010

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NCGNE0000 No Exposure Certification
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 all 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 Title III Section 313 Superfund
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40
CFR §1167
e. Are release valves on all secondary containment structures locked?
15) Hazardous Waste:
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:
Footnotes to Questions 14) c. & d.
❑ Yes ❑ No 4 N/A
❑ Yes ❑ No LIN/A
[-]Yes ❑ No 4 N/A
❑ Yes ❑ No y N/A
❑ Yes ❑ No XN/A
❑ Yes Y No
❑ Yes I No
❑ Yes [YNo
`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.
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S W U-N E-12Aug2010

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 )K�o
b. Does your facility have coal piles on site?
�i Yes XNo
c. Does your facility store other fuel sources outside in piles, such as wood chips,
❑ Yes
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
``//
❑ Yes <No
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 �<N/A
Please specify:
I. 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:
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S W U-NE-12Aug^e010

NCGNE0000 No Exposure Certification
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7) Cert cat on:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition o1='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 annually self re -certify No Exposure and, If requested, submit the re -certification to
DWQ or 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. eased 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 thisapplicationand that to the best of my knowledge and belief
such Information is true, complete, and accurate.
Printed Name of Person Sign��iny J ((,-' )Co L. J /1
Title: F1AI/'f" WAI'P7Ae,e('
of 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.
North Carolina General Statute 143-215.6 6(I) provides that:
Any parson 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 mlemaking 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 maintalned under this Article or rules of Iho
(Environmental Management) Commission Implementing this Article shall be guilty of a Class 2 misdemeanor which may Include a fine
not to exceed ten thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.
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S W U-NE-12Aug20t 0

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\I
NCGNE0000 No Exposure Certification I
1E6 2 0 P0�3
Final Checklist I I� (J
This application should Include the following Items:
0 This completed application and all supporting documentation.
A map with the location of the facility clearly marked.
❑ 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 Mall 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 Realonal Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office ... [phone]
Mooresville Office ... [phone]
Raleigh Office ........ [phone]
Washington Office ... [phone]
Wilmington Office ... [phone]
Winston-Salem ...... [phone]
Central Office .........[phone]
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SW U-NE-12Aug2010