NCGNE1032_COMPLETE FILE - HISTORICAL_20171204

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
Sj HISTORICAL FILE
DOC DATE
❑ 0 I 1 a
YYYYMMDD

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCG1&
DOC TYPE
❑ HISTORICAL FILE
DOC DATE
❑
YYYYMMDD

�oll(vll� V�CGVI �I632-�
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for F IAtt�f
Energy, Mineral NCGNE00
and Land Resources
ENVIRONMENTAL QUALITY DEC 04 full RECEIVED
National Pollutant Discharge Elimination System
on NO EXPOSURE:
FOR AGENCY USE ONLY
Dale Received
Year Momh
Day
Cenificale of Coverage
NC9NH
UL1 02 2017..
:for exclusion from a Stormwater Permit based
DENR-LAND ci! i !Tv
Submission of this No Exposure Certification constitutes notification that your facility does not re4bire''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, DEMLR 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Exposure Certification and your NPDES permit is rescinded, your facility must continue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. Ir,
addition, the exclusion from NPDES permitting is available on a facility -wide basis only —not for individual
outtalls. 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).
If approved, your conditional No Exposure Exclusion has no expiration date
BUT MUST BE self re -certified at least annually.
Please look for information about re -certification under the No Exposure section on this page:
https://deg. nc.goy/a bout/d ivisions/energy-m i neral-la nd-resources/energy-mineral-land-perm its/stormwater-
perm its/n pdes-i nd ustria I-sw
For questions, please contact the DEMLR Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of owner/operator (address to which all certificationcorrespondencewill be mailed):
Name CAI- ClJQTdG,re__ %2Ae]SPOQTATIO?J�co�,SS, LLG
Contact 'r0 ✓v) ry1I,-j W Id t T &-
Street Address J�.30) %3A/N09QiDGL i3G✓0
City State V/a ZIP Code ?3.32U
Telephone No. Z 01 Fax: 7S7 'f A/ 9/ /
Page 1 of 7
SWI I-NrhNF I asf revised QI?Wn1R

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
/: r4 t_ G A2TAC{ fc. T 12A rJ51dD,QTA TlO t� TX P,2rSS CLG .
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
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). 6oa7 N o2 N3ea.TH o 0 112. P3,jj¢uE-rr
IS 9M-TWEE-W Wo12T{- lbawe'q 621V 2 Q4Vgil
(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 VNo
5) Is this a Federal facility? ❑ Yes XNo
6) Latitude 34o 11 1j Longitude77' �(deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
K New or Proposed Facility Date operation is to begin ) 0 i
�K Existing Date operation began
qR Renewal of existing No Exposure Certification Certification No.: NCGNE ? P%L,J 6 W NrGQ- S H iP
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes V No
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4-digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: � 2 1 Z
10) Provide a brief description of the types of industrial activities and products produced at this facility:
TRuc.1C 4-rrLAi%_k_a_ 340Q_Vir4' nr.)Ly
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
'9 No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SWI I-NCQNE LRO revised 919RO B

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NCGNE0000 No Exposure Certification
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 1�1. No ❑ 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
1;0 No
❑ N/A
c. Materials or products from past industrial activity
❑ Yes
1A No
❑ N/A
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
fj� No
❑ N/A
e. Materials or products during loading/unloading or transporting activities ❑ Yes tR No ❑ N/A
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ig 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 �L No ❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes %No ❑ N/A
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes E� No ❑ N/A
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes 13 No ❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes �K No ❑ N/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 5L No ❑ 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 rA No ❑ N/A
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 ❑ Yes ❑ No 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 N/A
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 ❑ Yes ❑ No 1;10 N/A
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
Page 3 of 7
SWI1-NCGNE Last revised 912812018

NCGNE0000 No Exposure Certification
b. Is secondary containment provided for above ground storage containers stored ❑ Yes ❑ No t�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 N/A
Amendments and Reauthorization Act (SARA) water priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40 ❑ Yes ❑ No ¢bN/A
CFR §116?
e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No 1$1 N/A
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes 14 No ❑ N/A
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes 9� 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 A No ❑ 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:
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.
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 ❑ No ❑ N/A
b. Does your facility have coal piles on site? ❑ Yes ❑ No ❑ N/A
Page 4 of 7
SWU-N(1(;NE I.ast revised wmon16

NCGNE0000 No Exposure Certification
c. Does your facility store other fuel sources outside in piles, such as wood chips,
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
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? 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:
❑ Yes 1% No ❑ N/A
❑ Yes K No ❑ N/A
❑ Yes n No PR N/A
Page 5 of 7
SWII-N(:r;NE Lact rowkPO P/2R/201R

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 122.26(g)(2)).
I understand that I am obligated to maintain no exposure conditions and complete a Self -Recertification form at least once
each year, and if requested, provide this certification 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
Energy, Mineral, and Land Resources, 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 I
must keep a copy of annual re -certifications on file at the facility.
In the event that the site no lonqer 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. I ` I
Printed Name of Pherson Signing: IQ0 eUQ^i L�y�
Title: \� P Y L-44 )
( ate Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDEQ 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
SWI1-NCr;NF I.nst revised 9128/2016

NCGNEOOOO 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 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 Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR 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)
707-9220
Page 7 of 7
SWI1-NC(;NF I aM revised 9/28/2016

November 22, 2017
Stormwater Permitting Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699
In early October we sent a Rescission Request for California Cartage Express LLC because of a new
ownership and name change. We also sent application for a new NEC for the new name, Cal Cartage
Transportation Express LLC.
I would like to follow up on those to see if they got accomplished and if we have a new NEC number for
the facility.
Thank you for ur help.
o ert L ely
THE CALIFORNIA CARTAGE FAMILY OF COMPANIES
Can % �:>
California Cartage Company I P.O. Box 92829 1 Long Beach, CA 90809
www.calcarlage.earn I Tel: [phone] [e-mail]
Trans loadi n g/Deconsol i dation I Warehousing I Trucking I Contract Warehousing I CES

acPQOB
Stormwater Permitting Program
Division of Energy, mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
PrCEIVED
UL1 U2 ail
DENR-LAND QUALITY
S1 ORMWATER PERMITTING
Enclosed I have included a No E;,posure Certification for a facility in Wilmington located at 2507 Burnett
Blvd. I have also included a Notice of Termination (NOT) for the same site due to a change in ownership.
For the "NOT" I am not sure I filled out the correct form but it was the one I could find on your web site.
:e?rtVehf
for yo patl nce
California Cartage Company
2931 Redondo Ave
Long Beach, Ca 90806
310-537-1432
[e-mail]
THE CALIFORNIA CARTAGE FAMILY OF COMPANIES
'tom 19 a K YR :m- s =Zliv
California Cartage Company I P.O. Box 928291 Long Beach, CA 90809
www.calcartage. cam I Tel. [phone] sales Ocalcartage.core
Transloading/Deconsolidation I Warehousing I Trucking 1 Contract Warehousing I CES

©'t � .A
Division of Energy, Mineral & Land Resources
1�
Land Quality Section/Stormwater Permitting Program
NCDENRNational
Pollutant Discharge Elimination System
Name Cu+ww C[pmx[irt o.
Exvinoxw[rrt u.o Nm,nu P[OCMC[0
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N:,c 'b N C. G,
2) Owner/Facility Information: -Final correspondence will be mailed to the address noted below
Owner/Facility Name Cv3 L.I Co2,V 1 W GAIZTtA4f, TXPQ?fS.0 LI-C- -
Facility Contact
Street Address
City
County
Telephone No.
_ IJre_CJ I-Wh h-lOUti2. E-mail Address LL llI IiTj 6a CL3l-eA42-r!iF_ cayn
910 7/.,1 .<ZZb Fax: cW0 7/03 57Zz/
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑ Facility closed or is closing on F7771 . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to ind slrial activities or materials.
-tZ I
Facility sold to I fto ratsw�l, LLG -on / If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
❑ Other:
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complgte and ante.
Signature
T Li U LL
Print or type name of person signing above
Please return this completed rescission request form to:
Date 0'71el/r7
v!' 1`0L4ruNJLr1
Title
NPDES Permit Coverage Rescission
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
1612 Mail Service Center, Raleigh, North Carolina 27699-1612
Phone: [phone] FAX: [phone]
An Equal Opportunity 1 Affirmative Action Employer

I

Division of Water Quality / Surface Water Protection
�P�_ I
NC®ENR National Pollutant Discharge Elimination System
NMrn C.wouc. DVMn,ncm o. NO EXPOSURE CERTIFICATION for Exclusion
Cnvn+o+nr«r nno Naovx Resew+ces
NCCNE0000
NO EXPOSURE CERTIFICATION
USH ONLYDate
Received
Momh
Day,ficatearCoveragei
EFORGENCY
N E
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, 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
tny raw material, intermediate product, final product or waste product. A storm resistant shelter is not
required for the following industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed, provided those containers are not deteriorated and do not leak. "Sealed" means
banded or otherwise secured and with locked or non -operational taps or valves; adequately maintained
vehicles used in material handling; and final products, other than products that would be mobilized in
stormwater discharges (e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In
addition, the exclusion from NPDES permitting is available on a facility -wide basis only —not for individual
outfalls. If any industrial activities or materials are, or will be, exposed to precipitation, the facility is not
eligible for the no exposure exclusion. By signing and submitting this No Exposure Certification form, you
certify that a condition of no exposure exists at this facility or site and are obligated to comply with the
terms and conditions of 40 CFR 122.26(g).
uired to self re-certifv vour No Exposure Exclusion annua
For questions, please contact the DWQ Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of ownerloperator (address to which all certification correspondence will be mailed):
Name
Contact
Street Address
City
Telephone No.
Email
G 1'1 L ) FCt y t\.l l a r_ (� f2T FA (11L
toILyr,1 L4—kO)NJ State IjC= ZIP Code
10 ?tA 577_0 Fax:
L.WH ,a (:14t_Cq ZT14Cq�,CoNn
S W U-NE-12Aug2010
Page 1 of 7

NCGNE0000 No Exposure Certification
102) Location of facility producing discharge:
Facility Name r- oL 1 �C�lzrtit Iva C" �2T1�C �—
Facility Contact L1O Dom. W H 1 T 1�_
Facility Street Address )<CO ` '_1;� u J2_ TT PSLJ'p
City ILvM1tu(-- o0 State 1vL ZIPCode �LO1011
County ) f iru I.,A ra1'1O'v t'`O—
Telephone No. 61 10 2 6­i 5 2 Z-U __ Fax:
Email LWM I .Govvv
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). I 1 -) i JEST T O t_-3v a,v V- -rT 3Lvl '7
t.30 Q T 1-t Oo T5 \-1 2PJY TT '-
3 cx� Y Ail y) 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 X No
5) Is this a Federal facility? ❑ Yes No
6) Latitude '7l4o I 1 4-h� � " Longitude 77 Sao {9. S(o (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility
Existing
Date operation is to begin
Date operation began / I A 3
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes A 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 Z
10) Provide a brief description of the types of industrial activities and products produced at this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
> No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
S W U-NE-12Aug2010

NCGNE0000 No Exposure Certification
0 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 ;kNo
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
J
9
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes 0 No
c. Materials or products from past industrial activity ❑ Yes [X No
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes gi No
e. Materials or products during loading/unloading or transporting activities ❑ Yes SQ No
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes g 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 15�No
and similar containers
In. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes 1% No
the discharger
I. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes p No
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes �K No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes 06 No
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes 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 and piping free of rust, damaged or weathered coating, pits, or
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
❑ Yes O No P( N/A
❑ Yes ❑ No �KN/A
Page 3 of 7
S W U-NE-12Aug2010

NCGNE0000 No Exposure Certification
04) 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'?
Is secondary containment provided for hazardous substances" designated in 40
CFR §116?
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: e
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 1�(N/A
❑ Yes ❑ No g N/A
❑ Yes 0 No 14NIA
❑ Yes ❑ No 0 N/A
❑ Yes ❑ No 0 N/A
❑ Yes t4 No
Y
❑ Yes !�,No
❑ Yes 7.No
"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
Wf the hazardous substances listed in 40 CFR §117.3.
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NCGNE0000 No Exposure Certification
*6) 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 ' A No
b. Does your facility have coal piles on site?
c. Does your facility store other fuel sources outside in piles, such as wood chips
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g.,
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?
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:
0
❑ Yes �k No
❑ Yes EA No
❑ Yes !kNo
❑ Yes ❑ No X N/A
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SWU-NE-12Aug2010

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 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. 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: (.--t t�J I-) Y::,, W W I T r,—
Title:
(Signature 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 e(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.
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SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
Oinal 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 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 DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
0-sheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
E
Page 7 of 7
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