NCGNE1121_COMPLETE FILE - HISTORICAL_20160426

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE r p
DOC TYPE
Cif HISTORICAL FILE
DOC DATE
❑ ;M ( 'Oy a C�
YYYYMMDD

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCG41
DOC TYPE
❑ HISTORICAL FILE
DOC DATE
❑
YYYYMMDD

Division of Energy, Mineral and Land Resources
Land Quality Section
NCDENR
National Pollutant Discharge Elimination System
: -
. ,. �.... ..
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000 CC' -)I E ll2
NC Department of
�Environmental quality RECEIVEDD
National PollutantDiacharge Eliminatlbn System application for exclusion from a Stormwater Permit based
APR 2 6 2016
on NO EXPOSURES HFK 19 2016
DENR-1 Antn nnn, _..
Submission of this No • • •..... -----
t xPQ$(i(e.�tlon constitutes notification that y�r fscUhy does not require a
Permit for stormwater disc a s associated with industrial activity in the State of North Carolina because
it qualities for a no axPosure 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, snowmell, 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Exposure Certification and your NPDES permit is rescinded, your facility must continue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 Indude, 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 lightly 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 la, dlity qualifying for the no exposure exclusion. in
addition, the exclusion from NPDES permitting is available on a facility We basis only —not for individual
oulfalls. 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
torts and conditions of 40 CFR 122.26(g).
If approved, your conditional no -exposure exclusion must be self re -certified at least annually.
Please See information here: httO.//Dortal.ncdenr.orn/wehflrinndcc_ctnr ...ate.
I For questions, please contact the DEMLR Regional OHlce for your area. (See Dane 6)
1) Mailing address of owner/operator
Name C570f4z. s:
Contact
Street Address
City
Telephone No.
(Please print or type)
Pane 1 of 7
Fax:
ZIP Code
MAY l 2016
ill

i ro i , wi.

NCGNE0000 No Exposure Certification
21 Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
3) Physical location Information:
Please provide a narrative description of Crow to get to the facility (use street names, state road numbers, and
distance and direction from a roadway intersection). W ts+ on A• 4,....� �V --°r R�c+.h on
(A copy of a map with the facility dearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes ANO /
5) Is this a Federal facility? ❑ Yes SNo 6 ,-
6) Latitude '14* 15'Sy 2 0 Longitude -18003t '33. tB 'W (deg., min., seconds) V"� 0- / a
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
tD9xisting Date operation began 2O00
O Renewal of existing No Exposure Certification Certification No.: NCGNE
8) 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 Code: 2 S S
10) Provide a brief dese!r ption of the types of industrial activities and products produced at this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
A No
O Yes
If yes. list the permit numbers for all current Nor -Discharge permits for this facility.
�fj/f i1�G/t:/Ty
/S /J >/46
,ais>R/c

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 deaning industrial machinery or equipment, and areas where ❑ Yes Ao ❑ N/A
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stonmwater
b. Materials or residuals on the ground or In stonmwater inlets from spills/leaks ❑ Yes Lf No ❑ N/A
C. Materials or products from past industrial activity
❑ Yes
O NNo
❑ WA
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
131/o
❑ N/A
e. Materials or products during leadinglunloading or transporting activities
❑ Yes
teNo
❑ WA
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes
l3(No
Cl N/A
use (e.g., new cars) where exposure to stornwater does not result in the discharge
of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks,
❑ Yes
/
tit No
❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by
❑ Yes
/
m No
❑ N/A
the discharger
I. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes dNo ❑ N/A
J. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes U No ❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not
❑ Yes G!'No ❑ N/A
otherwise regulated (i.e., under an air quality control permit) and evident in the
stornwater outflow
/
I. Empty containers that previously contained materials that are not properly stored
❑ Yes No O N/A
(i.e., not dosed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums, barrels, tanks, and similar container;
❑ Yes Ac, ❑ 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 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 lie Yes ❑ No ❑ WA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?

NCGNE0000 No Exposure Certification
14) Secondary Containment: N you answer "No" to any of the following hems, you are at eligible for the
no exposure exclusion.
a. is secondary containment provided for single above ground storage containers
a 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
As
❑ No ❑ N/A
In dose 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
//
17Yes
❑ No ❑ N/A
Amendments and Reauthorization Act (SARA) water Priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40
ta'Yes
❑ No ❑ WA
CFR §116?
e. Are release valves on all secondary containment structures locked?
V es
❑ No ❑ WA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes WK ❑ N/A
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes W o ❑ WA
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes 'Flo ❑ 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.

i1CGNE0000 No Exposure Certification
6) Other Information: N you answer "Yes" to any of the following Items, you might not be eligible for the
no exposure excluslom 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 )tNo ❑ N/A
b. Does your facility have coal piles on site?
c. Does your facility store other fuel sources outside In plies, 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.
9. 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.) -rot
specified earlier in this application (such as Harardous Waste Permits, etc.r
Permit
Program:
Permit
Program:
Permit
Program:
Permit
Program:
Permit.
Program:
Permit
Program:
Permit
Program:
❑ Yes KNo ❑ NIA
❑ Yes k No ❑ NIA
❑ Yes � No ❑ N/A
❑ YeskNo ❑ N/A

NCGNE000O No Exposure Certification
17) Cerd8cation:
1 certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of Ono
exposure' and obtaining an exclusion from NPDES stomtwater Permitting.
1 tartly under Penalty of law that there are no discharges of stomrwater contaminated by exposure t0 industrial activities
Or materials from the Industrial facility or site identified In this document (except as allowed under 40 CFR 122.26(g)(2)).
1 understand that 1 am obligated to jkbMit a no exposure certification form once every five (5) wears to the North Carolina
Division of Water Quality and, it requested, to the operator of the local municipal separate storm sewer system (MS4) into
which the facility discharges (where aPPlicable). I understand that 1 must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is Into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request
In the event that the site no longer qualities for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES Permit prior to any point source discharge of stormwater from the fall' Additionally, law that this document and all attachments were �' n�' I certify under penalty of
Prepared under my direction or s.�ervision In accordance with a system
designed to assure that qualified personnel Property gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those Persons directly rasponside for gattmering 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 inforrtmotion, including the Possibility of fine and imprisonment for
knowing violations.
'certify that I am familiar with the information owdoinsd in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate. 11
Printed
Title:
Of APPlicard)
(Date Srgneq
Please note: This application for the No Exposure Exduslon 1s sub
NCDENR' Regional Office prior to Issuance. The Regional OtKce may I� a Your f� by the
compliance with no exposure conditions y sped Your facay lion
Inspect y PnO1 to that approval. The Regional OINce may also
your facility at an time In the future for compliance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 B(i) provides that:
AnY Pmmn who knowingly makes any false stetamem, rapmentrdbn, or Msticatioe in any apPtica0on, raced, report, Wan, or aemer
damament filed or requited to fee maintained under dig Article or a nil knPlamentna ads Amide; or who bwwh* makes a false
statement Of a materiel fad in a r lemaking ProceedirV or contested case under We Artide: or who fek( .
renders unaoaaate any reeordoq or monitommg device ormemos uked b tee operated rams cud'' or w or am
mqor mairrtainad under ode Nrules d am
or ru
IEnNrnxmetal Meagan" Commbebn k comer ang tide Nkia shall be gwmy of a Gass 2 misdemeanor which may kmdide a fro
red b emxe n ten etouamW do0am ($10,0001
Is currently no roe for a No

NCGNE0000 No Exposure Certification
This application should Include the following items:
This completed application and all supporting documentation.
O A map with the location of the facility dearly marked.
O If the site currently has an NPDES Stornwater Permit, be sure to indicate the permit number to Questl0n 8.
Mall the entire package to:
Stonnwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
1612 Mad Service Centex
Raleigh, North Carolina 27699-1612
NOW
The submission of this document does not guarantee the Issuance of a No Exposure Exclusion.
I 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)
807-6300

17
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