NCGNE1171_COMPLETE FILE - HISTORICAL_20170530

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE I n I
DOC TYPE
HISTORICAL FILE
DOC DATE
❑ DI �����
YYYYMMDD

Energy, Mineral &
Land Resources
ENVIRONMENTAL QUALITY
May 22, 2017
Theo Davis Printing-R.R Donnelley
Attn: Ryan Robinson
1415 W. Gannon Avenue
Zebulon, NC 27597
Subject: No Exposure Certification NCGNE1171
Theo Davis Printing
Wake County
Mr. Robinson:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
MAY 3 0 2017'.
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 as well as observations made by Thad Valentine with the Raleigh Regional Office on
May 19, 2017, the Division is granting your conditional exclusion from permitting as provided for under 40
CFR 122.26(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
the No Exposure Certification, 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. You must self re -certify annually using the enclosed form or obtain NPDES permit coverage for
any stormwater discharges from your facility. The annual self re -certification does not need to be
submitted to DEMLR unless requested.
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 Thad Valentine at [phone].
Sincerely,
rorTracy E. Davis, PE, CPM
Enclosure
cc: RRO — Land Quality Section, Stormwater Files (w/o enclosure)
Stormwater Permitting Program, No Exposure Files (w/o enclosure)
Nothing Compares.
State of North Carolina I Environmental Quallty I Energy, Mlncral and Land Resources
512 N. Salisbury Street 11612 Mail Service Center I Raleigh, North Carolina 27699-1612
919 707 9200

Energy, Min era! &
Land Resources
ENV IRONMENTAL QUALITY
May 22, 2017
Theo Davis Printing-R.R Donnelley
Attn: Ryan Robinson
1415 W. Gannon Avenue
Zebulon, NC 27597
Subject: No Exposure Certification NCGNE1171
Theo Davis Printing
Wake County
Mr. Robinson:
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
TRACY DAVIS
Director
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 as well as observations made by Thad Valentine with the Raleigh Regional Office on
May 19, 2017, the Division is granting your conditional exclusion from permitting as provided for under 40
CFR 122.26(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
the No Exposure Certification, 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. You must self re -certify annually using the enclosed form or obtain NPDES permit coverage for
any stormwater discharges from your facility. The annual self re -certification does not need to be
submitted to DEMLR unless requested.
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 Thad Valentine at [phone].
Enclosure
Sincerely,
W #-
L41
rorTracy E. Davis, PE, CPM
cc: RRO — Land Quality Section, Stormwater Files (w/o enclosure)
Stormwater Permitting Program, No Exposure Files (w/o enclosure)
Nothing Compares�
Slate or North Carolina I Euvironmontal Quality I Energy, Mineral and Land Resources
512 N. Salishury Shrcl 1 1612 Mail Service Cenci I Raleigh. North Carolina 27699-1612
9197079200

Division of Energy, Mineral and Land Resources
ft. Land Quality Section
National Pollutant Discharge Elimination System
" NO EXPOSURE CERTIFICATION for Exclusion
Energy, Mineral NCGNE0000
(Ind Land Resources
ENVIRONMENTAL GUALII'Y
USF;ONLY
D to ReceivedM,
nth Dayficate
ErORGGNCY
of Cowmge
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 no exposure exclusion. A condition of no a-t
6, facility means all
industrial materials and activities are protected by a storn
aceptions) to
prevent exposure to rain, snow, snowmelt, and/or runoff.
l<' p4/v
For permitted facilities in North Carolina, DEML
, C,� /Je tt lication for No
Exposure Certification before this exclusion is
sued a No
Exposure Certifl �}j�Iyrw•Fa ;?, i,t.. ermit
p
/%S' 0 _ � c 1 must continue
vA ,X la's ,1 e f 1,
to . , « ai t' ` 1ti . �-13. w sr . 4r h: e cui
Ind rr" t by {Zvi
F t limited to: mare.;o..._.. _ pment or activities,
and,f ear `?�y° ;off .§ri` roducts, by-products, final products, or waste products.
Mat(4 4i�'A ding and unloading, transportation, or conveyance of
any h` N99,wt ' «"y l ,> ct or waste product. A storm resistant shelter is not
requ.;:. tidy;ry.�4,' c"Rt " a ities: drums, barrels, tanks, and similar containers
that r p t,r tof deteriorated and do not leak. "Sealed" means
ban _A+rft�I}" operational taps or valves; adequately maintained
vehi Ott Jr4 `+r s, other than products that would be mobilized in
stormwater disc arse
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).
If approved, your conditional no -exposure exclusion must be self re -certified at least annually.
Please see information here:
For questions, please contact the DEMLR 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 Theo Davis Printing - R. R. Donnelley
Contact Ryan Robinson
Street Address 1415 W, Gannon Avenue
City Zebulon State NC ZIP Code 27597
Telephone No. 919-269-7401 Fax:
Page 1 of 7

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name
Facility Contact
Street Address
City
County
Telephone No.
Theo Davis Printing — R. R. Donnelley
Ryan Robinson
1415 W. Gannon Avenue
Zebulon State NC _ ZIP Code 27597
919-269-7401
3) Physical location information:
Fax:
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). From US 64 exit onto N. Arendell Avenue (US
6413usiness WINC 96) Turn right onto W Gannon Avenue (NC 97). Continue to facility, which will be
(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 ❑O No
6) Latitude 350 49 ` 15.6468 " N Longitude 780 20 ` 46.2912 " W (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
O Existing bate operation began
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes ❑O 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: 2752
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Various printed materials. _

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 ONo ❑ 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 O No ❑ N/A
c. Materials or products from past industrial activity ❑ Yes ❑x No ❑ N/A
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes ONo ❑ N/A
e. Materials or products during loading/unloading or transporting activities ❑ Yes O No ❑ N/A
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ONo ❑ 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 ONo ❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ONo ❑ N/A
the discharger
i. Waste material (except waste in covered, non -leaking containers (e.g., dumpsters]) ❑ Yes ONo ❑ N/A
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes ONo ❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ONo ❑ 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 ONo ❑ 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 ONo ❑ 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
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 ❑ No O N/A
❑ Yes ❑ No O N/A
Pace 3 of 7

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 single above ground storage containers ❑ Yes ❑ No ❑x 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 ❑ No ❑O 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
Amendments and Reauthorization Act (SARA) water priority chemicals*?
d. 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?
❑ Yes ❑ No O N/A
❑ Yes ❑ No ❑x N/A
❑ Yes ❑ No O N/A
❑ Yes ❑x No ❑ N/A
❑ Yes 1ZINo O N/A
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes 17No ❑ 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.
*nl :7 !L•p� M'?. i•1}S h^LO�n t?Ir 6FQ-CI'lljn sto, one minimums regllire

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?
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: Lithographic Sheet Fed Printing
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit?
Please specify: Exert: VOC Emissions below permit threshold
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 ZINo ❑ N/A
❑ Yes ❑ No 17N/A
❑ Yes IRINo ❑ N/A
ElYes ❑ No ❑ N/A
❑ Yes ❑O No ❑ N/A
Pape 5 of 7

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 submit a no exposure certification form once every five (5) years to the North Carolina
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system (MS4) into
which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing:
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 B(i) provides that:

�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 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 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)
807-6300
Pace 7 of 7

/Zro
b
Division of Energy, Mineral and Land Resources
i'
Land Quality Section
National Pollutant Discharge Elimination System
" NO EXPOSURE CERTIFICATION for Exclusion
FOR AGENCY USE ONLY
Dme Rc.wcd
Year
Monlh
Day
CetliricmcorcoVcmgc
N r
Energy, Land 4sour! NCGNE0000 %/�O !� /l /
and Land Resources (�
ENVIRONMENTAL OUALIIY
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 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. 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).
If approved, your conditional no -exposure exclusion must be self re -certified at least annually.
Please see information here: htto://I)ortal.ncdenr.orq/web/Ir/nodes-stormwater
For questions, please contact the DEMLR Regional Office for your area. (See oaae 6)
(Please print or type) ^S
1) Mailing address of owner/operator (address to which all certification corresoondence•wiDbe railed):
Name Theo Davis Printinn — R R nnnnAllAv W11;
Contact
Street Address
City
Telephone No.
CWI I_Nr:r:NF
.,,, y
i
� v
T
♦n
Page 1 of 7 M
- I acr rnrdcArl 'PM Kion' '{'Ly.�..

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Theo Davis Printing — R. R. Donnelley
Facility Contact
Street Address
City
County
Telephone No.
Ryan Robinson
1415 W. Gannon Avenue
Zebulon State NC ZIP Code 27597
919-269-7401
3) Physical location information:
Fax:
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). From US 64 exit onto N. Arendell Avenue (US
6413usiness W/NC 96). Turn right onto W Gannon Avenue INC 97) Continue to facility, which will be
on the left.
(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 35 al ar 3 - 7 81 3
0
5) Is this a Federal facility? ❑ Yes No 4
6) Latitude 350 49 ` 15.6468 " N Longitude 78' 20 ` 46.2912 " W (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility
0 Existing
Date operation is to begin
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? ❑ Yes O 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: 2752
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Various printed materials
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
0 No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
.cwii_NrrtiF ia�1'."m 11/91,001A

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 ONo ❑ 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 ❑O No ❑ N/A
c. Materials or products from past industrial activity ❑ Yes ❑x No ❑ N/A
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes I7No ❑ N/A
e. Materials or products during loading/unloading or transporting activities ❑ Yes ❑x No ❑ N/A
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ONo ❑ 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 ONo ❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ONo ❑ N/A
the discharger
Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes
ONo
O N/A
Application or disposal of process wastewater (unless otherwise permitted)
❑ Yes
1]No
❑ N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ONo ❑ 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 ONo ❑ 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 ONo ❑ 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
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 ❑ No ❑X N/A
El Yes ❑ No O N/A
Page 3 of 7
F1NI I_NCr:NF
1 acf rnviccri 1/7F/9MR

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 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 §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:
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 ❑O N/A
❑ Yes ❑ No ❑O N/A
❑ Yes ❑ No t7 N/A
❑ Yes ❑ No ❑x N/A
❑ Yes ❑ No t7 N/A
❑ Yes ONo ❑ N/A
❑ Yes ONo ❑ N/A
❑ Yes ONo ❑ N/A
`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
awi i_tir.r.NF, .0 r.„krl 10sn01a

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 t7No ❑ N/A
b. Does your facility have coal piles on site? ❑ Yes ❑ No ❑X N/A
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes t7No ❑ N/A
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ❑x Yes ❑ No ❑ N/A
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: Lithographic Sheet Fed Printing
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? ❑ Yes ONo ❑ N/A
Please specify: Exempt: VOC Emissions below permit threshold
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit:
Permit:
Permit:
Permit:
Permit:
Permit:
Permit:
Program:
Program:
Program:
Program:
Program:
Program:
Program:
RM I_Nr:f:NF
Page 5 of 7
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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 submit a no exposure certification form once every five (5) year to the North Carolina
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system (MS4) into
which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality, or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing: �ifA✓1 R Rr5/oln5bv.
Title: P/�CS id-,v +
Applicant)
(D to 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 fled 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 falsities, 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 tine
not to exceed ten thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
R W I I_N(:(:NF I act rovicari V95/9p'I fi

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
g This completed application and all supporting documentation.
t 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 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 .........
[phone]
smn i-NrrNF Page 7 of 7
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