NCGNE0001_COMPLETE FILE - HISTORICAL_20050420

W512, o
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE C)b tD 1
DOC TYPE
vrf HISTORICAL FILE
DOC DATE
D nro G D `l D/l�
YYYYMMDD

(r 1f1jA]� Michael F. Easley, Governor
`Ot� 9p6
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
0) ba -YAlan W. Klimek, P. E. Director
Division of Water Quality
0 Coleen 11. Sullins, Deputy Director
Division of Water Quality
April 20, 2005
Paul Charapata
Avery Dennison-Dunsirn
200 Citation Ct
Greensboro, NC 27409
Subject: No Exposure Certification NCGNE0001
Dunsirn-Greensboro - 200 Citation Ct
Guilford County
Dear Permittee:
The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on May 16, 2003. We apologize for the extended period it has
taken us to get back to you on this request and we appreciate your patience as we have worked through this
process. Based on your submittal and signed certification of no exposure at the above referenced facility the
Division is granting your certification 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. Your
conditional no -exposure exclusion expires in five years (April 30, 2010). At that time you must re -certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your certification of no exposure 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 Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
for Alan W. Klimek, P.E.
cc: Winston-Salem Regional Office Central Files —wlattachments
Stormwater Permitting Unit Files
N. C. Division of Water Quality 1617 Mail Service Censcr Raleigh, North Carolina 27699-1617 [phone]
NCDENR
Customer Service
1-977-623-6748

AVERY
DENNISON
Dunslrn Industries
Distribution
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FAX 3$6 �65;6496
2003
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June 11, 2003
Mr. Bradley Bennett
Permitting Authority
North Carolina Department of Environment
Division of Water Quality
512 N Salisbury St.
Raleigh, NC 27699-1617
Dear Mr. Bennett:
Enclosed please find a "No Exposure Certification for Exclusion from NPDES Storm Water Permitting"
application. As you will see, we had sent it to U.S. EPA, and were instructed to submit it to you instead.
Sincerely,
Ms. Kim Humphreys
Finishing Center Manager
Avery Dennison

J�,,FD U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA)
NATIONAL POLLUI'ANT DISCHARGE ELIMINATION SYS-MM (NPDES)
U S'l'ORM WATER NOTICE OF IN'FEN'l' CENTER
ar
PAUL CHARAPATA
AVERY DENNISON-DUNISIRN
200 CITATION COURT
GREENSBORO, NC 27409
REFERENCE NUMBER: NCRNEA063
Dear Operator:
FACILITY LOCA,rioN-
DUNSIRN-GREENSBORO
200 CITATION COURT
GREENSnORO,NC
27409
06/02/2003
Thank you for submitting a "No Exposure Certification for Exclusion from NPDES Storm Water
Permitting" application for the facility noted above. Upon review of your application, it has
been determined that the EPA cannot grant you exclusion from coverage for this facility.
The site location on your form is under the jurisdiction of the State of NC, which has been
authorized by the EPA to implement the NPDES program. Please submit the appropriate
application to the NPDES permitting authority at:
Web Address:
PERMITTING AUTHORITY
North Carolina Department of Environment
Division of Water Quality
512 N Salisbury St
Raleigh, NC 276991617
Phone:[phone]
Fax:
E-Mail: brad][e-mail]
Contact Person: Bradley Bennett
Web Address:
If you have any questions regarding this letter, please contact the Storm Water Notice of Intent
Processing Center at [phone]. If you have other general questions concerning the storm
water program, please call the EPA Region 04 contact: Floyd Wellborn, [phone].

May, 5 2003 4:27PM
i
NPDES
EPA
FORM
3510-11 Top,
hip 4
United States Environmental Protection Agency V _ >iis04p,
Washington„ DC 20460
NO EXPOSURE CERTIFICATION for Exclusion from MAY
NPDES Storm Water Permitting 9
B z00
Submission of this No Exposure Certification constitules notice that the ent)ty identified in Section A does not require permit au y. r itssiat v+ater
uischarges associated with industrial activity in the State identified in Section B under EPKs Storm Water Multi -Sector General Permit due to the
of a condition of no exposure.
A condition of no exposure exists at an industrial facility when all Industrial materials and activities are protected by a storm resistant shelter toipreveni
exposure to rain, snow, snowmelt, and/or runoff. 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, orwaste 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 teak. 'Sealed"
means banded or otherwise secured and without operational taps or valves;
- adequately maintained vehicles used in material handling; and
- final products, other than products that would be mobilized in storm water 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
nofeNgible for the rta exposure exclusion
By signing and submitting this No Exposure CedficaUon form. the entity in Section A is certifying that a condition of no exposure exists at its facility or site,
and Is obligated to comply with the terms and conditions of 40 CFR 122.26(g).
ALL INFORMATION MUST BE PROVIDED ON THIS FORM.
Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and d.
A- Facility Operator Information /
1 Name; U ?_ V-1 Q 1 S O ` U N S 1 fL 2. Phone: 7J b 6 rJ 14 U
3, Mailing Address: a Street; 1,�0101 IQ 1ITIf_V III 101t1l_1 Oilil riT1 I I I I i 1 I _I I_ 1 1 L
b.Cty 3lt"IP-lelis11b of rlo 1 11 I I 1 I 1 I 1 i 1 l estate; d.Zip Code' Iaij I L4I a191--I I i I I
0. Facility/Site Locatfon Information l
1 Facility Name: Q 1' $ t r i— r f, S p 10 1 f
2. a.. Street Address: AD I() "C i I'Tlptl TI t 101 114I I( 0101 CI r1 1 1 1 1 1 1 1 1 t 1 1
b. City-
f
N S O
r O c. County:
d. State:
1 tQ
e. Zip Code:
i C�t_j 144 10 91- I I 1 1 1
3. Is the facility located on Indian Larids? Yes ❑ No
4, is this a Federal facilily? Yes ❑ No-E�
S. a, Latitude: L3161 o IQ 9 1 HfT l - b, Longitude: C j 5k
LqA
6. a. Was the facility or site previously covered under an NPDES storm water permit? Yes ❑ No
b. If yes, enter NPDES permit number:. /
y.. StClActivity Codes: Primary: b, Secondary (if applicable): I i i L�
8. Total size of site associated with industrial activity; z5• q 4 acres
9, a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure excusion? Yes ❑ No 11
b. If yes, please indicate approxlmately how much area was paved or roofed over. Completing this question does not disqualify you for the no exposure
exclusion. However, your permitting authority may use this information in considering Whether storm water discharges from your site are likelybiNhave
art adverse Impact on water quality, in which case you could be required to obtain permit coverage.
Lew than one acre ❑ One to five arras ❑ More than free acres ❑ �u L 17 j�/{ 003
EPA Form 3510-11 (10-99) Page 1 of 4

17'

May 5 ?uu�- 4:21PM
N) J?4a P. '
Form Approved
NPDES �+ NO EXPOSURE CERTIFICATION for Exclusion from
\-EPA oM� No. zo4aoz11
3510 NPDES Storm Water Permitting
C. Exposure Checkliat
Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future?
(Please check either 'Yes or'No' in the appropriate box.) If you anzwer"Yes" to any of these questions
(1) through (11). you are not eligible for the no exposure exclusion.
1 Using, storing or clearing industrial machinery or equipment, and areas where residuals from using, storing
or cleaning industrial machinery or equipment remain and are exposed to storm water
2. Materials or residuals on the ground or In storm water inlets from spillstleaks
3_ Materials or products (torn past Industrial activity
4.. Material handling equipment (except adequately maintained vehicles)
5_ Materials or products during loadinontoading or transporting actNitles
6. Materials or products stored outdoors (except final products intended for outside use (e.g.. new cars) where
exposure to storm water doss not result in the discharge of pollutants)
7 Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers
8. Materials or products handled/stored on roads or rai"ys owned or maintained by the discharger
9. Waste material (except waste in covered, non -leaking containers [e.g.. dumpstersl)
10. Application or disposal of process wastewater (unless otherwise permitted)
11, Particulate matter or visible deposits of residuals from roof stacks andfor vents not otherwise regulated
(i.e.. under an air quality control permit) and evident in the storm water outflow
D. Certification Statement
Yes
11
I
I certify under penalty of taw that I have read and understand the eligibility requirements for claiming a condition of 'no exposure' and obtaining an
exclusion from NPDES storm water permitting.
I certify under penalty of law that there are no discharges of storm water contaminated by exposure to industrial actIvides or materials from the industrial
facility or site Identlfled 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 years to the NPDES permitting authority and, if requested, to
the operator of the local municipal separate storm sewer system (MSa) into which the facility discharges (where applicable), I understand that I must
allow the NPDES permitting authority, or MSa operator where the discharge is into the total MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request. I understand that I must obtain coverage under an NPDES permit 1prier
to any point source discharge of storm water from the facility,
Additionally, i certify order penalty of law that this document and ail attachments were prepared under my direclicn or super vision in accordance with a
system designed to assure that qualified personr.vl proparfy gathered and evaluated the infomration submitted. Rased on my snqulry 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 impiisonmentfor knowing violations.
PrintNomu� [1 4_G1 "f1 o I IL i�IAlViu1 �4�t IIGI I 1__1 rL.1
Print Title: 1! f I 1 ✓�lo_I C+ I D I �I 1 0I 1 I a �1 I --I at J 1 1I 1 I I
Signature:
Date. IV 1sj1 14 I01-3
EPA Form 3510-11 (1 D-99) Page 2 of 4