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Home My WebLink AboutNCGNE0051_COMPLETE FILE - HISTORICAL_20050420STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. NCGNE �5 � DOC TYPE ,EYHISTORICAL FILE DOC DATE � d � v YYYYMMDD F 1N A TF Nlichael F. Easley, Governor `O�O 19 William G. Ross )r., Secretary North Carolina Department of Environment and Natural Resources Cl) Alan W. Klimek, P. E. Director Division of Water Quality Coleen H. Sullins, Deputy Director Division of Water Quality April 20, 2005 Harry Meredith Avery Dennison 2305 Soabar Dr Greensboro, NC 27406 Subject: No Exposure Certification NCGNE0051 Avery Dennison - 2100 Summit Ave 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 September 9, 2004. 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 facilitf" 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 (919) 733-5083 ext. 537, or at jonathan.diggs@ncmail.net. Sincerely, for Alan W. Klimek, P.E. cc: Winston-Salem Regional Office Central Files — wlattachments Stormwater Permitting Unit Files Nt C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (9l9) 733-7015 VAP NCDENR Customer Service 1-877-623-6748 �a v` : •,.- I United States Environmental Protection Agency � ly CMe,-Form A�vo�sp raved•o2� t NPIJr i%! Washington, DC 20460 Q y FORM__:;;• C E P 1 �SE� 3fiifl-1® 1 NO EXPOSURE CERTIFICATION for Exclusion ratm NPDES Storm Water Permitting �`i Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit a1ation for its storm water discharges associated with industrial activity in the State identified in Section 8 under EPA's Storm Water Mufti -Sector General Permit due to the existence 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 to prevent 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, 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,-bai�ets, tanks— and similar contafrtiers that are -tightly sealed, provided those containers are not deteriorated and do not leak, "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 not eligible for the no exposure exclusion. Sy signing and submitting this No Exposure Certificalion 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 iNFORMAT10N MUST 6E PROVIDED ON THIS FORM Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4. A. Facility Operator Information 1.Name: I AAVT ,'f lrlil IUItIAIAI 11,5IylA_l I'I I I I I I_ I Y_l f l I. 1 12.Phone: I51'ICI iII+IS7t�7 3. Mailing Address: a. Street: I( I I I I I U 1 ,,I A,,I + I t1 I At VL,? I n lu l E l I 11 1 I_ I I I I I I I I b. City: ��_ I r LQ L L/C 15 L 61 Cal r- I D I -I I I I I 'I I I I I I I c. State: I Q d. Zip Code: 12 I-11 61I Q I'� I— I 1 1 I I B. Facility/Site Location Information 1. Facility Name: IA, v I LL I j I_ I � ,?z ! /I I I I I S l d lA,f t_ __1 I I I _I j 1 I I I I I I _l _ 1 1 2. a. Street Address: I� It 10101 1_ I `` 1^1 A4 I t-I 111 I/ I e 11%, 1 V I el l )_ I I I I I I I I I_ I I b. City: 6 1 •"IZ I el 61" 1 f^ J1 1 1 l I I I I C.County: I61ul'II Itlylr`ldl I d. State: ;Ul e. Zip Code: 17 1? 1 u 10 1 a "1 — I 11 1 3. Is the facility located on Indian Lands? Yes ❑ No 9 4, Is this a Federal facility? Yes ❑ No d . 5. a. Latitude: L? L OL _I �, b. Longitude: I01 t I I � Lit sJ L, 41 6. a. Was the facility or site previously covered under an NPDES storm water permit? Yes ❑ No b. If yes, enter NPDES permit number: 7. SIC/Activity Codes: Primary: 'I I _7I 7I of Secondary (if appticanle): I I 1 I 8. Total size of site associated with industrial activity: , U —1 �_ acres 9. a. Have you paved or roofed over a formerly exposed, pervious area in order to quality for the no exposure exclusion? Yes ❑ No a b. if yes, please indicate approximately 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 likely to have an adverse impact on water quality, in which case you could be required to obtain permit coverage. Less than one acre One to five acres ❑ More than five acres, ❑ EPA Form 3510-11 (10.99) Page 1 of d NAB M :EPA 1=aa. 3510-11:•.1 C. Exposure Checklist NO EXPOSURE CERTIFICATION for Exclusion from NPDES Storm Water Permitting 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 answer "Yes" to any of these questions (1) through (11), you are not eligible for the no exposure exclusion. 1. Using, storing or cleaning 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 spills/leaks 3. Materials or products from past industrial activity 4. Material handling equipment (except adequately maintained vehicles) 5. Materials or products during loading/unloading or transporting activities 6. iUlaterials or products stored outdoors (except final products intended for outside use [e.g., new cars/ where exposure to storm water does 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 railways owned or maintained by the discharger 9. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) 10. Application or disposal of process wastewater (unless otherwise permitted) 11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated (i.e., under an air quality control permit) and evident in the storm water outflow B. Certification Statement Form Approved OMB No. 2040-0211 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 storm water permitting. ' i certify under penalty of law that there are no discharges of storm water contaminated by exposure to industrial activities or materials from the industrial facility or site identified in this document (except as allowed under 40 CPR 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 (MS4) into which the facility discharges (where applicable). I understand that I must allow the NPDES permitting authority, 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 that I must obtain coverage under an NPDES permit prior to any point source discharge of storm water 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.. Print Name: Al4[,,C a Iti i Print Title: �' 2 Signature: Date: 1019 10 1910141 ^1Alglelr EPA Form 3510-11 (10-99) Page 2 of 4 D�OF W A r�RQG Michael 1', Easley, Governor Williamm G. !toss Jr., Secretary North Carolina Department of Environment and Natural Resources � Alan W. Klimek, P. E. Director w Division of Walcr Quality Q Y Coleen 14. Sullins, Deputy Director April 20, 2005 Harry Meredith Avery Dennison 2305 Soabar Dr Greensboro, NC 27406 Subject: No Exposure Certification NCGNE0051 Avery Dennison - 2100 Summit Ave Guilford County Dear Permittee: Division of Wafer Quality The Division has reviewed your submittal of the No -Exposure Certification for Exclusion from NPDES Stormwater Permitting form, which we received on September 9, 2004. 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 (919) 733-5083 ext. 537, or at jonathan.diggs@ncmail.net. cc: Winston-Salem Regional Office Stormwater Permitting Unit Files N. C. Division of Wafer Quality 1617 Mail Service Center Sincerely, for Alan W. Klimek, P.E. . . Central Files — w/attachments Raleigh, North Carolina 27699-1617 (919) 733-7015 �� NCDi=NR Customer Service 1-877-623-6748 v, Form Approved United States Environmental Protection Agency D CMB,�lo�00-0211, NPI WashingtonEPA, DC 20460 4 `�j' 3600 1n1 ®�� NO EXPOSURE CERTIFICATION for Exclusion roU SE NPDES Storm Water Permitting V Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit a R anon for its storm water discharges associated with industrial activity in the State identified in Section B under EPA's Storm Water Multi -Sector General Permit due to the existence 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 to prevent 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, or waste products. Moterfal 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 industria. materials and activities: drums 6ar�els, tanks, aril sirriilar containers that are -tightly sealed, provided those containers are hol deteriorated and do -not leak. "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. It any industrial activities or materials are or will be exposed to precipitation, the facility is not eligibie for the no exposure exclusion. By signing and submitting this No Exposure Certification 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 4. A. Facility operator Information r'~ 1. Name: I41 elrlYl __jbjtIAfAjI5IL L I I'!I I I I '1 1 11 2.Phone: 131_5 641(12I91716� 3. Mailing Address: a. Stredl: I I I 51 Lj l M1 MI + I tl ' I AI Vie 1 n l u l e l I- I I I I I I I I I I I b: City: �C l r l e 01 C1 f I O I I I I I I I I I I fl I Q. State: �CJ. d. Zip Code: 12 I', I qI QI S— I I I I B. Facility/Site Location Information 1. Facility Name: Allr -e I IL ti III S 1d 2. a. Street Address: 121110101 S u^ #- V 2 A U P I� b. City: Ir"IcIelAlsI61oIvlO1 I I I I I I I I Lj c.Counly: 16lr"I'11lflolrlcel I d. State: I111 e. Zip Code: 171'r 141 U I S-1 — I t I f 3. Is the facility Located on Indian Lands? Yes ❑ No ✓❑� 4. Is this a Federal facility? Yes ❑. Nod . . . t 5. a. Latitude: �J �6J ��J b. Longitude: �LJ 6. a. Was the facility or site previously covered under an NPDES storm water permit? .Yes ❑ No b. If yes, enter NPDES permit number: 7. SIC/Activity Codes: -Primary: `�I �I �I d� Secondary (if applicable): I . I •- I - 8. Total size of site associated with industrial activity: U 1 f4 acres 9. a. Have you paved or roofed over a formerly exposed, pervious area in order to quality for the no exposure exclusion? Yes ❑ No t� b. If yes, please indicate approx'.malely how much area was paved or roofed over. Compleling this'i ueslion 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 likely to have an adverse impact on water quality, in which case you could be required to obtain permit coverage. Less than one acre ❑ One to five acres ❑ More than five acres ❑ EPA Form 3510-11 (10-99) IV/ % Page 1 of 4 _. _ _� r �. t � `, 1 f . ` _ _ .. .. _. .. _ r • .,�_ '_ .. ra, . ., n �� . , NPDES �. `!, �� NO EXPOSURE CERTIFICATION for Exclusion from Form Approved FORM OMB , +a. No.2040-0211 `1 3510 11`.��.;OB NPDES Storm Water Permitting C. Exposure Checklist Are any of the following materials or activities exposed to precipitation, now or in the foresccable future? (Please check either "Yes" or "No" in the appropriate box.) If you answer "Yes" to any of these questions (1) through (11), you are not eligible for the no exposure exclusion. Yes No 1. Using, storing or cleaning industrial machinery or equipment, and areas where residuals from using, storing ❑ 171 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 spills/leaks 3. Materials or products from past industrial activity 0 4, Material handling equipment (except adequately maintained vehicles) El Q 5. Materials or products during loading/unloading or transporting activities 6. Materials or products stored outdoors (except final products intended for outside use (e.g.. new cars; where ❑ P exposure to storm water does not result in the discharge of pollutants) 7. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers Q 8. Materials or products handled/stored on reads or railways owned or maintained by the discharger Q 9. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters)) Q 10. Application or disposal of process wastewater (unless otherwise permitted) Q 11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated El Q (i.e., under an air quality control permit) and evident in the storm water outflow D. Certification Statement 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 storm water permitting. I certify under penalty of law that there are no discharges of storm water contaminated by exposure to industrial activities or materials from the industrial facility or site identified in this document (except as Mowed 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 permitfng authority 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 NPDES permitting authority, 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 that I must obtain coverage under an NPDES permit prior to any point source discharge of storm water 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. FrintName:10falrlrlyl l�I�I�lel�l tl�l�l I I I I III 1 11 11 1 1 I III � Print Title: IUIli?IRleIrI"I rI IAl-I^1,,1.911? Signature: Date: I0I9101q O',q EPA Form 3510-11 (10-99) Page 2 of 4