NCGNE1474_Application_20210419

Environmental
Quality
Division of Energy, Mineral and Land Resources
Land Quality Section
National Pollutant Discharge Elimination System
NO EXPOSURE CERTIFICATION for Exclusion
NCGNE0000
FOR AGENCY USE ONLY
Date Received
Year
I Month
I ay
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Certificate of Coverage
NCGnFl47�
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DENRL P,NC) QU AL.IT`(
National Pollutant Discharge Elimination System application for exclusion from @r%"M iW&FWWAk&1ed
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, 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Exposure Certification and your NPDES permit is rescinded, your facility must continue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 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:Hdea. nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/stormwater
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 certification correspondence will be mailed):
Name Colquimica Adhesives
Contact
Street Address
City
Telephone No.
Julia Thompson
2205 Beltway Boulevard, Suite 200
Charlotte State NC ZIP Code 28214
704 208-0019 Fax:
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NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Colquimica Adhesives
Facility Contact Julia Thompson
Street Address 2205 Beltway Boulevard, Suite 200
City Charlotte State NC ZIP Code 28214
County Mecklenburg
Telephone No. 704 208-0019 Fax:
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). From 1-85, exit north onto Sam Wilson Rd (exit 29). After exiting north, take the first left onto
Performance Road, then proceed approximately 0.25 miles and take a right on Beltway Boulevard. The site is at the end of this road, in the right-hand (north) building.
(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?0 Yes E No
5) Is this a Federal facility? M Yes El No
6) Latitude 35°, 15', 45.7"N Longitude 80°, 59', 08.6„W (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
0 New or Proposed Facility Date operation is to begin December 10, 2021
® Existing Date operation began
El Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? E3 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 8 9 1
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Adhesives manufacture: storaae of raw materials and finished products.
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
® No
0 Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
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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 E3 Yes 0 No p 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
c. Materials or products from past industrial activity
d. Material handling equipment (except adequately maintained vehicles)
e. Materials or products during loading/unloading or transporting activities
f. Materials or products stored outdoors (except final products intended for outside
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, and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained
by the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g.,
dumpsters])
j. Application or disposal of process wastewater (unless otherwise permitted)
p Yes
El No
in N/A
El Yes
El No
El N/A
El Yes
EI No
El N/A
E3 Yes
El No
E3 N/A
El Yes
El No
E3 N/A
® Yes EI No ® N/A
0 Yes El No 13 N/A
® Yes ® No E3 N/A
lj Yes Q No 0 N/A
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents E3 Yes El No 0 N/A
not 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 O Yes ® No 0 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 El Yes ® No E3 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 El Yes E3 No 0 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.
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NCGNE0000 No Exposure Certification
a. Is secondary containment provided for single above ground storage containers
El Yes p No E3 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
EI Yes []No III 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
ElYes ® No ® N/A
Amendments and Reauthorization Act (SARA) water priority chemicals*?
d. Is secondary containment provided for hazardous substances** designated in
E] Yes []No ® N/A
40 CFR §116?
e. Are release valves on all secondary containment structures locked?
EI Yes 0 No EI N/A
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ®Yes ® No Ei N/A
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous M Yes El No U N/A
waste generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste M Yes EI No p 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: Flammable Solvents
vendor:
How is material stored: Flame cabinets, flammable liquid storage can
Where Is material stored: Laboratory, warehouse
How many disposal shipments per year: Less than 1
Name of transport / disposal
TBD, no disposal yet since this is a new facility.
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.
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NCGNE0000 No Exposure Certification
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: Yes, hot mixing operations emit particulates and a boiler emits combustion emissions.
e. If you answered yes to d., are those emissions permitted by an Air Quality
Permit? Please Specify: No, Mecklenburg Countydetaminetl emissions do not require an air permit; however, they are listed as a Registered faulily(R713),
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:
El Yes El No E3 N/A
p Yes EI No IM N/A
El Yes U No 0 N/A
El Yes EJ No ® N/A
E3 Yes ® No 0 N/A
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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 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 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: Julia Thompson
Title: Quality Control Engineer
� April 14, 2021
(Signature f Applicant) (Date 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.
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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:
DEMLR - Stormwater Program
Dept. of Environmental Quality
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
... [phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
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APPROXIMATE
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SCALE IN FEET
U.S.G.S. QUADRANGLE MAP
MOUNTAIN ISLAND LAKE, NORTH CAROLINA
2019
QUADRANGLE
7.5 MINUTE SERIES (TOPOGRAPHIC)
TITLE
SITE LOCATION MAP
PROJECT
COLQIMICA ADHESIVES, INC.
2205 BELTWAY BLVD, SUITE 200
CHARLOTTE, NORTH CAROLINA
hart
sou',Triton Street-Suolina282
hickman
Ch.
Cha,otte, 1�-iorrh Carolina 28203
3
704-586-0007 (p) 704-586-0373 (f)
SMARTER ENVIRONMENTAL SOLUTIONS
DATE:
10-05-2020
REVISION NO: 0
JOB NO:
CQA-001
FIGURE: 1

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Business Corporation
Legal Name
Colquimica Adhesives, Inc.
Information
Sosld: 1898343
Status: Current -Active O
Date Formed: 10/1/2019
Citizenship: Domestic
Fiscal Month: December
Annual Report Due Date: April 15th
Registered Agent: COGENCY GLOBAL INC.
Addresses
Reg Office Reg Mailing Mailing Principal Office
212 South Tryon Street Suite 1000 212 South Tryon Street Suite 1000 2205 Beltway Blvd., Suite 200 2205 Beltway Blvd., Suite 200
Charlotte, NC 28281 Charlotte, NC 28281 Charlotte, NC 28214 Charlotte, NC 28214
Officers
Chief Executive Officer
Pedro Goncalves
227 West Trade Street Suite 1100
Charlotte NC 28202
Stock