NCGNE1495_Application_20210914

RFOPI F-
FOR AGENCY USE ONLY
NCGNE l �Lj_5_ SEP 14 2021
Assigned to: a_N Vy NEVANND QUALITY
ARO FRO('MRO RRO WARO WIRO WSRO STOMJI'A'ATERPERNIIIITTING
Division of Energy, Mineral, and Land Resources
National Pollutant Discharge Elimination System
No Exposure Certification for Exclusion
NCGNE0000
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. Industrial materials or activities include, but are not limited to:
• material handling equipment or activities, • by-products,
• industrial machinery, • final products, or
• raw materials, • waste products.
• intermediate 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 industrial materials stored in the following container types, provided
the containers are not deteriorated and do not leak:
• drums, • tanks, and
• barrels, • similar containers.
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rescinded, your facility must continue to abide by the terms and conditions of the current permit.
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. Additionally,
the exclusion from NPDES permitting is available on a facility -wide basis only — not for individual outfalls. If any
industrial activities or materials are, orwill be, exposed to precipitation, the facility is not eligible forthe 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 Certification has no expiration date but must be self -recertified at least
annually. Please look for information about recertification under the No Exposure section on this page:
https•//deg nc gov/about/divisions/energy-mineral-land-resources/npdes-no-exposure.
Directions: Print or type all entries on this application form. Send the original, signed application to: NCDEMLR
Stormwater Program, 1612 MSC, Raleigh, NC 27699-1612. The submission of this form does not guarantee
exclusion from NPDES stormwater permitting. Prior to exclusion from NPDES stormwater permitting a site
inspection will be conducted.
Page 1 of 5

1. Owner/Operator (to whom all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person (as signed in Item 7 below):
C LASS C N ins
EC — FOR LA)ER(O RIVAS
Street address:
-?,C)q S;,-w50A S i ILL 6 1
City:
c0N(314k R
State
Zip Code
Telephone number:
s3L -6Z7 1-10Ll6 EX1;-.%OS
Email address:
H 6 C 10 RoiZiVASdCLASS IC-L6-AiHim;R.CCA
Type of Ownership:
Government
El County 171 Federal El Municipal El State
Non -government
ER Business (If ownership is business, a copy of NCSOS report
must be included with this application)
171 Individual
2. Industrial Facility (facility requesting exclusion):
Facility name: _
CLASS1L LEAa 1116A 1NC
Facility environmental contact:
k6CNOR tW?kO RIVAS
Street address:
log sJAP A J RBI
Telephone number: _
JZZ-NOq-6 L r � �o�
Email address: r c LA5�1C - i &A 1 14ieR 4 C.om
NECiOR.iZ.i�A
City r ON a Vc p,
County CA-1 A W
State Alc
Zip Code 6 �,-1
Latitude of entrance: — $, 2q 55 l6 c'
Longitude of entrance: 16.4138 6
Parcel Identification Number (PIN): 66 - 09 56 f_3 1
Date operation began:
116
Standard Industrial Classification (SIC) Code:
z6 iZ 2.62 -1
Brief description of the types of industrial activities and products produced at this facility:
W CKK !D U ` �104LS EMD 614AIRc,
3. Consultant (if applicable):
Name of consultant: Consulting firm:
Street address: City: State and zip code:
Telephone number: Email address:
4. Exposure Checklists
Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future? If you
answer "Yes" to any of these items, you are not eligible for the no exposure exclusion.
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
stormwater
171 Yes El No El N/A
Materials or residuals on the ground or in stormwater inlets from spills/leaks
F71 Yes IT No El N/A
Materials or products from past industrial activity
Yes EK No [71 N/A
Material handling equipment (except adequately maintained vehicles)
I]Yes ICJ No 0 N/A
Page 2 of 5

Materials or products during loading/unloading or transporting activities
M Yes [9 No El N/A
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)
El Yes No 1771 N/A
Materials contained in open, deteriorated, non -sealed', or leaking storage drums barrels, tanks,
and similar containers
El Yes No 19 N/A
Materials or products handled/stored on roads or railways owned or maintained by the discharger
El Yes 0 No 0 N/A
Final products that would be mobilized in stormwater discharges (e.g., rock salt)
El Yes M No 0 N/A
Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
0 Yes 0 No 0 N/A
Application or disposal of process wastewater (unless otherwise permitted)
ElYes 91 No El N/A
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 stormwater outflow
El Yes No N/A
Empty containers that previously contained materials that are not properly stored (i.e., not closed
and stored upside down to prevent precipitation accumulation)
171 Yes No N/A
For any exterior ASTs, as well as drums, barrels, tanks and similar containers stored outside, has
the facility had any releases in the past three (3) years?
Yes No N/A
'Sealed means banded or otherwise secured and with locked or non -operational taps or valves.
Above Ground Storage Tanks (ASTs) and Secondary Containment
If you answer "No" to any of the following items, you are not eligible for the no exposure exclusion.
Are exterior ASTs or piping free of rust, damaged or weathered coating, pits, or deterioration, or
evidence of leaks?
E]Yes ElNo N/A
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?
El YesNo [ N/A
Is secondary containment provided for single above ground storage containers (including drums,
barrels, etc.) with a capacity of more than 660-gallons?
nYes F7lNo EM N/A
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?
YesEl No N/A
Is secondary containment provided for Title III Section 313 Superfund Amendments and
Reauthorization Act (SARA) water priority chemicals?
Yes 1771No E3 N/A
Is secondary containment provided for hazardous substances designated in 40 CFR §116?
ElYes El No 14 N/A
Are release valves on all secondary containment structures locked?
DYes ONo JM N/A
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.
Are vehicles used in material handling in disrepair and/or leaking fluid?
E3Yes NJ No [3 N/A
Does this facility store used, recycled, or otherwise reclaimed pallets outside?
ElYes 10 No N/A
Does this facility have coal piles on site?
E3 Yes No [ N/A
Does this facility store other fuel sources outside in piles, such as wood chips, sawdust, etc.?
ElYes No E3 N/A
Page 3 of 5

Does this facility have air emissions associated with industrial activity (e.g., degreasing operations, Yes ❑ No EN N/A
plating, painting, or metal finishing)?
If yes:
Describe the industrial activity: �a �} wooA �i�►SI�+��
Are those emissions permitted by an Air Quality Permit? MYesrINo
Please specify: Emissions noes Mx eACeedy,e rn.nir'um
5. Other Facility Conditions (check all that apply and explain accordingly):
❑ This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
❑ This facility has Non -Discharge permits (e.g. recycle permit).
If checked, list the permit numbers for all current Non -Discharge permits:
❑ This facility stores hazardous waste in the 100-year floodplain.
If checked, describe how the area is protected from flooding:
❑ This facility is a (mark all that apply)
❑ Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility
If checked, indicate:
• Kilograms of waste generated each month:
• Type(s) of waste:
• How material is stored:
• Where material is stored:
• Number of waste shipments per year:
• Name of transport/disposal vendor:
• Transport/disposal vendor EPA ID:
• Vendor address:
❑ This facility is located on a Brownfield or SUPERFUND site.
If checked, briefly describe the site conditions:
❑ This facility is located on Native American Lands.
6. Required Items (Application will be returned unless all of the following items have been included):
❑ Copy of most recent Annual Report to the NC Secretary of State (if applicable)
❑ This completed application and any supporting documentation
❑ Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 4 of 5

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J .'f BUSINESS CORPORATION ANNUAL REPORT
10.2017
NAME OF BUSINESS CORPORATION: Classic Leather, Inc.
SECRETARY OF STATE ID NUMBER: 0029260 STATE OF FORMATION: NC
REPORT FOR THE FISCAL YEAR END: 12/31/2020
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Shores Jr., Thomas H.
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual
Report
0029260
❑X Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS 8r COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
309 Simpson St SW PO Box 2404
Conover, NC 28613 Catawba County
Hickory, NC 28603
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Classic Leather Inc.
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] x 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
309 Simpson St SW
5. PRINCIPAL OFFICE MAILING ADDRESS
PO Box 2404
Conover, NC 28613 Hickory, NC 28603
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: OFFICERS (Enter additional officers in Section E.)
NAME: Rachel Leclair
TITLE: Secretary
ADDRESS:
PO Box 2404
Hickory, NC 28603-2404
NAME: Kimberly P Long
TITLE: Assistant Secretary
ADDRESS:
PO Box 2404
Hickory, NC 28603-2404
NAME: Brad Hoffman
TITLE: Vice President
ADDRESS:
PO Box 2404
Hickory, NC 28603-2404
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
enttlrityv�
omas H Shores Jr 4/15/2021
SIGNATURE
Form must be signed by an officer listed under Section C of this form.
Thomas H Shores Jr
Print or Type Name of Officer
DATE
Chief Executive Officer
Print or Type Title of Officer
11 u
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

9/15/2021
North Carolina Secretary of State Search Results
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online • Add Entity to My Email Notification List •View Filings • Print a
Pre -Populated Annual Report form • Print an Amended a Annual Report form
Business Corporation
Legal. Name
Classic Leather, Inc.
Prev Legal Name
Classic Upholstery, Inc.
Information
Sosid: 0029260
Status: Current -Active O
Date Formed: 12/20/1965
Citizenship: Domestic
Fiscat Month: December
Annual. Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Shores Jr., Thomas H.
Addresses
Principal Office Reg Office Reg Mailing Mailing
309 Simpson St SW 309 Simpson St SW PO Box 2404 PO Box 2404
Conover, NC 28613 Conover, NC 28613 Hickory, NC 28603 Hickory, NC 28603
Officers
Vice President
Brad Hoffman
PO Box 2404
Hickory NC 28603-2404
Stock
Class: COMMON
Shares: 300000
Par Value 5
Secretary
Rachel Leclair
PO Box 2404
Hickory NC 28603-2404
Assistant Secretary
Kimberly P Long
PO Box 2404
Hickory NC 28603-2404
Chief Executive Officer
Thomas H Shores , Jr
PO Box 2404
Hickory NC 28603-2404
President
Thomas H Shores , Jr
PO Box 2404
Hickory NC 28603-2404
https://www.sosnc.gov/online services/search/Business_Reciistration_Results 1/1