NCGNE1509_Application_20211026

FOR AGENCY USE ONLY
NCGNE15Q�I
Assigned to:
ARO FRO MRO WARO WIRO SRO RECEIVED
qr.,T ^ 0 2021
Division of Energy, Mineral, and Land Resources c>aCEIVED
National Pollutant Discharge Elimination Sy4te WGICALSU4*i
No Exposure Certification for Exclusion OCT 2 5 2021
NCGNE0000
DENR-LAND QUALITY
STORMWATER PERMITTING
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
tha rnntninarc nra not riatarinrntari �nri rin not I.A4
• drums,
• barrels,
`i
tanks, and (`
similarcontainers.
d
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rescinded, your facility must continue to abide by the terms and conditions of the current permit.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, 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 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.goy/about/divisions/energy-mineral-land-resources/nodes-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):
Kayser -Roth Corporation
Laval Choiniere
Street address:
City:
State
Zip Code
102 Corporate Center Boulevard
Greensboro
NC
27408
Telephone number:
Email address:
33ea52-2030
[e-mail]
Type of Ownership:
Government
E3County [3federal 13Municipal OState
Non -government
0 Business (If ownership is business, a copy of NCS05 report must be included with this application)
E3Individual
2. Industrial Facility (facility requesting exclusion):
Facility name:
Facility environmental contact:
Kayser -Roth Corporation
Laval Choiniere
Street address:
Telephone number:
714 Interstate Service Road
336-229-2269
Email address:
[e-mail]
City
County
State
Zip Code
Graham
Alamance
NC
27253
Latitude of entrance: 36.06217
Longitude of entrance:-79.42113
Parcel Identification Number (PIN):
133547 (State ID: 8874514429)
Date operation began:
Standard Industrial Classification (SIC) Code:
1975
2252
Brief description of the types of industrial activities and products produced at this facility:
Hosiery and sock manufacturing
3. Consultant (if applicable):
Name of consultant:
Consulting firm:
Andrew Rodak
S nterra Co ration
Street address:
City:
State and zip code:
511 Keisler Drive, Suite 102
Cary
27518
Telephone number:
Email address:
919-858-9898
[e-mail]
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
E3 Yes [3 No
13N/A
Materials or residuals on the ground or in stormwater inlets from spills/leaks
0Yes 0 No
ON/A
Materials or products from past industrial activity
E3 Yes 0 No
E3 N/A
Material handling equipment (except adequately maintained vehicles)
E3Yes O No
[3N/A
Page 2 of 5

Materials or products during loading/unloading or transporting activities
DYes 0 No D N/A
Materials or products stored outdoors (except final products intended for outside use [e.g., new
D Yes 0 No D N/A
cars] where exposure to stormwater does not result in the discharge of pollutants)
Materials contained in open, deteriorated, non -sealed', or leaking storage drums barrels, tanks,
D Yes 0 No D N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger
DYes D No 0 N/A
Final products that would be mobilized in stormwater discharges (e.g., rock salt)
DYes 0 No D N/A
Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
DYes 0 No D N/A
Application or disposal of process wastewater (unless otherwise permitted)
DYes 0 No D N/A
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise
Dyes EI No ❑ N/A
regulated (i.e. under an air quality control permit) and evident in the stormwater outflow
Empty containers that previously contained materials that are not properly stored (i.e., not closed
DYes No 0 N/A
and stored upside down to prevent precipitation accumulation)
For any exterior ASTs, as well as drums, barrels, tanks and similar containers stored outside, has
DYes No ❑ N/A
the facility had any releases in the past three (3) years?
'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
DYes ❑No [3 N/A
evidence of leaks?
Is secondary containment provided for all exterior ASTs? If so, is it free of any cracks, holes, or
El Yes ❑ No 0 N/A
evidence of leaks, and are drain valves maintained locked shut?
Is secondary containment provided for single above ground storage containers (including drums,
El Yes ❑No D N/A
barrels, etc.) with a capacity of more than 660-gallons?
Is secondary containment provided for above ground storage containers stored in close proximity
DYes ❑ No N/A
to each other with a combined capacity of more than 1,320 gallons?
Is secondary containment provided for Tide III Section 313 Superfund Amendments and
El Yes No D N/A
Reauthorization Act (SARA) water priority chemicals?
Is secondary containment provided for hazardous substances designated in 40 CFR §316?
DYes DNo D N/A
Are release valves on all secondary containment structures locked?
DYes DNo D 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?
0 Yes 0 No [3 N/A
Does this facility store used, recycled, or otherwise reclaimed pallets outside?
DYes 0 No ❑ N/A
Does this facility have coal piles on site?
D Yes 0 No D N/A
Does this facility store other fuel sources outside in piles, such as wood chips, sawdust, etc.?
Dyes 0 No D N/A
Page 3 of 5

Does this facility have air emissions associated with industrial activity (e.g., degreasing operations, DYes 0 No 13 N/A
plating, painting, or metal finishing)?
If yes:
Describe the industrial activity:
Boiler operations related to textile operations (cleanin� dyeing)
Are those emissions permitted by an Air Quality Permit? Yes 13No
Please specify: Permit ID 04059R12
S. Other Facility Conditions (check all that apply and explain accordingly):
El This facility has other NPDES permits.
If checked, list the permit numbers for all current NPDES permits:
IUP #0052 for indirect wastewater discharge, issued by City of Burlington
❑ 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: I
• 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):
O Copy of most recent Annual Report to the NC Secretary of State (if applicable)
O This completed application and any supporting documentation
El Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 4 of 5

�. Applicant Certification
North Carolina General Statute 143-215.68 (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 ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000). I hereby request exclusion from NPDES stormwater permitting.
Under penalty of law, I certify that:
O I am the person responsible for the industrial activity, for satisfying the requirements of this exclusion, and for any civil
or criminal penalties incurred due to violations of this exclusion.
O I have read and understand the eligibility requirements for claiming a condition of "no exposure" and obtaining an
exclusion from NPDES stormwater permitting.
O 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)).
1 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 applicable, 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 recertifications on file at the facility.
El I understand that in the event that the site no longer qualifies for a No Exposure Exclusion that I must obtain coverage
under an NPDES permit prior to any point source discharge of stormwater from the facility.
0 The information submitted in this NOI is, to the best of my knowledge and belief, true, accurate, and complete based on
my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the
information.
Printed Name of Person Signing:
Title:
of ApplicantDate S gne
Mail the entire package to: DEMLR— Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 5 of 5

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BUSINESS CORPORATION ANNUAL REPORT
..ti
razov
NAME OF BUSINESS CORPORATION: Kayser-roth Corporation
SECRETARY OF STATE ID NUMBER: 0177339 STATE OF FORMATION: DE
REPORT FOR THE FISCAL YEAR END: 12/31 /2019
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: CT Corporation System
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE
Nne Offics U. y
E - Filed Annual Report
0177339
CA202022300519
8/10/2020 08:15
❑X Changes
APPOINTMENT
13. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
160 Mine Lake Ct Ste 200
Raleiqh, NC 27615 Wake Countv
SECTION B:
160 Mine Lake Ct Ste 200
Raleigh, NC 27615
1. DESCRIPTION OF NATURE OF BUSINESS: Hosiery Manaufacturing
i 2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
64. PRINCIPAL OFFICE STREETADDRESS
5. PRINCIPAL OFFICE MAILING ADDRESS
102 Corporate Center Boulevard 102 Corporate Center Boulevard
Greensboro, NC 27408-3172 Greensboro, NC 27408-3172
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: Todd Howard NAME: Nicola Gallob NAME:
TITLE: Secretary TITLE: Chairman Of The Board TITLE:
ADDRESS:
102 Corporate Center Blvd.
Greensboro, NC 27408-3172
ADDRESS:
102 Corporate Center Blvd
Greensboro, NC 27408
ADDRESS: '
SECTION D: CERTIFICATION OF ANNUAL REPORT, Section D must be completed in Its entirety by a person/business
ehTodd Howard 8/10/2020
1 SIGNATURE DATE
Form must be signed by an officer listed under Section C of this form.
Todd Howard
Print or Type Name of Officer
Secretary
Pdnt or Type Tdle of Officer
This Annual Report has been fled electronically.
MAIL TO: Secretary of Stale, Business Registration Division, Post Once Box 29525, Raleigh, NC 27626-0525