NCGNE1512_Application_20211104

FOR AGENCY USE ONLY
NCGNE � 12
Assigned to: GLatt 1.C4 dOYI ARO FRO MRO RRO WARO WIRO WSRO RF �a •FIUF—D
NO✓ o 2 9R91
Division of Energy, Mineral, and Land Resources DENR-LAND QUALITY
National Pollutant Discharge Elimination SystemTORMWATERPERMl771µG
No Exposure Certification for Exclusion
NCG N E0000
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 fora 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rescinded, your facility must continue to abide by the terms and conditions of the current permit.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, 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.gov/a bout/divisions/energy-m i ne ra I-land-resources/n pdes-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):
Signode Industrial Group LLC, dba Angleboard
Jimmy Barnett
Street address:
City:
State
Zip Code
610 Industrial Ave
Salisbury
NC
28144
Telephone number:
Email address:
704-633-3215
[e-mail]
Type of Ownership:
Government
County E3 Federal 13 Municipal E3 State
Non -government
0 Business (If ownership is business, a copy of NCSOS report must be included with this application)
Individual
2. Industrial Facility (facility requesting exclusion):
Facility name:
Facility environmental contact:
Signode Angleboard
Jimmy Barnett
Street address:
Telephone number:
610 Industrial Ave
704-633-3215
Email address:
[e-mail]
City
County
State
Zip Code
Salisbury
Rowan
NC
28144
Latitude of entrance: 35.67982871833402,
Longitude of entrance:-80.50040085458058
Parcel Identification Number (PIN):
450A029
Date operation began:
Standard Industrial Classification (SIC) Code:
06/01/1968
2679
Brief description of the types of industrial activities and products produced atthis facility:
Manufacture of paper angleboard protective packaging
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
E3 Yes 0 No © N/A
Materials or residuals on the ground or in stormwater inlets from spills/leaks
E3 Yes 13 No 13 N/A
Materials or products from past industrial activity
® Yes 0 No © N/A
Material handling equipment (except adequately maintained vehicles)
0 Yes 0 No E3 N/A
Page 2 of 5

Materials or products during load!ng/unloading or transporting activities
❑Yes 0 No 0 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)
❑ Yes 0 No ❑ N/A
Materials contained in open, deteriorated, non -sealed', or leaking storage drums barrels, tanks,
and similar containers
E3 Yes E3 No E3 N/A
Materials or products handled/stored on roads or railways owned or maintained by the discharger
13 Yes ® No E3 N/A
Final products that would be mobilized in stormwater discharges (e.g., rock salt)
0 Yes 0 No E3 N/A
Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
❑ Yes ❑ No 13 N/A
Application or disposal of process wastewater (unless otherwise permitted)
E3 Yes ® No ® 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
❑ Yes M 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)
DYes 0 No 13 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 D 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
E3 Yes ❑No El N/A
evidence of leaks?
Is secondary containment provided for all exterior ASTs? If so, is it free of any cracks, holes, or
E3 Yes ❑ No El N/A
evidence of leaks, and are drain valves maintained locked shut?
Is secondary containment provided for single above ground storage containers (including drums,
EjYes E3 No ❑ 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
El Yes E3 No ❑ N/A
to each other with a combined capacity of more than 1,320 gallons?
Is secondary containment provided for Title III Section 313 Superfund Amendments and
Dyes ❑No El N/A
Reauthorization Act (SARA) water priority chemicals?
Is secondary containment provided for hazardous substances designated in 40 CFR §116?
Dyes ❑No 0 N/A
Are release valves on all secondary containment structures locked?
E3 Yes El No El 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?
❑ Yes M No E3 N/A
Does this facility store used, recycled, or otherwise reclaimed pallets outside?
E3 Yes EZI No © N/A
Does this facility have coal piles on site?
E3 Yes 0 No ® N/A
Does this facility store other fuel sources outside in piles, such as wood chips, sawdust, etc.?
[:]Yes El No ® N/A
Page 3 of 5

Does this facility have air emissions associated with industrial activity (e.g., degreasing operations, 13 Yes 0 No E3 N/A
plating, painting, or metal finishing)?
1( yes:
Describe the industrial activity:
Are those emissions permitted by an Air Quality Permit? ❑Yes I❑ No
Please specify:
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 lOD-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):
I7 Copy of most recent Annual Report to the NC Secretary of State (if applicable)
(a This completed application and any supporting documentation
O Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 4 of 5

7. Applicant Certification
North Carolina General Statute 143-215.6E (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). 1 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.
El 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)).
O 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 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.
❑ 1 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.
❑ 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: Jimmy Barnett
Title: Plant Manager
ture of Applicant
10/21/2021
Date Signed
Mail the entire package to: DEMLR— Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 5 of 5

LIMITED LIABILITY COMPANY ANNUAL REPORT ■
mnnv
NAME OF LIMITED LIABILITY COMPANY: Signode Industrial Group LLC
SECRETARY OF STATE ID NUMBER: 1353915 STATE OF FORMATION: DE
REPORT FOR THE CALENDAR YEAR: 2021
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: CT Corporation System
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
1353915
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
09:15
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
160 Mine Lake Ct Ste 200
Raleigh, NC 27615-6417 Wake County
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Manufacturer
160 Mine Lake Ct Ste 200
Raleigh. NC 27615-6417
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS
3650 West Lake Ave. 3650 West Lake Ave.
Glenview, IL 60026 Glenview, IL 60026
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: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: Signode Industrial Group US Inc. NAME:
TITLE: Member TITLE:
ADDRESS:
3650 West Lake Ave.
Glenview, IL 60026
ADDRESS:
NAME:
TITLE:
ADDRESS:
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
Signode Industrial Group US Inc., by Kelly Lettmann POA 3/5/2021
SIGNATURE
Form must be signed by a Company Official listed under Section C of This form.
DATE
Signode Industrial Group US Inc., by Kelly Lettmann POA Member
Print or Type Name of Company Official Print or Type Tifie of Company Official
This Annual Report has been Tied electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

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