NCGNE1519_No Exposure Submission_20220315

FOR AGENCY USE ONLY
NCGNE
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Division of Energy, Mineral, and Ladd Resources
National Pollutant Discharge Elimination System
No Exposure Certification for Exclusion
NCGNE0000
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JAN 2 5 2022
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
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rescinded, your facility must continue to abide by the terms and conditions of the current permit.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/energv-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

Materials or products during loading/unloading or transporting activities
D Yes M No D 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 N/A
Materials contained in open, deteriorated, non -sealed', or leaking storage drums barrels, tanks,
and similar containers
D Yes D No D N/A
Materials or products handled/stored on roads or railways owned or maintained by the discharger
El Yes ® No D N/A
Final products that would be mobilized in stormwater discharges (e.g., rock salt)
D Yes ® No D N/A
Waste material (except waste in covered, non -leaking containers [e.g., dumpsters])
D Yes El No D N/A
Application or disposal of process wastewater (unless otherwise permitted)
El Yes Z1 No D 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 ®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 El No El 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?
El 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
evidence of leaks?
91Yes El No D 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?
®Yes DNo N/A
Is secondary containment provided for single above ground storage containers (including drums,
barrels, etc.) with a capacity of more than 660-gallons?
El Yes El ® 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?
®Yes ®No ®N/A
Is secondary containment provided for Title III Section 313 Superfund Amendments and
Reauthorization Act (SARA) water priority chemicals?
Dyes DNo D N/A
Is secondary containment provided for hazardous substances designated in 40 CFR §116?
DYes DNo D N/A
Are release valves on all secondary containment structures locked?
5aYes 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?
El Yes ® No D N/A
Does this facility store used, recycled, or otherwise reclaimed pallets outside?
El Yes ® No D N/A
Does this facility have coal piles on site?
D Yes ® No D N/A
Does this facility store other fuel sources outside in piles, such as wood chips, sawdust, etc.?
D Yes ® No D N/A
Page 3 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:
® 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.
I have read and understand the eligibility requirements for claiming a condition of "no exposure" and obtaining an
exclusion from NPDES stormwater permitting.
® 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 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.
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.
$I The information submitted in this NO1 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:
Signature of Applicant
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

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Waste Material Type
Waste Material Types
Please indicate the types of waste material managed by this facility.
Municipal Solid Waste
r Yes
r No
Construction and Demolition Waste
r Yes
r %
Industrial Waste
r Yes
r No
Land Clearing and Inert Debris [LCID]
f Yes
r No
Medical Waste
r Yes
r No
Yard Waste
r Yes
r No
Household Hazardous Waste
r Yes
r No
Waste or Scrap Tires
r Yes
r No
Other Waste Type r

Waste Data
Waste Data Entry*
"buld you prefer to Mbnually Enter Data or Upload a Spreadsheet?
r tilanually Enter Waste Disposal Data
(- Upload Spreadsheet
Waste Data Upload
Pleaseupload Spreadsheet file for more complicated records.
Note: Upload is configured to accept a Peel or OpenDocument spreadsheet
East Spencer TS Annual Tonnage.)dsx 17.49KB
Total Waste Received from NC Sources*
Please enter the total amount ofwaste received from North Carolina sources here:
46,659.55
Total Waste Received from OrdofStateSources*
Please enter the total amount ofwastereceiwdfrom Out-of-Statesourceshere:
0.00

Recovered Material Data
Please indicate what other activities occur at this facility below.
r Recycling/Reuse Collection r- Scrap Tire Collection r White Goods Collection
r Household Hazardous Waste r- Enter Other Activity
Collection
Recovered Materials Table
Please list below the quantities of materials recovered at this facilityduring Fi,2020-21.
Material
Tons
Aluminum Cans
0.00
Cardboard
0.00
Carpet
0.00
Commingled Recyclables
0.00
Computer Equipment
0.00
Concrete / Rubble / Asphalt
0.00
Fluorescent Light Bulbs
0.00
Glass
0.00
Gypsum / Drywall Board
0.00
Metal: Steel Cans
0.00
Metal: Other
0.00
Pallets
0.00
Paper
0.00
Plastic
0.00
Televisions
0.00
Used Oil / Oil Filters
0.00
Wood 0.00
Specify Other Recovered Tons(?)
0.00
Total Recovered Material, Tons 0.00

Operators / Certification / Submittal
Certified Operators*
Are SWANAor other certified operator[s] employed at your facility..
r Yes f No
Certification*
W CERTIFICATION: I certify that the information provided is an accurate representation of the
activity at this facility.
REMNDER: According to GS.130A309.09D(b), this report must be sent to the County Manager of each muntyfrom which
waste was received. Acopyofthis report will be automaticallyforwarded to the Regional Environmental Senior Specialist for
your county.
Name
Timothy Owens
Title*
District Manager
Snail *
[e-mail]
Date *
7/30/2021
Comments