NCGNE1627_Application_20230629

RECEIVE®
FOR AGENCY USE ONLY
NCGNE JUN 2 6 zM
Assignedto: C004-1
ARO', FRO® RRO WARD WIRO WSRO DEMLR•StormwaterProgram
Division of Energy, Mineral, and Land Resources
National Pollutant Discharge Elimination System
No Exposure Certification for Exclusion
NCG N EOOOO
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 new facilities, applicants should apply no earlier than 60 days before the start of operation. This will allow
DEMLR staff to verify conditions during active operation. For facilities that already have an industrial stormwater
permit in North Carolina,DEMUR 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 Until you are issued a No Exposure Certification and your NPDES permit is rescinded,your facility must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 forthe 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).
For new facilities, applicants should not apply more than 60 days before the start of operation date.This
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/nodes-no-exposure.
Directions: Print or type all entries on this application form. Send the original, signed application to: NCDEMLR
Stormwater Program, 2612 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 6

1. Owr.-ter/Operator-(to-whom-all-permit correspondence will- emailed
Name of legal organizational entity: Legally responsible person(as signed in Item 7 below):
i C iwk
Street address: City: State Zip Code
1 Cornrt i N G foIR
Telephone number: Email address:
9 SI &6 M;CPoe eaftNmco e .com
Type of Ownership:
Government
•❑ County ❑ Federal ❑ Municipal ❑State
n-government
i+J 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:
8� N&Street address: II `1,1 Telephone number:
Lsn 1[3 7oy 5f38
Email adiiress:
City, County State - Zip
Code
Latitude'of entrance:3S"; -
Longitude-pf entrance:,_go.9O�r 6o _
ication Number Parcel Idedtfi er(P ar T.
Date operation began[ -- : -M_Standard Industrial Clas`sification,(SIC)Code:
Sp O1 35-1 4 't' M.
Brief description of the types of industrial activities and products produced at this facility-, `
L' wF a..nd LanllPLdv Cog2er v�AC'- C -hy7
3. Cgnsultant(if applicable): s
Name of consultant: Consulting firm:
Street address: City: State and zip code:
Telephone number: Email address:
4. Exposure Checklists
Are any of tfie 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 ❑Yes �"No❑ N/A
stormwater
Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑Yes No ❑ N/A
Materials orproducts from past industrial activity ❑Yes IZNo ❑ N/A
Material handling equipment(except adequately maintained vehicles) ❑ Yes No ❑ N/A
Page 3 of 6

-Materials-or-products-during loading/unloadingor transporting activities ❑Yes /No ❑ N/A
Materials or products stored outdoors(except final products intended for outside use[e.g.,new ❑yes m No ❑ 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, ❑Yes 11� No ❑ N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger ❑Yes No ❑ N/A
Final products that would be mobilized in stormwater discharges(e.g.,rock salt) ❑ Yes Ao ❑ N/A
Waste material(except waste in covered,non-leaking containers[e.g.,dumpsters]) ❑ Yes iNo ❑ N/A
Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes RfNo ElN/A
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise ElYes ®(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 ❑Yes No❑ N/A
and stored upside down to prevent precipitation accumulation) J
For any exterior ASTs,as well as drums,barrels,tanks and similar containers stored outside,has ❑yes R'1 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 itemss;you—a_re____�_noYeligiblee —fof'_the__ no---exposuren excicl usion:`-..
Are exterior ASTs or piping free of.rust,damaged orweathered coating.piis,:or deteriorauom or //
es❑`No N N/A
evidence of leaks? /
Is secondary containment provided for all exterior ASTs?/If so is ii free of any cracks,holes,or ❑.Yes❑ No L9 N/A
evidence of leaks,and are drain valves maintained locked shut?
Is secondary.containment.provided for single above ground storage containers(including drums,
barrels,etc.)with a capacity of more than 660-gallons? - ❑Y6'❑ No M N/A
Is secondary containment provided1or aboveground storage•containers stored in close proximity-:-
to each other with a combined capacity of more than 1,320 gallons?' F•' ❑Yes❑No N/A
Is secondary containment provided for Title III Section 313 Superfund Amend m_entsand
Reauthorization Act(SARA)water priority chemicals? El Yes❑No N/A
Is secondary containment provided for hazardous substances designated in 40 CFR§136? ❑Yes❑No N/A
Are release valves on all secondary containment structures locked? ❑Yes❑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.
i
Are vehicles used in material handling in disrepair and/or leaking fluid? ❑Yes VNo ❑ N/A
Does this facility store used,recycled,or otherwise reclaimed pallets outside? ❑Yes No ❑ N/A
Does this facility have coal piles on site? ❑Yes 19 No ❑ N/A
Does this facility store other fuel sources outside in piles,such as wood chips,sawdust,etc.? ❑Yes d No ❑ N/A
Page 4 of 6

Does this-facilityhaveairemissiorns-associated with industrial activity(e.g.,degreasing operations, ❑Yes No ❑ N/A
plating,painting,or metal finishing)?
If yes:
Describe the industrial activity:
Are those emissions permitted by an Air Quality Permit? ❑Yes ❑ 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 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:S
• Type(s)of waste:,
• How material is stored:. -
• Where.material is,stored:
• Number of waste shipments per year: > ;
• Nameobtransport/disposal vendor: �,_ 1.
-
• Transport/disposal vendor EPA ID: �
• Vendor address:
❑This facility is located on a Brownfield orSUPERFUND 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 5 of 6

7-.Applicant-C-ertification
North Carolina General Statute 143-215.66(1)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:
❑ 1 am the person responsible forthe industrial activity,for satisfying the requirements of this exclusion,and for any civil
or criminal penalties incurred due to violations of this exclusion.
❑ 1 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.
❑ 1 understand that in the event that the site no longer qu_alifi_gs for a No Ex posure.Exclusion that l,must obtain coverage
under an NPDES permit prior to any point source discharge'o`f'tormwater from the faality.—
❑ 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 whomanage the system;or those persons directly responsible forgathering the
information.
Printed Name:of Person Signing:'—'-
Title: J
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 6 of 6

BUSINESS CORPORATION ANNUAL REPORT
1W20n
NAME OF BUSINESS CORPORATION: Commscope,Inc. of North Carolina
0032725 Filing of0®use n
SECRETARY OF STATE ID NUMBER: STATE OF FORMATION: NC E-Filed Annual Report
0032725
REPORT FOR THE FISCAL YEAR END: 4/30/2023 CA202309407380
4/42023 02:30
SECTION A: REGISTERED AGENT'S INFORMATION Changes
1. NAME OF REGISTERED AGENT: United Agent Group Inc.
2.SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3.REGISTERED AGENT OFFICE STREET ADDRESS&COUNTY 4.REGISTERED AGENT OFFICE MAILING ADDRESS
15720 Brixham Hill Avenue #300 15720 Brixham Hill Avenue#300
Charlotte, NC 28277 Mecklenburg County Charlotte, NC 28277
SECTION.B:PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Sales &Manufacturing
2. PRINCIPAL OFFICE PHONE NUMBER: (561_) 508-5033 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction
4.PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
1100 Commscope Place,SE 1100 Commscope Place,SE
Hickory, NC 28602-3619 Hickory,NC 28602-3619
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: Charles L. Treadway , Jr. NAME: Kyle D. Lorentzen NAME: Justin C. Choi
TITLE: President TITLE: Chief Financial Officer TITLE: Secretary
ADDRESS: ADDRESS: ADDRESS:
1100 CommScope Place,SE 1100 Commscope PL SE 1100 CommScope Place SE
Hickory,NC 28603 Hickory,NC 26802 Hickory,NC 28602
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
entity.
Justin C.Choi 4/4/2023
SIGNATURE DATE
Forth must be signed by an officer listed under Section C of this form.
Justin C.Choi Secretary
Print or Type Name of Officer Print or Type Title of Officer
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27626-0525

14
SECTION E:ADDITIONAL OFFICERS
NAME: Justin C. Chasseur NAME: NAME:
TITLE: Treasurer TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
1100 Commscope PL SE
Hickory, NC 26802
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: Name:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:
NAME: NAME: NAME:
TITLE: TITLE: TITLE:
ADDRESS: ADDRESS: ADDRESS:

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