NCGNE1638_Application_20230905

FOR AGENCY USE ONLY
NCGNE ? 6 3.a � � NGGOSODR� REG�`��O
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ARO FRO MRO ®WARO WIRO WSRO "^ ^
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Division of Energy, Mineral,and Land Resources
EM`RStc���t
National Pollutant Discharge Elimination System
No Exposure Certification for Exclusion
NCGNEODOO
Submission of this No Exposure Certification constitutes notlflcatlon 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 orevent exposure to rain,snow,snowmelt,
end/or runoff.Industrial materials or activities inc ude,but are not linked to:
• material handling equipment or activities, • by-products,
• Industrial machinery, • final products,or
• raw materlass, • 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 stone resistant shelter Is not required for industrial materials stored In the following container types, provided
the containers are not deteriorated and do rat leak:
• drums, . tanks,and
• barrels, . sim ilar containers.
For new facilities, applicants should apply no earlier th;o 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,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is effective.Until you are issued a No Exposure Certification and your NPDES permit is rescinded,your fadlity must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 comF4v sihh tyre terms s,nd cL-nditlons 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:
httos:;;ae_qnc. ov aboutidwision�ienet&-mineral-land-resourceslnpdes-no-exuosure.
Directions:: Print or type all entries on this application form. Send the original,signed application to: NCDEMLR
Stortmvater 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 6

1. Owner/Operator(to whom all permit correspondence will be mailed):
Name of legal organizational entity: Legally responsible person(as signed In nem 7-below).-
Evergreen Packaging LLC Paul Brang
Street address: City: State Zip Code
2215 S Wilmington St Raleigh NC 27603
Telephone number: Email address:
[phone] [e-mail]
Type of Ownership:
Government
❑County ❑ Federal ❑Municipal ❑State
Non-government
2 Business(If ownership is business,a copy of NCSI r report must be included with this application)
❑ Individual
2. Industrial Facility(facility requesting exclusion):
Facility name: Facility environmental contact:
Evergreen Packaging LLC William Dani
Street address: Telephone number:
2215 S Wilmington St 98"84-2217
Email address:
[e-mail]
City County State Ap Code
Raleigh Wake NC 27603
Latitude of entrance:35.7522
Longitude of entrance:-78 6402
Parcel Identification Number(PIN):
Date operation began: Standard Industrial Classification(SIC)Code:
1958 2657
Brief description of the types of industrial activities and products produced at this facility:
Paper Board Food Packaging
3. Consultant(if applicable):
Name of consultant: Consulting Bnn:
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 ❑Yes 8 No❑ N/A
stormwater
Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑Yes 8 No❑ N/A
Materials or products from past industrial activity ❑Yes♦a No❑N/A
Material handling equipment(except adequately maintained vehicles) ❑Yes 12 No❑ N/A
Page 3 of 6

Materials or products during Ioadiry/unloadfng or transporting activities O Yes 0 No❑N/A
Materials or products stored outdoors(except*no]products intended for outside hues[a.&,new
cars)where exposure to stormwater does not result In the discaarge of pollutants) ❑.Ye 0 No O N/A
Materials contained In opery deteriorated,non salad',or Inking storage drWro barrels,tsoks, O Yes B No O N/A
and similar containers
Materials or products handled/stored an roads or ralhwys owned or maintained by the disdmrrgar ❑Yes 0 No❑WA
Hnel products thatwould be mobilized In stcr nowter discharges(e.g.,rock salt) ❑Yes 0 No❑WA
Waste material(except waste In covered,nomlmidng containers(e.g,dumpstrsp O Yes B No O N/A
Application or disposai of process wastewater(unless othaiwlse permitted) ❑Yes 0 No❑N/A
Particulate matter or visible deposits of residuals from roof dada and/or vents not otherwise ❑Yes 0 No O N/A
regulated(i.e.under an air quality control permit)and evident In the stormwater outfbw
Empty containers that previously tornained materials that are not properly stored(le.not dosed
and stored upside down to prevent precipitation accumulation) O Yes 0 No❑WA
For any exterior AST;as wall as drums.barrels,tanks and shNlar containers stored outside,has CI Yes 0 No❑N/A
the facility had any releases in the past three(3)years?
'Sealed means banded or otherwise secured and with locked or nonoperational taps or vaves.
Above Ground Storage Tonics(AM)and Secondary Containment
If you answer'No'to arty 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 O Yes O No❑N/A
evidence of leaks?
Is secondary containment provided for all exterior ASTs?If so,is it free of any crada,holes,or Yes O No❑N/A
evidence of leaks,and are drain valves maintained locked shut?
Is secondary containment provided for single above ground storage containers(Including OYes O No❑WA
barreb,eta)with a opacity of more than 660-gallons?
Is secondary containment provided for above ground storage containers stored in dose proximity 0 Yes O No❑WA
to each other with a combined capacity of more than 1X0 gallons?
Is secondary containment provided for Title ill Section 313 Superfund Amendmerts end O Yes O No B N/A
Reauthorization Act(SARA)water priority chemicals?
Is secondary containment provided for hazardous substances designated In 40 CFR§116? O Yes O No 0 N/A
Are release valves on N secondary containment structures ticked? O Yes O No 0 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 ardor Naidng fluid? O Vas 0 No❑N/A
Does this facility store used,recychK or otherwise reclaimed pallets outside? ❑Yes 0 No❑N/A
Does this facility have coal piles on sire? O Yes 0 No❑N/A
Does this Willy store other fuel sources outside In plies,such as wood dNps,sawdust,etc? ❑Yes 0 No❑N/A
Page 4 of 6

---------------
EMM
'have air emissions assotlated with industdat ettivhy(e.g.,degraasing operations,
Plating, ,or metal ftnishing)?
0 Yes❑No❑N/A
e the industrial activity: Paper
board Printing and storage
e emissions permitted by an Air quality Permit? 0 Yes❑No
pectly;Air Permit(dUnitlB,03912R21
5. Other Faculty Conditions(cheCK all that a explain
a oryCo Smog) —
0 This facility has other NpDES penny pplY and explain accordingly): —
1f checked,list the
NCG050099 Permit numbers for all currant NPDES permits:
❑This%difty has Non-Dlscha e — —
If checked,Ilat rg permits(e.g.recycle
the permit numbers for as current Non-Discharge permits:
❑This faciiIry stores hazardous waste in the 1DDyear floodplain.
If checked,describe how the area Is protected from flooding:
0 This facility Is a(mark aB that apply)
0 Hazardous Waste Generation Facility
❑Hazardous Waste Treatment Facility
Cl Hazardous waste Storage Facility
❑Hazardous Waste Disposal Facility --
If checked,Indicate;
• Kilograms of waste generated each mo 9 20 0 KGW
• Type(s)of waste:Falafnmabie Liquids (Solvants)
• How material is stored: 55 gallon drums
• where material Is stored; Hazardous Waste Buildi
ft
• Number of waste shipments per year. Approximately/4
• Name of transport/dlsposal vendor.
Resource• TronsporVdisposal vendor EPA ID: SCD036275626 Revery
• vendor address: 755 Industrial Road Sumter, SC 29150
❑This facility Is located b —�--
on a Brownfteld or SUpEgFUND she.If checked,briefly describe the site conditions:
❑This facility Is located on Native American Unds.
6. Required hems(Application VAD be retumed unless all of the following - -
Items have been Included):
Copy of most recent Annual Report to the NC Secretary of State(If applicable)I0This completed appllcatien and any supporiI ecreurantation
0 of�ntr map or 1 565 quad sheet with the bcatlon of the fadfl
q �jmwked
page 5 of 6

7. Apphorst CerdRcation
North Carolina General Statute 143-215.611(Ii provides that Any person who knowingly nukes any%Ise statement,
representation,or certification in any application,record,report,plan,or other document filed or required to be maintained
under this Artida or a rule Implementing this Article...shall be guilty of a Class 2 misdemeanorwhldi may Include a fine not
to exceed ten thousand dollars($10.OW).1 hereby request exclusion from NPDES stormwater pentritting•
Under penalty of law,t certify that:
m� 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.
s� I have read and understand the el WIRY 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 Se{f-tecerUflcatfon form at least
once each year and,if requested,provide this certlflratlon 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 rearti iatlons on Ale 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 arty point source discharge of stormwater from the facility.
The Information submitted In this N01 is,to the best of my knowledge and belief,true,accurate,and complete based on
my Inquiry of the person or persons who manage thesystc-,,orthosepersons 'reaiyresp lerof gathering the
Information.
Printed Name of Person Signing: P3UI Brang
Tide: Facility Manager
81161
541unSi une of xplolioara. Date Signed
Mall the entire package to: DEMLR—StornwaterProgram
Department of Environmental Quality
1612 Mail Service Center
Raleigh,NC 27699-1612
Page 6 of 6

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