NCGNE1650_Application_20231129

FOR AGENCY USE ONLY Revised 10/6/2023
NCGNE I k_6 0
Assigned to: ,cp Cook
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Division of Energy, Mineral, and Land Resources (XV
National Pollutant Discharge Elimination System
No Exposure Certification for Exclusion 'MLR-Stormwater Program
NCGNE0000
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 oractivities 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
DEMUR 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 Until you are issued a No Exposure Certification and your NPDES permit is rescinded,yourfacility must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 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).
NC DEQ Stormwater Program requires a one-time$250 application fee via check made payable to NC DEQ. There
is no annual fee once covered under a No Exposure Certification. 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://deci.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

1. Owner/Operator(to whom all permit correspondence will be mailed):
Name of legal organizational entity: �es\ BU' Legal[ responsible person(as signed in Item 7 below):
T ish N a
Mailing address: City: r State Zip Code
1&01 Penn Ave S. is -Piet MA! 55423
Telephone number: Email address:
a55-22R- Kq(1 alveoWTAanceCa bes-Ebuv,com
Type of Ownership:
Government
❑ County ❑ Federal ❑ Municipal ❑ State
Non-government
❑Business(If ownership is business,a copy of NCSOS report must be included with this application)
KIndividual
2. Industrial Facility(facility requesting exclusion):
Facility name: n 2> Facility Snv ro ment�I contact:
5� gux DDC # 58} 1 /}
Street address, TOdd Rd Telephone number:
3 855 -2zq-uq l f
Email address:
P,1'lvcom llance @ be540 'Co
`ityCkor,044G County,
bur State C' ipCode� Z28Z1
Latitude of entrance:95,2.4fts—
Longitude of entrance:%O.Q 54 51°W
Parcel Identification Number(PIN): ,OS C7 C ZIO
Date operation'began:`7 /1-7/W Z37 I Standard Industrial Classification(SIC)Code:
Brief description of the types of industrial activities and products produced at this facility-, 'I
GUfG�� wa4ehous-In (Rot Sl-ordr
3. Consultant(if applicable): .�t
Name of consultant: A^ ;Cr1 of DtAA1 S / Consulting firm: PTTN1
Street address: C/ //pVVUII DTC Bid S�C (p�D (j� IIf ! State and zipgddi:11
Jt7 I i C7
Telephone number: Email address:
y10- 19 gV71 Mic �e i s a �i)Vl . Co
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® No❑ N/A
stormwater
Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑Yes® No❑ N/A
Materials or products from past industrial activity ❑Yes 18 No❑ N/A
Material handling equipment(except adequately maintained vehicles) ❑Yes ZNo❑ N/A
Page 2 of 5

Materials or products during loading/unloading or transporting activities ❑Yes 19 No❑ N/A
Materials or products stored outdoors(except final products intended for outside use[e.g.,new ❑Yes 9 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 A No❑ N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger ❑Yes UK No❑ N/A
Final products that would be mobilized in stormwater discharges(e.g.,rock salt) ❑Yes K No❑ N/A
Waste material(except waste in covered,non-leaking containers[e.g.,dumpsters]) ❑Yes R No❑ N/A
Application or disposal of process wastewater(unless otherwise permitted) ❑Yes® No❑ N/A
Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise El Yes ® 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)
For any exterior ASTs,as well as drums,barrels,tanks and similar containers stored outside,has ❑yes-I&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 ofrusf,damaged or weathered coating,pits,or deterioration,or ❑.yes❑No®N/A
evidence of leaks?
Is secondary containment provided for all exterior ASTs?If so,is it free of any cracks,holes,or ❑Ye3❑No N/A
evidence of leaks,and are drain.yalves maiptained locked shut?
Is secondary containment provided for single above ground storage containers(including drums, p Yes❑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 p Yes El No @Q 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 ❑Yes❑No N/A
Reauthorization Act(SARA)water priority chemicals?
Is secondary containment provided for hazardous substances designated in 40 CFR§116? ❑Yes❑No N/A
Are release valves on all secondary containment structures locked? ❑Yes❑No NLN/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 R.No❑ N/A
Does this facility store used,recycled,or otherwise reclaimed pallets outside? ❑Yes IQ No❑ N/A
Does this facility have coal piles on site? ❑Yes IQ No❑ N/A
Does this facility store other fuel sources outside in piles,such as wood chips,sawdust,etc.? ❑Yes R&No❑ N/A
Page 3 of 5

Does this facility have air emissions associated with industrial activity(e.g.,degreasing operations, ❑Yes 19 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)
N Hazardous waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑Hazardous Waste Disposal Facility"
If checked,indicate:
• Kilograms of waste genefated each month: Z 100 k 15
• TYpe(s)of was_we Aercnois, cta+n•^j VTOAK111
• How material is stored: SS-y,11on Awe'+'
• Where materialisstored: VUZA Ao- V_7'N4e 5kcr'k A'rti
• Number of waste shipments per year: A'wwi-t AAL,
• Name of transport/disposal vendor: Geo^ CZA,hti
• Transport/disposal vendor EPA ID:
• Vendor address: 413Z Qom V.'wUyr-NA, 0-'Avo e tlC• 2LSMka -
❑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):
IKCheck for$250 made payable to NCDEQ
❑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 4 of 5

7..Applican`Certification—
North Carolina General Statute 143-215.6B(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:
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 recertification on file at the facility.
L� 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.
€S] 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 personor persons who manage the system,or those persons directly responsiblel6r.gathering the
information. -'
Printed Name of Person Signing:
Title:
L.tO • fJ..s�v�'ut�lt_ pc.�'a�x 21{�7.tir.3
Signature Date Signed
Mail the entire package to: DEMLR—StormwaterProgram
Department of Environmental Quality
1612 Mail Service Center
Raleigh,NC 27699-1612
Page 5 of 5

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