NCGNE1668_Application_20240311

FOR AGErCX U,S,E ONLY Revised 10/6/2023
NCGNE ( (o (p
Assigned to: �. C 6v_ Q p 3/\\/Pt
ARO FRO MRO R WARO WIRO WSRO 1'
Division of Energy, Mineral, and Land Resources
National Pollutant Discharge Elimination System
No Exposure Certification for Exclusion
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 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, 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 Until you are issued a No Exposure Certification and your NPDES permit is rescinded,your facility must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).
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://deg.nc.gov/about/divisions/energy-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: Legally responsible person(as signed in Item 7 below):
Carsgen Therapeutics Corporation jie jia
Mailing address: City: State Zip Code
4021 Stirrup Creek Dr, Ste 350 Durham NC 27703
Telephone number: Email address:
216-633-8758 [e-mail]
Type of Ownership:
Government
❑ County ❑ Federal ❑ Municipal ❑ State
Nor-government
Iff 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:
4022 Ted Krenkel
Street address: Telephone number:
4022 Stirrup Creek Dr,Ste 320 402-312-5656
Email address: [e-mail]
City Durham County Durham State INC Zip Code 27703
Latitude of entrance: 35.91599469023682
Longitude of entrance: -78.84425594547535
Parcel Identification Number(PIN):
Unknown
Date operation began: Standard Industrial Classification(SIC)Code:
February 18,2022 2836
Brief description of the types of industrial activities and products produced at this facility:
Biotech laboratory research and clinical manufacturing
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 ❑Yes P6 No ❑ N/A
stormwater
Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑Yes IeNo ❑ N/A
Materials or products from past industrial activity ❑Yes No ❑ N/A
Material handling equipment(except adequately maintained vehicles) ❑Yes L'No ❑ N/A
Page 2 of 5

- - _ ___Materials-or_products.during loading/unloading or-transporting activities-T ❑_Yes_ _No_❑_N/A_
Materials or products stored outdoors(except final products intended for outside use[e.g.,new ❑Yes WNo ❑ N/A
cars]where exposure to stormwater does not result in the discharge of pollutants) J
Materials contained in open,deteriorated,non-sealed',or leaking storage drums barrels,tanks, El Yes N No ❑ N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger ❑Yes TrNo ❑ N/A
Final products that would be mobilized in stormwater discharges(e.g.,rock salt) ❑Yes No ❑ N/A
Waste material(except waste in covered,non-leaking containers[e.g.,dumpsters]) ❑Yes NrNo ❑ N/A
Application or disposal of process wastewater(unless otherwise permitted) ❑Yes #No ❑ N/A
Particulate matter orvisible deposits of residuals from roof stacks and/or vents not otherwise ❑ Yes G 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 eNo❑ 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 (JJ 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 of rust,damaged or weathered coating,pits,'or deterioration,or
0-Yes❑No Ed'N/A
evidence of leaks? !
Is secondary containment provided for all exteriorASTsTlf so,is it free of any cracks,holes,or ❑� r ❑Yes No C'N/A
evidence of leaks,and are drain valves maintained locked shut?
Is secondary containment provided for single.above ground storage,containers(including drums, +`❑Yes❑No LKN/A
barrels,etc.)with a capacity of more than 660-gallons?
Is secondary,containment provided for above ground storage containers stored in close proximity- ❑Yes❑No �N/A
to each other v✓iil a combined capacity of more than 1,320 gallons?
Is secondary containment provided for Title III Section 313 Superfund Amendments and ❑Yes❑No N 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 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❑ No VN/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 IVNo ❑ N/A
Does this facility store other fuel sources outside in piles,such as wood chips,sawdust,etc.? ❑Yes No ❑ N/A
Page 3 of 5

— — -—-Does-this facility-have-air_emissions-associated with industrial activity(e.g.,-degreasing-operations, _-p.Yes-reNo-QN/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:
S. 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:
6YThis facility is a(mark all that apply)
ReHazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility v
❑ Hazardous Waste Disposal Facility-
If checked,indicate:
• Kilograms of waste generated each month:'Less than 10bKg
- os�
• Type(s)of waste: Laboratory Chemical Waste
• How material is stored:_In original container.]abeled hazardous waste r.
• Where material is stored: Internal storage area
• Number of waste shipments per year: 4
• Name of.transport/disposal vendor:.Triumvirate.Environ_mental
• Transport/disposal vendor EPA ID: MAC300016672
• Vendor address: 1916 Garner Station Blvd, Raleigh, NC 27603
❑This facility is located on a Brownfield orSUPERFUND site.
If checked,briefly describe the site conditions: N/A
❑This facility is located on Native American Lands. N/A
6. Required Items (Application will be returned unless all of the following items have been included):
CeCheck for$250 made payable to NCDEQ
VCopy of most recent Annual Report to the NC Secretary of State(if applicable) _
NOThis completed application and any supporting documentation
L"Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 4 of 5

7.__Applicant_Certifcation
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:
Roo 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.
L`l 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)).
d 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 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.
Y' 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 dischargeof stormwater from the facility.
LY The information submitted in this-N01 is,Io the-best of my knowledge and belief,true,accurate,and complete based on
m inquiry of the person or persons who man. a the.system,'or those ersoris direct) responsible for atherin the
Y 9 ry P P g P Y P g g
information.
Printed Name of Person Signing:
-�ieJi2,.
.. r.
Title: Vice President F_
i,l 1
March 4, 2024
Signature of App)U nt 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

1111M An official website of the United States government Hens how you know
Map Locator
4022 Stirrup Creek Drive,Durham,North Carolina,27703
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