NCGNE0963_COMPLETE FILE - HISTORICAL (Import Scan)_20141014

STORMWATER DIVISION CODING SHEET
NCG PERMITS
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PERMIT NO. /v 0 ta3
DOC TYPE �J' HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ ()+� ) U y
YYYYMMDD

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Ar
MC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
October 9, 2014
Larry Walker RECEIVED
Columbiana Hi Tech, Lt_C
1802 Fairfax Road OCT 14 2014
Greensboro, NC 27407
Subject: No Exposure Certification NCGNE0963 CENTRAL FILES
p DWR SECTION
Columbiana Hi Tech —204-D South Westgate Drive site
Guilford County
Dear Mr. Walker:
On October 8, 2014, Aana Taylor-Smith of the Winston-Salem Regional Office of the Division of Energy, Mineral, and
Land Resources(DEMLR) inspected the Columbiana Hi Tech site at 204-D South Westgate Drive in Greensboro, Guilford
County to determine compliance with No Exposure Certification NCGNE0963 issued on November 25, 2013. DEMLR file
review and site inspection revealed that the site is compliant with the terms and conditions of this certification. Site
conditions were found to be excellent. Please find a copy of the completed form entitled "Stormwater Inspection Report"
attached to this letter.
Please note that as per your No Exposure Certification, Columbiana Hi Tech is obligated to maintain no exposure
conditions at this facility. If conditions change such that the facility no longer qualifies for no exposure exclusion, you are
obligated to immediately obtain NPDES permit coverage for any stormwater discharge. Otherwise, the discharge
becomes subject to enforcement as unpermitted discharge.
As a reminder, Columbiana Hi Tech must recertify the no exposure status annually using the NCDENR self-recertification
form. Any"yes" answer would require that you obtain NPDES permit coverage for stormwater discharge from the facility.
The annual self-recertification form does not need to be submitted to DEMLR, unless requested. For extra copies
of the form, please visit our website at httpalportal.ncdenr.org/web/ir/npdes-stormwater#tab-5 or contact the Winston-
Salem Regional Office. Please note that this conditional exclusion from permitting does not affect your facility's legal
requirements to obtain environmental permits that may be required under other federal, state, or local regulations or
ordinances.
If you have any questions or need further information, please contact Aana Taylor-Smith or me at(336) 771-5000.
Sincerely,
Matthew E. Gantt, PE
Regional Engineer
Land Quality Section
Enclosures:
1. Stormwater Inspection Report
CC: Debbie Shoffner(City of Greensboro Stormwater Management Division,via email: [e-mail])
Central Files - DWR
WSRO Files—Land Quality
Division of Energy, Mineral, and Land Resources
Land Quality Section -Winston-Salem Regional Office
585 Waughtown Street,Winston-Salem, NC 27107 • Phone: [phone] FAX: [phone]

k
Compliance Inspection Report `!
f
Permit: NGGNE0963 Effective: 11/25/13 Expiration: Owner: Columbiana Hi Tech LLC
SOC: Effective: Expiration: Facility: Columbiana Hi Tech LLC
i 204 5 Westgate Dr Ste 1)
County: Guilford
Region: Winston-Salem
Greensboro NC 27407
Contact Person: Larry Walker Title: Phone: [phone]
Directions to Facility:
From 1.85 take exit 34 holden rd travel north 3,9 mi on holden turn left onto spring garden 1.4 mi it onto pomona.2 mi rt on dundas
.2 mi left onto south westgate.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 10108/2014 Entry Time: 11;OOAM Exit Time: 11:10ANI
Primary Inspector: Aana Taylor-Smith Phone: [phone]
Secondary Inspector)s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Uischarge,No Exposure Certificate
Facility Status: ® Compliant Not Compliant
Question Areas:
® Miscellaneous Queslions ® Misc
a
(See attachment summary)
Page: 1

V
Permit: NCGNE0963 Owner-Facility:Columbiana HI Tech LLC
Inspection Date: 1 010 81201 4 Inspection Type:Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Please refer to attached inspection letter.
t
Page: 2

Permit: NCGNE0963 Owner-Facility:Columbiana HI Tech LLC
Inspection Date: 10108/2014 Inspection Type:Compliance Evaluation Reason for Visit: Routine
Misc
Yes No NA NE
Is the facility compliant? M ❑ ❑ ❑
Comment. Facility is in compliance with NCGNE0953. Site is in very good condition.
Page; 3

Algh
V CDE R
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
October 9, 2014
Larry Walker
Columbiana-Hi Tech, LLC
1802 Fairfax Road
Greensboro, NC 27407
Subject: No Exposure Certification NCGNE0963
Columbiana Hi Tech —204-D South Westgate Drive site
Guilford County
Dear Mr. Walker:
On October 8, 2014, Aana Taylor-Smith of the Winston-Salem Regional Office of the Division of Energy, Mineral, and
Land Resources (DEMLR) inspected the Columbiana Hi Tech site at 204-D South Westgate Drive in Greensboro, Guilford
County to determine compliance with No Exposure Certification NCGNE0963 issued on November 25, 2013. DEMLR file
review and site inspection revealed that the site is compliant with the terms and conditions of this certification. Site
conditions were found to be excellent. Please find a copy of the completed form entitled "Stormwater Inspection Report"
attached to this letter.
Please note that as per your No Exposure Certification, Columbiana Hi Tech is obligated to maintain no exposure
conditions at this facility. If conditions change such that the facility no longer qualifies for no exposure exclusion, you are
obligated to immediately obtain NPDES permit coverage for any stormwater discharge. Otherwise, the discharge
becomes subject to enforcement as unpermitted discharge.
Asa reminder, Columbiana Hi Tech must recertify the no exposure status annually using the NCDENR self-recertification
form. Any"yes" answer would require that you obtain NPDES permit coverage for stormwater discharge from the facility.
The annual self-recertification form does not need to be submitted to DEMLR, unless requested. For extra copies
of the form, please visit our website at http://portal.ncdenr.oM/web/Ir/npdes-stormwater#tab-5 or contact the Winston-
Salem Regional Office. Please note that this conditional exclusion from permitting does not affect your facility's legal
requirements to obtain environmental permits that may be required under other federal, state, or local regulations or
ordinances.
If you have any questions or need further information, please contact Aana Taylor-Smith or me at(336) 771-5000.
Sincerely,
Matthew E. Gantt, PE
Regional Engineer
Land Quality Section
Enclosures:
1. Stormwater Inspection Report
CC: Debbie Shoffner(City of Greensboro Stormwater Management Division,via email:[e-mail])
Central Files - DWR
WSRO Files—Land Quality
Division of Energy, Mineral, and Land Resources
Land Quality Section -Winston-Salem Regional Office
585 Waughtown Street, Winston-Salem, NC 27107 - Phone:[phone] FAX: [phone]

Compliance Inspection Report
Permit: NCGNE0963 Effective: 11125113 Expiration: Owner; Columbiana Hi Tech LLC
SOC: Effective: Expiration: Facility: Columbiana Hi Tech LLC
County: Guilford 204 S Westgate Dr Ste D
Region: Winston-Salem
Greensboro NC 27407
Contact Person: Larry Walker Title: Phone: [phone]
Directions to Facility:
From 1-85 take exit 34 holden rd travel north 3.9 mi on holden turn left onto spring garden 1.4 mi rt onto pomona.2 mi rt on dundas
.2 mi left onto south westgate.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Oate: 1010812014 Entry Time: 13:00AM Exit Time: 11:10ANI
Primary Inspector: Aana Taylor-Smith Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge,No Exposure Certificate
Facility Status: ® Compliant ❑ Not Compliant
Question Areas:
® Miscellaneous Questions ® Misc
(See attachment summary)
Page: 1

Permit: NCGN£0965 owner-Facility:Columbiana HI Tech LLC
Inspection Date: 10/0812014 inspection Type:Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Please refer to attached inspection letter.
7
Page: 2

r t
Permit: NCGNE0963 Owner-Facility:Columbiana HlTech LLC
Inspection Date: 1010812014 Inspection Type:Compliance Evaluation Reason for Visit: Routine
Misc Yes No NA NE
Is the facility compliant? ® ❑ ❑ ❑
Comment: Facility is in compliance with NCGNE0963. Site is in very good condition.
Page: 3

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Energy, Mineral, and Land Resources
Land Quality Section
Tracy E. Davis, PE, CPM .Pat McCrory, Governor
Director John E. Skvarla, III, Secretary
November 25, 2013
Larry Walker
Columbiana Hi Tech LLC
1802 Fairfax Road
Greensboro, NC 27407
Subject:. No Exposure Certification NCGNE0963
Columbiana Hi Tech LLC—Westgate Drive Site
Guilford County
Dear Mr. Walker:
The Division has reviewed your submittal of the application for No Exposure Certification requesting exclusion from
NPDES stormwater permitting for the Columbiana Hi Tech LLC facility located at 204 South Westgate Drive Ste D in
Greensboro, NC. Based on your submittal of a signed certification of no exposure, the site visit conducted by Aana Taylor-
Smith on October 15, 2013, and recent upgrades to the site, the Division is granting conditional exclusion from permitting
as provided for under 40 CFR 122.26(g), which is incorporated by reference in North Carolina regulations.
Please note that by our acceptance of your No Exposure Certification, Columbiana Hi Tech LLC is obligated to maintain
no exposure conditions at this facility. If conditions change such that the facility no longer qualifies for no exposure
exclusion, you are obligated to immediately obtain NPDES permit coverage for any stormwater discharge. Otherwise, the
discharge becomes subject to enforcement as unpermitted discharge.
Columbiana Hi Tech LLC must recertify the no exposure status annually using the included form. Any"yes" answer would
require that you obtain NPDES permit coverage for stormwater discharge from the facility. The annual self-
recertification form does not need to be submitted to DEMLR, unless requested. Please note that this conditional
exclusion from permitting does not affect your facility's legal requirements to obtain environmental permits that may be
required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact Aana Taylor-Smith or me at(336) 771-5000.
Sincerely,
Matthew E. Gantt, PE
Regional Engineer
Land Quality Section
Enclosures:
1. Annual Self-Recertification Form
CC: Debbie Shoffner(City of Greensboro Stormwater Management Division,via email:[e-mail])
Stormwater Permitting Unit— No Exposure Files
Central Files - DWR
WSRO Files— Land Quality
Winston-Salem Regional Office
585 Waughtown Street,Winston-Salem, NC 27107 a Phone: [phone] FAX: [phone]

Taylor-Smith, Aana
From: Matt Willett <[e-mail]>
Sent: Monday, November 25, 2013 1:41 PM
To: Taylor-Smith, Aana
Subject: Westgate Dumpster Covers
Attachments: Westgate Dumpser Cover 1.jpg
Aana,
I have attached a picture of our dumpsters with covers over them at our Westgate facility.
Thanks,
Matt Willett
Safety Coordinator
Columbiana Hi Tech, LLC
336-852-5679 ext. 38
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Compliance Inspection Report
Permit: NCGNE0963 Effective: Expiration: Owner: Columbiana Hi Tech LLC
SOC: Effective: Expiration: Facility: Columbiana Hi Tech LLC
County: Guilford 204 S Westgate Dr Ste D
Region: Winston-Salem
Greensboro NC 27407
Contact Person: Larry Walker Title:_ Phone: [phone]
Directions to Facility:
From 1-85 take exit 34 holden rd travel north 3.9 mi on holden turn left onto spring garden 1.4 mi rt onto pomona .2 mi rt on dundas .2
mi left onto south wgstgate.
System Classificatiorfs:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 1 011 5/201 3 Entry Time: 09:15 AM Exit Time: 09:45 AM
Primary Inspector: Aana Taylor-Smith Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge,No Exposure Certificate
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
Miscellaneous Questions E Misc
(See attachment summary)
COLUMBIANA HI TECH LLC
PTO' Specialized Manufacturing and Services
W for the Nuclear Industry
Matt Willett
Safety Coordinator
1802 Fairfax Road Phone: [phone]
Greensboro, NC 27407 Fax: [phone] Page: 1
e-mail: [e-mail]

Permit: NCGNE0963 Owner-Facility: Columbiana Hi Tech LLC
Inspection Date: 10/15/2013 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Facility will be issued No.Exposure certification upon receipt of covered dumpsters from DH Griffin.
Misc Yes No NA NE
Is the facility compliant? 0000
Comment: Facility will be issued No Exposure certification upon receipt of covered
dumpsters from DH Griffin.
Page: 2

Taylor-Smith, Aana
From: Shoffner, Debbie <[e-mail]>
Sent: Wednesday, October 09, 2013 8:27 AM
To: Taylor-Smith, Aana
Subject: RE: Unpermitted facilities in GSO
Let me know when you go, and I may or may not be able to go on this one. Busy week as usual but some things less
flexible than usual.
Posted this morning: http://citynet/hr/Pages/Employment_Careers.aspx
Debbie Shaffner, Water Quality Specialist
Department of Water Resources
City of Greensboro
Phone: [phone] Fax: [phone]
PO Box 3136, Greensboro, NC 27402-3136
www.greensboro-nc.gov
From: Taylor-Smith, Aana Emailto:[e-mail]]
Sent: Tuesday, October 08, 2013 11:49 AM
To: Shoffner, Debbie
Subject: Unpermitted facilities in GSO
Hey Debbie,
Here's an update on the facilities you asked me to look into at the end of last month:
1. Columbiana Hi-Tech:this company submitted one application for No Exposure and one application for a NCG03
(metal fab) permit for its two locations in Greensboro. Neither has been issued yet, but I will keep you in the
loop when they are.The contact for both locations is Larry Walker, [phone]. See below for details:
a. NCGNE0963: Facility name is Columbiana Hi Tech LLC, located at 204 S.Westgate Dr. Suite D
b. NCG030639: Facility name is Columbiana Hi Tech LLC 2, located at 1802 Fairfax Rd.
2. Box Board @ 8313 Triad Dr: I just got off the phone with the EHS guy,Jim Adams. He was very interested in
getting a permit, and is currently reviewing whether the facility would qualify for No Exposure. His phone
number is [phone] x1068 and email address is 'adams boxboard roducts.com.Their SIC code (2653)
qualifies them for an NCG05 permit for printing, etc., but they will apply for No Exposure if possible.
3. PBM @ 415 Westcliff Rd:This facility does digital commercial printing services.They are most likely going to
qualify for an NCG05 as well.The EHS guy there,Johnny, is currently reviewing their processes for me to
determine their SIC code. I suspect it's 2759. If that's the case, I'll have them apply for NCGDS.The phone
number at the Greensboro location is(336) 664-5800.
Thanks again for the heads-up, and I will pass along updates as they become available. I will probably go review
Columbiana's No Exposure next week, if you want to come with?O
-Aana
Aana Taylor-Smith
Land Quality Section
Division of Energy, Mineral, and Land Resources
NC DENR Winston-Salem Regional Office
1

Phone: [phone],
Fax [phone]
E-moil correspondence to and from this address may be subject to the North Carolina Public Records Low and may be disclosed to
third parties.
Please note that email sent to and from this address is subject
to the North Carolina Public Records Law and may be disclosed to third
parties .
2

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NO EXPOSURE CERTIFICATION t0 1 1r, 1 1'' �
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit based
on NO EXPOSURE:
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.
For permitted facilities in North Carolina, DWO 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.
Industrial materials or activities include, but are not limited to: material handling equipment or activities,
industrial machinery,raw materials,intermediate products,by-products, final products, or waste 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 the following industrial materials and activities: drums, barrels, tanks, and similar containers
that are tightly sealed,provided those containers are not deteriorated and do not leak. "Sealed"means
banded or otherwise secured and with locked or non-operational taps or valves;adequately maintained
vehicles used in material handling;and final products, other than products that would be mobilized in
stormwater discharges(e.g., rock sail).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In
addition, 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 comply with the
terms and conditions of 40 CFR 122.26(g).
You are required to self re-certify your No Exposure Exclusion annually.
For questions,please contact the DWQ Regional Office for your area. (Seepage 6)
(Please print or type)
1) Mailing address of owner/operator address to which all certification correspondence will be mailed):
Name C:o[unibiana Hi Tech LLC;
Contact L irry Walker
Street Address 1802 Fafi fax Road
City GT-eensboTo state NC: ZIP Code '_ 407
Te4ephone No. 336 8_w2-56 Q Fax: '336 852-61.19
Email lwalktr�trlcht}�i,�cicar.co���
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Page 1 of 7 t �ljW
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9 tSWU-NE-12Aug2010 AUG .� iI❑ NRcI4 QW e �wat

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Columbiana i!3 `Cech LLC
Facility Contact Lairry Walker
Facility Street Address 204 Somh Westgate Drive, Suite D
City Greensboro State NC ZIP Code 2?=107
County Gil illb-rd
Telephone No. 336 t�2-�ti7�)_ � Fax: 33G 852-6149
Email Il�r,llcer«ici7[i�uc:Et ir.c��ui
3) Physical location information:
Please provide a narrative description of how to get to the facility(use street names, state road numbers, and
distance and direction from a roadway intersection). .From l-by, t.ikc Exit 34- Holden Rd._'rmycl rronh 3.9 tddes
on t-fnldc!n. Turn left onto Sprint, Grarden (1.4 miles): Riahi MILO Primona r0.2 nZiles►: Right on Dnndas(0,2);
(A copy of a map with the facility clearly located on it should be included with the certification application-)l;It tira() South
4) Is the facility located on Native American Lands? C] Yes R No 11 e"teate
5) Is this a Federal facility? ❑ Yes f`No
6) Latitude N 36'4'-1" Longitude '+' 719`51'36" (deg., min.,seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following-
0 New or Proposed Facility Date operation is to begin
[X Existing Date operation began
a Renewal of existing No Exposure Certification Certification No.: NCGNE
13) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes iXNo
If yes,what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code(SIC Code)that describes the primary industrial
activity at this facility
SIC Code:3 4 9 9 0.14"bieS ..Unr f�1C_L-ion
10) Provide a brief description of the types of industrial activities and products produced at this facility:
The facility primarily conducts drilling/routing or steel and ahiminurn products which are.niamifriciured
xR mid location
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
Oi',No
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
Page 2 of 7
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NCGNE0000 No Exposure Certification
Exposure Checklists(12.- 14.)
12) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable
future? (Please check either"Yes" or"No.") If you answer"Yes"to any of these items,you are not
eligible for the no exposure exclusion.
a. Using,storing, or cleaning industrial machinery or equipment,and areas where ❑ Yes M No
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks D.Yes (XNo
c. Materials or products from past industrial activity ❑Yes 0,No
d. Material handling equipment(except adequately maintained vehicles) ❑ Yes IQ No
e. Materials or products during loading/unloading or transporting activities ❑ Yes [INo
f. Materials or products stored outdoors(except final products intended for outside ❑ Yes Q No
use[e.g., new cars]where exposure to stormwater does not result in the discharge
of pollutants)
g. Materials contained in open,deteriorated or leaking storage drums,barrels, tanks, ❑ Yes I;k No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes M'No
the discharger
i. Waste material (except waste in covered, non-leaking containers je.g., dumpsters]) El Yes 1XNo
j. Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes N No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes LkNo
otherwise regulated(i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored ❑ Yes N No
(i.e., not closed and stored upside down to prevent precipitation accumulation)
m. For any exterior ASTs, as well as drums,barrels,tanks,and similar containers ❑ Yes allo
stored outside, has the facility had any releases in the past three(3) years?
13) Above Ground Storage Tanks(ASTs): If you answer"No" to any of the following items,you are not
eligible for the no exposure exclusion.
a. Are exterior ASTs and piping free of rust, damaged or weathered coating,pits, or a Yes ❑ No X N/A
deterioration,or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No N N/A
cracks, holes,or evidence of leaks,and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
14) Secondary Containment: If you answer"No"to any of the following items, you are not eligible for the
no exposure exclusion.
a. Is secondary containment provided for all single above ground storage ❑ Yes fl No L'71 NIA
containers(including drums,barrels,etc.)with a capacity of more than 660-
gallons?
b. Is secondary containment provided for above ground storage containers stored ❑ Yes ❑ No t4 NIA
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. is secondary containment provided for Title III Section 313 Superfund ❑ Yes 0 No .W NIA
Amendments and Reauthorization Act (SARA)water priority chemicals'?
d. Is secondary containment provided for hazardous substances'"designated in 40 ❑ Yes ❑ No P1 NIA
CFR§116?
e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No M NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment,Storage,or Disposal Facility? ❑ Yes ❑No
b. Is this facility a Small Quantity Generator(less than 1000 kg.of hazardous waste D Yes (a No
generated per month)of hazardous waste?
c. Is this facility a Large Quantity Generator(1000 kg.or more of hazardous waste 0 Yes UK No
generated per month) of hazardous waste?
If you answered yes to questions b.or c.,please provide the following information:
Type(s)of waste:
How is material stored:
Where is material stored:
How many disposal shipments per year:
Name of transport/disposal vendor:
Vendor address:
Footnotes to Questions 14) c.&d.
-Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for de minimis amounts of certain substances,
and1or other qualifiers, as described in the exemptions from reporting requirements of Title Ill SARA 313 in 40 CFR
§372.38.
"Note that amounts below the 660-gallon (single)and 1,320-gallon(combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for amounts less than the Reportable Quantities
of the hazardous substances listed in 40 CFR §117.3.
Page 4 of 7
SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
16) 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.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? ❑ Yes Q No
b. Does your facility have coal piles on site? ❑ Yes CLNo
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes [XNo
sawdust,etc.?
d. Does your facility have air emissions associated with its industrial activity(e.g., p Yes N No
degreasing operations, plating,painting and metal finishing)? If so, describe the
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? ❑ Yes h No ❑ NIA
Please specify:
f. Please list any other environmental program permits(federal, state, etc.) not
specified earlier in this application(such as Hazardous Waste Permits, etc.):
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5 of 7
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NCGNEOOOO No Exposure Certification
17) Certification:
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of"no
exposure"and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that 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 GFR 122.26(g)(2)).
I understand that I am obligated to 1nnui self re-certify No Exposure and,if requested,submit the re-certification to
DWQ or 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 Water Quality,or MS4 operator where the
discharge is into the local MS4,to perform inspections to confirm the condition of no exposure and to make such
inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion,I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility.Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted- Based on my
inquiry of,the person or persons who manage the system,or those persons directly responsible for gathering the
information,the information submitted is to the best of my knowledge and belief true,accurate and complete. I am aware
that there are significant penalties for submitting false information,including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowiedge and belief
such information is true,complete,and accurate.
Printed Name of Person Signing: .it�n:,lila❑ $s[t4ct1
Title: Plant A4anaiger
-
(Siqlla7ture of Applicant) (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 B(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;or who knowingly makes a false
statement of a material tact in a rulemaking proceeding or contested case under this Article;or who falsifies,tampers with,or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
lEnvironmentat Managementl Commission Implementing this Article shall be guilty of a Glass 2 misdemeanor which may include a fine
not to exceed ten thousand dollars($10,0000.
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
n, This completed application and all supporting documentation.
a A map with the location of the facility clearly marked.
INVA If the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1647 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions,please contact the DWQ Regional Office for your area.
DWO Regional Office Contact Information:
Asheville Office ..... 828 29fi 4500 _5}
Fayetteville Office ... (910)4-33-3300
Mooresville Office ... [phone]
Raleigh Office ........ (90)791-4200 � •u;- "
Washington Office ...[phone]
Wilmington Office ... [phone]i _ �--
Winston-Salem ...... [phone]
^•µ:YE__:.::-� �:-" �,�;
Central Office .........[phone] �
R$tnn
Page 7 of 7
S W U-N E-12Aug2010

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