NCGNE0017_COMPLETE FILE - HISTORICAL_20090828

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /V L& IVC 00
DOC TYPE HISTORICAL FILE
0 MONITORING REPORTS
DOC DATE ❑ �UV S OU vt� _
YYYYMMDD

Division of Water Quality
n Division of Soil and Water Conservation
❑ Other Agency
Facility Number: Facility Status: Proposed_ Permit:_NCGNE001.7 ❑ Denied Access
Inspection Type: Compliance Evaluation Inactive or Closed Date:
Reason for Visit: Routine County: Forsyth Region: Winston-Salem
Date of Visit: 08/20/2009 Entry Time:06,00 AM Exit Time: --1¢t3;AM Incident#F:
Farm Names7CorrFlex.Display-& Packaging Owner Email: steve_pusefskiec€gray
Owner: Corrflex Display& Packaging Phone: [phone]
Mailing Address: PO Box 12669 Winston Salem NC 27117
Physical Address: 555 Aureola St Winston Salem NC 27107
Facility Status: ® Compliant n Not Compliant Integrator:
Location of Farm: Latitude: Longitude:
Question Areas:
Certified Operator: Operator Certification Number:
Secondary OIC(s):
On-Site Representative(s): Name Title Phone
Primary Inspector: Ron 0?1 Phone: [phone]
Cf/6 Ext.2202
Inspector Signature: Date: CAR 2 yr/2u`Z3�
Secondary Inspector(s):
Inspection Summary:
Facility still meets no exposure requirements.
Page: 1

Permit: NCGNE0017 Owner-Facility: Convex Display&Packaging Facility Number:
Inspection Date: 08/2012009 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Page: 2

�0 VJATF9p Michael F. Easley,Governor
�o G William G. Ross Jr.,Secretary
rNorth Carolina Department of Environment and Natural Resources
-� Alan W.Klimek,P.E.Director
Division of Water Quality
Corrflex Display &Packaging
555 Aureola Street
Winston Salem, NC 27107
Subject: General Stormwater Permit Inspections
Corrflez Display & Packaging
Permit No. NCGNE0017
Forsyth County
Dear Sir or Madaam:
Your facility holds a General Permit from the North Carolina Division of Water Quality to
discharge stormwater associated with industrial activities performed at your facility. Please be
advised that the Winston-Salem Regional Office will be performing NPDES Stormwater
Inspections sometime in the near future.
If this office has not previously inspected your facility, you should be prepared to demonstrate
compliance with all terms and conditions included in the Permit. Specifically, we will be
evaluating the following: Stormwater Pollution Prevention Plan, Stormwater Outfall Locations,
Qualitative and Analytical Monitoring Data and any other activities required by your permit.
Copies of the general permits and accompanying documents can be accessed from the following
webpage: http://h2o.enr.state.nc.us/su/Forms_Documents.htm#StormwaterGP.
If you have any questions, please contact Rose Pruitt in the Winston-Salem Regional Office at
[phone].
Sincerely,
«a 4w�
Rose Pruitt
cc: NPS Compliance & Assistance Oversight Unit
SWP-Central Files
WSRO Fires
ne
No- Carolina
turrz!!J
North Carolina Division of Water Quality 585 Waughtown Street Winston-Salem,NC 27107 Phone[phone] Fax[phone]
Internet: h2o.enr.state.nc.us
An Equal OpportunitylAffirmafive Action Employer—50%Recycledl10%Post Consumer Paper

NIATF Michael F.Easley,Governor
9QG William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
Alan W.Klimek,P.E.Director
>_ >{ Division of Water Quality
Q Coleen H.Sullins,Deputy Director
Division of Water Quality
April 20, 2005
RECEIVED
N.C,aenL of ENR
Steve Gusefski APR 2 7 2005
Corrflex Display& Packaging
Winston-Salem
P O Box 12669 Regional Office
Winston Salem, NC 27117
Subject: No Exposure Certification NCGNE0017
Corrflex Display& Packaging - 555 Aureola St
Forsyth County
Dear Permittee:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on May 9, 2002. We apologize for the extended period it has
taken us to get back to you on this request and we appreciate your patience as we have worked through this
process. Based on your submittal and signed certification of no exposure at the above referenced facility the
Division is granting your certification as provided for under 40 CFR 126.22(g)which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of your no exposure certification, you are obligated to maintain no
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no-exposure exclusion expires in five years (April 30, 2010). At that time you must re-certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your certification of no exposure 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 Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
for Alan W. Klimek, P.E.
cc: Winston-Salem Regional Office Central Files—wlattachments
Stormwater Permitting Unit Files �,
A
NICD R
N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 [phone] Customer Service
1-877-623-0748

F VI A
T� Michael F.Easley,Governor
`OtO 9QG William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
�2 Alan W.Klimek,P. E.Director
>_ Division of Water Quality
0 Coleen H.Sullins,Deputy Director
Division of Water Quality
April 20, 2005
Steve Gusefski
Corrflex Display& Packaging
P O Box 12669
Winston Salem, NC 27117
Subject: No Exposure Certification NCGNE0017
Corrflex Display& Packaging - 555 Aureola St
Forsyth County
Dear Permittee:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on May 9, 2002. We apologize for the extended period it has
taken us to get back to you on this request and we appreciate your patience as we have worked through this
process. Based on your submittal and signed certification of no exposure at the above referenced facility the
Division is granting your certification as provided for under 40 CFR 126.22(g)which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of your no exposure certification, you are obligated to maintain no
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no-exposure exclusion expires in five years (April 30, 2010). At that time you must re-certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your certification of no exposure 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 Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
For Alan W. Klimek, P.E.
cc: Winston-Salem Regional Office - _ . Central Files—wlattachments
Stormwater Permitting Unit Files ,
tVCDE 'R
N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 [phone] Customer Service
1-877-623-6748

F WAT� Michael P.Easley,Governor
\O�0 qQG `� William G.Ross Secretary
�el North Carolina Department of Environment and Natural
Resources
o 7 ✓ Alan W.Klimek,P.F.Director
Division of Water Quality
Q m Coleen H.Sullins,Deputy Director
Division of Water Quality
April 20, 2005
Steve Gusefski
Corrflex Display& Packaging
P O Box 12669
Winston Salem, NC 27117
Subject: No Exposure Certification NCGNE0017
Corrflex Display& Packaging - 555 Aureola St
Forsyth County
Dear Permittee:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
Stormwater Permitting form,which we received on May 9, 2002. We apologize for the extended period it has
taken us to get back to you on this request and we appreciate your patience as we have worked through this
process. Based on your submittal and signed certification of no exposure at the above referenced facility the
Division is granting your certification as provided for under 40 CFR 126.22(g)which is incorporated by
reference in North Carolina regulations.
Please note that by our acceptance of your no exposure certification, you are obligated to maintain no
exposure conditions at your facility. If conditions change such that your facility can no longer qualify for a no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for your Stormwater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge. Your
conditional no-exposure exclusion expires in five years (April 30, 2010). At that time you must re-certify with
the Division, or obtain NPDES permit coverage for any stormwater discharges from your facility.
Your certification of no exposure 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 Jonathan Diggs at [phone] ext.
537, or at [e-mail].
Sincerely,
for Alan W. Klimek, P.E.
cc: Winston-Salem Regional Office Central Files—wlattachments
Stormwater Permitting Unit Files r
R�
NCDEHR
N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 [phone] Customer Service
1-877-623-6748

CQRRFLEx DISPLAY& PACKAGING RECEIVED
N.0 GeQt. of �H�1�'
APR 18 2002
P6 Box 12669
Wins=- cm.IBC 27117 - n stG t'j S a e m
Strea April 17, 2002 R600na1 Qfflc*
335/61550.7539T539
Fax 33&771-3400
Mr. Corey Basinger +
North Carolina Department of Environment and Natural Resources -.
Division of Water Quality 200Z
585 Waughtown Street
Winston-Street, NC 27107-2275 � x - �a�-E 0I ALITY
POINT BRANCH
Dear Mr. Basinger:
We would like to be exempt from our Storm Water Permit n. NCG050028. Our SIC Code is
2653. We no longer store pallets outside and therefore believe we should be exempt from a
Storm Water Permit. Please contact me so that we can schedule a site inspection at your earliest
convenience.
Thank you,
Steve G. Gusefski
Plant Engineer
Email: [e-mail]
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United States Environmental Protection Agency Form Approved
NPDES Washington, DC 20460 OMB No.2040-0211
FORM `,�,EPA NO EXPOSURE CERTIFICATION for Exclusion from
3510-11
NPDES Storm Water Permitting
Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit authorization for its storm water
discharges associated with industrial activity in the State identified in Section B under EPA's Storm Water Muiti-Sector General Permit due to the existence
of a condition of no exposure.
A condition of no exposure exists at an industrial facility when all industrial materials and activities are protected by a storm resistant shelter 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,
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 without operational taps or valves;
- adequately maintained vehicles used in material handling;and
- final products,other than products that would be mobilized in storm water discharges(e.g.,rock salt).
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,the entity in Section A is certifying that a condition of no exposure exists at its facility or site,
and is Obligated to comply with the terms and conditions of 40 CFR 122.26(g),
ALL INFORMATION MUST BE PROVIDED ON THIS FORM.
Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4.
A. Facility Operator Information
1. Name: I0101AEI9Ir'1{-IG1k1 Dl l l slPI t_d At Yt 41 IPl 4I G xfAG-l1 2• Phone: [phone]i5Io 1715i31 1
3. Mailing Address: a.Street: 155isi iAi&&iF-iaioiL-i6 .sor-19-10-IC-TTI
b.City: �%SII1f3I--ITIala1 ^ISIRILliffj-tl I I I I I I_I 1 1 C.State: JAflC d.Zip Code: I Z 1-11 1 [0 1-71-I I I
B. Facility/Site Location Information
1. Facility Name: Jai 41C1K1 1e-)I/ 1SIP1`1,4l YI IA I
2.a. Street Address: Ss SS ff I[ R- e o L E S 6-r
b. City: 1�1 � 1+�1S1T1oI�IJsl1�-�I I i I _1 H I L L I. c.County: FOSS y
d.State: I01jCl e.Zip Code: I U'7 1 1 10171-1 1 1 1 1
3. Is the facility located on Indian Lands? Yes ❑ No ❑K
4. Is this a Federal facility? Yes ❑ No k
S. a. Latitude: L�_.J o L _j I I I b. Longitude:
6.a.Was the facility or site previously covered under an NPDES storm water permit? Yes No ❑
b. If yes,enter NPDES permit number: p"64 O SOD ze
7. SIC/Activity Codes: Primary: ZlLt0lsl3J Secondary(if applicable): I I I
8,Total size of site associated with industrial activity: /. acres
9.a.Have you paved or roofed over a formerly exposed,pervious area in order to quality for the no exposure exclusion? Yes ❑ No
b. If yes,please indicate approximately how much area was paved or roofed over. Completing this question does not disqualify you for the no exposure
exclusion. However,your permitting authority may use this information in considering whether storm water discharges from your site are likely to have
an adverse impact on water quality,in which case you could be.required to obtain permit coverage.
Less than one acre ❑ One to five acres ❑ More than five acres ❑
EPA Form 3510-11 (10-99) Page 1 of 4
/I

FORM NO EXPOSURE CERTIFICATION for Exclusion from OMB N2oao 021d1
3510-11 ••EPA NPDES Storm Water Permitting
C. Exposure Checklist
Are any of the following materials or activities exposed to precipitation,now or in the foreseeable future?
(Please check either"Yes"or"No"in the appropriate box.) if you answer"Yes"to any of these questions
(1)through(11),you are not eligible for the no exposure exclusion.
Yes No
1. 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 storm water
2. Materials or residuals on the ground or in storm water inlets from spilWleaks }�
3. Materials or products from past industrial activity
4. Material handling equipment(except adequately maintained vehicles) �-
5, Materials or products during loading/unloading or transporting activities
6. Materials or products stored outdoors(except final products intended for outside use(e.g.,new cars)where
exposure to storm water does not result in the discharge of pollutants)
7. Materials contained in open,deteriorated or leaking storage drums,barrels,tanks,and similar containers
8. Materials or products handled/stored on roads or railways owned or maintained by the discharger
9, waste material(except waste in covered,non-leaking containers[e.g,,dumpsters))
10. Application or disposal of process wastewater(unless otherwise permitted)
11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated
(i.e.,under an air quality control permit)and evident in the storm water outflow
D. Certification Statement' ,
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 trom NPDES storm water permitting.
I certify under penalty of law that there are no discharges of storm water 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 1 am obligated to submit a no exposure certification form once every five years to the NPDES permitting authority and,if requested,to
the operator of the focal municipal separate"storm sewer system (MS4) into which the facility discharges(where applicable). I understand that I must
allow the NPDES permitting authority,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. I understand that l must obtain coverage under an NPDES permit prior
to any point source discharge of storm water 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.
Print Name: 1�I! I4I 11� IUjJ yf��ll�l l�I"all ! I i I I I I l _� I I I I— I— LPL
Print Title: A.4164��GI4 ! -1 I l I I I I I I I I I I I I I
Signature: _-Zz _ r
Date: 101s,70161
EPA Form 3510-11 (10-99) .-Lj 31plo Page 2 of 4