HomeMy WebLinkAboutNCGNE0124_COMPLETE FILE - HISTORICAL_20050805 - - STORMWATER-DIVISION CODING SHEET-
RESCISSIONS .
PERMIT NO.
v
DOC TYPE ❑ COMPLETE FILE - HISTORICAL
DATE OF ❑ (J�I�VJ O�V�
RESCISSION YWYMMDD
�(1)A Michael F.Easley.Governor
`Otwl G
N William G.Ross Jr..Secretary
North Carolina Department of Environment and Natural Resources
Alan W.Klimek.P.E.Director
Division of Water Quality
Coleen H.Sullins,Deputy Director
Division of Water Quality
August 5, 2005
Mr. Bryan King, Plant Manger
Rock-Tenn Packaging and Paperboard, LLC
33 Burgin Street
Marion, NC 28752
Subject: Ownership Change
No Exposure Certification NCGNE0124
Rock-Tenn Company-Marion Folding
Formerly: Resolution Packaging
33 Burgin Street-Marion, NC
McDowell County
Dear Mr. King:
The Division has reviewed your submittal of the permit name/ownership change form for your No-Exposure
Certification, which we received on July 14, 2005. Division personnel have reviewed and approved your
request to transfer coverage under your Certificate of No-Exposure.
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 (June 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 Sarah Young at (919) 733-5083, ext.
502, or at sarah.young@ncmail.net.
Sincerely,
�44
for Alan W. Klimek, P.E.
cc: Asheville Regional Office Central Files—wlattachments
Stormwater Permitting Unit Files _
WC-6ENOR
N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 (919)733-7015 Customer Service
1-877-623-6748
i
ROCK-TENN COMPANY
Via Certified Mail
June 30, 2005
JAL 14 2005
Wetlands and Storm Water Branch -
Division of Water Quality Bands$ +�Qu��7y
1617 Mail Service Center ° water
Raleigh, NC 27699-1617
RE: Gulf States Paper Corporation, Marion, NC
Stormwater Permit Number NCGNEO124
Dear Sir or Madam :
Rock-Tenn Packaging and Paperboard, LLC acquired the Gulf States Paper Corporation
facility located at 33 Burgin Street in Marion, NC 28752 on June 6, 2005. The facility has
been operating under Storm Water Permit Number NCGNE0124. Enclosed is the Permit
Name Change and Permit Ownership Change Form to have this permit transferred.
If you have any questions please feel free to contact me at 678-291-7319.
Sincerely,
� Q a,3
Carla A. Bachunas
Environmental & Safety Compliance Coordinator
cc: Mr. Kevin Austin
P.O. BOX 4098 • NORCROSS, GA 30091 • tel: 770-448-2193
�I•V A9O Michael F.Easley,Governor
rCi rr William G.Ross Jr.,Secretary
r`' r North Carolina Department of rnvironment and Natural Resources
Alan W.Klimek,P.E.Director
Division of Water Quality
SURFACE WATER PROTECTION SECTION
PERMIT NAMEIOWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (oJ) Certificate of Coverage
N I C I I I I I I I I jNjC.jGjW610j 2 4
H. Permit status to status change. &LLL~f- .5TATkS PAPrc'- CO i-p p Set
a. Permit issued to(company name): i\LSO L K+I O n PA C k A 4 I n* C{
b. Person legally responsible for permit: �tz_V anf r
First ! MI / Last
rylA�,a4�0.
Title
Permit Holder Mailing Address
M A IL iO A �j (, 2-S 7SL
City state Zip
�S>r- 5�11 (81-8) "1 - 313�-
Phone Fax
c. Facility name(discharge): g50i4jj C 40 ,(1
d. Facility address: 33 iQ K I:Ly t r+
Address
KIA21aA Mtn Z %-7S2-
City _ State �1 Zip
e. Facility contact person: Ke"i J a R • A u S T 1-1 (25?- 11
First t MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of A Change in ownership of the facility
❑ Name change of the facility or owner
if other please explain:
b. Permit issued to(company name): Rack.- TEpir1_PRC��p,C�tn(G__ A�10 PR (cR C3c�a� LLC
c. Person legally responsible for permit:
�X First MI / Last
Oar& ma nq
itle R
33 Bura i r aret+,
Permit Holder Mailing Address
M&>r[o " _ )t- �2
City State Zip
('W21) Co d- 5i1 10V-0 )reCk-re0n.C&A
Phone E-[nail Addr `'`
d. Facility name(discharge): CoYn.d-mo_ ILIC ri n Rylcu"Or
e. Facility address: 33 B►UZ- tat STREET
Address
0(- 1WTs-
City state Zip
f. Facility contact person: K-I—yI P _ LZ O1tiSS I is
First / MI / Last
(dig) {�S1-SS11 k tr. or- kt--t,c.o1"
Phone E-mail Address
Revised 712005
PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of
IV. Permit contact information: (if different from the person legally responsible for the permit)
Permit contact: �EJ 1 LDS 71
rj
First , MI / Last
�PF�zy ��n[tIl tZonrrv.E�irt� �,000- tns AT+OZ
Title
3 3 9yLiL4l"1 StgLe-P--1
Mailing Address
MaaLt o nO I11 CS�-
City State Zip
ka.r, :&- -,„- 10- +Coc{�.��►�+�. cor..
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior to
this ownership or name change?
A Yes
❑ No(please explain)
VI. Required Items: THIS A PPLICA TION WILL BE RETURNED UNPROCESSED IF ITErtISARE
INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change requests.
ML Legal documentation of the transfer of ownership (such as relevant pages of a contract deed, or a bill
of sale) is required for an ownership change request. Articles of incorporation are not sufficient for
an ownership change.
.....................................................................................................
The certifications below must be completed and signed by hoth the permit holder prior to the change, and the new
applicant in the case of an ownership change request. For a name change request, the signed Applicant's Certification
is sufficient.
PERMITTEE CERTIFICATION (Permit holderprior to ownership change):
1, MI'C k a I (f 4S E attest that this application for a name/ownership
change has been reviewed and is accurate and complete to the best of my knowledge. I understand that if all required
parts of this application are not completed and that if all required supporting information is not included, this
application package will be returned as incomplete.
WAR, �a 7 ? LO 5
Signature Date
APPLICANT CERTIFICATION:
I, Girecy) U Kind attest that this application for a name/ownership
change hh beeA reviewed1nd is accurate and complete to the best of my knowledge. I understand that if all required
parts of this application are not completed and that if all required supporting information is not included, this
application package will be returned as incomplete.
Signal-loop- Date
....................
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh,North Carolina 27699-1 6 17
Revised 7/2005
\NA7F Michael F.Easley,Governor
William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
Alan W.Klimek,P.E.Director
>_ Division of Water Quality
t Coleco H.Sullins,Deputy Director
Division of Water Quality
April 20,2005
Bryan King, Manager Plant
Gulf States Paper Corporation
1400 Jack Warner Pkwy
Tuscaloosa,AL 35404
Subject: No Exposure Certification NCGNE0124
Resolution Packaging-33 Burgin St
Dear Permittee:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
Stormwater Permitting form,which we received on August 28, 2003. 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(919)733-5083 ext.
537,or at jonathan.diggs@ncmail.net.
Sincerely,
for Alan W. Klimek, P.E.
cc: Asheville Regional Office Central Files—w/attachments
Stormwater Permitting Unit Files
AMU
N.C.Division of Water Quality 1617 Mail Service Center Raleigh,Noah Carolina 27699-1617 (919)733-701 S Customer Service
1-977-623-674 8
ASSET PURCHASE AGREEMENT
THIS ASSET. PURCHASE AGREEMENT (this "Agreement"), dated as of April 27,
2005, by and between ROCK-TENN COMPANY, a Georgia corporation (`Buyer Parent"),
ROCK-TENN PACKAGING AND PAPERBOARD, LLC, a Georgia limited liability company
and a wholly-owned indirect subsidiary of Buyer Parent (`Buyer," and together with Buyer
Parent, the "Buyer Parties"), and GULF STATES PAPER CORPORATION, a Delaware
corporation ("Seller Parent"), GSPC ENTERPRISES, INC., a Delaware corporation, and a
wholly-owned subsidiary of Seller Parent ("Seller Sub I"), GULF STATES-TEXAS, L.L.C., a
Delaware limited liability company, whose member interests are wholly owned by Seller Sub I
("Seller Sub IT'), GULF STATES-TEXAS, L.P., a Delaware limited partnership, whose partners
are Seller Sub I and Seller Sub II ("Seller Sub III") (Seller Parent, Seller Sub I, Seller Sub R and
Seller Sub III are collectively, and individually where the context so requires or permits, referred
to as "Seller").
WITNESSETH:
WHEREAS, Seller is engaged, among other things, in the production and sale of
paperboard and packaging; and
WHEREAS, Seller wishes to sell its Pulp and Paperboard Division, Paperboard
Packaging Division, Resolution Packaging operations and Livingston Box operations
(collectively, the `Business") and its joint venture interest (the "Seller JV Interest") in GSD
Packaging, L.L.C., a Delaware limited liability company ("Seller JV"), including, without
limitation, all of the assets used or held for use in connection with the Business as described
herein and Buyer desires to purchase the Business and the Seller JV Interest, all subject to the
terms and conditions set forth herein. .
NOW, THEREFORE, in consideration of the prernises and of the mutual covenants and
agreements set forth herein, the parties hereto agree as follows:
ARTICLE 1.
PURCHASE AND SALE
Section I.I. Agreement to Purchase and Sell. Subject to the terms and conditions of
this Agreement, at the Closing (as hereinafter defined) and except for the Excluded Assets (as
hereinafter defined), Seller shall_b ant, sell, assign, transfer and deliver to Buyer, and Buyer will
purchase and acquire from Seller, all right, title and interest of Seller in and to (a) the Business,
(b) the Seller JV Interest and (c) all of the assets, properties and rights of Seller, of every kind
and description, real, personal and mixed, tangible and intangible, wherever situated and used or
held for use in connection with the Business (which Business, Seller JV Interest, assets,
properties and rights are hereinafter more particularly defined collectively as the "Assets"), free
and clear of all mortgages, liens, pledges, security interests, charges, claims, restrictions and
encumbrances of any nature whatsoever, except Permitted Encumbrances (as hereinafter
defined) and Assumed.Liabilities (as hereinafter defined).
.r
Section 1.2. Included Assets. Except as otherwise expressly set forth in Section 13
hereof, the Assets shall include, without limitation, the following assets, properties and rights of
Seller as of the Closing Date (as hereinafter defined):
(a) all accounts receivable, notes receivable and related instruments,
prepaid expenses, deposits, sureties, advances, and credits of the Business;
(b) all inventories, including finished products, work-in-process, raw
materials, spare parts, replacement parts, component parts, stores and supplies, office supplies
and other inventory items of the Business including, without limitation, such inventory
(i) located on the Seller Real Property (as hereinafter defined), and (ii) located in the warehouse
facility owned by Seller in Maplesville, Alabama (the "Maplesville Facility") (collectively, the
"Inventory");
(c) all apparatus, machinery, equipment, business machines,
computers, vehicles, furniture, fixtures, tools, dies, molds, parts, rolling stock, and other tangible
personal property of the Business (together with the Inventory, collectively, the `"Tangible
Personal Property");
(d) unless not assigned pursuant to Section 2.7(b), all right, title and
interest.of Seller in (i) the Material Contracts (as hereinafter defined) of Seller identified on
Schedule 1.2(d) and (ii) all contracts (other than Material Contracts, whether written or oral) of
the Business in the ordinary course, including, without limitation, all purchase orders, and
contracts with customers and suppliers (collectively, the "Assumed Contracts");
(e) all real property identified as "Fee Parcels" on Schedule L2 e (the
"Fee Parcels") and Seller Sub I's leasehold estate in the real property located in Demopolis,
Alabama and identified as "Leasehold Parcels" on Schedule 1.2(e) (the "IDB Leasehold Parcel")
pursuant to the applicable leases described on Schedule 1.2(e) (the "IDB Leases") and the other
"Leasehold Parcels" described on Schedule 1.2 e (together with the IDB Leasehold Parcel, the
"Leasehold Parcels"), including, without limitation, all easements and other rights appurtenant to
the Fee Parcels and the Leasehold Parcels, and including, without limitation, all buildings,
structures, fixtures and improvements located on the Fee Parcels and the Leasehold Parcels, but
expressly excluding the "Excluded Mill Property" as defined in Section 5.20 (collectively, the
Fee Parcels, the Leasehold Parcels and such improvements (but excluding the Excluded Mill
Property), the "Seller Real Property");
(f) all goodwill, customer lists, patents, copyrights, software, technical
documentation, inventories, know-how, designs, shop and royalty rights, trade secrets,
trademarks, servicemarks, website addresses, brand names and UPC codes, and trade names (and
all registrations and rights thereto and applications therefor, including all rights under contracts
granting any right, title, license or privilege under the intellectual property rights of any third
party), of the Business, including, without limitation, those set forth on Schedule 1.2(f);
(g) except as provided in Section 1.3(d), all rights to causes of action,
lawsuits, judgments, claims and demands of any nature available to or being pursued by Seller
Schedule 1.2(e)
Included Assets - Seller Real Property
(For more complete legal description, see Schedule 3.5(a))
Fee Parcels
I. Demopolis Plant Site, comprised of(i) a tract of approximately 243 acres and (ii)the
IDB Tract (hereinafter defined), excluding the title to the IDB Tract held by the ID
Bond (hereinafter defined) and leased to Seller pursuant to the IDB Lease, 28270 US
Highway 80 West, Demopolis, AL 36732-9701 (less and except to the Excluded Mill
Property).
2. Conover Plant, 214 Conover Blvd. SE, 302 Conover Blvd, S.E., Conover,NC 28613-
1925.
;. Claremont Plant, 2690 Kelly Blvd., Claremont, NC 28610
4. Joplin Plant, 4200 East 32"d Street, Joplin, M4 64804-4416
5. Nicholasville Plant, 200 Stephens Drive, Nicholasville, KY 40356-1071
6. Waco Plant,401 Precision Drive, Waco, TX 76710-6970
7. Livingston Box, 210 North Industrial Park, Livingston, AL 35470
8. Marion Plant, 19 Burgin Street, 21 Burgin Street, 33 Burgin Street, Marion,NC
28752.
9. McDowell Plant, 468 Carolina Avenue, Marion,NC 28752
10. Hazleton Plant, 33 North Powell Drive, Hazleton, PA 18201
11. Columbus Plant, 3961 Cusseta Road, Columbus, GA 31902
Leasehold Parcels - IDB Lease, approximately 1018 acres, US Highway 80 West,
Demopolis, AL 36732-9701 (the "IDB Tract') Less and except the Excluded Mill Property.
See Schedule 3.5(a).
I. IDB Lease Agreement, by and between Gulf States Paper Corporation and Industrial
Development Board of the City of Demopolis (the "ID Board"), dated May 1, 1990,
as supplemented and amended by a Supplemental and Amendatory Lease, dated
December 1, 1993, and a Second Supplemental and Amendatory Lease, dated
September 1, 1995, and as assigned to and assumed by GSPC Enterprises, Inc. by an
Assignment and Assumption Agreement, dated December 29, 2002.
2. IDB Lease Agreement, by and between Gulf States Paper Corporation and ID Board
of the City of Demopolis, dated December 1, 1991, and as assigned to and assumed
26
NORTH CAROLINA
Department of The Secretary of State
CERTIFICATE OF AUTHORITY
I, ELAINE F. MARSHALL, Secretary of State of the State of North Carolina, do
hereby certify that
ROCK-TENN PACKAGING AND PAPERBOARD, LLC
having filed on this date an application conforming to the requirements of the General Statutes
of North Carolina, a copy of which is hereto attached, is hereby granted authority to transact
business in the State of North Carolina.
D ?wm��'T
IN WITNESS WHEREOF, I have hereunto
y ` set my hand and affixed my official seal at the
City of Raleigh, this 27th day of May, 2005
PR1112.1171' _t�7
Secretary of State
Document Id: C20051470029
1
. � aV5111:11"/S4'14Y
Date Filed: 5/27/2005 4:11:00 PM
Elaine F.Marshall
North Carolina Secretary of State
C200514700291
State of North Carolina
Department of the Secretary of State
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR LIMITED LIABILITY COMPANY
Pursuant to§57C-7-04 of the General Statutes of North Carolina,the undersigned limited liability company hereby applies for a
Certificate of Authority to transact business in the State of North Carolina,and for that purpose submits the following;
1. The name of the limited liability company is Rock-Tenn Packa2ing and Paperboard.LLC
and if the limited liability company name is unavailable for use in the State of North Carolina,the name the limited
liability company wishes to use is
2. The state or country under whose laws the limited liability company was formed is: Georgia
3. The date of formation was April 26,2005 ;its period of duration is: Perpetual
4. Principal office information: (Select either a or b.)
a. 0 The limited liability company has a principal office.
The street address and county of the principal office of the limited liability company is:
Number and Street 504 Thrasher Street
City,State,Zip Code Norcross,Georgia 30071 County Gwinnelt
The mailing address,if different from the street address,of the principal office of the corporation is:
b. ❑ The limited liability company does not have a principal office.
S. The street address and county of the registered office in the State of North Carolina is:
Number and Street 120 Penmarc Drive,Suite 118
City,State,Zip Code Raleigh, NC 27603 _ County Wake
6. The mailing address,if different from the street address,of the registered office in the State of North Carolina is:
7. The name of the registered agent in the State of North Carolina is: National Registered Agents, Inc.
8. The names,titles,and usual business addresses of the current managers of the limited liability company are:
(use attachment if necessary)
acne Business Address
Rock-Tenn Converting Company(sole member) 504 Thrasher Street,Norcross,Georgia 30071
(Revised January 2002) (Form L-04)
CORPORATIONS DIVISION P.0.BOX 29622 RALEIGH,NC V626-0622
APPLICA TION FOR CERTIFICATE OF A UTHORITY
Page 2
9. Attached is a certificate of existence(or document of similar import),duly authenticated by the secretary of state or other official
having custody of limited liability company records in the state or country of formation. The Certifisate of Existence must be tess
thou six months old. A photacopLof the certification cannot be accepted.
10. If the limited liability company is required to use a fictitious name in order to transact business in this State,a copy of the resolution
.of its managers adopting the fictitious name is attached.
11.This application will be effective upon filing,unless a delayed date and/or time is specified:
This the a5day of ,20 05
Rock-Tenn Packaging and Paperboard,LLC
Name ofLimired Liability Company.
Rock—T Convertin Company
Si f Manager
G V4LNA V-?res.
Typ or Pr Name
(Revised January 2002) (Form L-09)
CONTROL NUMBER 0526435
Secretary of State DATE INC/AUTH/FILED: 04/26/2005
Corporations Division JURISoICTION GEORGIA
p PRINT DATE 05/26/2005
315 West Tower FORM NUMBER 211
#2 Martin Luther King, Jr. Dr.
Atlanta, Georgia 30334-1530
PARANET CORPORATION SERVICES, INC.
GWENDOLYN ANDREWS
3761 VENTURE DRIVE, SUITE 260
DULUTH, GA 30096
CERTIFICATE OF EXISTENCE
1, Cathy Cox, the secretary of State of the State of Georgia, do hereby certify
under the seal of my office that as of the above print date
ROCK-TENN PACKAGING AND PAPERBOARD, LLC
A GEORGIA LIMITED LIABILITY COMPANY
is in compliance with the applicable filing and annual, registration provisions
of Title 14 of the Official Code of Georgia Annotated.
said entity was formed in the jurisdiction stated above or was authorized to
transact business in Georgia on the above date and has not filed articles of
dissolution, certificate of cancellation or any other similar document with the
Office of the Secretary of State.
This certificate relates only to the legal existence of the above-named entity
as of the print date above. rt does not certify whether or not a notice of
intent to dissolve, an application for withdrawal, a statement of commencement
of winding up or any other similar document has been filed or is pending with
the Secretary of State.
This information is electronically transmitted, issued and certified in
accordance with the Georgia Electronic Records and Signatures Act and Title 14
of the Official Code of Georgia Annotated and is prima-facie evidence that said
entity is in existence or is authorized to transact business in this state.
20050526195726559
'>
Cathy Cox
fY76 Secretary of State
F NJ A Michael F.Easley,Governor
�DtO RQ�i William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
00 � Alan W.Klimek,P.E.Director
7 Division of Water Quality
Coleen H.Sullins,Deputy Director
Division of Water Quality
April 20, 2005
Bryan King, Manager Plant
Gulf States Paper Corporation
1400 Jack Warner Pkwy
Tuscaloosa, AL 35404
Subject: No Exposure Certification NCGNE0124
Resolution Packaging - 33 Burgin St
McDowell 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 August 28, 2003. 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 12E.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 (919) 733-5083 ext.
537, or at jonathan.diggs@ncmail.net.
Sincerely,
for Alan W. Klimek, P.E.
cc: Asheville Regional Office _ Central Files—wlattachments
Stormwater Permitting Unit Files �
rA
NC[3�h'R
N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1 6 1 7 (919)733-7015 Customer Service
1-877-623-6748
United States Environmental Protection A e G Farm Approved
9 Y oMa No.2040-0211
NPDES EPA
Washington, DC 20480
FORM `�' 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 Multi-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(9).
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: GitkiLIr1- iSI ItAjkiSt iPiAIPIEllZi I1+1011?1P101V-IA1-111"10 2.Phone: 12101,51$IbiZIJlV1'01Oi
3. Mailing Address: a.Street: 1111101 01 131 AIC I C1 Ih(I Al I IFI IL I lZ-i I P I RIFF-1 V-4 V41 Al dl 1 1 1 1 1 1 1 j
In.City LL f 5 A f L O 10 5 R c.State: JAII-1 d.Zip Code: I31-5 410 41-t 11 014`1 24
B. Facility/Site Location Information O
1,Facility Name: 191E-IS101L-IL�tiTI tIOINI If IAI(QK-1A141I 1A11(�1 1 1- 1 1 1 1 1 1 1 1
2.a.Street Address: I33i f&IKIR16I1 1141 151`IIiZI�CiE-fT( 1 1 1 I 1 1 I I I I I I I I I I
b. City: A Al F4 1 101 AJI I I I I I I I I I I I rI I I I I � c.County: 1h'^t c1D 101 a1 tl�l'1 I
d.State: L�9 e.Zip Code: 219 Il l�I Z I-i"3 It I J 1
3.Is the facility located on Indian Lands? Yes No 0
4.Is this a Federal facility? Yes No INATER
5.a. Latitude: �L9J '�0� SL3� b. Longitude: 4 oL(O� �l6. a.Was the facility or site previously covered under an NPDES storm water permit? Yes No ® AUG L 8 2003b. If yes,enter NPDES permit number: UJ7.S1CIActivity Codes; Primary: Z Secondary(if applicable): II I I I Yl '�EG1lOf+1 E, {
S.Total size of site associated with industrial activity: x acres
9.a.Have you paved or roofed over a formerly exposed,pervious area in order to qualify for the no exposure exclusion? Yes No iLu
b. if yes,please indicate approximately how much area was paved or roofed over. Completing this quesh'on 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. ' r,:',
+ 1 tJ
Less than one acre ❑ One to five acres More than five acres Q
EPA Form 3510-11 (10.99) - Page 1 of 4
NPDES �, NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
FORM `r++,Epp OMB No,2040-0211
3510-1i 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 spills/leaks
3. Materials or products from past industrial activity
4. Material handling equipment(except adequately maintained vehicles) El
5. Materials or products during load inglunloading 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)
T 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 El V_V
g. 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 from 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 i 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 local 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 I 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 10 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: I_ I Kk 1 INI(-11 I I I_I I I 1 .1 1 1 1 1 1 1 ! 1 1 1 1 1 1 1
PrintT(tle: IPtLIRt411[ !?ti ftJ(A4lC_j?4 i I f t f t I I I I 1 I I I I I I I I
Date: loll Zl?ID 13 I
EPA Form 3510-11 (10-99) v Page 2 of 4
NPDES NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
FORM SOMA No.2040-0211
3510-11 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 f ndustrial machinery or equipment remain and are exposed to storm water
2. Materials or residuals on the ground or in storm water inlets from spillskaks
3. Materials or products from past industrial activity 0
4. Material handling equipment(except adequately maintained vehicles) FA
5. Materials or products during load inglunloading 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) El
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 from 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 I 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 local 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 I 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: 43 i7_4�A ill I Kl f I NI LV I I I I I I # I I I I I I ] I I I I I I I I
Print Titte: 1F L fa
i
Signature:
Date: 101g120 00
EPA Form 3510-11 (10-99) Page 2 of 4
r
United States Environmental Protection Agency Farm Approved
g Y OMB No.2040-0211
NPDES as PA
Washington, DC 20460
FORM 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 Multi-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: 41LkIL,& I lsl-flAJIEiSI IPIAJP€(-,lEI IC01JZIPIOIRIAITI1101tA 2.Phone: 1910 �IG'I�JI�l�1�1
3. Mailing Address: a.Street: u 1+0101 Ill A iG t IQ I al A It I&J IL-,I IZi 19 I Al-tL1 r-10JI AI 1 I I I r I I I I
b.City: C'rUti LlRlt-I al 415lN! I f I_ i I I I i _L Code: � 2
B. Facility/Site Location Information /f�'�
1.Facility Name: IF-1 E S 101 LIK i I I > 101t41 IA AI CIr-I Ai 41 i 10141 [ I_ 1 1 1 1 t i_ I�
2.a.Street Address: L4ilo l'�I C I A jZi A 4 i 1J I A I A%I L u%il l L 1I li�l I I I I I I I Z I I J !
b. City: MAIiLi 4 I0I N I I I I I I I I I I I I I I I I I I c.County: 11h (-.l i3 Q Vil k4 i- '--I
d.State: " (. '-i e.Zip Code: 14 81�ISI -131 I q IS 12,I
3. Is the facility located on Indian Lands? Yes ❑ No
4, Is this a Federal facility? Yes ❑ No T�
5.a.Latitude: 13 L7_A" b. Longitude: I I �I J � Lj
6.a.Was the facility or site previously covered under an NPDES storm water permit? Yes ❑ No
b. If yes,enter NPDES permit number:
7.SICIActivity Codes: Primary: 10I1p KI I Secondary(if applicable): I 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 qualify 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.., L
Less than one acre ❑ One to five acres ❑ More than five acres ❑
EPA Form 3510-11 (10-99) Page 1 of 4