NCGNE0284_COMPLETE FILE - HISTORICAL_20060628

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
YYYYMMDD

OF \fli A]� — ce 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
pColeen H.Sullins,Deputy Director
Division of Water Quality
N.C.Dec:
June 23, 2006 JUN 2 8 2006
Ms. Alisha Barnes wincton-salem
Carson's Hospitality Regional Office
PO Box 14186
Archdale, NC 27263
Subject: No Exposure Certification NCGNE0284
Carson's Hospitality
2400 South College Drive, High Point, NC
Guilford County
Dear Ms. Barnes:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on May 16, 2006. 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 (May 30, 2011). 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 [e-mail].
Sincerely,
ORIGINAL SIGNED BY
KEN PICKLE
for Alan W. Klimek, P.E.
cc: Winston-Salem Regional Office Central Files—wlattachments
Stormwater Permitting Unit Files
N D£NR
N,C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 [phone] Customer Service
1-877-623.6748

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Copyright(C)1998.Maptech,Inc.

CARSON'S OF HIGH POINT
P.O.Box 14186
ARCHDALE,NC 27263
NCDENR/DWQ/SWPS/Point Source Branch
1617 Mail Service Center
Raleigh, NC 27699-161732
May 12, 2006
Dear Sir/Madam,
Please find enclosed the storm water"No Exposure Certification" form for our facility on
College Drive in High Point. We have also submitted a copy to the EPA at the
designated address in Washington DC.
If you have further questions, please feel free to contact our office at 336-431-1101.
Sincerely,
Alisha Barnes
Enclosure

i'
Form Approved
United States Environmental Protection Agency OMB No.2UO-0211
NPDES a� Washington,DC 20460
FORM ®4�
3 EDJX NO EXPOSURE CERTIFICATION for Exclusion from
510-11
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 Mutti-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 mobillzed In storm water discharges(e.g.,rock salt).
A No Exposure Certtftcadon must be provided for each facility qualifying for the no exposure exclusion. In addltton,the exclusl m NPDES pe Is
available on a facility-wide basis only,not for individual outfalts. If any Industrial activities or materials are or will be exposed cipltation,the Is
not eligible for the no exposure exclusion. z. t
By signing and submitting this No Exposure Cerilkadon form,the entity In Section A Is certifying that a condition of no expost ro t1sts afha facill4l e,
and is obligated to comply with the terms and conditions of 40 CFR 122.26(g). i
ALL INFORMATION MUST BE PROVIDED ON THIS FORM.
Detailed Instructions for completing this Corm and obtaining the no exposure exclusion are provided on pages 3 and d =r
s:
A. Facility Operator Information
1, Name: e S a l 1 1 S 1 (T 2.Phone:
3. Malting Address: a.Street 1?01_t6lC>I%I it 14 11%-(12 1 _f_j_ 1 1 1 I__1 1 1 I 1__ 1 1 1 1 1_ 11 1 I
b.City. I,I RI Gl , ipAl LI .I...I I--L I I L I I I I�I I I I C.Stater} d.Zip Code: IeZI�lal'P131—11 11 I
B. FacAltylSito Location Information l {,
1.Facility Name: 161& 1SIaI'"1�51 IN IQ I Ill l IT_�1 Lf Ti r�E _1_I I__1 l 1. 1_LI
2, a,Street Address: I al 41 a 01 IIS 101 t�fl I 10-1 {71 LL 161&IS1 1�1 4 I I I I I I _I I I I 1
b.City: j�(i I.iG A—' I PI oI I _t_ I I i__I I I_E_L I I I I c.County: I -L_l l I t L—L I I I
d.State: 0�+ e.Zip Code: I ryl a[ I�I I I I, I I
3, Is the facility located on Indian lands? Yes❑ No
4. Is this a Federal fa01110 Yea❑ No N
S.a.Latitude: � �� b,Longitude: ) [�J
6.a.Was the facility or site previously covered under an NPDES storm water permit? Yes ❑ No
b.If yes,enter NPDES permit number:
T.SIC/Activity Codes:' Primary; Io2-1 I t 1 Secondary(if applicable): I I I 1
S.Total size of slte.associated with Industrial activity: — a.a acres
9. a.Have you paved or roofed over a formerty exposed,pervious area in order to qualify for the no exposure exclusion? Yes ❑ No.�
b.If yes,please Indicate approxlmatety 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 rase you could be required to obtain permit coverage.
Less than one acre ❑ One to five acres ❑ More than five acres ❑
EPA Form 3510-11(10-9g) Page i of4

r-
NPDESFORM ,A NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
Pp� .��EPA OMB No.2o40-0211
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.) it you answer"Yes"to any of these questions
(11)through(11),you are not eligible for the no exposure excluslon.
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 E) '
3. Materials or products from past industrial activity ❑ Y
4. Material handling equipment(except adequately maintained vehicles) ❑
5. Materials or products during loadinglunloading 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 handledistored on roads or railways owned or maintained by the discharger 11
9. Waste material(except waste in covered,non-leaking containers[e,g.,dumpaters])
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 quallty control permit)and evident In the storm water outflow
D. Certification statement
I certify under penalty of taw 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 certlfy 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 two 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). 1 understand that I must
allow the NPDES permitting authority,of 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 1 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 mry 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. 1 am aware that there are significant penalties for submitting false Information,Including the possibility
of fine and imprisonment for knowing violations.
Print Name: IA W 151 916 3iAlRI Z iSi I I I I L_ 11 1 I I i I _I I I I I I 1 1
Print Title: 1~14 S pr/t�
Signature:
Date: 16 ly 1 i 161d ki
EPA Form 3510-11(10-99) Page 2 of 4

1
F \NA Michael F.Easley,Crovernor
0 ROG William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
Alan W.Klimek,P.E.Director
Division of Water Quality
p Coleen H,Sullins,Deputy Director
Division of Water Quality
June 23, 2006
Ms. Alisha Barnes
Carson's Hospitality
PO Box 14186
Archdale, NC 27263
Subject: No Exposure Certification NCGNE0284
Carson's Hospitality
2400 South College Drive, High Point, NC
Guilford County
Dear Ms. Barnes:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on May 16, 2006. 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 (May 30, 2011). 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 [e-mail].
Sincerely,
XL `. d&
for Alan W. Klimek, P.E.
cc: Winston-Salem Regional Office Central Files—wlattachments
Stormwater Permitting Unit Files
NFL EIR
N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 [phone] Customer Service
1-877-623-6748

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Re: no-exposure apps
Subject: Re: no-exposure apps
From: Corey Basinger<Corey.Basinger@ncmaiLnet>
Date: Fri, 09 Jun 2006 t4:20:44 -0400
'ro: Sarah young <sarah.young@ncmaiI-net>
OK to proceed with issuance of NCGNE0284 & NCGNF-0285
Corey Basinger
Corey.Basinger@NCmail .net
NC DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
(336) 771-5000
Fax (336) 771-4630
On 5/31/2006 3:57 PM, Sarah young wrote:
2 more no-exposure apps. for your region. -sarah
Corey Basinger <[e-mail]>
WSRO
t NC DENR
l of 1 6/9/2006 3:4.

r '
NC&
CARSON'S of HIGH POINT
P.O. Box 14186 A 1 �
ARCHDALE,NC 27263 V�
NCDENR/DWQ/SWPS/Point Source Branch
1617 Mail Service Center
Raleigh, NC 27699-161732
May 12, 2006
Dear Sir/Madam,
Please find enclosed the storm water"No Exposure Certification" form for our facility on
College Drive in High Point. We have also submitted a copy to the EPA at the
designated address in Washington DC.
If you have further questions, please feel free to contact our office at 336-431-1101.
Sincerely,
Alisha Barnes
Enclosure

Form Approved
United States Environmental Protection Agency OMB No.204&0211
NIRDES at1 Washington,DC 20460
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 6 under EPA's Storm Water MuldSector 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 seated,provided those containers are not deteriorated and do not leak. 'Seated'
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 exdusi m NPDES pe is
available on a facility-wide basis only,not for individual outfalls. If any industrial activities or materials are or will be exposed cipitation,the is
not eligible for the no exposure exclusion. '
By signing and submitting this No Exposure Certification form,the entity in Section A is certtfying that a condition of no expost 0 mists antIffir facilii e,
and is obligated to comply with the terms and conditions of40 CFR 122.26(g),
ALL INFORMATION MUST BE PROVIDED ON THIS FORM.
g
Detailed Instructions for compietlng this form and obtaining the no exposure exclusion are provided on pages 3 and AA
r
A. Facility Operator Information
1. Name: ICI A'i RJS k y ti1SI l Q IS 17P I l 1'`I PhLt r IT yl 1 I I I I I I I 12.Phone: L
3. Mailing Address: a.Street Its 01 1410XI 1 I l l 4 11,91(QL I t I I I _I I I_I I I I I I I I I I I I
b.City-. C �. c.State: L+S � d.Zip Code: AI !y I of{N.31-I I [ I
B. Facility/Site Location Information
1, Facility Name: l I i I .I 11_ 1 I I
2.a.Street Address: 1.?141 9 OI 181 0L0-l-IN_j ICI Q L-IL-I�IGI�L ID19 I I I f I I I f I I r
b.City: I I I I I I I III I I I c.County: I I I I I I I I_I I
d.State: �� a.Zip Code: 2J IL21' 0I 1 l I I_ I
3. Is the facility located on Indian Lands? Yes No Cg
4. Is this a Federal facility? Yes ❑ No N
5.a.Latitude: ail-A 4 L�-" , I 161' b.Longitude: L IYiol ' LQLC,j , I(I I_I
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.SIC/Activity Codes: Primary: �TJ Secondary(if applicable): L I I I
8. Total size of site,assodated with industrial activity: . 3.0 acres
9.a.Have you paved or roofed over a formerly exposed,pervious area in order to quality for the no exposure exclusion? Yes E] No K
b. If yes,please indicate approximately how much area was paved or roofed over. Completing this question does not disqualify you far 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-g9) Page 1 of 4

.:.
----
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-"� 1 L__ '
�.f w f
_\. ���i�
.1
X. ti'f
i' I;�

NPDES e+ NO EXPOSURE CERTIFICATION for Exclusion from Form Approved
FORM \��EPA aMf3 No.zo40 Ozii
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'Na in the appropriate box.) tf 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) El14
5. Materials or products during loading/unloading or transporting activities ❑ 19
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
6. Materials or products handled/stored on roads or railways owned or maintained by the discharger El IN
9. Waste material(except waste in covered,non-leaking containers[e.g.,dumpsters]) ❑
10. Application or disposal of process wastewater(unless otherwise permitted) El L11J
11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated ❑ 13
(Le.,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.
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)).
understand that I am obligated to submit a no exposure certification form once every fore 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). 1 understand that I must
allow the NPDES permitting authority,or MS4 operator where the discharge is into the focal 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: t. N A R tJA5
Print Title: 194A5I IMAIN A066 Ri l i t i i i i t i i l l i i I i i f i i i
Signature:
Date: la i I%to 0 I w{
EPA Form 3510-11 (10-99) Page 2 of 4