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HomeMy WebLinkAboutNCGNE0293_COMPLETE FILE - HISTORICAL_20060821 STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. DOC TYPE E HISTORICAL FILE ❑ MONITORING REPORTS DOC DATE ❑ (�W b O� YYYYMMDD \N A7-F Michael F.Easley,Governor RQG William G.Ross Jr.,Secretary North Carolina Department of Environment and Natural Resources Alan W.Klimek,P.E.Director Division of Water Quality 0 Coleen H.Sullins,Deputy Director Division of Water Quality August 21, 2006 Mr. Michael G. Hollman Twin City Warehouses, Inc. 3300 Old Lexington Road Winston-Salem, NC 27107 Subject: No Exposure Certification NCGNE0293 Twin City Warehouses, Inc. 4800 South Main Street, Winston-Salem, NC Forsyth County Dear Mr. Hallman: The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater Permitting form, which we received on June 26, 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, and hereby rescinding your former Certificate of Coverage number NCG060193. 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 yeas (August 31, 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 sarah.young@ncmail.net. Sincerely, for Alan W. Klimek, P.E. cc: Winston-Salem Regional Office Central Files--wlattachments VXF Stormwater Permitting Unit Files tJ Gbm N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 (919)733-7015 Customer Service 1-877-623-6748 -� �, `r �� I �• Alhti.�l ��' •'� r i-. N'`�, _°• � � r L4.:��'" { Tt1 � r' / -y0�� c ++ All r ti r 1� _ r",11+ A' I •� !\1 G17 J � Y �Y ."-ya r. _ ,r`r �' � r � ,fir• r r � •'s` � f� ` �"�` T3-r ! 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Re: no-exposures Subject: Re: no-exposures From: Corey Basinger <Corey,Basinger@ncmai1.net> Date: Mon, 24 Jul 2006 09:29:10 -0400 To: Sarah Young <sarah.young@ncmai1.net> OK to process. Corey 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 6/27/2006 4:06 PM, Sarah Young wrote: Corey- No-Exposures for the week. -Sarah { Corey Basinger <Corey.Basingera,NCma i1.nct> W5R0� � NC DE•'NR l of 1 7/24/2006 11:09 AM Form Approved United States Environmental Protection Agency OMB No.2040-0211 NPIDIESFORM S� � � Washington, DC 20460 FORM `�► NO EXPOSURE CERTIFICATION for Exclusion from 351p-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 industriai 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 outfalis. 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: JML-JI t 1121 Ci t I Ti I1 iL46121 C1g10 C71S G f f7^ I Gf I I 1 1 2. Phone: 5171� �`- r 't ,+ 7 _l_ 1 5!. L L_.. _... I�� L_ 1'" I I' L.- 1�"1�J 3. Mailing Address: a.Street: U I IS 10101 i©I E I D 1 1 1e1 el KI, I' I G1TI D IM I 19-1 01(0)1 1 1 1 1 1 1 1 1 b.City l I N C lIL 4s 1 01 LI e c.State: 03 d.Zip Code: 17 1 011 1 10 1�}1—# I B. Facility/Site Location Information 1.Facility Name: 1T I L-i I AI I!LLt I'Tj,6 Wi 41 ei It--1 PoISifil;.l T4 INLG i I l I l 2.a.Street Address: I'q 15l 0ia 1 iS I O Iy jT}AI 19A Al d I A1_L171 1 I I, I I I�I_..I�I I I ,I, I I b. City: lwn I►%f`at TI 01 A(—1 f eL"j I 1_ 1 1, t I 1 1 f c.County: Jt`!O 1y2.1S 14 JTI141 i I � d.State: yl� (—I e.Zip Code: I-L[2 It 1011 1-1 1 I 1 a r j 119 the facility located on Indian Lands? Yes No w 4.Is this a Federal facility? Yes F� Na f7 �2 LIL�5.a.Latitude: �� � 0 I1 (� o ~1 b. Longitude: 161 c� Z 3 5 "3 `1 ' a 6. a.Was the facility or site previously covered under an NPDES storm water permit? Yes � No El 3 p ry C b. If yes,enter NPDES permit number: n C(30('p 3n 7, SIC/Activity Codes: Primary: Iq 111'11 Secondary(if applicable): 1 I I . I 6.Total size of site associated with industrial activity: If_ 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. Less than one acre One to five acres More than five acres EPA Form 3510-11 (10-99) Page 1 of 4 r NPDES NO EXPOSURE CERTIFICATION for Exclusion from Form Approved FORM a'EP� OMB tva.204D-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. T Yes No 1. Using,storing or cleaning industrial machinery or equipment,and areas where residuals from using,storing El or cleaning industrial machinery or equipment remain and are exposed to storm water 2. Matefiais or residuals on the ground or in storm water inlets from spillslleaks 3. Materials or products from past industrial activity 4, Material handling equipment(except adequately maintained vehicles) S. 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 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 availabie 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: n t I L.1 Vi IN1L-1 IGI I[AID 11](—01 1 i i 1 ! I I I 1 3 I I 1 I 4 Print Title: C O ? ` ri Signature: J�✓3 F f��� ___ �� Date: 101 ic{c-1 7.I 01 (e{ EPA Form 3510-11 (10-99) Page 2 of 4 i NPDES �, Instructions for the NO EXPOSURE CERTIFICATION for Form Approved FORM �'�jEPA OMB No.20aa-o211 3510-11 Exclusion from NPDES Storm Water Permitting Who May File a No Exposure Certification Section B. FacilitylSite Location Information Federal law at 40 CFR Part 122.26 prohibits point source discharges of 1. Enter the official or legal name of the facility or site. storm water associated with industrial activity to waters of the U.S.without a National Pollutant Discharge Elimination System(NPDES)permit. However, 2. Enter the complete street address(if no street address exists,provide NPDES permit coverage is not required for discharges of storm water a geographic description(e.g., Intersection of Routes 9 and 55)),city, associated with industrial activities identified at 40 CFR 122.26(b)(14)(i)- county,state,and zip code. Do not use a P.O. Box number. (ix)and(xi)if the discharger can certify that a conditlon of"no exposure" exists at the industrial facility or site. 3. Indicate whether the facility is located on Indian Lands. Storm water discharges from construction activities identified in 40 CFR 4. Indicate whether the industrial facility is operated by a department or 122.26(b)(14)(x)and(b)(15)are not eligible for the no exposure exclusion. agency of the Federal Government(see also Section 313 of the Clean Water Act). Obtaining and Maintaining the No Exposure Exclusion 5. Enter the latitude and longitude of the approximate center of the facility This form is used to certify that a condition of no exposure exists at the or site in degreeslminuteslseconds. Latitude and longitude can industrial facility or site described herein. This certification is only applicable be obtained from United States Geological Survey(USGS)quadrangle in jurisdictions where EPA is the NPDES permitting authority and must be or topographic mans, by calling 1-(BBB)ASK-USGS, or by accessing re-submitted at least once every five years. EPA's web site at htip://www.epa,govlowmiswlindustrytindex.htm and selecting Latitude and Longitude Finders under the Resources/Permit The industrial facility operator must maintain a condition of no exposure at section. its facility or site in order for the no exposure exclusion to remain applicable. If conditions change resulting in the exposure of materials and activities to Latitude and longitude for a facility in decimal form must be converted storm water,the facility operator must obtain coverage under an NPDES to degrees (1), minutes ('), and seconds (") for proper entry on storm water permit immediately. the certification form. To convert decimal latitude or longitude to degreeslminuteslseconds,follow the steps in the following example. Where to File the No Exposure Certification form Example: Convert decimal latitude 45.1234567 la degrees(°),minutes Mail the completed no exposure certification form to: ('),and seconds('). a) The numbers to the left of the decimal point are the degrees: 45°. Storm Water No Exposure Certification(4203) USEPA b) To obtain minutes,multiply the first four numbers to the right of the 401 M Street,SW decimal point by 0.006: 1234 x 0 006=7.404. Washington,D.C. 20460 c) The numbers to the left of the decimal point in the result obtained in(b)are the minutes: 7'. Completing the Form d) To obtain seconds, multiply the remaining three numbers to the You must type or print,using uppercase letters,in appropriate areas only. right of the decimal from the result obtained in (b) by 0.06: Enter only one character per space(i.e.,between the marks). Abbreviate 404 x 0.06=24.24. Since the numbers to the right of the decimal if necessary 10 stay within the number of characters allowed for each item. point are not used,the result is 24". Use one space for breaks between words. One form must be completed for each facility or site for which you are seeking to certify a condition of no e) The conversion for 45.1234567=45° 7' 24". exposure. Additional guidance on completing this form can be accessed through EPA's web site at www.epa.govlowmisw, Please make sure you 6. Indicate whether the facility was previously covered under an NPDES have addressed all applicable questions and have made a photocopy for storm water permit. If so,include the permit number. , your records before sending the completed form to the above address. 7. Enter the 4-digit SIC code which identifies the facility's primary activity, and second 4-digit SIC code identifying the facility's secondary activity, Section A. Facility Operator Information ff applicable. SIC codes can be obtained from the Standard Industrial Classification Manual,19B7. 1. Provide the Legal name of the person,firm,public organization,or any other entity that operates the facility or site described in this certification, 8, Enter the total size of the site associated with industrial activity in acres. The name of the operator may or may not be the same as the name of Acreage may be determined by dividing square footage by 43,560.as the facility. The operator is the legal entity that controls the facility's demonstrated in the following example, operation, rather than the plant or site manager. 2. Provide the telephone number of the facility operator. Example: Convert 54,450 ft2 to acres Divide 54,450 ft2 by 43,560 square feet per acre: 3. Provide the mailing address of the operator(P.O.Box numbers may be 54,450 ft2+43,560 ft2/acre=1.25 acres. used). Include the city, state, and zip code. All correspondence will be sent to this address. 9. Check"Yes"or"No"as appropriate to indicate whether you have paved or roofed over a formerly exposed,pervious area(i.e., lawn, meadow, dirt or gravel foadlparking lot)in order to qualify for no exposure. If yes, also indicate approximately how much area was paved or roofed over and is now impervious area. EPA Form 3510-11 (10-99) Page 3 of 4 NPDE FORM �_, Instructions for the NO EXPOSURE CERTIFICATION for Form Approved FORM ai EPA OMB No.2040-0211 3510-1 S Exclusion from NPDES Storm Water Permitting Section C. Exposure Checklist authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures; Check"Yes"or"No"as appropriate to describe the exposure conditions at your facility. If you answer"Yes"to ANY of the questions(1)through (11) For a partnership or sole proprietorship: by a general partner or the in this section, a potential for exposure exists at your site and you cannot proprietor;or certify to a condition of no exposure. You must obtain (or already have) coverage under an NPDES storm water permit. After obtaining permit For a municipal, State, Federal, or other public facility: by either a coverage,you can institute modifications to eliminate the potential for a principal executive or ranking elected official. discharge of storm water exposed to industrial activity,and then certify to a condition of no exposure. Paperwork Reduction Act Notice Section D. Certification Statement Public reporting burden for this certification is estimated to average 1.0 hour per certification,including time for reviewing instructions,searching existing Federal statutes provide for severe penalties for submitting false information data sources,gathering and maintaining the data needed,and completing on this application form. Federal regulations require this application to be and reviewing the collection of information. Burden means the total time, signed as follows: effort,or financial resources expended by persons to generate,maintain, retain,or disclose to provide information to or for a Federal agency. This For a corporation: by a responsible corporate officer,which mears: includes the time needed to review instructions;develop, acquire, install, and utilize technology and systems for the purposes of collecting,validating, (i) president,secretary,treasurer,or vice-president of the corporation and verifying information, processing and maintaining information, and in charge of a principal business function, or any other person disclosing and providing information;adjust the existing ways to comply with who performs similar policy or decision making functions for the any previously applicable instructions and requirements;train personnel to corporation,or be able to respond to a collection of information;search data sources; complete and review the collection of information;and transmit or otherwise (ii) the manager of one or more manufacturing, production, or disclose the information. An agency may not conduct or sponsor, and a operating facilities,provided the manager is authorized to make person is not required to respond to, a collection of information unless it management decisions which govern the operation of the displays a currently valid OMS control number. Send comments regarding regulated facility including having the explicit or implicit duty of the burden estimate, any other aspect of the collection of information,or making major capita$investment recommendations,and initiating suggestions for improving this form,including any suggestions which may and directing other comprehensive measures to assure long increase or reduce this burden to: Director,OPPE{regulatory Informaiion term environmental compliance with environmental laws and Division (2137), USEPA, 401 M Street, SW, Washington, D.C.20450. regulations; the manager can ensure that the necessary systems include the OMB control number of this form on any correspondence. Do are established or actions taken to gather complete and accurate not send the completed No Exposure Certification form to this address. information for permit application requirements; and where EPA Form 3510-11 (10-99) Page 4 of 4 STATE OF NTORTH CAROL.I A DEPARTMENT OF ENVIRONNMINTT AND NATURAL RESOURCES DMSION OF WATER QUALITY GENTERAL PERiNffT NO.NCG060000 CERTMCATE OF COVERAGE No.NCGO60193 STORMWATER DISCHARGES NATIONAL POLLUTANT DISCHARGE ELMUNATION SYSTEM TIn compliance with,the provision of North Carolina General Statute 143-215.1,other lawful standards and regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution Control.Act, as amended, TWIN CI Y WAREHOUSES INC is hereby authorized to discharge stormwater from a facility located at TWIN CITY WAREHOUSES INC-SOUTH MAIN 4800 SOUTH MAIN ST WII STON SALEM FORSY ru COTJ.NTTY to receiving waters designated as the Winston-Salem MS SS to Soak-as Creek,a class C stream,in the Yadkin-Pee Dee River Basin in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I,II,III,IV,V, and VI of General Permit No.NCG060000 as attached. This certij5cate of coverage shall become effective September 1,2002. This Certificate of Coverage shall remain in effect for the duration of the General Permit_ Signed this day August 23,2002, b� �/� for Alan W. Klimek,P.E_,Director Dii�sion of Water Quality By Authority of the Environmental Management Commission �0F,W A7- 9p Michael F.Easley,Governor William G.Ross Jr',Secretary rNorth Carolina Department of Environment and Natural Resources -� Alan W.Klimek,P.E.Director Division of Water Quality March 7, 2006 Mike Hollman Twin City Warehouses Inc. 4800 S Main Street Winston Salem, NC 27107 Subject: General Stormwater Permit Inspections Twin City Warehouses Inc Permit No. NCG060193 & NCG060194 Forsyth County Dear Mr. Hollman: Thank you for your information regarding your stormwater permits for Twin City Warehouses. However, as we discussed by phone it will be necessary for you to request that the permits be rescinded or that you apply for No Ex osure Certification through the Stormwater Permitting Unit in Raleigh. At that time it will be helpful if you can furnish your SIC code. I have enclosed a technical Bulletin and a Sample Notice of Intent (application) for Your information. There is also a No Exposure Certification form enclosed should you determine you are eligible. After receiving your request the Stbrmwater Permitting Unit will provide you with a contact person to answer any further questions. Please direct your request to: NC Division of Water Quality Stormwater and General Permits Unit 1617 Mail Service Center Raleigh NC 27699-1617 Phone 919-733-5083 Fax 919-733-0719 Please contact me at 336-771-5000 if I can be of any further assistance. Sincerely, -1 Rose Pruitt cc: WSRO Central Files Stormwater and General Permits Unit o� N Carolin Naa tura!!y North Carolina Division of Water Quality 585 W3ughtown Street Phone 336)771-5000 Customer Service Internet: www.newatereualitv.org Winston Salem,NC 27107 Fax (336)771-4630 1-877.623-6748 An Equal DpportunitylAffirmative Action Employer—50%Recycled110%Post Consumer Paper TWIN CI1 1 WAREHOUSES DISTRIBUTION LOGISTICS November 2, 2004 'g Department of Environment, Natural Resources- . Attn: Rose Pruitt 585 Waughtown Street Winston-Salem, NC 72107 Dear Ms. Pruitt: This letter is in follow-up to our conversation concerning the 2 Storm water permits at our Chatham Road and South Main streets locations. I have included copies of both storm water permits and a letter from Sherri Knight of the State of North Carolina Dept. of Environment, Health and Natural Resources. Ms. Knight states in her letter that our sites should have been exempt from storm water permits. We have continued to renew these permits in error. Should you have any questions, please feel free to contact me. Sincerely, Mike Hollman Complex Manager (336) 499-7265 direct (336) 414-9062 cell Enclosure(s) r 3302 OLD LEXINGTON ROAD •_V INTSTON-SALEM,NORTH C.AROLINA 27107•TELEPHONE(336)184-2100 'ATI39ITE:wA�.tcwlogistics.com p A SWF� State of North Carolina Department of Environment, Health, and Natural Resources Winston-Salem Regional Office James G. N vtn, Governor Margaret Plemmons Poster William W. cobey,Jr., ry S DTVIS20N OF ENVIRONMENTAL MANAGEMENT Regional Manager July 10 , 1991 Mr. Mike Hollman Twin City Industrial Center 800 Chatham Road Winston-Salem, NC -27106 SUBJECT: Stormwater Permit Forsyth County Dear Mr. Hallman: In regard to your recent inquiry about the Federal N, Sto;7`.T.water regT.:l atilarherd the stL7milary document prepared by our section. Your industrial activity appears to be in category 8. With this classification, your activity is considered an industrial activity as defined by the subject regulations. Please realize that permit applications are only required if you have on-site vehicle maintenance activity and a point source discharge associated with stormwater. If the stormwater flow from your site is sheet flow, that is not concentrated into a ditch, pipe curb and gutter,, etc. that is discharging to the waters of the State, you are not required to apply for a stormwater discharge permit. You indicated during our telephone conversation that the subject site was used for public warehousing and that no vehicle maintenance was performed at the site, thereby exempting the site from stormwater application.. Other lessees of the building would be responsible for . applying for a permit for their activities if applicable, however the items mentioned during our conversation would probably not require application. Natural gas tanks are considered a raw material, however if a leak occurred, it would not nose a threat to surface waters. The same .is true of spring water tanks. 8025 North point BOUT yard, Suitt 100, WrnSton 5ai=m, N.0 ?7iQa:?63 • Tciephonc 9)D000U= (919) E%-7nC7 Mr. Mike Holman July 10 , 1991 Page Two If you have any questions , please feel free to call. Sincerely► Sherri V. Knight nviror- rental Engineer WSRO J- 1 NN A 7•F Michael F.Easley,Governor `O�0 9pG William G.Ross Jr.,Secretary North Carolina Department of Environment and Natural Resources 7 Alan W.Klimek,P.E.Director CO J Division of Water Quality Q Coleen H.Sullins,Deputy Director Division of Water Quality August 21, 2006 Mr. Michael G. Hollman Twin City Warehouses, Inc. 3300 Old Lexington Road Winston-Salem, NC 27107 Subject: No Exposure Certification NCGNE0293 Twin City Warehouses, Inc. 4800 South Main Street, Winston-Salem, NC Forsyth County. Dear Mr. Hollman: The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater Permitting form, which we received on June 26, 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, and hereby rescinding your former Certificate of Coverage number NCG060193. 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(August 31, 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 sarah.young@ncmail.net. Sincerely, ORIGINAL SIGNED BY for Alan W. Klimek, E"KLE cc: Winston-Salem Regional Office Central Files-wlattachments Stormwater Permitting Unit Files , Mot N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 (919)733-7015 Customer Service 1-877-623-6748 United States Environmental Protection Agency EPA Washington,D.C.20460 Form Approved. OMB No.2040-0057 Water Compliance Inspection Report 'Approval expires 8-31-98 Section A: National Data System Coding(i.e., PCS) Transaction Code NPDES yr/molday Inspection Type Inspector Fac Type 1 1N1 2 151 31 NCG060193 111 121 06/07/13 1 17 181W1 19151 201 Remarks 21 6 Inspection Work Days Facility Self-Monitoring Evaivation Rating 131 QA --------------------------Reserved--------------------- 671 1 69 70131 711 1 72! N 1 73 L__Lj 74 751 1 1 1 1 1 Li 80 Section B: Facility Data Name and Location of Facility Inspected(For Industrial Users discharging to POTW,also include Entry Time/Date Permit Effective Date POTW name and NPDES permit Number) 11:33 AM 06/07/13 02/09/01 Twin City Warehouses Inc -South Main 4800 S Main St Exit Time/Date Permit Expiration Date Winston Salem NC 27107 11:34 AM 06/07/13 07/08/31 Name(s)of Onsite Rep resentative(s)lTittes(s)/Phone and Fax Number(s) Other Facility Data Name,Address of Responsible Officiat/Title/Phone and Fax Number Patricia T Brown,3302 Old Lexington Rd Winston Salem NC Contacted 27107//910-724-7431/ No Section C: Areas Evaluated During Inspection (Check only those areas evaluated) Storm Water Section D: Summary of Findin (Comments Attach additional sheets of narrative and checklists as necessary) (See attachment summary) Name(s)and Signature(s)of Inspector(s) Agency/Office/Phone and Fax Numbers Date Rose Pruitt wSRO wQ//336-771-5000/ Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date EPA Form 3560-3(Rev 9-94)Previous editions are obsolete. Page# 1 NPDi=s yrlmo/day Inspection Type 1 3I NCG060193 I11 12I 06/07/13 18 Section D: Summary of Finding/Comments(Attach additional sheets of narrative and checklists as necessary) Evaluate for No Exposure Certification, approved by RO Page# 2 02/21/2006 13: 07 4996011 AKI TCW DC PAGE 06/07 STATE OF NORTH CAROLINA DEPARTMWF OF EIVJRO�T.AND NATURAL RESOURCES DIVISION OF WATER QUALITY GEI FRA.L PERW.r NO.NCGO60000 CERTMCATF, OF COVERAGE No.NCG060193 STORMW,A'TER DISCHARGES NATIONAL POLLUT-TNT MSCOARGE ELD41NATION SYSTE M In compliarim with the provision of North Carolina General Statute 143-215.1,other lawful standards and regulations promulgated and adopted by the North Carolina Erviromental Management Commission, and the Fedcral Water Pollution Control Act as amended, TWw CTrY WARBUOUSE9 INC is hereby anthori7sd to discharge stormwater from a facility located'at 77IN CT7'Y WARE-HOUSES INC-SOUTH MAIN 4800 SOUTH MAIN ST WINSTON SALEM FORS'Y'T'li COUNTY to T'eeeiving wzters drSignated as the Winston-Salem MSSS to Soakas Creek,a Glass C stream in ft Yadkin-lee Dee River Basin in accordance wikb the cffluept limitations,monitoring requirements,and other conditious set forth in,Parts 1,H,IE,TV,V, and VI of.General Permit No.NCG060000 as attachod. Ibis certificate of coverage shall beebme tff=,tive September 1,2002. Ibis Certificate of Coverage shall rcm.a.in.in effect for the duration of the General Permit. Si ped this day August 23,2002. f for Alan W. TQimok,P.B_,Duector Division of water Quality By Authority of the Environmental Management Compazssion A/O United States Environmental Protection Agency Form Approved NPDES A Washington, DC 20460 OMB No.20400211 FORM �`�® E �� 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 industrW activity in the State identified in Section B under EPA's Stofm Water Mu4i-Seclor 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,andlor 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, leading 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 - fina[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 obtalning the no exposure exclusion are provided on pages 3 and 4. A. Facility Operator Information 1. Name: Mo i 11Ai r,1 4 I'rI WI 4 4tt-N 12(CIlAI�I_�?I�IC I Si_ 11-1'A I Cl 1__ 1_ 1 l _1 2.Phone: 3. Mailing Address: a.Street: 13I51QI0l 101l 10 1 1 G 1rt,KIt I►^qci-rioIV1I It11D1t4iio1 1 ^I 4 I_ t I i b.Gity. W{t l 01 ;!I-7'f 2LO f-f5i 9 LI Cun f I I I I 3 I 1 I c,State: +J d.Zip Code: LZ L2_I 1 10 111 1 1 1 13. Facility/Site Location information 1.Facility Name: IT t YL Z I 1 rT t,(, i�l n t9 Is 1ci S 2.a.Street Address: I151010 1 IS I u 10 171 Al I�Al t l;kl 6 171 1 __I 1 1 1 1 1 1 t - I 1 I�i{ b. City: H 1`, _a F4 - S f4 L t~ 1 1 1 11 111 1 lcCounty: I 10 10-Is Ili t:C I V4I 1 1 1 _ d.State: 10,L a.Zip Code: L12 I t-1O111 1-.J_ 1 -1 1 3. Is the facility located on Indian Lands? Yes F No 4,is this a Federal facility? Yes No ? { 5.a.Latitude: G b t t D -1 b.Longitude: c'I LLL_Sj ' f U 6.a.Was the facility or site previously covered under an NPDES storm water permit?• Yes ® No ❑ 3 D ;C: b.If yes,enter NPDES permit number: 7.SIC/Activity Codes: Primary: `i 1 Z '- { Secondary(if applicable): I_j_ 1. I 8.Total size of site associaled 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 disquatiy 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 NPDES Form Approved FORM `�„/��/� NO EXPOSURE CERTIFICATION for Exclusion from One No.2040-0211 3510.11 A 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 LIU 4 Material handling equipment(except adequately maintained vehicles) 5. Materials or products during loadingfunloading or transporting activities B. Materials or products stored outdoors(except final products Intended for outside use(e.g.,new carsl 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 S. Matefials or products handledlstered on roads or railways owned or maintained by the discharger 9. Waste material(except waste in covered,non-leaking containers(e.g.,dumpstersl) 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 LW (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). l 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 pofnt 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 submitled. 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, 1I L cr (..Ifi i�O ► i ` Print Title: g k I ILI AlLAI t4 G r� Signature: Date: ����I r�I EPA Form 3510-11 (10-99) Page 2 of 4 f IY i5• f/ « rL � ,• (� i itr 1 .-�+} � .�.� � y�y �� � �• �'. /� h`- 11 �•.I V�.•: ICI 1�; �.} - � .�.� � y4 `�� � ;.. ��,,�� \Y!�--• 34 "�_I ...2�� y,,.;y � F r., �\ � f'aZ'•r ,.a 't� r��- w ri. fit + �' s �'• _y.�� I w+ Q owl t. ,Q Orly Ware .71 r'`�-�i[h�r}`�,.��- '.1+1:y� ry .?�: ,�1, '� t•.` `k``^��r } '� � r i !` f�' I _ �ti I, `-rs r-,_, •�:- ��c.,. �r'EJlLSxT�-.•{�w„` qs� � I.i' ' _,y'� �` 't '�\.,, � ���`_>i` .) C.,�l �,���9. ' .r t.,. _ '�lj�Vi�fJQ r j ��'j'� }�F� � f - .1 Th �� •It• '7�� f:�• �' �y`� S _i, t' j� \�"� j,-' �y '�� lZ i -)"` ' 1 �� �.�� ' (�l.•'` a-S r. 1y 3 (IU�i��.;15 t ;4;, 1%�C` 1 `;t •/' � }; ��,rl+k4t� � r'7 +s:. �j' �+^--..'rr"'.a��?i.:'�'��,''�\ I I I� nY. •'+ r � �r � L./ ' .�� 1 � ���, ��� I lllf, •l i'/..'_�� ��� ,I fl ':,� �';� t ^��ra � �''�1 �� .r �k'{ 1• �I -.�,�3f,+ f.� ,I - � • I [ 1 '-.� l ,rye _ V \ I _ ,� J t I 1, �, 4. `l � -� % ��t' !' � I ,i� ' 'ter♦ � � � r � ' � ,� .•,: ,,. FI ' ;;C "w_c �, r, ?�„tom/ r 'i '?r. ,� •t ' f5i Copyright(C)1998,Maptech,Inc. �V William G.Ross Jr.,Secretary rNorth Carolina Department of Environment and Natural Resources p r Alan W.Klimek,P.E.Director Division of Water Quality March 7, 2006 Mike Hollman Twin City Warehouses Inc. 4800 S Main Street Winston Salem, NC 27107 Subject: General Stormwater Permit Inspections Twin City Warehouses Inc Permit No. NCG060193 & NCG060194 Forsyth County Dear Mr. Hollman: Thank you for your.information regarding your stormwater permits for Twin City Warehouses. However, as we discussed by phone it will be necessary for you-to request that the permits be rescinded or that you apply for No Exposure Certification through the Stormwater Permitting Unit in Raleigh. At that time it will be helpful if you can furnish your SIC code. i have enclosed a technical Bulletin and a sample Notice of Intent (application) for your information. There is also a No Exposure Certification form enclosed should you determine you are eligible. After receiving your request the Stormwater Permitting Unit will provide you with a contact person to answer any further questions. Please direct your request to: NC Division of Water Quality Stormwater and General Permits Unit 1617 Mail Service Center Raleigh NC 27699-1617 Phone 919-733-5083 Fax 919-733-0719 Please contact me at 336-771-5000 if 1 can be of any further assistance. Sincerely, Rose Pruitt Ir cc: WSRO Central Files Stormwater and General Permits Unit ion, f North Carolina Division of Water Quality 585 Waughtown Street Phone 336)771-5000 Customer S Internet: www.rnewaterquality.or¢ Winston Salem,NC 27107 Fax (336)771-4630 1-877-62? An Equal Opportunity/Affirmative Action Employer—500/6 Recycled110%Post Consumer Paper 02/21/2006 13:07 4996011 AKI TCW DC PAGE 03f07 cn 1 WAREHOUSES DISTRIBUTION LOGISTICS November 2, 2004 'a Department of Environment, Natural Resources : Attn: Rose Pruitt 585 Waughtawn Street Winston-Salem, NC 72107 Dear Ms. Pruitt: This letter is in follow-up to our conversation concerning the 2 Storm water permits at our Chatham Road and South Maid streets locations. 1 have included copies of both storm water permits and a letter from Sherri Knight of the State of North Carolina Dept of Environment, Health and Natural Resources. Ms. Knight states in her letter that our sites should have been exempt from storm water permits. We have continued to renew these permits in error_ Should you have any questions, please feel free to contact me. Since" y, Mike Hoilman Complex Manager (336) 499-7265 direct (336) 414-9062 cell Enclosure(s) 3302 OLD T P-XrNGTON A0,kD•WINSTON-SALEM,NORrU.CAROLiNA.27107•TELEPHONE(336)754-2100 WEBSITF:www.tcw]vgisdcs_com 02/21/2006 13. 07 4996011 AKI '1CW DC PAGE 04/07 e..Stirr' State of North Carolina Department of Environment, Health, and Natural Resources Winston-Saicrn Regional Office James C, Martin, C<wmor Mang m Plemmorts osier V1111ani W Cobey,Jr., Rrgional Managcr DJVISION OF SNVIR0NMENTAL- MANAn�2= July 10 , 1991 Mr. Nike Rollman Twin City In+3ustrial Canter 900 Chatham Road Winston- SAlem, NC 27106 snitcT: stdrmwater Permit .Forsyth county Dear Mr_ fib1,IM&n: In regard to your recent inquiry about the Fed6ral NPDE8 Stortiwater regulations, we have attached the summary document prepared by our section. . Your ,industrial activity appears to be"'in category'B-.' "With this clAssificatibn; your activity is donsidered, an industrial activity as defined by the subject regti1aticns. Please ra-aiize that permit applicaticas are only required if Y704 ha,V2 on- ite vehicle tAinte-nance activity azad A point source discharge. associatad With stormwater. If the stcrrawatez flow from youx site is sheet fio�i, that ,i.s not cohceritxated into a ditch, pipe curb and gutter, etc. that is ciischaiginw [ to the waters of the State, you are not requirea to apply for a starmwater discharge hermit. You indicated during our telephone conversatioa tbat the subject site was used fox public warehousing and t]".iat no vehicle mainteaazace was performed at the site, thereby exempting the site from stormwater. application... Other lessees of the building would be responsible for applying for a permit for their activities if applicable, however the items mentioned during our conversation would probably not require application_ Natural gas tanks aze considered a raw material, however if a leak occurred, it ,,could not pose a threat to surface waters- The same is true of spring water tanks. 8025 Nord Point 8ouk_,wd,S-ice M, Winsian Saicn, fv.C. 27i0G3203 •Tckphonc TMZQO;n� (919) E96-?X7 02/21/2006 13:07 4996011 AKI TCW DC PAGE Mr. Mike gollman July 10, 1991 Page Two :cf you have, any questions, please feel free to call. Sincerely, Sherri V_ Knight Envirunmental Engineer WSRO -� nx- Fx-T�� ��5.'.�pjv rf'O Y� ��9��� g.��g �Y.t+��`4�4.��' >� ., � •e� ��:gg.1�4"� �T! �N.�'s.. 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MapQuest and its suppliers assume no responsibility for any loss or delay resulting from such use. 1 1 of 1 7/13/2006 10:04 AM United States Environmental Protection Agenc Form Approved y flM8 No.2040-0211 NPDFOFlM ®� E DA Washington, TI N 60 fo 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 Slate identified in Section B under EPA's Storm Water Mulli•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 simiiar 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 cer(ifying 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 PROV0ED 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: 1TiLAJ1i r (I11 ICI I I'"j WI IWI' L91F1410f c4 f4^I (_i l t f I � 2.Phone: l"I-i 11' Ir Ir j''I I •-I Zl 3. Mailing Address; a.Street: 13 IS 1 QI01 161 L 101 I 1�1 CI K.It I+,�cl Ti n iA I I d-I o I toil)I I I I I I _I I I,� b.C&)r. t sn 7 1710 AI-t IS I k Lt C c.Stale: ►J d.Zip Code: 17 i'll f 10 B. FacMtylSite Location Information 1.Facility Name: ITIt,-l1. rAi IC-1 t I"rl`fi WI Al IT[ Alq I . II!I—i_1 2. a.Street Address: { f1?I dip t S I+�Ir�J I Kl r N`t�I t1f�l l4 (TI I I I I S I ! _) I l , i 1 1 b.City: ]{t k_IA 4 S 771 al KI 1'51 A•ILI�rIL41 I I I _I I I I I i _I c.County: lt`10 IV-IS14 I-TIt41 I I d.State: 11,131(--1 e.Zip Code: t2 'f It i0111 f—I n rw u i 3 Is the facility located on Indian Lands? Yes❑ No a a! -� °n' 4.Is this a Federal facility? Yes❑ No 5.a.Latitude: b.Longitude: 6. a.Was the facility or site previously covered under an NPDES storm water permit? Yes ® No ❑ 3 O r,) b.If yes,enter NPDES permit number: 7.S106kotivhy Codes: Primary: `t J 1 "_ Secondary(If applicable): S.Total size of site associated with industrial aclivity. _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 disqualifyyou for the no exposure exclusion. However,your permitting authority may use this information in considering whether storm water discharges from your site are fikely 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 Y. EPA Form 3510-11 (10-99) IPage 1 of 4 !J 4— NPDES Form Approved FORM EPA NO EXPOSURE CERTIFICATION for Exclusion from OMB 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 industrial machinery or equipment remain and are exposed to storm water 2. Materiafs or residuals on the ground or in storm water inlets from spillslleaks ❑ 3, Materials or products from past industrial activity ❑ 4. Material handling equipment(except adequately maintained vehicles) 1.121 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 handledlstored on roads or railways owned or maintained by the discharger ❑ S. 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 Ulu (i.e.,under an air quality control permit)and evident in the storm water outflow D. Certification Statement I certify under penatty of few 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 122,25(g)(2)). 1 understand that t 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 t 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 signXiicant penalties for submitting false information,including the possibility of fine and imprisonment for knowing violations. Print Name:n I, 4 e_t W is i II4n±rt n)ii; I 11 I I I I I [^I�f ,f f i I � Print Title: itwlr I 11LIJ Alt't I yk G6!2. 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