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HomeMy WebLinkAboutNCGNE0294_COMPLETE FILE - HISTORICAL_20060825 STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. DOC TYPE [HISTORICAL FILE 0 MONITORING REPORTS DOC DATE ❑ �l�v����� YYYYMMUD �N A Michael F.Easley,Governor `O�O E9pG William G.Ross Jr.,Secretary North Carolina Department of Environment and Natural Resources Alan W.Klimek,P.E.Director `-1 Division of Water Quality p Coleen H.Sullins,Deputy Director Division of Water Quality RECEIVED August 21, 2006 N.C.Peat of ENR AG I 5 2M Mr. Michael G. Holtman w'snstonsaiem Twin City Warehouses, Inc. Regional offi-ce 3300 Old Lexington Road Winston-Salem, NC 27107 Subject: No Exposure Certification NCGNE0294 Twin City Warehouses, Inc- 800 Chatham Road, 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 NCG060194. 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 KEN PICKLE for Alan W. Klimek, P.E. cc: Winston-Salem Regional Office Central Files—wlattachments Stormwater Permitting Unit Files "4 NCDENR 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 ,.j� ,�a �� i ' 1 a. IS ►�s;-� � i e.��•,•.• � � p �r � � ,t •Its ~� r tk ofs-a. ; �_ r" •� -�J ��' � Gil } •a a wqF_ I DO Fan A I •.t}: . qvq 41 ou Ilk �i � _ i f�' �•}�".--.-�{.�•'�j 11�13� { it fl tw Nap— � '� ]Fyff]ee,, tI1- P I{iY�#ryy� /V.�f�X• �....l.M ` '-—I—S fL v �Yl�1. ,:J � `s ��;+^�`!•� � , it r�--~=w ��� t-- i �� ,y RION -'r. rQ.° �k I'_ _ .�Ip°4"u�y �• l _ ��• '•{�sr3� ;", �n�nr p �� hi a✓~ r1y'1.�J fT 1 i ♦ �4'-��..' 'k YM.... ' ��1.�- g1'.1,w1LF 7��d�iyt y � 93-61 MI r4�J LiJa�� .�--�, i \�r ' 1% /.� • f: %' 'R'�Q�� �5�'� � .1; t IVy 1 a}I4'-l'.iil�i32 ! ' �(t/' III ) crilellt,,L1�4 �S.c� a ;• tj L ' � �"ram•` �i -`1 V �My�����If_[��_�tt+t��LEi�'ildA�1 '� t f��1�Fi � 1rtS;�� �C�F i1�.�ww.-�• � �!� +f � �'� �'8'�.�tf�flA�w }� t� '� t�~ IVALha ' sv r , _t 91 ' �i � �I{ 1 IPWA 1 1 .pe°u4�it�.• y 4M WO . : �SBvtElfr; p "„� 43 u �: j ��ll il►� 1 ' �I �'- -r� �B'4 - A }LL' }` ., •• -• TM W A] 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 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 NCGNE0294 Twin City Warehouses, Inc. 800 Chatham Road, 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 NCG060194. 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. x 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 Stormwater Permitting Unit Files ° Ncl) NR N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 (919)733-7015 Customer Service 1-877-623-6748 � _� t� , + ��, 'fpS'�{ ?- • +r�_ y _ {a far'/ � t` gg Ula /'j{�`��' � 1ir his f��;��r. 11• ,� ;.�� �g� �. ��' -��• r`, r trey, ? 3.,/1+,.�"'Y H I�I �=�, �14 �� • i:r -=-L_ ';r' WE lip SEN. is <� � .� ri ��1 �_.-1•_y. 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CIF ►.o' • Yam" r� IT i�� 7._.7� }�F o r►V. a Ir ! #Lf t��., Kul ��� '411[ a` ��`�t � iil'�'.s 4/'r i� �\\�••e f ®1iy��J I LWr��y \Yili� ��W_�S.,y�-- '� Oct .A} � ! �j �yry 1fi�^i 4\:��i�l'\ �Y � �•r�F.�: 1 � ���"'ffp�l fi•L_,. —�A--- -� S ��:. .� ��I'�� 1;' �����•� � 1��� l�Q�. � � . .�f ram. )� e 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@ncmail.net> OK to process. Corey Corey Basinger Ccrey.Basinger@NCmai.l.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.Basinger rr,NCmail.net> WSRO NC DENR 1 of 1 7/24/2006 1 1:09 AM wsp Form Approved United States Environmental Protection Agency OMB No.2040-0211 NPDES t1 Washington, DC 20460 FORM �`wM ��� NO EXPOSURE CERTIFICATION for Exclusion from 3510-i 1 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 S under EPA's Storm Water Multi-Sector Generai 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 dandling 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: 1t,;i t I'A}I. I ; i _j_ 3. Mailing Address: a.Street: t D L 101 4 ID I _I b I tS e l I I11 I Lcl T 1p ltl 1� DI 411')l 1 L ELT 1 1 _1 1: b.City: 0 t IN 15 1 T 101+LI-15 I A-I t 161 PI 1 1 1 1 1 } i 1 1 c.State: 10 1(-1 d.Zip Code: Iz I t) t t ICI'] 1 9. FacilitylSite Location Information 1. Facility Name: M0i- IitI, tGl11it `ffI IL-� VI-ICit'l(^�0It%is1blSl. IS--l111GI I I I 1 1 I 2.a.Street Address: Q f B O A-1 1 IL4,1 l41 t^ I L�l n G- D' II I + I 1 i 1 b.City: {Jh t 1ti S 1-7 o r< - 'S !ILL- ( ++' I 1 1 1 c.County: 10 1 15 141 f !".1 C Zf L d.State: e.Zip Code: }211 I I 10 1 n I-I i I I C " -2 3. is the facility located an Indian Lands? Yes No D 4. Is this a Federal facility? Yes No10 ® C 5. a.Latitude: � to C S c( b. Longitude: 15 O Z- S I`� S 3 D �, 6. a.Was the facility or site previously covered under an NPDES storm water permit? Yes No '4�-a b.If yes,enter NPDES permit number: T SIC/Activity Codes: Primary: =f 1- 1+1 S Secondary(if applicable): 1 1 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. Less than one acre One to five acres More than five acres EPA Form 3510-11 (10-99) Page 1 of 4 NPDES A Form Approved - FORM `,1 EP NO EXPOSURE CERTIFICATION for Exclusion from OMB No-2040-0211 3510 11 1_ 1"1 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,staring or cleaning industrial machinery or equipment,and areas where residuals from using,storing El54 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 spillslleaks El 191 3. Materials or products from past industrial activity 4- Material handling equipment(except adequately maintained vehicles) ❑ 5. Materials or products during loading/unloading or transporting activitles ❑ M & Materials or products stored outdoors(except final products intended for ou?side 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 El 8. Materials or products handled/stored on roads or railways owned or maintained by the discharger El 9. Waste material(except waste in covered,non-leaking containers[e.g..dumpsters]) 10. Application or disposal of process wastewater(unless otherwise permitted) M, 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 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. 1 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)). t 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 appticabte), 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 confi„,t:e 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. 1 am aware that there are significant penalties for submitting false information,including the possibility of fine and imprisonment for knowing violations. Print Name. �l t l C-I L� t�I 6'I Q 11'.1 O I t,I(-IKAf al�l 11 I I I L_ 1 1 t I I I I i 1 ; 1 Print Title: I0I I [ t 6 kt IMI (4t 019 f' 161 Signature: Date: I Jf W EPA Form 3510-11 (10-99) Page 2 of 4 NPDES Instructions for the NO EXPOSURE CERTIFICATION for Form Approved FORM `SPA OMB No.2040-0211 3510-11 Exclusion from NPDES Storm Water Permitting Who May File a No Exposure Certification Section S. Facility/Site Location Information Federal law at 40 CFR Part 122.26 prohibits paint source discharges of 1. Enter the oft"icial 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 Eiimination 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.,tntersecticr,,of Roulas 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 conditicn of"no exposure' exists at the industrial facility or site. 3. Indicate whether the facility is located on Indian Lanus. 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 farm 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 maps,by calling 1-(BB8)ASK-USGS,or by accessing re-submitted at least once every five years. EPA's web site at http://www.epa-goviowmirwfindustry/index.htm and selecting Latitude and Longitude Finders under the ResourceslPermit 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. Latitude and tongitude for a facility in decimal form must be conversed If conditions change resulting in the exposure of materials and activities to storm water, the facility operator must obtain coverage under an NPDES to degrees (°), minutes ('), and seconds (") for proper entry on storm water permit immediately. the certification form. To convert decimal latitude or longitude to degrees/minutes/seconds,follow the steps in the following example. Where to File the No Exposure Certification Form Exam le: Convert decimat latitude 45.1234567 to degrees(1),minutes _Maillhe cram leted no exposure certification form to: and seconds("). ------ he numbers to the-left of the decimal point are the degrees: 451. 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 to stay within th a 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 if applicable. SIC codes can be obtained from the Standard Industrial 'L. Provide the:egol name of the person.farm,public brganizaiion, or any Classification Manual,1987. other entity that operates the facility or site described in this certification. B_ Enter the toial 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 ft2lacre=1.25 acres. used), lnciude 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 roadlparking 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 FORM Instructions for the NO EXPOSURE CERTIFICATION for Farm,4 C-021d FORM „EPq Or416 No.2040-0211 3510-11 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 means: 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 OMB control dumber. 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 capital investment recommendations,and initiating suggestions for improving this form,including any suggestions which may and-direciing other comprehensive measures to assure long increase or reduce this burden tc: Director,OPPE Regulatory Information term environmental compliance with environmental laws and Division (2"T37)-USEP.�401-M-Street, SW-Washington7D-G-20460— 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 1 V Y I V C� 1 WAREHOUSES DISTRIBUTION LOGISTICS June 22, 2006 D NC Division of Water Quality JUN D Ms Sara Young Storm water and General Permits Unit 1617 Mail Service Center .-...,., Raleigh, NC 27699-1617 Dear Ms Young, I'm requesting that the two storm water permits that we have,be rescinded or that they be changed to a No Exposure Certification. I have enclosed copies of the permits that we are requesting be rescinded or changed. I have also enclosed the applications for the No Exposure Certifications if that is the way we need to go. I have talked with both Sherri Knight and Rose Pruitt about this matter. I have enclosed the letters from both about this matter. Should you have any questions, please contact me at either 336-414-9062 or 336-499- 7265. ` Sincerely, Micha 1 . oilman Complex Manager 3302 OLD LEXINGTON ROAD•WINSTON-SALEM,NORTH CAROLINA 27107•TELEPHONE(336)784-2100 WEBSITE: www.tcwlogistics.com STATE OF NORTH C AROLD'?A DEPARTN ENT OF EN V RONIvI TT ANTD NATURAL RESOURCES DIVISION OF WATER QUALITY GENERAL PERMIT NO.NCG060000 CERTIFICATE OF COVERAGE No.NCG060194 STORMWATER DISCHARGES NATIONAL POLLUTANT DISCHARGE ELMM2 ATION SYSTEM In compliance Mth the provision of North Carolina General Stanate 143-215.1,other la-wfu,]standards and regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water Pollution Control Act, as amended, TWIN CITY WAREHOUSES INC D is hereby authorized to discharge stormwater from a facility located at TWIN CITY WAREHOUSES INC-CHATHAM RD 800 CHATHAM RD •r.IP�A!l��r WINSTON S.ALFM COUNTY to receiving waters designated as Peters 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.NCG-060000 as attached_ This certificate 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. for Alan W.Klimek,P.E_,Director Division of Water Quality By Authority of the Environmental Management Commission • I�GC�- � � a� � ws� United States Environmental Protection enc Form Approved Y dMENo.2t340-02i1 NPDES ®� EPA Washington, CDC 20464 35'1l)-11 FORM �' NO EXPOSURE CERTIFICATION for Exclusion from NPDES Storm Water Permitting Submission of this No Exposure Cer-66cation 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 Stale 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 net limited to,material handling ea'uipment 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 teak. 'Sealed" means banded or Otherwise secured and without operational laps 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 forthe no exposure exclusion, to addition,the exclusion from NPDES permitling 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: J:EIIt*l r I n I 1,--i I rri r 1{,_% 1a1fPK-1;al e lu I S TJOISJ I Zj I I TI 21-Phorib7t1 22{J--t�lg7H-r+I?i l l -- 3. Mailing Address: a.Street I, I 10 id l 161( ID 1 IL 1 0)V I i 111 I Gf 71 r 1 11 1 104 0S%5,1171 I I 11 I I I I � b.City.. t I K 15 1 71 O I r LI-I S I(",I f_1t--1" l 1 1 1 1 1 I I i C.State: LLLa d.Zip Code: h 11) 11 1 CI'71-I 1 -1 1 I B. Facifityl5ite Location Information 1.Facility Name: I L2 I I n-1 164 t I` I'v I I L4_w1 V-1 LI-i-0 I L 14-1 6C�I I���1 Gt-I I I 2.a.Street Address: 14 le,i 01 1121ola-1 Dl i -I_ i t 1 t { 1_ I I I- I f I_ I __ b.City: Jillt i l t"I 511-TI t)I r1 I--I S l Al t-1G=1""LI I I. 1 �_ I I _I I C.county: (r 101 •1 51 1,1'i t?i I d-State; I V (-Ie.Zip Code: I'LI 1_I t I b I'1 I-I L I 4_ _ 3. Is the facility located on Indian Lands? Yes❑ No R] f 4.Is this a Federal facility? Yes ❑ No ® j rj as L= 5.a.Latitude: � k, 4 O LLI��.( b. Longitude: 10ICi 2 5 H jLL 6, a.Was the facility or site previously covered under an NPDES storm water per. Yes ❑ No ❑ ..,. b. If yes,enter NPDES permit number: n ors e(,C '3 <- 7. SICIActivity Codes: Primary; =f I?I�-I 5 Secondary(if applicable): 9.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. Less than one acre ❑ One to five acres ❑ More than five acres EPA Form 3510-11 (10-99) Paoe 1 of a V r� NPDES r, NO EXPOSURE CERTIFICATION for Exclusion from Form Approved FORM �"/EPA QhdB 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.) Ifyou 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 cieaning industrial machinery or equipment remain and are exposed to storm water 2. Materials or residuals on the ground or in storm water inlets from spillslleaks 3. Mater,'ais or products from past industrial activity 4. Material handling equipment(except adequately maintained vehicles) 5. Materials or products during loadinglunloading or transporting activities M 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 of maintained by the discharger 9. Waste material(except waste in covered,non4eaking 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 0. 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. 1 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), t 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,t 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. l l I I C.l t-ii n f l L-I, ll?.I C I G 4 L-rAl Al V�l I I I I I _ I I I_ I _4 I j_1 i _4 1- Print Title: 10 1 I S- 6 'n 114"16` Mir! 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