Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
NCGNE0372_COMPLETE FILE - HISTORICAL_20131014
STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. IVC.,&N E70 � � DOC TYPE [9'HISTORICAL FILE 0 MONITORING REPORTS DOC DATE YYVYMMDD Taylor-Smith, Aana From: Taylor-Smith, Aana Sent: Monday, October 14, 2013 11:51 AM To: 'tombr@jeld-wen.com' Subject: No Exposure Renewal Attachments: NPDES-NCGNE-SelfRecert-20100729-DWQ-SPU.doc Hi Tom, We received your request to renew the No Exposure Certification for Jeld-Wen (NCGNE0372). However, there is no longer a requirement to send in a form to renew No Exposure coverage. The only requirement is to self-certify that Jeld- Wen still qualifies for No Exposure by filling out the attached form each year.That form does not have to be sent to DENR, but must be kept on-site with your records. Please feel free to contact me at any time with any questions or concerns you may have. Thanks very muchl Aana Taylor-Smith Land Quality Section Division of Energy, Mineral, and Land Resources NC DENR Winston-Salem Regional Office Phone: (336)771-5034 Fax (336) 771-4631 E-mail correspondence to and from this address may be subject to the North Carolina Public Records Caw and may be disclosed to third parties. 1 FOR AGENCY USE ONLY Daie Received Division of Water Quality 1 Surface Water Protection Year b,ontn n:,y NCDENR National Pollutant Discharge Elimination System Certificate of Coverage CGNE whr„cuo, L—.<w,•rvEWOF NO EXPOSURE CERTIFICATION for Exclusion RECEIVED rry rar.T.,n NmnN.pr.,c_Rcrs NCGNEOOOO N.C,Dept,of ENR OCT 0 8 2013 NO EXPOSURE CERTIFICATION Winston-Salem National Pollutant Discharge Elimination System application for exclusion from a Stormwal er4Permitrbased on NO EXPOSURE: Submission of this No Exposure Certification constitutes notification that your facility does not require a permit for stormwater discharges associated with industrial activity in the State of North Carolina because it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means all industrial materials and activities are protected by a storm resistant shelter(with some exceptions)to prevent exposure to rain, snow, snowmelt, and/or runoff. For permitted facilities in North Carolina, DWQ must approve your application for No Exposure Certification before this exclusion is effective. Until you are issued a No Exposure Certification and your NPDES permit is rescinded, your facility must continue to abide by the terms and conditions of the current permit. 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 with locked or non-operational taps or valves;adequately maintained vehicles used in material handling;and final products, other than products that would be mobilized in stormwater 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, you certify that a condition of no exposure exists at this facility or site and are obligated to comply with the terms and conditions of 40 CFR 122.26(g). You are required to self re-certify your No Exposure Exclusion annually. For questions, please contact the DWG?Regional Office for your area. (See page 6) (Please print or type) 1) Mailing address of owner/operator(address to which all certification correspondence will be mailed): Name JELD-WEN, inc. Contact Michael Hiatt Street Address 407 Harbor Isles Blvd City Klamath Falls State OR ZIP Code 97601 Telephone No. (541) 883-3373 Fax: 541 885-7400 Email michaelhi��eld-wen.comwen.com Page 1 of 7 Swu-NE-12Aug2010 NCGNE0000 No Exposure Certification 2) Location of facility producing discharge: Facility Name JELD-WEN, Composites - North Wilkesboro Facility Contact Tom Brown Facility Street Address 205 Lanes Drive City North Wilkesboro State NC ZIP Code 28659 County Wilkes Telephone No. (336) 838-0292 Fax: Email tombr@jeld-wen.com 3) Physical location information: Please provide a narrative description of how to get to the facility (use street names, state road numbers, and distance and direction from a roadway Intersection). dead North on N Carolina 268 EIElkin H1VY,Turn Right onto Woodside Dr, Turn Right onto River Liberty Grove Church Road,Lake 1 st Right onto Lanes Drive,Facility will be on the left. _ (A copy of a map with the facility clearly located on it should be included with the certification application.) 4) Is the facility located on Native American Lands?0 Yes 5j No 5) Is this a Federal facility? ❑ Yes 0 No 6) Latitude 36 11' 24.00" N Longitude 81 05' 14.09" W (deg., min., seconds) 7) This NPDES No Exposure Exclusion application applies to which of the following: ❑ New or Proposed Facility Date operation is to begin ❑ Existing Date operation began 9 Renewal of existing No Exposure Certification Certification No.: NCGNE 0372 8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes 7 No If yes, what is the NPDES Permit Number? 9) Standard Industrial Classification: Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial activity at this facility SIC Code: 3 0 8 9 10) Provide a brief description of the types of industrial activities and products produced at this facility: Facility manufactures fiberglass composite door facings. Facings are molded from prefab material. 11) Does this facility have any Non-Discharge permits (ex: recycle permits)? 0 No ❑ Yes If yes, list the permit numbers for all current Non-Discharge permits for this facility: Page 2of7 SWU-NE-12Aug2010 NCGNE0000 No Exposure Certification Exposure Checklists(12. - 14.) 12) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future? (Please check either "Yes" or "No.") If you answer "Yes" to any of these items, you are not eligible for the no exposure exclusion. a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes :0 No residuals from using, storing or cleaning industrial machinery or equipment remain and are exposed to stormwater b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes 7 No c. Materials or products from past industrial activity ❑ Yes No d. Material handling equipment(except adequately maintained vehicles) ❑ Yes ] No e. Materials or products during loading/unloading or transporting activities ❑ Yes ID No f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ® No use [e.g., new cars]where exposure to stormwater does not result in the discharge of pollutants) g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes FLI No and similar containers h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes 1� No the discharger i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes 0 No j. Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes 91 No k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes W No otherwise regulated (i.e., under an air quality control permit) and evident in the stormwater outflow 1. Empty containers that previously contained materials that are not properly stored ❑ Yes IKI No (i.e., not closed and stored upside down to prevent precipitation accumulation) m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes 5D No stored outside, has the facility had any releases in the past three (3) years? 13) Above Ground Storage Tanks (ASTs): If you answer "No" to any of the following items,you are not eligible for the no exposure exclusion. a. Are exterior ASTs and piping free of rust, damaged or weathered coating, pits, or p Yes ❑ No ❑ N/A deterioration, or evidence of leaks? b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ® Yes ❑ No ❑ NIA cracks, holes, or evidence of leaks, and are drain valves maintained locked shut? Page 3 of 7 SWU-NE-12Aug2010 NCGNE0000 No Exposure Certification 14) Secondary Containment: If you answer "No" to any of the following items, you are not eligible for the no exposure exclusion. a. Is secondary containment provided for all single above ground storage ID Yes ❑ No ❑ NIA containers (including drums, barrels, etc.) with a capacity of more than 660- gallons? b. Is secondary containment provided for above ground storage containers stored ID Yes ❑ No ❑ NIA in close proximity to each other with a combined capacity of more than 1,320- gallons? c. Is secondary containment provided for Title III Section 313 Superfund ❑ Yes ❑ No ® NIA Amendments and Reauthorization Act (SARA) water priority chemicals'? d. Is secondary containment provided for hazardous substances— designated in 40 Cj Yes ❑ No ® NIA CFR §116? e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No ld NIA 15) Hazardous Waste: a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes FZ1 No b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste ❑ Yes ® No generated per month) of hazardous waste? c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑ Yes ® No generated per month) of hazardous waste? If you answered yes to questions b. or c., please provide the following information: Type(s) of waste: How is material stored: Where is material stored: How many disposal shipments per year: Name of transport/disposal vendor: Vendor address: Footnotes to Questions 14) c. & d. 'Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require secondary containment. However, some exceptions may be made for de minimis amounts of certain substances, and/or other qualifiers, as described in the exemptions from reporting requirements of Title III SARA 313 in 40 CFR §372.38. "'Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require secondary containment. However, some exceptions may be made for amounts less than the Reportable Quantities of the hazardous substances listed in 40 CFR §117.3, Page 4 of 7 S W U-NE-12Aug2010 NCGNE0000 No Exposure Certification 16) Other information: If you answer "Yes" to any of the following items, you might not be eligible for the no exposure exclusion. A more in-depth evaluation of the site circumstances may be required. a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? ❑ Yes ® No b. Does your facility have coal piles on site? ❑ Yes ® No c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes 0 No sawdust, etc.? d. Does your facility have air emissions associated with its industrial activity(e.g., 60 Yes 0 No degreasing operations, plating, painting and metal finishing)? If so, describe the industrial activity: Skin Molding Process e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? l3d Yes ❑ No ❑ NIA Please specify: Permit#10247R00 f. Please list any other environmental program permits (federal, state, etc.) not specified earlier in this application (such as Hazardous Waste Permits, etc.): Permit: Program: Permit: Program: Permit: Program: Permit: Program: Permit: Program: Permit: Program: Permit: Program: Page 5 of 7 5W U-NE-12Aug201 U NCGNE0000 No Exposure Certification 17) Certification: 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 stormwater permitting. I certify under penalty of law that there are no discharges of stormwater 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 annually self re-certify No Exposure and, if requested, submit the re-certification to DWQ or 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 North Carolina Division of Water Quality, 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. In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under an NPDES permit prior to any point source discharge of stormwater 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. I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief such information is true, complete, and accurate. Printed Name of Person Signing: Tom Brown Title: General Mang ( gnature of Applicant) (Date Srgned) Please note: This application for the No Exposure Exclusion is subject to approval by the NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for compliance with no exposure conditions prior to that approval. The Regional Office may also inspect your facility at any time in the future for compliance with the No Exposure Exclusion. North Carolina General Statute 143-215.6 B(i) provides that: Any person who knowingly makes any false statement, representation,or certification in any application,record, report,plan,or other document filed or required to be maintained under this Article or a rule implementing this Article;or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Article;or who falsifies,tampers with,or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the [Environmental Management]Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars($10,000). There is currently no fee for a No Exposure Exclusion. Page 6 of 7 SWU-NE-12Aug2010 NCGNE0000 No Exposure Certification Final Checklist This application should include the following items: E This completed application and all supporting documentation. D A map with the location of the facility clearly marked. o If the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8. Mail the entire package to: Stormwater Permitting Unit Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Note The submission of this document does not guarantee the issuance of a No Exposure Exclusion. For questions,please contact the DWQ Regional Office for your area. DWO Regional Office Contact Information: Asheville Office ...... (828) 296-4500 win ro Sole Fayetteville Office ... (910) 433-3300 Mooresville Office ... (704) 663-1699 •,` _ '" ° Raleigh Office ..... .. 919 791-4200 m ,.x Washington Office ...(252) 946-6481 :`, Wilmington Office ... (910) 796-7215 Winston-Salem ...... (336) 771-5000 Central Office .........(919) 807-6300 t nwan Page 7 of 7 SW U-N E-1 2Aug201 0 JELD'WEN JELD-WEN Composite Door Skins WINDOWS & nOORS 205 Lanes Drive North Wilkesboro, North Carolina Storm Water Location Map 360 11' 24.00" N, 810 05' 14.09" W s JELD-WVN Facility i t y w 9111/13 Gong le M aps Google Directions from North Wilkesboro, NC to 205 Lane's Dr Drive 5.6 mi, 13 min m � S � VIA a° \ 41 �t la pn,ez L i - xee yam, z Palk 'S1. 8 Opleniel 421 rPW St A • r w o - ` `�'rldkee Regiaul oeo� 4St/`/Mrdcei Center `�-jyyy l�//, \ �,-�.r-��.1�� �.—�.t..L[4- ..�—-� ..:SNwY f77\."`rG. .�+• r _ z, S A North Wilkesboro, NC Continue to C B D Loop 16 c�s -- -_ -- --- - - - - — - 0.1mi/30s �c 1. Head northeast toward 9th St �� ON. V 1 sChane aw a`" me 2. Take the 1 st right onto 9th St Ntrpestiwc 144 ft } vre,eoutin wiy ' s �y Public Library to qak clr� Loop ..— orMM, academy� l ,p com B—My Moun lA d10w 1 i SmaMeEtousi f1 51ppPin9 peze eni Reenevy f I Take 2nd St and NC-268 E/Elkin Hwy to httpsJAw w.goog!e.00rWmaps/pre\iewA.data--!4m29!3m28!1m5!1sNorth+Wi!Iesboro%2C+NC!2s0)68517338d592bed5%3AMbd6b65b985a7e79!3m2!3d36.15... 113 9111113 Gong l e Maps Woodside Dr ---- - - - - - — 4.3 mi /9 min 3. Take the 1st left onto C B Q Loop 0.3 mi 4. Turn left onto fish St 5. Take the 1st right onto B St/Main St 8 Continue to follow B St ! /o" ��[�`P� s,� ✓� ,� '��v �E� " -- - --- - - - ---- ----- 0.4 mi { s"09&AA --\ b '+�,y, L1+n�I WALImO e'�9o� 3M � �l 6. Continue onto 2nd St \`, �g3� Mrma al Pak , 1. VFW ------ - __ - - �� - 1.1 mi j dui aS �C1y - f, � J M� )a 7. Turn right onto NC-268 E/Elkin Hwy ©-sa4 h7jeAdj �__ -_ -- - _ - -- ---- --- - 2.4mi II � Z\�/�\•���t 'Q Sm�uoi A�rA �0- N 0 Continue on Woodside Dr. Drive to Lane's Dr in J� � � r mac �o 100 c . North Wilkesboro (L1 ��� r 8. Turn right onto Woodside Dr n A���✓ - - - -- -- _ - - - - - 0.9mi a 9. Turn right onto River Liberty Grove Church Rd _,p 10. Take the 1 st right onto Lane's Dr �� n, g 8 Destination will be on the left - ..-- - - ---- - - - --- - -- - -- 0.1 mi B 205 Lane's Dr North Wilkesboro,NC 28659 These directions are for planning purposes only. You may find that construction projects,traffic,weather,or other events may cause conditions to differ from the map results,and you should plan your route accordingly. You must obey all signs or notices regarding your route. Map data©2013 Google https lhaluw.g oog le.corrdmaps/previ ev.O data--!4m29!3m281 t m5!1 s North+Wi I Iesboro%2C+N C!2s0)B8.517338d592bed5%3AO)6bd6b656985a7e79!3m2!3d36.15... 213 Smith, George From: Pickle, Ken Sent: Friday, April 26, 2013 9:53 AM To: Smith, George Cc: Montalvo, Sheri A; Georgoulias, Bethany; Bennett, Bradley Subject: RE: No Exposure re-submittal Oh George,one other thing: I note that BIMS shows NCGNE0372 as 'Active', meaning we have no need to correct the permit status information in RIMS. Ken Pickle Environmental Engineer NCDENR I DWQ I Stormwater Permitting Unit 1617 Mail Service Center, Raleigh, NC 27699-1617 512 N. Salisbury St, Raleigh, NC 27604 Phone: (919) 807-6376 Fax: (919) 807-6494 Email: ken.pickle@ncdeni-.gov Website: http://portal.ncdenr.org/web/wq/ws/su ** Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties unless the content is exempt by statute or other regulations.** From: Pickle, Ken Sent: Friday, April 26, 2013 9:17 AM To: Smith, George Cc: Montalvo, Sheri A; Georgoulias, Bethany; Bennett, Bradley Subject: RE: No Exposure re-submittal Hi George, RE: NCGNE0938 vs. NCGNE0372—1eld-Wen, Inc. OK, George, thanks for the info. So, from BIMS it appears this facility is already covered by NCGNE0372, issued 8 23 2007. • But they have submitted another application, which we received 4/15/2013. • Same name; same address, 205 Lanes Drive, N. Wilkesboro, NC. • I do not think we would have advised them to re-submit. So, trying to reconstruct what may have happened (I don't actually know the facts): • My guess: Looks like maybe someone at the facility saw that the 2007 No Exposure had expired, (back in 2007 we were issuing them for 5 years.) We have since gone to annual self-renewal of no exposure, pending annual self-certification of continuing no-exposure conditions. • So, the facility submitted another NCGNE NO1 in April 2013, thinking it was past time to renew. Apparently, they did not record in the new submittal that this was a renewal, and so we assigned a new number, and began the processing of it, with anew NCGNE number, NCGNE0938. Sheri would have logged it in and forwarded it to WSRO for action, as if it were a new facility. 1 Presumably this unnecessary application would have made its way through Corey to you, which brings us up to the current set of circumstances, I think. Does this all add up with the known facts? So, unless you want to pursue this further with them, I think you can file that unnecessary re-application in your site files with a note that it is superfluous. Sheri—once we hear back from George that this 411512013 application is a mistake, can you just show the application as withdrawn, or some other similar status in RIMS? Have we corrected this kind of second application before? 1 think we need to wait on a reply from George, however, since I'm just guessing haw all of this happened. Bradley, Bethany—do you think this procedural short-cut(i.e. ignore the re-submittal), make sense for our RIMS record, or other procedural considerations? Ken Ken Pickle Environmental Engineer NCDENR I DWQ I Stormwater Permitting Unit 1617 Mail Service Center, Raleigh, NC 27699-1617 512 N. Salisbury St, Raleigh, NC 27604 Phone: (919) 807-6376 Fax: (919) 807-6494 Email: ken.pickle@ncdenr.gov Website: http://p_ortal,ncdenr,org/webZwa/ws/su ** Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties unless the content is exempt by statute or other regulations." From: Smith, George Sent: Friday, April 26, 2013 8:09 AM To: Pickle, Ken Subject: RE: No Exposure re-submittal Ken, I'll get back with. I am out in the field this morning. JELD-WEN, Inc. NCGNE0938 George George Smith New email: Qeorge.smithPncdenr.gov NC DENR Winston-Salem Regional Office Division of Water Quality, Water Quality Section 585 Waughtown Street Winston-Salem, NC 27107 Voice: (336) 771-4968 FAX: (336) 771-4630 . z E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties. From: Pickle, Ken Sent: Thursday, April 25, 2013 1:54 PM To: Smith, George Subject: No Exposure re-submittal Hi George, I'm not sure why you received a No Exposure Certification for a facility that already had been granted the No Exposure Exclusion from permitting. I don't think we would have advised them to re-submit, unless there has been a name or ownership change. Otherwise, my suspicion is that they just mistakenly assumed we want a copy of each year's annual recertification: we don't; I don't think you do either, right?. I've been to our website to check out the forms we have posted, and here's what they say: • The initial application form, NCGNE0000 No Exposure Certification: Item 17) says, "...I understand that I am obligated to annually self re-certify No Exposure and, if requested, submit the re-certification to DWQ..." (my bold text for focus) • The required annual No Exposure Self Re-Certification form: o The boxed text at the top of page one says,"Do not submit this form to DWQ unless requested." (my bold text for focus.) a Item 6) says, "I understand that I am obligated to annually self re-certify No Exposure and, if requested, submit this recertification to DWQ..." (my bold text for focus.) • The DWQ posted guidance for the annual repeat certification, the No Exposure Self Re-Certification Information: says, "Do not submit the recertification to DWQ unless requested. If requested, submit a copy of the re- certification..." (bold text shown exactly as it is in the guidance document.) I'd say, double check BIMS to see if there has been an ownership change. (I think it makes sense for them to re-submit the NCGNE application form, if there has been an ownership change—otherwise, we have no record that the new owner has any knowledge of the No Exposure Exclusion from permitting.) My guess is that they didn't read the documents very closely, and just reacted without that information. ..........................One perspective might be that if they're not really paying attention to what's required of them, maybe they need on-site help from DWQ to understand what no exposure is. If you will send me the NCGNE number, I'll check our paper files to see if we have anything going with these folks. Nothing similar has crossed my desk, afaik. Have a great weekend, Ken Ken Pickle Environmental Engineer NCDENR I DWQ I Stormwater Permitting Unit 1617 Mail Service Center, Raleigh, NC 27699-1617 512 N. Salisbury St, Raleigh, NC 27604 Phone: (919) 807-6376 3 Fax: (919) 807-6494 Email: ken.pickleO ncdenr.gov Website: http://portal.ncdenr.org/web/wq/ws/su ** Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third parties unless the content is exempt by statute or other regulations-** 4 rOR AGENCY USE ONLY A • Date Received �, Di�rision of Water Quality 1 Surface LYater Protection Year Month pay �e NCDENRNational Pollutant Discharge Elimination System Cen'ificateofCoverage r ,� k.W q rz axEv NO EXPOSURE CERTIFICATION for Exclusion N.C.Dept ofENR NCGNE0000 APR 17 2013 NO EXPOSURE CERTIFICATION Winston-Salem Re zonal Office National Pollutant Discharge Elimination System application for exclusion from a Stormwater erm "based on NO EXPOSURE: Submission of this No Exposure Certification constitutes notification that your facility does not require a permit for storm water discharges associated with industrial activity in the State of North Carolina because it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means all industrial materials and activities are protected by a storm resistant shelter(with some exceptions) to prevent exposure to rain, snow, snowmelt, and/or runoff. For permitted facilities in North Carolina, DWQ must approve your application for No Exposure Certification before this exclusion is effective. Until you are issued a No Exposure Certification and your NPDES permit is rescinded, your facility must continue to abide by the terms and conditions of the current permit. 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 with locked or non-operational taps or valves;adequately maintained vehicles used in material handling;and final products, other than products that would be mobilized in stormwater discharges(e.g., rock salt). A No Exposure Certification must be provided for each �acilr'ty gcialifying 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, you certify that a condition of no exposure exists at this facility or site and are obligated to comply with the terms and conditions of 40 CFR 122.26(g). You are required to self re-certify your No Exposure Exclusion annualiy. For questions, please contact the DWO Regional Office for your area. (See page 6) (Please print or type) 1) Mailing address of owner/operator(address to which all certification correspondence will be mailed): Name JELD-WEN, inc., Contact Michael Hiatt Street Address 407 Harbor Isles Blvd City Klamath Falls State OR ZIP Code 97601 Telephone No. 541) 883-3373 Fax: 541 885-7400 Email michaelhi@jeld-wen�.com �`] I� APR 1 2013 WA7R� TY SWU-NE-12Aug2410 &arch NCGNE0000 No Exposure Certification 2) Location of facility producing discharge: Facility Name IELD-WEN, Composites.- North Wilkesboro Facility Contact Tom Brown Facility Street Address 205 Lanes Drive City North Wilkesboro State NC ZIP Code 28659 County Wilkes Telephone No. (336) 838-0292 Fax: Email tombr@jeld-wen.com 3) Physical location information: Please provide a narrative description of how to get to the facility (use street names, state road numbers, and distance and direction from a roadway intersection). Head North on N Carolina 268 E/Elkin HWY,Turn Right onto Woodside Dr, Turn Right onto River Liberty Grove Church Road,Lake]st Right onto Lanes Drive,Facility�dll be on the left. (A copy of a map with the facility clearly located on it should be included with the certification application.) 4) Is the facility located on Native American Lands? ❑ Yes ] No S) Is this a Federal facility? ❑ Yes p No 6) Latitude 36 11' 24.00" N Longitude 81 05' 14.09" W (deg., min., seconds) 7) This NPDES No Exposure Exclusion application applies to which of the following: ❑ New or Proposed Facility Dale operation is to begin 0 Existing Date operation began KI Renewal of existing No Exposure Certification Certification No.: NCGNE 0372 8) Was this facility or site ever covered under an NPDES Slormwater Permit? ❑ Yes 1 No If yes, what is the NPDES Permit Number? 9) Standard Industrial Classification: Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial activity at this facility SIC Code: 3 0 8 9 10) Provide a brief description of the types of industrial activities and products produced at this facility: Facility manufactures fiberglass composite doo'r'faci &sg .;Facings are molded from prefab material. 11) Does this facility have any Non-Discharge permits (ex: recycle permits)? jt7 No ❑ Yes If yes, list the permit numbers for all current Non-Discharge permits for this facility: Page 2of7 SW U-NE-12Aug2010 NCGNE0000 No Exposure Certification = " ` Exposure Checklists(12. - 14.) 12) Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future? (Please check either "Yes" or "No.") If you answer "Yes"to any of these items, you are not eligible for the no exposure exclusion. a. Using, storing, or cleaning industrial machinery or equipment, and areas where ❑ Yes k7 No residuals from using, storing or cleaning industrial machinery'or equipment remain and are exposed to stormwater b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes :p No c. Materials or products from past industrial activity ❑ Yes k] No d. Material handling equipment (except adequately maintained vehicles) ❑ Yes :p No e. Materials or products during loading/unloading or transporting activities ❑ Yes ® No f. Materials or products stored outdoors (except final products intended for outside ❑ Yes M No use [e.g., new cars]where exposure to stormwater does not result in the discharge of pollutants) = << g. Materials contained in open, deteriorated or leaking storage dFOms, barrels, tanks, ❑ Yes :0 No and similar containers f h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes q No the discharger i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes 50 No j. Application or disposal of process wastewater (unless otherwise permitted) 0 Yes ® No k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes p No otherwise regulated (i.e., under an air quality control permit) and evident in the stormwater outflow I. Empty containers that previously contained materials that are not properly stored ❑ Yes ® No (i.e., not closed and stored upside down to prevent precipitation accumulation) m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ❑ Yes R) No stored outside, has the facility had any releases in the past three (3) years? 13) Above Ground Storage Tanks(ASTs): If you answer',"No" to any of the following items, you are not eligible for the no exposure exclusion._ 9 <; :_, •: S- a. Are exterior ASTs and piping free of rust, damaged or weathered coating, pits, or 50 Yes ❑ No ❑ NIA deterioration, or evidence of leaks? b. Is secondary containment provided for all exterior ASTs? If so, is it free of any 91 Yes ❑ No © N/A cracks, holes, or evidence of leaks, and are drain valves maintained locked shut? Page 3 of 7 S W U-NE-12Aug2010 NCGNE0000 No Exposure Certification 14) Secondary Containment: If you answer "No' to any of the following items, you are not eligible for the no exposure exclusion. a. Is secondary containment provided for all single above ground storage II Yes ❑ No ❑ NIA containers (including drums, barrels, etc.) with a capacity of more than 660- gallons? b. Is secondary containment provided for above ground,storage'containers stored ® Yes ❑ No ❑ NIA in close proximity to each other with a combined capacity of more than 1,320- gallons? c. Is secondary containment provided for Title III Section 313 Superfund ❑ Yes ❑ No ® NIA Amendments and Reauthorization Act (SARA) water priority chemicals'? d. Is secondary containment provided for hazardous substances`" designated in 40 ❑ Yes ❑ No II NIA CFR §116? e. Are release valves on all secondary containment structures locked? [] Yes ❑ No p NIA 15) Hazardous Waste: a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes 50 No b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes ® No generated per month) of hazardous waste? c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑ Yes ® No generated per month) of hazardous waste? If you answered yes to questions b. or c., please provide the following information: Type(s) of waste:How is is material stored: Where is material stored: How many disposal shipments per year: Name of transport/disposal vendor: Vendor address: Footnotes to Questions 14) c. & d. "Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require secondary containment. However, some exceptions may be made for de minimis amounts of certain substances, and/or other qualifiers, as described in the exemptions from reporting requirements of Title III SARA 313 in 40 CFR §372.38. '"Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require secondary containment. However, some exceptions may be made for amounts less than the Reportable Quantities of the hazardous substances listed in 40 CFR §1 17.3. k Page 4 of 7 SWU-NE-1 Mu92010 NCGNE0000 No Exposure Certification 16) Other information: If you answer "Yes" to any of the following items,you might not be eligible for the no exposure exclusion. A more in-depth evaluation of the site circumstances may be required. a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? ❑ Yes ® No b. Does your facility Have coal piles on site? © Yes 0 No c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes 5a No sawdust, etc.? d. Does your facility have air emissions associated with its industrial activity(e.g., 50 Yes ❑ No degreasing operations, plating, painting and metal finishing)? If so, describe the industrial activity: Skin Molding Process e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? ® Yes ❑ No ❑ NIA Please specify: Perujit #10247ROO f. Please list any other environmental program permits (federal, state, etc.) not specified earlier in this application (such as Hazardous Waste Permits, etc.): Permit: Program: Permit: Program: Permit: Program: Permit: Program: Permit: Program: Permit: Program: Permit: Program: Page 5 of 7 SW U-NE-12Aug2010 NCGNE0000 No Exposure Certification 17) Certification: 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 stormwater permitting. I certify under penalty of law that there are no discharges of stormwater 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 annually self re-certify No Exposure and, if requested, submit the re-certification to DWQ or 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 North Carolina Division of Water Quality, 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. In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under an NPDES permit prior to any point source discharge of stormwater 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. I certify that I am familiar with the information contained in this'application and that to the best of my knowledge and belief such information is true,complete, and accurate. Printed Name of Person Signing: Tom Brown Title:-General Manager (Signature of Applicant) (Date Signed) Please note: This application for the No Exposure Exclusion is subject to approval by the NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for compliance with no exposure conditions prior to that approval. The Regional Office may also inspect your facility at any time in the future for compliance with the No Exposure Exclusion. North Carolina General Statute 143-215.6 B(i) provides that: Any person who knowingly makes any false statement,representation,or certification in any application,record,report,plan,or other document filed or required to be maintained under this Article or a rule implementing this Article;or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Article;or who falsifies, tampers with,or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the (Environmental Management]Commission implementing this Article shall be.guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars($10,000). There is currently no fee for a No Exposure Exclusion. Page 6 of 7 SWU-NE-12Aug2010 NCGNE0000 No Exposure Certification Final Checklist This application should include the following items: ® This completed application and all supporting documentation. J7 A map with the location of the facility clearly marked. 0 If the site currently has an NPDES Stormwater Permit;.be sure to indicate the permit number in Question 8. Mail the entire package to: Stormwater Permitting Unit Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Note The submission of this document does not guarantee the issuance of a No Exposure Exclusion. For questions,please contact the DWQ Regional Office for your area. DWQ Regional Office Contact Information: 1-r"J win tan Sale ' Asheville Office ...... (828) 296-4500 Fayetteville Office ... (910) 433-3300 f+ �_ 1 .\! gh _ Mooresville Office ... 704 663-1699 Raleigh Office ........ (919) 791-4200 f` -r *� � r s u� , vorgsi Washington Office ...(252) 946-6481 ; _ .,'• �, Wilmington Office ... (910) 796-7215 Winston-Salem ...... (336) 771-5000 `F tt nl[e, Central Office .........(919) 807-6300 �kWil' nglon �=7Ci Page 7 of 7 SWU-NE-12Aug2010 � r -r ' af' r:s4 i •� Y••v �f - o � �..!�71'�f X + 'ram tw§ tis - '♦ ,z� �"'"_*T�. - i �r��i.."r. '7rrrr°'i£` r �„w, t°. .. �i t"`Y`� � •�.����. V^`,.ct. �������','1 �', 3y���n��4y��: >�t.. � �T�tl�i4..,.j"���� �,rye' J'�"`k t• ~^��• Y �4 R r,G _ �7~ r.t o •��_ 4�.ti, :.1.� .., *KfY." m :'rM" rr,., net _tiy` r .� reE° R. .r'' ti" �u a `�„ „s,•*, ""y,r�;w�.?''*e .F :K°*� :,• 'w.1:!.",�b.:+°r".,t. +:k. _T u= "'.rs'• •47 ''�" 'M ° '+ '`,`' ' h�,e}•z'7t ,§ .a.. y :3�• - ... w 5.. ��r �y�v � v�• ���! l .,�.;" y. � S ��, r yam• �, N �•+'� �� -,'�.r S,X.. - � �,�.��a �.r � `• >V i��." w 7+r`• •�ji i is""`, a� t,t4,,,. r � � 'tom C�7A ��7, �•� '•�,���y�y �;� �yti` *:.,• K.r<};,..�i. �w.s'.� i,,-}' •.•�.. '• ��. �•t u., �� �•t��' �`i;'i �: t ,� 1 r - .�� a �„�-w.ys .� ;i-Sf rr 1ti� :at•',.may, .s�-+,.r.•'�'.a t _• s _` .'�.�., •r �. 11�N '+ .. t¢-• �7,r• ��. Yi� t�-�„ 15..�t- � r - $. 1 L ri :u l `: .`,'•+�'' w '?��'�rt�"'t .7 ��� � �•+�Y� 'ki' �7 },�M 4��J t,. - 1�, '•r`��h � ti�� 'Sw 1•^s�,y �,.-..a ��.:�••ti ^q., f�C"'tl"4i`��� trz;e,YM J",�,��,F, sif ,����.� �n��7•�'� k'; 4 I Y. ��.� �.S M„Ry ,"; i• ..,. u,�.^J5"! t .+Wi`�7 �<t' 'X��i a1.�r �`.. r 1 'rs`r.}X; '� 'tE ,. ,�; y rx tr g ^r�" � } L�w •. .•� ,Y�F�• .y �i[.7. A 5r ti k ' 115E t < 4 ` Ellr J�F�r' `[•����T �` - •� S� \ �P �I SL, ti.. K+.�`. w 1.7-r3 X, 17 jam•a �F k' � r�i` ? ..e�'t i � '� y� y ,X•JYJ ��t � µ �• , ` 5+•'�f,F„•afx:T R�i ?r It fRt i,� �., q y ��S�nppf 3r {� wr\ :wk, �r: :rt.♦ r� ��" n[ i•irk„1fd u� �� _ .,��t'*''�. :'� o„af't�r.ias sS+' V.1 r��f��.i� = 1 f5Y h.§r,""tr. 45z , ; / Ot}.'t. "y y •xt ,w�,w�� 'C'''r''$+d i§, ;$ ks�,..+ s *[ . i. � � � �=,�' fit•��S '�,'� 14.�? ryt�'S t'"�. §` fir• '�, �.�,'•it: a i�.,Y. ��1• .y ��•��r....��,y,�.,� ,. °', '^�y4 r ,9: tf""€ `.7,. �'r r �. �. 1 �f..[.� S r ''�' ?�• "r` �3 `�vr a � ,�t'. �w�Y•,L.T tR -.�J .a �i•_y ti f;r�r1`` .�t +�Ta.�1,'r� ��'.�..`�'ci't 4 �-:5:�i`4;.0•�r3 � '�k� `k'�'FF�.�- i�iy*„Y r�}•rry't�'�r ."+,��fr`��i,y�,�,ry �M^`+t.�` u� �i r� �•.��y�� �A�,�:�,�,,� ��i�.'.�''�}1Y�`�� 'r'i J.�,F�w �.,�� d� �� � - ;ry • u. k'�'^�, cs, y f,,'�'+ �.,- �:~,+- y` io"� ; r.1 yam.}�6�v�a+f l-���''�'.S�i�k-'1 � 3•},'��ctta�F u�il°�j � ��;,*.�,.�• ,}• r„ ,�°�� `,w- ,�: w•. t.aµ�;Y; ,*, ��H yy'r"��5 r7s•�l"' } i �yc, j 5 1..�3,'f.�1g*�..�. `7' F'� -. (a�rt �,. LZ� -,�'" .� 4' n'�;.�^w,i+:' �'?sy�i`�1�T3 tl�. ifT '�F�'T"��' �F..� k%r` .•r, ,�,?r 1 S}`i�� :� .e' r ,'� i w r.i��in�f::,'�r d�a t �� yf���'�"':.•' �la I 1 "I�tr � �fG�t'Y,.w+' ��,��� �� r A 1 ,�,. yy [r rlgq!^ d„ x ,..• .A •�"'bs, j� t tty • 7'. ?�f�.F��r..F .1•}.+n, ti� e�at:..•.�s.:at�'. z ,�.�:�.�+.'�2'c'i:�� .M11�'i\�tl :�.. c ':} .��1�t .�. 4.h Y•. (r NI A 7�F Michael F.Easley,Governor `O�� 9QG William G.Ross Jr.,Secretary North Carolina Department of Environment and Natural Resources Coleen H,Sullins,Director p ^� Division of Water Quality August 24, 2007 Mr. Ernie Hoyle JELD-WEN, Inc. 407 Harbor Isles Blvd. Klamath Falls, OR 97601 Subject: No Exposure Certification] NCGNE0372 JELD-WEN Millwork Distribution 205 Lanes Drive, N. Wilkesboro, NC WilkesCounty Dear Mr. Hoyle: The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater"Permitting form, which we received on April 4, 2007. 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 (August 31, 2012). 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, P for Coleen H. Sullins cc:. Winston-Salem Regional Office-George Smith !Central Files -wlattachments Stormwater Permitting Unit Files ; 6ENR. N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 (919)733-7015 Customer Service 1-877-623-6748 NJ �r>. _ Af1 m Ir ____\j�j v 1Co J,� N .\ t J?, 1- j 4 7, 17 � 1pI . ,o VJ -6 � , W e j-: b oo n ��, . "o, j J 11,C ktKurnyc " 1 �, o37� I; Z ` %V4 N U" 7C Ti �7X Fi ",, 0 0 5 a y .tomt Z, 141 ,J. , . -a5ff )Jeld-Wen-Millwork Q sJV peel 2 Distribution /tog 1WT J 4 `i_, NMA � j N V '" nr�N 01 • t -11J f -PI U )of K m > A- I , , . j re N"U� ice'I •t nv ,NN v 'Yt �yv Copyright(C)1998,Mapterh,Inc. [Fwd: Fwd: next group of no-exposures]] Subject: [Fwd: [Fwd: next group of no-exposures]] From: George Smith <George.Smith@ncmai1.net> Date: Tue, 17 Jul 2007 08:01:22 -0400 To: Sarah Young <Sarah.Young@ncmail.net> Sarah, I forgot about this no exposure. Sorry for the late response: Recommend the issuance of this no exposure. JELD-WEN located in North Wilkesboro George -------- Original Message -------- Subjectmext group of no-exposures Date:Sun, 03 Jun 2007 12:16:47 -0400 From:Sarah Young <sarah.youngnncmai1.net> To:Steve Tedder <Steve.Tedder a ncmail.net>, Corey Basinger <Core}.Basinger@ncmaii.net> Here's the next set of no exposures for your region. Please let me know within 30 days if we can issue these. If you need more time just let me know. Thanks, Sarah Steve Tedder Steve.Tedder@ncmail .net NC DENR Division of Water Quality 585 Waughtown Street Winston-Salem, NC 27107 (336)-771-4950 Fax (336) 771-4630 George Smith NC DENR Winston-Salem Regional Office Division of Water Quality, Water Quality Section 585 Waughtown Street Winston-Salem, NC 27107 Voice: (336) 771-4968 FAX: (336) 771-4630 George Smith <George.Smith(abNCmai1.net> wSRO NC DENR 1 of 2 8/17/2007 1:48 PM . � a3 Form Approved United States Environmental Protection Agency OMB Na 2040-0211 NPDES A 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 B under EPA's Storm Water Muftl-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,snowmen,and/or runoff. Industrial materials or activities include,but are not limited to,material handling equipment or activities, industrial machinery,raw materials, intermediate products,by-products,final products,or waste products. Material handling activities include the storage, loading and unloading,transportation,or conveyance of any raw material,Intermediate product,final product or waste product. A Storm resistant shelter is not required for the following Industrial materials and activities: - drums,barrels,tanks,and similar containers that are tightly sealed,provided those containers are not deteriorated and do not leak. "Sealed" means banded or otherwise secured and without operational taps or valves; - adequately maintained vehicles used in material handling;and - final products,other than products that would be mobilized In storm water discharges(e.g.,rock salt). A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In addition,the exclusion from NPDES permitting is available on a facility-wide basis only,not for individual outfalls. If any Industrial acNvitles 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 sfte, and Is obligated to comply with the terms and conditions of 40 CFR 122.26(g). ALL INFORMATION MUST BE PROVIDE]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 dnfon7rnsstlon�+�T r T�+ �n���T p ,. Name i�1�,1-�LI--1 1 11 uu�E I n� IUt 1�1��lYccvl1-4i`4 I I 1 1 2.Phone: 1514j J8,93�3i31713i 3. Mailing Address: a.SVeety,E41 1 �1�rl�ulri 111 1�"t I VjC_ l I III_ --�L_ 1n1 1_ b.Clty. �.11�a tI1�I IF�l1 Il SI I 1 t I i__1 I I j c.State: Q& d.Zip Code: 3 /6 Vl 1.1-1 1 L__1 IL Faclifty/Slte Locatioon�~InnfforTmation }- {- 1.Facility Name: N t,•�,(�p �r��1��-1IpMi,1�11 1�fr1 i�li �-1r11 t ut -11101 2.a Street Address: 121"151r,,�T,_llnlgSI^lpr1 -- L l l 1 I l 1 1 1 1 1 11 1 t 11 l i b.City. NPIKlt} [ lyyl111tk�-1S1�Qrp I I__f I I I c.County: tyy1il11k{ei t q=-- d.Slate: ka e.Zp Code: 20 i-f I I 1 )T - ` 3.Is the facility located on Indian Lands? Yes❑ No © r . 1 1 4.Is this a Federal facility? ' � Yes❑ No © o I 5.a Latitude: 3161 (�L1� C��u l b.Longitude: j0,51 L1}2j D N 1 C Q 6.a.Was the facility or site previously covered under an NPDES storm water permit? ws ❑ No Z w Q a 1f yes,enter NPDES permit number. 7.SIC/Activity Codes: Primary: 21413111 Secondary(it applicable): S 0 a 111 8.Total size of site associated with industrial activity: 5 ...,.,1„ 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 Bering whether storm water discharges from your site are likely to have an adverse Impact on water quaflty,in which case you could be required to obtain permit coverage. Less than one acre ❑ One to five saes ❑ More than five acres ❑ EPA Form 3610-11 (10-99) Page 1 of 4 1 � a 1- NPIDESFORM ,r, NO EXPOSURE CERTIFICATION for Exclusion from Form Approved FORM �E� OMB No.2040-0211 3510-11 NPDES Storm Water Permitting C. Exposure Checidlst 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 0 3. Materials or products from past industrial activity 4. Material handling equipment(except adequately maintained vehicles) L] 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 Q 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.,dumpstersD 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 rive years to the NPDES permitting authority and,if requested,to the operator of the local municipal separate storm sewer system(MS4)into which the facility discharges(where applicable). I understand that I must allow the NPDES permitting authority,or MS4 operator where the discharge is into the local MS4,to perform inspections to confirm the condition of no exposure and to make such inspection reports publicly available upon request. I understand that I must obtain coverage under an NPDES permit prior to any point source discharge of storm water from the facility. Additionally,I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information,the information submitted is to the best of my knowledge and belief true,accurate and complete. I am aware that there are significant penalties for submitting false information,Including the possibility of fine and imprisonment for knowing violations. Print Name: jEjry r p n Print Title: Lq' ml�grl _i_anialg€eir, 1 Signature: Date: ��IQ�t71 EPA Form 3510-11 (10-99) Page 2 of 4