NCGNE0422_COMPLETE FILE - HISTORICAL_20070625

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

1
• i
F WATF RECEIVED Michael 1".Easley,Governor
R pG N.C.Deot of tcNR William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
JUN 2 9 2007
Coleen H.Sullins,Director
0 � Wineton•5alem Division of Water Quality
Reglonal Office
June 25, 2007
Ms. Debbie Nix
Unity Holdings, LLC
550 Sheldon Mill Road j
Auburn, AL 36830
Subject: No Exposure Certification NCGNE0422
Mesa Industries, Inc.
1408 Unity Street, Thomasville, NC
Davidson County
Dear Ms. Nix:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on June 22, 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 (June 30, 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 [phone], ext.
502, or at [e-mail].
Sincerely,
ORIGINAL SIGNED BY
KEN PICKLE
for Coleen H. Sullins
cc: Winston-Salem Regional Office-Jenifer Carter Central Files—wlattachments.
Stormwater Permitting Unit Files
AAA
NCO ra
N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1 6 1 7 [phone] Customer Service
1-877-623-6748

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Compliance Inspection Report
Permit: NCGNE0422 Effective: 06/25/07 Expiration: Owner: Unity Holdings LLC
SOC: Effective: Expiration: Facility: Mesa Industries, Inc.
County: Davidson 1408 Unity St
Region: Winston-Salem
Thomasville NC 27360
Contact Person: Debbie Nix Title: Phone: [phone]
Directions to Facility:
NC-109 South L.onto Unity Street in Thomasville 2.5 miles on the left.
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
On-site representative Barry Elliott Phone: [phone]
Related Permits:
Inspection Date: 02/16/2012 Entry Time: 10:45 AM Exit Time: 10:55 AM
Primary Inspector: Jenifer Carter Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ■ Compliant fl Not Compliant
Question Areas:
0 Miscellaneous Questions 0 Misc
(See attachment summary)
Page: 1

Permit: NCGNE0422 Owner-Facility: Unity Holdings LLC
Inspection Date: 02JI612012 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Misc Yes No NA NE
Is the facility compliant? ■ 0 n n
Comment:
Page: 2

06-22-' 07 M 15 FROM-NCDENR-WSRO 336-771-4630 T-078 P002/008 F-185
F'(1H AGIiVI'Y l7tili U\LY
Division of Writer Quality / Surface Water Protection on+
r Ye;tr MruFs ila%,
NCDENRNational Pollutant Discharge Elimination Systf;m CCtII6CcdCOFCciti�cra§
N C C; T`I E�.1 NO EXPOSURE C1 KTlf:i.CATION for Exclusion -
E.vH.r<ncvr wnu r�aua.ti Hc:Kvrcr9
NCGNE0000
-NO EXPOSURE CERTIFICATION
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit
based on NO EXPOSURE: C3
S
Submission of this No Exposure Certification constitrites notice that your facility does not require r {
authorization for its stormwater discharges associated with industrial activity in the State of North p n
Carolina because it qualifies fora no exposure exclusion. A condition of no exposure at an industri �v
facility means all industrial materials and activities are protected by a storm resistant shelter(with
exceptions) to prevent exposure to rain, snow, snowrnelt, and/or runoff. �l
Industrial materials or activities include, but are not limited to_ material handling equipment or activ a
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 resistan
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 reapply for-the No Exposure Exclusion once every five (5) years.
For questions,please contact the DWQ Regional Office for your area. (See page 5)
(Please print or type)
Mailing address of ownerloperato (acid ess to which all certification correspondence will be mailed):
Name - +(
Street Address
City Stale ZlP Code
Telephone No. Ml - Fax: g �
2) Location of facility producing discharge:
Facility Name Ae) �l•ln{ i �f` a Yi�'- _
Facility Contact
Street Address
City 1jf % ,� State ZIP Coders
County 1 frM 6. C)n
l elephone No. ' , ,7— ..5 Fax: •, ! �> `:
Page 1 of 5
SWU-NG-060607 Last revised 0610610Y
I

06-22-' 07 09:15 FROM-14GDEHR-WSRO 336-771-1630 T-078 P003/008 F-185
NCGNE0000 No Exposure Certification
3) Physical location information-
Please provide a narrative description of how to gel to•I�e facility(use street names, stale road numbers, and
distance and direction from a roadway ay intersection). llv L" ^ 15L) .t.� )" d
to I � orA,-15V, ile „�.,5 1'YJ17e Y 1'`u
(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? LI Yes LXKO
5) Is this a Federal facility? t 1 Yes txivlo
6) Latitude o � l�(O, Longitude (deg,(deg, min, sec)
7) This NPDES Permit Application applies to which of the following:
0 flew or Proposed Facility Date operation is to begin
lil Existing Date operation began /12,
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes 1yt,,N6
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 Gode:2- 1) . t5 7
10) Provide a brief description of the types of industrial activities and products produced at this facility:
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
Woo
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility.-
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.") It 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 rho
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 f-4�o
c. Materials or products from past industrial activity U Yes UIN6
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes ZINIO
e. Materials or products during loadinglunloading or transporting activities L_1 Yes I:W
f. Materials or products stored Outdoors (except final products intended for outside U Yes D-N-0
use[e.g., new cars]where exposure to stormwater does not result in the discharge
of pollutants)
Page 2 of 5
SWU-NC-060607 Lasl revised 06/06/07

06-22` 07 09: 15 FROM-NGDEM-WSRO 336-771-4630 T-078 P004/008 F-185
1
NCGNE0000 No Exposure Certification
g. Materiats contained in open, deteriorated or leaking storage drums, barrels, tanks, ri Yes ❑ No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by a Yes rj"No L
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g.,dumpsters]) 0 Yes clot ld
j.Application or disposal of process wastewater(unless otherwise permitted) I-t Yes C 60
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not Ct Yes Lr6o
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 0 Yes C/ 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 U Yes
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 or piping free of rust, damaged or weathered coating, pits, or 2/yes U No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTO If so, is it free of any ❑ Yes ❑ No Af fi
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
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 single above ground storage containers ❑ Yes U No
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. is secondary containment provided for above ground storage containers stored ❑ Yes El No N%
in close proximity to each other with a combined capac'riy of more than 1,320-
gallons?
c. Are release valves on all secondary containment structures locked? I-) Yes ❑ No
Page 3 of 5
SWU-NE-060607 t_ast revised 06/06/07

06-22-' 07 09: 16 FR0M-NCDENR-WSR0 336-771-4630 T-078 P005/008 F-185
NCGNE0Q00 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes FAO
b. is this facility a Small Quantity Generator(less than 1000 kg. ol:hazardous waste ❑ Yes I No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste 0 Yes [3-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 I disposal vendor:
Vendor address:
16) Certification:
I certify under penally of law that 1 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 contam{nated 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 gypry five (5)Vears to the North Carolina
Division of Water Quality 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 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 iaw 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, yy,,
( Prin# me of Person Signing: I,A
Title: dJ
C�
(Signature of Applicant) (Date Signer!)
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.
Page 4 of 5
SWU-NE-060607 last revised 06/06/07

06-22-' 07 09, 16 FROM-NMENR-WSPO 336-771-4630 T-078 P006/009 F-185
NCGNE0000 No Exposure Certification
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 mainlained under lhis 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 mainlained under this Article or rules of the
11=nvironmental Management]Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars(510,000).
There is currently no fee fora No Exposure Exclusion.
Final Checklist
This application should include the following items:
! This completed application and all supporting documentation.
t'" A map with the location of the facility clearly marked.
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:
Asheville Office ...... [phone] 4 1r' i ' ` ri �\'
Fayetteville Office ... [phone] sh
Mooresville Office ... [phone]
Raleigh Office ........ [phone] r ]
Washington Office ...[phone] MPbfs�tilt � �
Wilmington Office ... [phone]
Winston-Salem ...... [phone] — �� arr �ritle
Central Office .........[phone]
J�WiI�Srrgron
Page 5 of.5
SVVU-NE-060607 Last revi ed 06/06107

06-22-' 07 09:16 FRON-NCDEHR-WSPO
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QipyTight(C)1998,Maptech,Inc.

T
WA Michael F.Easley,Governor
`O�O RpG William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
yColeen H.Sullins,Director
.� Division of Water Quality
June 25, 2007
Ms. Debbie Nix
Unity Holdings, LLC
550 Sheldon Mill Road
Auburn, AL 36830
Subject: No Exposure Certification NCGNE0422
Mesa Industries, Inc.
1408 Unity Street, Thomasville, NC'
Davidson County
Dear Ms. Nix:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
Stormwater Permitting form, which we received on June 22, 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 (June 30, 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 [e-mail].
Sincerely,
�_�P_,te�
for Coleen H. Sullins
cc: Winston-Salem Regional Office-Jenifer Carter Central Files—w/attachments-,
Stormwater Permitting Unit Files
NCDlrNR
N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 [phone] Customer Service
1-877-623-6748

Jan.,22. 29,7 .11 :2VA P SA 1NCUSTRIE3 336 7?1-4638 -�No• 2$81,2/3 � 7-185
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1 Divisions of Water Quality i Surface Water Protection Yew "r .Ih Orw �
NCDENR National Pollutant lsscharge Ehlinfltion System ,�orc�.t�CIGINIE
NO EXPOSURE CERTIFICATION for Exclusion O
E.,,.,,ceiran a�Nautti Reec�neea
NCGNE0000
NO EXPOSURE CERTIFICATION #
i
National pollutant Discharge Elimination System application for exclusion from a Stormwater Permit i
based on NO EXPOSURE:
,Submission of this No Exposure Certification constitutes notice that your facility does not require permit
authorization for its ston"watet discharges associated with industrial activity In the State of North 4
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/orrunoff.
Industrial materials or activities Include, but are not limited to: material handling equipment oractivities,
Industrial machinery,raw materials,Intermediate products,by-products, final products, or waste
products. Material handling activities Includo 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 dateriorated 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 facillt qualifying for the no exposure exclusion.
In addition, the exclusion from NPDES permitting is available on a facfllty-wlde 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 922.28(g).
You are fi3gUlf2d to reapgly for the NO Exposure Exclusion once.ewer�C.five 5 years.
For questions,please contact the DWO Regional Office for your area.(See page S)
(Please print or type)
+ 7) Mailing address of ownerioperato add ess to which all certification corres ondenco will be malled :
Name + �
Street Address
City A State ZIP Code
Telephone No. aD Fax: -
2) Location of facility producing discharger
P�A 'y1tU S i Q 1
Facility Name
Facility Contact i
Street Address 1l fir'
City State ZIP Code 7•,Y o 4'1
County !r r'G5 L,
Telephone No. _ Fax 3 ! - la"
Page 1 of 5
SWU•NE-060607 Last revised W06107

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I
NCGNEOOOO No Exposure Certification i
3) Physical location information:
Please provide a narrative description of how to get to It�e facility(use street names, state road numbers, and
distance and direction From a roadway intersection). PV __• '1 ,'�c SI f f
� S
1 e 11 LhmeyiVt Ile r` e !:11 Me -
(A copy of a map with the acuity clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands?0 Yes M<O i
6) Is this a Federal facility? O Yes P-40
6) Latitude fi a � d WI i'st.�r� Longitude, . . (deg, min, sec)
7) This NPDES Permit Application applies to which of the following:
p ew or Proposed Facility Date operation is to begin
xisting Date operation began_
8) was this facility or site ever covered under an NPDES Stormwater Permit? p Yes t�,Atfi
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: d
10) Provide a brief desc iption of the types of Industrial activities and products produced at this facility:
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
p Yes
Ir yes,list the permit numbers for all current Non-Discharge permits for this racility;
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 6'1110
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 spillslleaks 0 Yes Ito
c. Materials or products from past industrial activity 13 Yes
d. Material handling equipment (except adequately maintained vehicles) p Yes ZIKO
{
e. Materials or products during loadinglunloading or transporting activities G Yes 044`8'
f. Materials or products stored outdoors(except final products intended for outside 0 Yes 1344-01,
use[e.g., new cars]where exposure to stormwater does not result in the discharge
of pollutants)
I
Page 2 of 5
5wU N -dfi()fi07 Lasl revised ofJD6{07

:lur., 22. 2007 11 : 29A
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V 415 wji$v 336-771-4630 T-� O, 248 U$ O,L 4-185
NCGNEOOOO No Exposure Certification
i
g. Materials contained in open,deteriorated or leaking storage drums,barrels, lank$, ❑ Yes No
and similar containers {
h. Materials or products handled/stored on roads or railways owned or maintained by 0 Yes CrfV0 -
the discharger
i.Waste material (except waste in covered, non-leaking containers[e.g.,dumpsters]) 0 Yes D t 6
j.Application or disposal of process wastewater(unless otherwise permitted) ❑Yes 1311KQ
i
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not 0 Yes 340
otherwise regulated (i.e,,under an air quality control permit)and evident in the
stormwater outfiam
I. Empty containers that previously contained materials that are not properly stored ❑ Yes CS No
(i.e., not closed and stored upside down to prevent precipitation accumulation) /
m.For any exterior ASTs, as well as drums, barrels, tanks,and similar containers ❑Yes
stored outside, has the facility had any releases in the past three(3)years?
13) Above Ground Storage Tanks (ASTs): If you answer"No"to any of the following items,you are not
eligible for the no exposure exclusion_
a.Are exterior ASTs or piping free of rust,damaged or weathered coating, pits,or M/es 0 No
deterioration,or evidence of leaks?
b. Is secondary containment provided for all exterior AST$? If so, is it free of any Cl Yes ❑ No
cracks,'holes, or evidence of leaks, and are drain valves maintained locked shut?
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 single above ground storage containers ❑Yes ❑ No A)I#
(including drums, barrels,elc.)with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored ❑Yes ❑ No ,
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c, Are release valves on all secondary containment structures locked? ❑Yes U NO
i
.j
. 1
Page 3 of 5
SWU-NE-050507 Last ravFsad 06/06/07

_Iu7. 22. NO 11 : 29AM MESA 1N)NSiR1ES No. 2SS3 �,
m� rru
;to rnuM-NCun—w=u 336-771-1630 T-era r-r,r,5f 0VL r 85
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NCGNEOOOO No Exposure Certification
15) Hazardous Waste: {
a. is this facility a Hazardous Waste Treatmeni, Storage, or Disposal Facility? ❑ Yes 00
b. Is this facility a Small Quantity Generator(less than 1000 kg.of hazardous waste ❑ Yes
generated per month) of hazardous waste?
c. Is this Facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑ Yes '!o
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:
i
Where is material stared: �
How many disposal shipments per year:
Name of transport!disposal vendor: i
Vendor address:
16) 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 penally of law that there are no discharges of stormwater conlaminaled by exposure to industrial activities
or materials from the industrial facility or site identified in this document(except as allowed under40 CFR 122.26(g)(2)).
understand!hat I am obligated to sub Wit no exposure certiflcabon form once every five{5)years to the North Carolina
Division of Water Quality and,if requested,to the operator of the local municipal separate storm sewer system(MS4)into
which the facility discharges(where applicable). I understand twat 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 Foquest.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDE5 permit prior to any point source discharge of stormwater from the facility.Additionally, I corlify under penalty
of law that this document and all attachments were propared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gathered and ovalualed the information submitted. Based
on my inquiry of the person orpor5ons who manage the system, or those porsons directly responsible for gathering the
information, the information submitted is to the best of my knowledge and belief true, accurate and complato- I am aware
that there are significant penalties for submitting false information, including the possibility of tine and imprisonmont for
knowing violations.
I certify that 1 am familiar with the information contained in this application and that to the best of my knowledge and
belief Surh information is true,complete,and accurale.
�I
Print a of Person Signing:_ V"111 le }C
Tile:
14
(Signrjture Of Applicant) (bate Signed)
Please note. This applicatlon for the No Exposure Exclusion Is subject to approval by the
NCOENR Regional Office prior to issuance. The Regional Office may inspect your facility for i
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 Na Exposure Exclusion.
page 4 of 5
SwU-N E-t7808c7 Last revised CWDGI07 j

Jun, 22. 2007 'il : ]OAM MESA INDUSTRIES 33fi-??1-4630 -6�0 °`�lg/0 '�
uu—r-t— cur ru AU rnf V—Kjiuiu waixs
3
NCGNEOOOO No Exposure Certificatlon
North Carolina General Statute 143-215.6 B(I) prov[des that:
i
Any person who knowingly makes any false slalamenl,representation,or certincation in any application,record,repent,plan,or other
i
documeni filed or required to be maintained under this Article or a rule implementing this Article;or wno knowingly makes a farce I
statement of a material fact in a rulamak proceeding of contested ease under this Article;or who faisifes,larnpers with,or knwAngly
renders Inaccurala dny recording or monitoring device or method required to rye operated or maintained under this Article or rules of the
[Environmental Management)Commisslon implementing this Article shall be guilty of a Glass 2 misdemeanor which may Ir%rJude a fine
i
not to exceed len thousand dollars($10,000)-
Thera is currently no fee for a No Exposure Exclusion_ T�
Flnal Ch"Kllst
This application should include the following Items:
0' This completed application arid all supporting documenlation.
i� A map with the location of the facility clearly marked.
i
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 Excluslon.
For questions,please contact the DWQ Regional Office far your area, w M-
DWQ_Regional Office Contact Information:
Asheville Office .. ... [phone] : r� 4(Wiii tPri Sala -, `k t
Fayetteville Office .,, [phone]
Mooresville Office [phone]
...t �,.� ..._ .
Raleigh Office ......., [phone]
Washington Office...[phone]
Wilmington Office ... [phone]
Winston-Salem ...... [phone] \P tt�lo
Central Office ....,,...[phone]
WII ngton
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Page 5 of.
SWU-NE-060607 i,mt revised 0WOW07

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Mesa Industries No Exposure Application
Subject: Mesa Industries No Exposure Application
From: Jenifer Carter <[e-mail]>
Date: Fri, 22 Jun 2007 10:36:23 -0400
To: Sarah Young <[e-mail]>
Hi Sarah,
You will be receiving a faxed application for No Exposure for Mesa Industries, Inc. today. I inspected
them yesterday and feel that they easily qualify for no exposure. They have a small double-hulled tank
(500 gallons) outside for used motor oil with spill materials nearby. There was no evidence of previous
spills.
Their contact, Debra Nix, said they are selling the company and need the certification by June 29th in
order to complete the sale. I spoke with Bradley Bennett this morning and he said y'all could process a
letter quickly. Ms. Nix has been instructed to send the original via snail mail too.
Let me know if you have any questions.
Thanks!
Jenifer Carter
NC DENR Winston-Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston--Salem, NC 27107
Voice: (336) 771-5000
PAX: (336) 771-4630
of 1 6/22/2007 11:35 AM