NCGNE0450_COMPLETE FILE - HISTORICAL_20100702

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE L7 HISTORICAL FILE
0 MONITORING REPORTS
DOC DATE ❑ 30 ) 000 U a
YYYYMMDD

NCENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
RECEIVE"
Governor Director N.C:Dept of EHR Secretary
June 24, 2010 JUL Q 2 2010
Winston-Salem
Regional ofnce
Carrie Kress
Pass & Seymour Inc - Pass & Seymour
50 Boyd Ave
Syracuse, NY 13209
Subject: Rescission of NPDES General Permit
Certificate of Coverage Number NCG030508
Pass& Seymour Inc -Pass & Seymour
Dear Permittee:
On 2/23/2010, the Division of Water Quality received your request to rescind your-coverage under .
Certificate of Coverage Number NCG030508. In accordance with your request, Certificate of Coverage
Number NCG030508 is rescinded effective immediately.
Operating a treatment facility, discharging wastewater or discharging specific types of stormwater to
waters of the State without valid covei�5ge under an NPDES permit will subject the responsible party to a
civil penalty of up to$25,000 per day. It is the intention of DWQ that enforcement proceedings will
occur for persons that have voluntarily relinquished permit coverage when, in fact, continuing permit
coverage was necessary. If, in retrospect, you feel the site still requires permit coverage, you should
notify this office immediately. Furthermore, if in the future you wish to again discharge to the State's
surface waters, you must first apply for and'receive a new NPDES permit.
If the facility is in the process of being sold,-you will be performing a public service if you would inform
the new or prospective owners of their potential need for NPDES permit coverage.
If you have questions about this matter, please contact Brian-Lowther at [phone], or the Water
Quality staff in our Winston-Salem Regional Office at 336-771-5000.
Sincerely,
for Coleen H. Sullins, Director
cc: Winston-Salem Regional Office
Stormwater Permitting Unit
DWQ Central Files - w/attachments
Fran McPherson, DWQ Budget Office
Wetlands and Stormwater Branch One
1617 Mail Service Center,Ralegh,North Carafina 27699-1617 NorthCarolina
Location:512 N.Salisbury St Ralegh,North Carolina 27604
Phone:[phone] FAX:[phone] Customer Service:1-877-623-6748 AQtura1111
Internet:www.wwaterquality.org
An Equal Opportunity 1 AffrmaGva Acton Employer

Pass&Seymour a
0 legrando
4515 Enterprise Drive, N.W.
Concord,NC 28026
Phone o 1 Fax[phone] q
www.passassandseymoeymour.com
February 5, 2010
NCDENR—Division of Water Quality �r
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Permit#NCG0-0508
Dear Division of Water Quality:
This letter is to notify you that Pass & Seymour 1 Legrand has closed its plant located at 6511
Franz Warner Pkwy, Whitsett, NC as of September 30, 2009.
The building was sold to a business named Machine Specialties, Inc. Their President is Rob
Simmons. Their previous address was 1034 Boulder Road, Greensboro, NC.
Please cancel the enclosed invoice for Pass & Seymour/ Legrand for the period of 2010-01-01 to
2010-12-31.
Thank you for your help with this matter.
• Sincerely,
a4J_ _
[�
Carrie Kress
Accounts Payable [�
P 704.795.3226
F 704.795.3264
[e-mail]
�d
6o

F WAIF
Q IQQG Michael F. Easley,Governor
0�
CO
William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
Coleen H.Sullins,Director
Division of Water Quality
4 September 2008
Mr, Ed Williams
Pass& Seymour, Inc.
6511 Franz Warner Parkwav
Whitsett, NC 27377
SUBJECT: Compliance Evaluation Inspection
Pass & Seymour, Inc.
NPDES Permit No. NCG030508& NCGNE0450
Guilford County
Dear Mr, Williams:
A Compliance Evaluation Inspection was performed on the Pass& Seymour, Inc. general stormwater permit(NCG030508
&&.NCGNE0450)on September 4, 2008 by Corey Basinger of the Winston-Salem Regional Office. The inspection
consisted of two parts: an on-site inspection of the facility and an in-office file review. The following are the findings from
the subject inspection.'
I. Permit
The NPDES General Storm'wvater Permit for Pass& Seymour, Inc. became effective on November I, 2007 and expires on
October 31, 2012. The No Exposure Certification for Pass& Seymour, Inc. became effective January 2, 2008 and expires
on January 1, 2013,
II. Records/Reports
All applicable data is collected as per the NPDES Permit and No Exposure Certification requirements.
III. Facility-Site Review
The subject facility meets all the requirements for no exposure certification.
IV. Effluent& Receiving Waters
Pass& Seymour, Inc. discharges stormwater to Little Alamance Creek. There was no discharge on the date of the
inspection.
V. Self-Monitoring Program
The self-monitoring program is consistent with the no exposure certification requirements.
Overall the facility is deemed to be in substantial compliance with No Exposure Certification NCGNE0450. If you should
have any questions or concerns regarding this report,please contact this Office at(336) 771-5000.
Sincerely,
Steve W. Tedder
Water Quality Supervisor
Cc: Guilford County Health Dept.
Central Files, WSRO NofthCarolina
,IA'atura!!y
North Carolina Division of Water Quality 585%Vaughtonm Street Phone[phone] Customer Service
Winston-Salem Regional Office Winston-Salem,NC 27107 Fax [phone] 1-877-623-6748
Internet: wu,.v.ncwaterouality.org
An Equal OpportunitylAftirmative Action Employer—50%Recycled110%Post Consumer Paper

��. Form Approved
OMB No.2040-0057
-� Approval Expires
United States Environmental Protection Agenev. Washington_ D.C._ 20460 8-31-98
Section A: National Data System Coding
Transaction Code NPDES No. Yr/Nlo/Day Inspection Type Inspector FacilityType
N 5 NCG030508 08-09-04 C S 2
NCGNE0450
Facility Evaluation Rating BI QA ..........Reserved...........
5 N N
Section B: Facility Data
Name and Location of Facility Inspected: Entry Time: Permit Effective
Pass&Seymour, Inc. 0850 hrs. Date: Nov. 1, 2007
Located at 6511 Franz Warner Parkway in Guilford County. Jan. 2, 2008
From WSRO,take 1-40 east. Take exit 135 and TR. TL left onto Franz Warner Pkwy.
Facility is on left at 6511 Franz Warner Pkwy. Exit Time: Permit Expiration
0935 hrs. Date: Oct.31, 2012
Jan. 1,2013
Narne(s)of On-Site Represent ative(s): Title(s): Phone No(s)
Mr. Ed Williams EHS [phone]
Name,Address of Responsible Official: Title: EHS
Mr. Ed Williams
Pass& Seymour,Inc. Phone No. Contacted? Yes
6511 Franz Warner Pkwy
336-449-3572
Whitsett,NC 27377
Section C: Areas Evaluated During Inspection(check only those areas evaluated)
X Permit NA Flow Measurement X Operations/Maintenanee NA Sewer Overflow
X Records/Reports X Self-Monitoring Program NA Sludge Handling/Disposal NA Pollution Prevention
X Facility Site Review NA Compliance Schedules NA Pretreatment
X Effluent/Receiving Waters NA Laboratory NA Stormwater
Section D: Summary of Findings/Comments
See attached letter for further details regarding the subject inspection.
Names and Signature(s)of Inspectors: Agency/Office/Telephone: Date:
DWQ/WSRO/[phone]
Signature of Rev' er: Agency/Office: Date:
DWQ I WSRO I(336)771-5000

LN.C.
ECEIVED
�pF W ATEgp Dept.of ENR ichael F.Easley,Governor
Wlliam G.Ross Jr.,Secretary
�,, f, !!08North Carolina Department of Environment and Natural Resources
U 't UUston-Salem Coleen H.Sullins,Director
ional Office Division of Water Quality
January 2, 2008
Bradford Old
Pass & Seymour/Legrand
6511 Franz Warner Parkway
Whitsett, NC 27377
Subject: No Exposure Certification NCGNE0450
Pass & Seymour 1 Legrand
6511 Franz Warner Parkway, Whitsett
Guilford County
Dear Mr. Old:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
— Stormwater-Permitting-form;-which-we-received-on-Sep tember 51-2007: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, and
hereby rescinding your current Certificate of Coverage NCG0030508.
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 (December 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 [e-mail].
Sincerely,
for Coleen H. Sullins
cc: Winston-Salem Regional Office-Corey Basinger Central Files—wlattachments
Stormwater Permitting Unit Files Fran McPherson-Budget Office
NCG030508 Permit file
NCDENR
N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 [phone] Customer Service
1-877-623-6748

y
r ! IV403o5�S
VIA
W FOR AGENCY USE ONLY
Division of Water Quality/Surface Water Protection vcar NieR emd D.
�C`D�NR th
National Pollutant Discharge Elimination System celi®c„eorewcm
RCYRb C.V1OlYM.OP.1".i.n1d NO EXPOSURE CERTIFICATION for Exclusion
Ewrnd..t+r wo RS.w.ti ReSa.e[rs NCGNEODOO
EXPOSURE CERTIFICATION wilto
NO E RE GERTI TI
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit
based on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notice that your facility does not require permit
authorization for its 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(orrunoff.
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 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)
1) Mailing address of ownerloperator address to whiO all certification correspondence will be mailed):
Name Brad Old-Plant Manager
Street Address 6511 Franz Warner Parkway
City Whitsett State NC ZIP Code 27377
Telephone No. [phone] Fax: [phone]
2) Location of facility producing discharge:
Facility Name Pass& Seymour!Legrand
Facility Contact _Ed Williams- Environmental 1 Facilities Manager
Street Address 6511 Franz Warner Parkway
City Whitsett State NC ZIP Code _27377
County Guildford
Telephone No. (3�)44 9-3572 Fax: [phone]
Page 1 of 5
SWU-NE-060607 Last revised 061OW7

NCGNE0000 No Exposure Certification
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). F-ily lo-ted approximately 3 miles off Interstate cones at the Rock creek Dairy
exit see Google ma exit 136. Fadhty is third business located on the left side or road.
(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
5) Is this a Federal facility? ❑Yes ® No
6) Latitude 36N 03' 12,55" Longitude -79W 35'23.9" (deg,thin,sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
91 Existing Date operation began Oct. 1994
8) Was this facility or site ever covered under an NPDES Stormwater Permit? 9 Yes ❑ No
If yes,what is the NPDES Permit Number?NCG030000
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 6 4 3
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Manufactuer f resmdental electrical
nror_egRps inrlltrlQ" inr etinn molding. metal stamping and assembly.
11) Does this facility have any Non-Discharge permits(ex: recycle permits)?
91 No
❑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.") 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 91 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 ® No
c. Materials or products from past industrial activity ❑Yes El No
d. Material handling equipment(except adequately maintained vehicles) ❑ Yes 21 No
e. Materials or products during loadinglun loading or transporting activities ❑Yes El No
f. Materials or products stored outdoors(except final products intended for outside ❑Yes ZI No
use[e.g.,new cars]where exposure to stormwater does not result in the discharge
of pollutants)
Page 2of5
SWU-NE-060607 Last revised 06106107

, I
NCGNE0000 No Exposure Certification
g. Materials contained in open,deteriorated or leaking storage drums,barrels,tanks, ❑Yes M No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes 91 No
the discharger
i.Waste material(except waste in covered, non-leaking containers[e.g.,dumpsters]) ❑Yes 91 No
j. Application or disposal of process wastewater(unless otherwise permitted) ❑Yes ® No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑Yes ® 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 91 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 or piping free of rust,damaged or weathered coating, pits, or M Yes ❑ No
deterioration,or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so,is it free of any in 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 18 Yes ❑ 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 ❑ 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? 91 Yes ❑ No
Page 3of5
SWU-NE-060607 Last revised 06106/07

NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage,or Disposal Facility? 0 Yes ® No
b. Is this facility a Small Quantity Generator(less than 1000 kg.of hazardous waste ❑ Yes M No
generated per month)of hazardous waste?
c. 1s this facility a Large Quantity Generator(1000 kg. or more of hazardous waste Q Yes Ili 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:
16) Certification:
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)).
l understand that I am obligated to submit a no exposure certification 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 that I must allow the North Carolina Division of Water
Quality,or M54 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 stomzwater 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.
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: Bradford Old
Title: Plant Manager
ice=
fSignatur2 of Applicant} (Data 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.
Page 4 of 5
SWU-NE-060607 Last revised 06t06/07

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 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 fora No Exposure Exclusion.
Final Checklist
This application should include the following items:
❑ This completed application and all supporting documentation.
❑ 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 questfons,please contact the DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ...... 828 296-4500
Fayetteville Office... [phone] d
Mooresville Office ... [phone]
Raleigh Office........ [phone] M r t }
Washington Office ...[phone]
Wilmington Office ... [phone]
Winston-Salem ...... [phone]
Central Office .........[phone]
ngton
Page 5of5
SWU-NE-060607 Last revised 06/06/07

. 6511 Franz Warner Pkwy--Google Maps Page I of 1
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W,q r�C� Michael F.Easley,Governor
`O�O T pG William G.Ross Jr.,Secretary
North Carolina Department of Environment and Natural Resources
G] �
Coleen H.Sullins,Director
p Division of Water Quality
January 2, 2008
Bradford Old
Pass & Seymour/Legrand
6511 Franz Warner Parkway
Whitsett, NC 27377
Subject: No Exposure Certification NCGNE0450
Pass & Seymour 1 Legrand
6511 Franz Warner Parkway, Whitsett
Guilford County
Dear Mr. Old:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES
- .,--Stormwater-Perm itting-form;-which-we-received-on-September s;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, and
hereby rescinding your current Certificate of Coverage NCG0030508.
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 (December 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 [phone], ext.
502, or at [e-mail].
Sincerely,
4140
for Coleen H. Sullins
cc: Winston-Salem Regional Office-Corey Basinger Central Files—w/attachments
Stormwater Permitting Unit Files Fran McPherson-Budget Office
NCG030508 Permit file
NCDENR
N.C.Division of Water Quality 1617 Mail Service Center Raleigh,North Carolina 27699-1617 [phone] Customer Service
1-877-623-6748

NCGNE0450
Subject: NCGNE0450
From: Corey Basinger <[e-mail]>
Date: Wed, 26 Sep 2007 12.29.57 -0400
To: Sarah Young <[e-mail]>
OK to process NCGNE0450 in Guilford County. I visited today and they do not have any outside
exposure.
Thanks!
Corey
Corey Basinger
[e-mail]
NC DENR Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
(336) 771-5000
Fax (336) 771-4630
I Corey Basinger <Corey.Basinger a NICtnail,net>
WSRO
NC DENR
1 of 1 12/11/2007 1:51 PM

Pass& Seymour NC(rI*JE016o
0 legWYwsf4
6511 Franz Warner Parkway r�
Whitsett,NC 27377
Phone[phone]!Fax[phone]
www.passandseymour.com G v�
September 4, 2007 r
Stormwater Permitting Unit
Division of Water Quality p
1617 Mail Service Center —'
Raleigh, North Carolina 27699-1617
Dear Madam/Sirs
Please find attached the completed NCDENR document NCNE0000 No Exposure Certification for Exclusion for
your review. This document has been prepared after review of all our operations at the 6511 Franz Warner facility
and additional steps/actions taken to eliminate stormwater exposure from any operations or wastes which also
includes a permanent stormwater retention pond to reduce any risks to surrounding waterways.
Please review the attached information and if you have any questions please call me at 336-449-3572 and I will be
more than happy to answer any questions or assist you in whatever way I can.
Since
i
Ed Williams
Environmental/Facilities Manager
Pass&Seymour/LEGRAND NA
Whitsett,N.C.
Attachments:
NCGNE0000
Directional Map to Facility
Aerial Photograph of Facility

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FOR AGENCY USE ONLY
. Date Received
Division of Water Quality/ Surface Water Protection Year Month Da
o
NCDENR National Pollutant Discharge Elimination System CertificateorCnvera e
NICIGINIE10
,,a.,„C_C ,,,..___ NO EXPOSURE CERTIFICATION for Exclusion
Ewv�nowircrrt Iwo Nain.ti.Rc�daccs
NO EXPOSURE CERTIFICATION NCGNE0000 W45fro
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit
based on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notice that your facility does not require permit
authorization for its 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.
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 onlyL.--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)
1) Mailing address of ownerloperator(address to which all certification correspondence will be mailed):
Name Brad Old- Plant Manager
Street Address 6511 Franz Warner Parkway
City Whitsett State NC ZIP Code 27377
Telephone No. [phone] Fax; [phone]
2) Location of facility producing discharge:
Facility Name Pass &Seymour/Le rand
Facility Contact Ed Williams- Environmental /Facilities Manager
Street Address 6511 Franz Warner Parkway
City Whitsett State NC ZIP Code _27377
County Guildford
Telephone No. [phone] Fax: [phone]
Page 1 of 5
SWU-NE-060607 Last revised 06/06107

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NCGNEOOOO No Exposure Certification
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). Facility located approximately 3 miles off Interstate ROM at the Rock Creek Dairy
exit(see Google map)exit 136. Facility is third business located on the left side of road.
(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
5) Is this a Federal facility? ❑ Yes ® No
6) Latitude 36N 03' 12.55" Longitude -79W 35'23.9" (deg, min,sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
® Existing Date operation began Oct. 1994
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ZI Yes ❑ No
If yes,what is the NPDES Permit Number? NGG030000 iJtG-030506
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code(SIC Cade) that describes the primary industrial
activity at this facility
SIC Code: 3 6 4 3
10) Provide a brief description of the types of industrial activities and products produced at this facility:
Manufactuer of residential electrical switches. receatales and molded utility boxes.
nrncesses inclttde jnjectinn molding, metal stamping and asSernbly.
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
M No
❑ 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.") 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 ® 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 spillslleaks ❑ Yes ® No
c. Materials or products from past industrial activity F-I Yes ® No
d. Material handling equipment(except adequately maintained vehicles) ❑ Yes KI 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 ® No
use (e.g., new cars]where exposure to stormwater does not result in the discharge
of pollutants)
Page 2 of 5
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NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes ® No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ® No
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters)) ❑ Yes ® No
j. Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes ® No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ® 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 ® 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 ® 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 or piping free of rust, damaged or weathered coating, pits, or ® Yes ❑ No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ® 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
(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
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 ❑ No
Page 3 of 5
SWU-NE-060607 Last revised 06/06/07

NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes ® 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:
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 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 submit a no exposure certification 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 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: Bradford Old
Title: Plant 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.
Page 4 of 5
SWU-NE-060607 Last revised 06/06/07

NCGNE0000 No Exposure Certification
North Carolina General Statute 143-215.6 S(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.
Final Checklist
This application should include the following items:
❑ This completed application and all supporting documentation.
❑ 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] in nISale ' 1
Fayetteville Office ... [phone] ^� eh l
Mooresville Office ... [phone] $ `
Raleigh Office ........ [phone] i5 •IIe oar �,•r+°
Washington Office ...[phone] �
Wilmington Office ... [phone] i
Winston-Salem ...... [phone] Fey° Ile
Central Office .........[phone]
WitC nWon
Page 5 of 5
SWU-NE-060607 Last revised 06/06107

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