NCGNE0497_COMPLETE FILE - HISTORICAL_20090313

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE O'/HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ (j)�
YYYYMMDD

Aia
NCENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
February 27, 2009 RECEIVED
N.C.Dept of ENR
MAR 13 2009
Mr. Randy S. Waibel
Hickory Springs Mfg. Co. Winston-Salem
2352 Avenue, NW
nd Regional office
Hickory, NC 28601
Subject: No-Exposure Certification NCGNE0497
Triad Fabco Industries
1325 Baker Rd., High Point, NC 27263
Guilford County
Dear Mr. Waibel:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater
Permitting form. Based on your submittal and signed certification of no exposure at the above referenced facility, the
Division is granting your conditional exclusion from permitting 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 (February 26, 2014). At that time you must re-certify with the Division, or
obtain NPDES permit coverage for any stormwater discharges from your facility.
Your conditional exclusion from permitting 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 Robert Patterson at [phone], or at
[e-mail].
Sincerely,
2.IGC
for Coleen H. Sullins
cc: Winston-Salem Regional Office-Corey Basinger
Stormwater Permitting Unit No- Exposure Files
Wetlands and Stormwater Branch 1�TOne
1617 Mall Service Center,Raleigh,North Carolina 27699-1617 1 Noft I,l Carol1
rt na
Location:512 N.Salisbury 51.Raleigh,North Carolina 27604 I
Phone:[phone] FAX:[phone] Customer Service:1-877-623-6748 �a`tuta�r l/ff
Internet:www.ncwaterquality.org
An Equal Opportunity 4 Affirmative Action Employer

A7i"A
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
February 27, 2009
Mr. Randy S. Waibel
Hickory Springs Mfg. Co.
23.52"d Avenue, NW
Hickory, NC 28601
Subject: No-Exposure Certification NCGNE0497
Triad Fabco Industries
1325 Baker Rd., High Point, NC 27263
Guilford County
Dear Mr. Waibel:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater
Permitting form. Based on your submittal and signed certification of no exposure at the above referenced facility, the
Division is granting your conditional exclusion from permitting 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 (February 26, 2014), At that time you must re-certify with the Division, or
obtain NPDES permit coverage for any stormwater discharges from your facility.
Your conditional exclusion from permitting 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 Robert Patterson at(919) 807-6375, or at
[e-mail].
Sincerely,
IRIGIN&SIGNED�BY
KEN PICKLE ._
for Coleen H. Sullins
cc: Winston-Salem Regional Office-Corey Basinger
Stormwater Permitting Unit No- Exposure Files
Wetlands and Stormwater Branch One
1617 Mail Service Center,Raleigh,North Carolina 27699-1617
Location:512 N.Salisbury St.Raleigh,North Carolina 27604 Nol'thCa1 o�lnc�
Phone:[phone] FAX:[phone] Customer Service:1-877-623-6748 �gturallJ
Internet:www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer

no exposures...
Subject: no exposures...
From: Corey Basinger <Corey.Basinger a ncmail.net>
Date: Fri, 17 Oct 2008 10:40:1 1 -0400
To: Sarah Young <Sarah.Young a neniad.net>
Sarah,
I visited the following sites in Guilford County for no exposure.
NCGNE0534, 0498, 0497, 0482, 0517, & 0525.
All are OK to approve. ['ll be visiting the other sites in Guilford next week.
Corey
Corey Basinger
Corey.BasingerMirail.net
NC DENR Division of water Quality
585 Waughtown Street
Winston-Salem, NC 27107
(336) 771-5000
Fax (336) 771-4630
Corey Basinger <Corey.13asin+ger g NCmail.net>
WSRO
NC I)ENR
I of 1 1/31/2009 2:48 I',vl

. w
w5leo V/SY
FOR AGENCY USE ONLY
Dalc Received
Division of Water Quality 1 Surface Water Protection Year I Month I Day
D Ef 1 o a
NCDENRNational Pollutant Discharge Elimination System CeairtcateofCovcmgc
N_C__>.. eMrr C HT or NO EXPOSURE CERTIFICATION for Exclusion
Envinp+He.rc uo N.QIiRK REsgxxC[5
NCGNE0000
NO EXPOSURE CERTIFICATION
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 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 everu 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 117Ck47ry S R rl 115.3 14,� . d,,d"j S. !/l/6e/
Street Address Z s~ 2_ �4v e Al
City / c o State 41T ZIP Code 2-8kc/
Telephone No. 828 S— Z4 I Fax: f 5 -qZ2-8
2) Location of facility producing discharge:
Facility Name rrtctd Fabco Tndesfries
Facility Contact j�o) /- • L edhu,-d
Street Address j3 ZS~ , e,, Rea
City #iA h AO/ al _ _. State /1'C ZIP Code 2-7Z63
County Gui/fnrd
Telephone No. 33(, Fax: 336 1131 Y008
Page I of 5
SWU-NE-110607 last revised 11/06/07

f
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 dire Lion from a roadway intersection). h i�e.�/u�e 5 (15 No,, 70 (i h
uct,741i on US 70, /e �-v=r/o Few.-Few. 4ve, /ref- ,,ihV /au
(A copy of a map with the facility clearly located on it should be included with the certificallion application.)
4) Is the facility located on Native American Lands? ❑ Yes XNo
5) Is this a Federal facility? ❑ Yes ;<No
6) Latitude 35'O$"-(-"2_1-VO "^/ Longitude - f7 ib'7 73#lyl(deg, min, sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
)(I Existing Date operation began /7 75
S) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes XNo
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 G
10) Provide a brief description f the types of industrial activities and products produced at this facility:
Manurad"rtr o� 1"0 eac/ Aoa C u5 i u !ham
e A e ,cra•{�ur� SC Acao I b us Gt,4 o F ectr_ ' S // s.
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
^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 X 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 XNo
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes No
e. Materials or products during loading/unloading or transporting activities ❑ Yes XNo
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 2of5
SWU-NE-110607 Last revised 11/06/07
J

dAve �
L
ate .., t. M y , --
< -d„i
ya„�� � �p rr � iD � � � � �` w '� ✓ " # � � � ." �� ,� ; ,.e.^ �,y4 a;u '' sue'
"may-f-
3 dr
.� •?`# '��-�� �4'?��p_ _ ! '� �. _ �x r i,•. 6,. f�L � ed._ 1.. � n�:F, '.��r ��^ � �g a� p� � a�3
�ROs1�PI�. wl,"t. r� _ _ Vic.- ` .�' .�. "�•"� a► _, .�
t
Elves'¢_ ate
w a
r _ �x �'• s '.sn) 1 ,,i .s i ?7`` .R, ti7e <�. a' - `'�, ..F {
t,�e,
e
�GlT��.S� f s; ` �4I.M �] �F .- ��.._.i.F,� .. -'�x � _ t. a•„ f�`�
4
k�r��;�'_ �,��.� �,� ��� :- �'�� � � � .,�.a, � '� �' ►1i325 8�k - �,�Rcl6H ��P,r,ii�l; N��2��3� �>.. � �
-i1y-f 0Triad Fabco Industries
i.
'�"-�'�e,�l�,v
1325
Baker
Road
fir~
z..
� <" ''"r�_►+ �� i� � �_ m a�� g d 204�7 C-Elr�4{?�Tthnr;lcfgios�' w �.,� �^ � � �. '- t � .z � E r�JA. -- A � � �,�.
A..IYI r/ll� i s��k '�W�]* i -tip; _ n '' G�611.NVUE A`- ,y.
x p� ,r< ;! x .. ']..t ;I Malt�IC3Scrbe �b
�sF�.,.a
OGS
�! ;��• -e: i� r y � { . �s' �f`.�`lc+� "' �;c.: '..k '. � ! s X`rk .. � a �jr�['�,�,_r'K9� x: � e�
�P.,,ainiter?- .�.G.�35.(3it22�7t7��d! -`�"�79�5(3,�102.2Qd4��W�elvvl���}�G�f1��3trrc�r�iin53��1�I���I7�+�'10�•'�6, : � �"=� �`" _,9� •..��` :�C-yY`'�eaalf�T 7747 iS�

NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels,tanks, ❑ Yes PkNo
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes KNo
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes 'KNo
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 XNo
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 X 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 ElNo
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 KYes ❑ No
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for any amount of Title III Section 313 XYes ❑ No
Superfund Amendments and Reauthorization Act (SARA) water priority
chemicals?
d. Is secondary containment provided for gny amount of hazardous substances? Yes ❑ No
e. Are release valves on all secondary containment structures locked? XYes ❑ No
Page 3 of 5
SWU-NE-110607 Last revised 11/06/07

NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes XNo
b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste ❑ Yes XNo
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes X 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 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 12226(g)(2)).
I understand that I am obligated to submit a no exposure certification form once every fivee(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.
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.
S ATE'
Printed Name of Person Signing: RC07CIy S U!ui 6C, ['y �y �, S'
Title: [�Gr or Env)6 r cr lo_oic Ma-it er �6>
UU 7 . :
(Signature of Applicant) (Date Signed) r'
Page 4 of 5
SwU-NE-110607 Last revise

NCGNE0000 No Exposure Certification
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.
Final Checklist
This application should include the following items:
C 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, Forth Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions,please contact the DWO Regional Office for your area.
DWO Regional Office Contact Information:
Ik
Asheville Office ...... [phone] wf sal
t
Fayetteville Office ... [phone] �� st► `'- _ E,,
Mooresville Office ... [phone]
Raleigh Office ......L. [phone] f to
os►r le .
Washington Office ...[phone]
Wilmington Office ... [phone] ,e
Winston-Salem ...... [phone] F o IIo
Central Office .........[phone]
Wil ngton
Page 5of5
SWU-NE-110607 Last revised 11/06/07

b•.
HICKORYSPRJNGS
n4ANUFACTGRiNG COMPANY
March 3, 2008 VIA CERTIFIED MAIL
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617 v`
RE: NPDES No Exposure Certification ?� 7�; ,
Triad Fabco Industries t
1325 Baker Road, High Point, NC
1908 Nuggett Road, High Point, NC p
To Whom It May Concern:
Please find the enclosed NPDES applications for exclusion from the stormwater
permitting program based on "no exposure" conditions.
The enclosed applications are for the two above-referenced Triad Fabco locations, which have
recently become a division of the Hickory Springs Manufacturing Company.
Should you require additional information or have any questions concerning, please feel free to
contact me at [phone], Ext. 3244 or [e-mail].
Sincerely,
HICKORY SPRINGS MANUFACTURING COMPANY
Randy S. Waibel, CHMM
Corporate Environmental Compliance Manager
Enclosures
cc: P. Allred (423)
B. Bush (Corp)
C. Essik (423)
K. Livingston (611)

�
Ws�U
a
`t FOR AGENCY USE ONLY
Date Received
Division of Water Quality/Surface Water Protection yew j Mon,,, I pa
� O 031 e5
NC®��� National Pollutant Discharge Elimination System Certifica:enfCuvei2ge
�.a NO EXPOSURE CERTIFICATION for Exclusion
[«.wo«�cur Iwo Hvww«rewnces
NCGNE0000
NO EXPOSURE CERTIFICATION
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 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 () years.
For questions,please contact the DWO Regional Office for your area. (See page 5)
(Please print or type)
1) Mailing address of owner/operator(address to which all certification correspondence will be mailed]:
Name iCkvey Sprier ��9 con14 /�a•r�� S. !rl/2r6e
Street Address 2 3 5~ Z" .4v e n u c. /V W �7
City / c a• State ,VC ZIP Code 7-
Telephone No. 92�V_ : 0- 20 Fax: 02,t� ^ 32 P, 42-2-f;
2) Location of facility producing discharge:
Facility Name Tri•ud Fq bca .!<�c/v•�trig
Facility Contact Do.-) 4 . L ea'-7urd
V1h Street Address i3 25- ei ea
City #jo h State &C ZIP Code (0-3
County 67 .ui/!bird i iSpM
Telephone No. 33 6 86l-`-f tef S- Fax: 33 Y3i Y00b i,Lp
Page 1 of 5
SWU-NE-110607 Last revised 11/06l00

r 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 aid dire tion from a/roadway intersection). e � 8 fr f1s. /Peale .70. 0'h
Av/%,f 5 uuTh or+ US 70 /� v:7/o %vc>lHs2•�a ve
(A copy of a map with the facility clearly located on it should be included with the certifica ion application.)
4) Is the facility located on Native American lands?❑ Yes )K'No
5) Is this a Federal facility? ❑ Yes fi(No
6) Latitude.35'05 E 12,c°60 /\/ Longitude 79 ps7.57.73'/V/(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 1175
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes 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 G 9 &
10) Provide a brief description �f the types of industrial activities and products produced at this facility:
Ala 4"Aaae llcfrC/ V� ~ reho�id �oo -fus ia; 1'117r a>te�/c s
✓ e SC A ov I hS' a vl d C j F L7{r) 0 //e S.
11) Does this facility have any Non-Discharge permits(ex: recycle permits)?
)<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 X 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 XNo
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 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
SWU-NE-1 10607 Last revised 11/06/07

r�' €' ,r'`
:y
Sp-d-
Ot�II>t311+{UhU'i,l
-a1 ♦ , i Sf s x r-, g «� a4 r t ' ask a «�
���',b�a �`,=M� SO+y'r' s, " ' �d •` a3e .0 `P w+w:.` � �� } f r i. ,, { U} �a
�;c.qz i_ -Y �'^ � s• I R > .Y "x',r" �. �: -rt. v 4- � .i� t1y:q _� 4.a"�:�"S .�'4� .s
T A !r 'r r+1 !: r;peal
'..
�i
ekeS r "7 F '`"}.X, �' t�,,g„ F�''.. �, ' .1`•"?• r ems'-.-�rrt4--f' .
_ :.4'�"d "�1 .._�. r, r r'r'+e.- i�' -'.:.c �� ':r'�-' -ia � 5i," rra. "^"�,�� �.,��F� f1 >: .�•. i�;� <'6. l!� i�.
���4' - {{ � � c 7Y :. 3• r Nam' _ ':,':xc. �- � � lJ�--
rz W;
V5.
�`i',k --.5r ^' • t - .v.;Y K -J _ 1 n "Vr?;x s' i, `•-a �l.'1 ;,,�N <�1 a .�-`-�'
r
?�i # �-���•�'.. K 13 a r," r aka. � :cam
r• ..
y,IN
.e. `�. -
ei R" v'k r. - FP :1,c.'r i__
_��"✓_.� 5,�✓� r c e; s -Nh _4 �,� Z. 5�^-1 ss 9-•. s ,*.fz ff'a+b° 3
sT� � s{! ���d`.3,�. �'w -.`�� M s x.• t i.� '� �� '43� 7i,
*'+•'"�'� ..�f�_� s� ,,,A"_"{i. -5 �.`s4e '�—:�r s �!1 �!1#r�F � .-... —i°e«.i.E-> ``�3'��adlifi-a.�n�� '*! y -�. ��-w.�'E s �� i
� �•'3 i�r-t'�4',�� r{ a rti � c a, �r? ,L.a (p r r5'. ��r.-t y �xk- z �'�f �":.
�...: s,. D,� r -:`' � '.w'=i � cw`�, .�-.--; 5,� 3r e� �� ,,,,�.- �,, - r ,r kf..t �- svt."LC;Y f��„ +y,,•�� ��, ^s_
':x� �: :y x�' „"s s � a.z_�"' r K..:S � v r'a" ., r+ ' .i:is+ y;x_.,. �� �' �,�ary),��°. ->s ^•�' r � at�� ' 'S � t `!� t�-.�`a
r1 �C�� .ras.^T 1 't',ty 1, s- r.,ai i •ti. �� .a...hv,�y tv 4ily`" -".'- ,' I `' _Yw .E" 3-;a+.i/i v 'li$�. - t' � ^ys,"
_�^" '�.r fRII' f■ �1 3. ^ �p•�� r"V t. � .�s. - - t,�,t""•a �s�. .F-+.2 -'� 4 .a^"rs ''i... a 4 �:'
;T �y� ,::- >�,_ , �...t. ... ,� Bek RdrHih;Piit;�NG:-2?2f 3r 1 - f
�Y� p f'
�".� �-..'€.�
�t s$
�4 ^ �1La➢T`� M 4 �Y, 4 H �' 'fir
Triad M • • • r
�c
+m ;g4�W7; "�:n -� �y,e '�3 -1 ri 's�� �-f+���.r -��R dE1E-au'�s� - 3t' `a''.iSl�S,•_.'+.=�} '�.r,`w-. $$L!3`.�r®rr�-N.-�1�,�Q -.s-1<f}l r"�c3.., �}L�r�-.sIP y a �yS E' �-_� "�f�arJ-Y qi<.� `�'r',� frF 1325 Baker
Ie Road
-
�. -
�
dc.
gy°�Pi :;T °F�.+ �`�t�''T". l. #�}:' ..,� ;� y�y s�.�L•,+�-sx:'�� µ„s.�,..'I+s'f"i `�,*�� ,. ' n {�„"� �-,.l.�"�+ ',} -.�w
f ,
.Sr " �A£ °? � �0��r-- c ;�.^., ,►�`i �� a �;r r", �,,<�r -�� �r ��,�`�.� � tea,:�;�'_ f .� e�-kR,{ '�.a�'r��� �'`
O'dLlrPZ3CR7�j{d
,:.. i'� -' _�-��_.�i.-e - �►�.�it�. ��=`:��'�' "�'" " �"a. �j�., .f�;�6 H�, �� k ^•'��- �-�i anu -a,.i �.[�t. �_�. s��� "t X�-';.,+, "'t �"
"j
� v r
?yea'.:.;NO-
0"�'�•.+ . ..w" ,: .. �`- '�..�.. ' . t_ �°` L3 2tJ07r-.Uf17 �Te'chnuiv l06 ,x ' �` � >,� �� � ��. .,Oi}7 D,�y�tr�!(3�Inbe E
y���,err "t �r .r :�`� �� � ,� a3'F`�,�� � r w��,•. ��a � •� �. r'ry�s'4S,7;r',r�s� s 5 �,F•. t r ,-, .�' - �'° .�`h'a,��. -E�t ��f
31-'I, t_ r ,;• ! i Ej ,•, t
,4, -..:�:��,,. ��� ;•�.4��.:;�....�--
r';viryten-�_3 `Sa.22�+7�7al�1 ''�79°aa,'Qa�2 " W; �a`I �rrw03,_G°it;� trevniin �� 140ryb-.w `''' Y� �a^ "C a?e!i ::: 7sT0,7kt1
s� .�lt�Iltsl�p� T

. NCGNE0000 No Exposure Certification
-g. Materials contained in open,deteriorated or leaking storage drums, barrels,tanks, ❑ Yes p'kNo
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by Cl Yes KNo
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑Yes 'KNo
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 )(INo
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 )<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 AYes ❑ No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any xYes ❑ 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 KYes ❑ No
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for any amount of Title III Section 313 XYes ❑ No
Superfund Amendments and Reauthorization Act (SARA) water priority
chemicals?
d. Is secondary containment provided for any amount of hazardous substances? )(Yes ❑ No
e. Are release valves on all secondary containment structures locked? )(Yes ❑ No
Page 3 of 5
SWU-NE-110607 Last revised 11106/07

NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? 0 Yes iX No
b. is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes XNo
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator(1 ODO kg: or more of hazardous waste ❑ Yes X 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.
f �ZIti �r
Printed Name of Person Signing: R_ 0170'V S• Wa'�!�C C/f/►f/Vf ) S.
Title: ['vr o: �i1vi� cf ia01 /�1Qn�t ear ,�� `ate
M ec'I
a 12037
(Signature of Applicant) (Date Signed) d
c� cHMM ,a
Page 4 of 5
5WU-NE-110607 Last revise

NCGNE0000 No Exposure Certification
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 falsities,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:
CAS 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.
DWO Regional Office Contact Information:
Asheville Office ...... [phone] win
•
Fayetteville Office ... [phone]
Mooresville Office ... [phone]
Raleigh Office ........ [phone] � 1, _
Washington Office ...[phone]
Wilmington Office ... [phone]
Winston-Salem ...... [phone]
Central Office .........[phone]
W:f rtg�
Page 5of5
SWU-NE-110607 Last revised 11/06/07

i
HICKORY SPRING!_
M AN U F A CTU R ING C 0 M PAN Y
March 3, 2008 VIA CERTIFIED.MAIL
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Caroiina 27699-1617
RE: NPDES No Exposure Certification
Triad Fabco Industries p d11,
1325 Baker Road, High Point, NC
1908 Nuggett Road, High Point, NC
o
To Whom It May Concern:
Please find the enclosed NPDES applications for exclusion from the stormwater
permitting program based on "no exposure" conditions.
The enclosed applications are for the two above-referenced Triad Fabco locations, which have
recently become a division of the Hickory Springs Manufacturing Company.
Should you require additional information or have any questions concerning, please feel free to
contact me at [phone], Ext. 3244 or [e-mail].
Sincerely,
HICKORY SPRINGS MANUFACTURING COMPANY
'Randy S. Waibel, CHMM
Corporate Environmental Compliance Manager
Enclosures
cc: P. Allred (423)
B. Bush (Corp)
C. Essik (423)
K. Livingston (611)