NCGNE0498_COMPLETE FILE - HISTORICAL_20090313

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. IV U&NCO l 9
DOC TYPE ,.B' HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ 62uj S 0313
YYYYMMDD

A70
NC® NR
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 Dent.of ENR s
Mr. Randy S. Waibel
BAR 13 2009
Hickory Springs Mfg. Co. rrnstan•Sslem
235 2"d Avenue, NW Regional Office
Hickory, NC 28601
Subject: No-Exposure Certification NCGNE0498
Triad Fabco Industries
1908 Nuggett 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 tie 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,
for Coleen H. Sullins
cc: Winston-Salem Regional Office-Corey Basinger
stormwater Permitting Unit No- Exposure Files
Wetlands and Stom3water Branch 1�TOne
1617 Mai!Service Center,Raleigh,North Carolina 27699-1617 1 v ortt 1 Carol l n a
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:91M07-63001 FAX:[phone] Customer Service:1-877-623-6748 �atura!!
Internet:www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer

AgA
MCDENR
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.
235 2"d Avenue, NW
Hickory, NC 28601
Subject: No-Exposure Certification NCGNE0498
Triad Fabco Industries
1908 Nuggett 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 i
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 focal regulations or ordinances.
If you have any questions or need further information, please contact Robert Patterson at [phone], or at
[e-mail].
Sincerely,
ORIGINAL SIGNED BY
for Coleen"�!`uFJP151LE
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 NorthCarolina
Locasion:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:91 M07-6300 l FAX:[phone] Customer Semite:1-877-623-6748
Internet:www.ncwaterquality.org J
An Equal Opporlunity l Affirmative Action Employer

no exposures...
Subject: no exposures...
From: Corey Basinger <Corey.Basinger cr ncmail.net>
Date: Fri, 17 Oct 2008 10:40:1 1 -0400
To: Sarah Young <[e-mail]>
Sarah,
visited the following sites in Guilford County for no exposure.
NCGNF0534, 0498, 0497, 0482, 0517, & 0525.
All are OK to approve. I'll be visiting the other sites in Guilford next week.
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
Corey Basinger <Coi•[e-mail]>
wSRO
NC t7E NR
1 of] 1/31/2009 2:48 PM

FOR AGENCY USE ONLY
Date Rrwivcd
A Division of Water Quality 1 Surface Water Protection Yew I Month oay
National Pollutant Discharge Elimination System Cc>uricatc or
NCDENR
NO EXPOSURE CERTIFICATION for Exclusion
ENNwpr.nrxr ulo lFQinw Rf]OlRCC3
NCGNEoaoo
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 NPOES 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 (Q years.
For questions,please contact the DWO Regional Office for your area. (Seepage 5)
(Please print or type)
1) Mailing address of owner/operator(address to which all certification correspondence will be mailed):
Name ic•ker S rjr! S AlAq. Co. Randv S Wal,he/
Street Address 235 2 d Vert u �. jV W
City or State IVC ZIP Code 7-0601
Telephone No. 92:8-_ Z$- QI Fax: 82-8 $- q 2-7-8
2) Location of facility producing discharge:
Facility Name -77ia d' Fa 6ro 1n du;--ri eS
Facility Contact 0 d r) I- L eon and
Street Address 1708 Nuavvft Reuid
City poln State N_ZIP Code 7—. 6
County 6ki/f7,vrd
Telephone No. fro,_ $61- yl 7-S- Fax: W31 - 4R0$
Page 1 of 5
SWU-NE-110607 Last revised 11/06/07

- 7
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). %nl-e-rsA Xff SS /y 1/5 Roc k 70 (f/yX/ Aoin/j
duo"fie 70, /elf o.j /o Tuvhsr.�d ✓C . /�, f d� f� Aker iCd. 1elr� '
(A copy of a map with the facility clearly located on it should be included with the certification application.) 04 .1-0
4) Is the facility located on Native American Lands?❑ Yes ;(No Alu9.5`'/4 Kc/,
5) Is this a Federal facility? ❑ Yes No
6) Latitude 3505(n'Z6,12-rN Longitude _79`.S0'47-`)S iV/(deg, min, sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
X Existing Date operation began 19qo
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— 0 �v
10) Provide a brief des cri tion of the types of industrial activities and products produced at this facility:
Manul�c&J_er 0 rndlcled rebood {o.a n CuSAI/v,7in y rvikY-er-ra /s A
in.`Ae,re, sc hcio/ b U5, if-id yol f C'a/ m t; A ri2S. -
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 XNo
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 (No
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 N0
use [e.g., new cars] where exposure to stormwater does not result in the discharge
of pollutants)
Page 2 of 5
SWU-NE-110607 Last revised 11/06/07

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NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes XNo
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes ';1,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 '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 )<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 'A"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 XYes ❑ 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 Ayes ❑ No
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for gny 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 11/06/07

' 1
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 ps�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:
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 122.26(g)(2)).
I understand that I am obligated to submit a no exposure certification form once every five 5 ears 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, l 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.
y
'��GtQ y
Printed Name of Perj�on Signing: RaiidV S• VVCc% e�, C fy/� t� „ 5, ;rt� .
Title: flpr' OlrZt'�' Erf l�l/r C �'os� �4nC /v1C[v��Lc-fir' ��'•�.,���, �'f4��S
i � EicsFoi'�!
(Signature of Applicant) (Date Signed) vsy c,
�O CHM a�
Page 4 of 5
SWU-NE-110607 Last revise 6l07

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:
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:
Win ale
Asheville Office ...... [phone]
Fayetteville Office ... [phone]
Mooresville Office ... [phone]vv
Raleigh Office ........ [phone] le
Washington Office .._(252) 946-6481
Wilmington Office ... [phone] T
Winston-Salem ...... [phone] 'ryI° Wes=
Central Office .........[phone]
F�e
emu.
Page 5 of 5
SWU-NE-110607 Last revised 11/06/07

W �5v
FOR AGENCY USE ONLY
Ae GZA
Division of Water Quality I Surface Water Protection Year oatMoth nay a
NCDENRNational Pollutant Discharge Elimination System Cenif"icam IN I ofCo�c
N� NICId
ragc
., C__C ..,.,.__. NO EXPOSURE CERTIFICATION for Exclusion
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 outfalis. if any industrial activities or materials are, or will be, exposed to precipitation, the
facility is not eligible for the no exposure exclusion. By signing and submitting this No Exposure
Certification form,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)
I) , Mailing address of owner/operator(address to which all certification correspondence will be mailed):
Name ' iskos- S �f s . CO. A"n: Randv 5. Waihel
Street Address 2 3 v r1 u e AI W
City l'f,'ckory State 1UC ZIP Code Z�rvo�
Telephone No. 162-8 2-9- 2-2-41 Fax: 028 52-0 - 142-7-8
2) Location of Facility producing discharge:
Facility Name -77ia d I O hCO _17 d y5J—rJ eS
Facility Contact 7)orI I_ Lea 17 and
Street Address 7 0 6 /V u qy e f-F Rt2
City ' Polp 6 State IC ZIP Code 2-7 2-6-3
County 6-r6/ r,rd �3S
Telephone Na. a(0 qj 95 Fax: 5,j - 43 i - q pag
Page 1 of 5
SWU-NE-110607 Last revised11106/07 �����

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). /n fcr_s�a le 65- /y VS Rou k- 76 (111qj r Id,1,1
M 74: /e rev 'Fe z e4d Aivele k JR6 ke--Rd. . 1e if
(A copy of a map with the facility clearly located on it should be included with the certification application.) 0 s /p
4) Is the facility located on Native American Lands? ❑ Yes ANo '41u95 K
5) Is this a Federal facility? ❑ Yes )<No
6) Latitude 35 5k, 16,32'N Longitude 7`)°j$jo7_�5w�({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 1 q90
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes KNo
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 O 8 6
10) Provide a brief description of the types of industrial activities and products produced at this facility:
man Kfa47ttgrer vr►7v/1r1eey re6e,.:d roam CushleaIn 0141-erra/S 41— Ire
A.-n,'Ivre, sc haa/ b BLS. rrd qol
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
'KNo
❑ 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 XNo
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 KNo
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes ANo
e. Materials or products during loading/unloading or transporting activities ❑ Yes 1 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-110607 Last revised 11/06/07

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, _ 4 � Y _ : .. II11IlI1Ii , y.

NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes XNo
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 -p(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 )<N0
(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. Is secondary containment provided for awn rr amount of Title 111 Section 313 XYes ❑ No
Superfund Amendments and Reauthorization Act(SARA) water priority
chemicals?
d. Is secondary containment provided for awn++amount of hazardous substances? Yes ❑ No
e. Are release valves on all secondary containment structures locked? `1(Yes ❑ No
Page 3of5
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 ^lo
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.
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)).
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 t 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.
R�A ti
I`�
Printed Name of Peron Signing. cz,>r y 3. 412--/ e4 C/ f�/Lf `4�,�''`"S.
� g 9� � d .-.. s* �. S. Ef
Title: f'�� orate Era lrir' t i �o:�, /i4nCe ln�� �� `�� �f4 �' ;
(Signature of Applicant) (Date Signed)
CHMM a�
Page 4 of 5
5WU-NE-110607 Last revis 6107

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:
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 ...... 828 296-4500 "
Fayetteville Office ... [phone]
Mooresville Office ... 704 663-1699
Raleigh Office ........ [phone]
Washington Office ...[phone] p J
aim
Wilmington Office ... [phone] >;
_ 'lto
Winston-Salem ...... 336 771-5000
Central Office .........[phone] I
Page 5 of 5
SWU-NE-110607 Last revised 11/06/07