NCGNE0504_COMPLETE FILE - HISTORICAL_20090313

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /V CCU I VL
DOC TYPE Y'HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ �C�(J3 �c3
YYYYMMDD

NC®EN
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
RECEIVED
February 27, 2009 N-C.N°t-of ERR
MAR 1 3 2009 -
Mr. Steve Hildreth wmston-salami
ASMO North America Regional Offica
470 Crawford Road
Statesville, NC 28625
Subject: No-Exposure Certification NCGNE0504
Automotive Motors of Thomasville
113 Sunrise Center Dr., Thomasville, NC 27360
Davidson County
Dear Mr. Hildreth:
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.
We are aware that manufacturing has stopped, and if you choose to permanently dismantle the equipment, you could
request that the No Exposure be rescinded.
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,
for Coleen H. Sullins
cc: Winston-Salem Regional Office- er Stormwater Permitting Unit No- Exposure Files
Wetlands and Stormwater Branch One
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 North Carofi na
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:[phone] FAX:[phone] Customer Service:1-877-623-6748 Naturall#
Internet:www.ncwaterquality.org
An Equal Opportunity 1Affiirmative Action Employer

NC®ENR
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. Steve Hildreth
ASMO North America
470 Crawford Road
Statesville, NC 28625
Subject: No-Exposure Certification NCGNE0504
Automotive Motors of Thomasville
113 Sunrise Center Dr., Thomasville, NC 27360
Davidson County
Dear Mr. Hildreth: -
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.
We are aware that manufacturing has stopped, and if you choose to permanently dismantle the equipment, you could
request that the No Exposure be rescinded.
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]. a.
Sincerely,
ORIGINAL SIGNED BY
KEN PICKLE
for Coleen H. Sullins
Cc. Winston-Salem Regional Office-Jenifer Carter Stormwater Permitting Unit No- Exposure Files
Wetlands and Stormwater Branch One
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 NorthCarolina
. Location:512 N.Salisbury 5f.Raleigh,North Carolina 27604 �lxtllr�l�l�/
Phone:9IM07-63001 FAX:[phone] Customer Service:1-877-623-6748
Internet:www.ncwaterquality.org
An Equal Opportunity 4Affrmative Action Employer

ASMO NE Application
Subject: ASMO NE Application UC-CrN[CS
From:'.lenifer Carter <[e-mail]>
Date: Fri, 06 Feb 2009 14:29:47 -0500
To: Sarah Young <[e-mail]>
Sarah.
I made an unannounced visit to this facility in Thomasville today... the secretary told me that they had
just closed down and let most of the staff go, and will now be a warehouse only. The manufacturing
floor was dark with no employees... they're trying to sell equipment. They easily qualify for no exposure
at least. If it didn't still look like they could start the manufacturing back.up, I'd suggest that they rescind
the permit altogether. I would at least mention that you are aware that manufacturing has stopped, and
that if they choose to permanently dismantle the equipment, they could request that the NCGNE-be
rescinded. What do you think?
Jenifer Carter
NC OENR Winston-Salem Regional Office
Division of Water Quality`—"'
585 Waughtown Street
Winston-Salem, NC 27107
Voice: (336) 771-4957
FAX: (336) 771-4630
E-mail correspondence to and from this address may be subject to the
North Carolina Public Records Law and may be disclosed to third parties.
1 of 1 2/6/2009 2:32 PM

PP
Subject: Re: ASMO NE Application ;NJ G 6N6O-Vo
From: Sarah Young <Sarah.Young@nc mail.net>
Date: Fri, 06 Feb 2009 14:32:17 -0500
To: Jenifer Carter <Jeni [e-mail]>
Sounds like a plan to me. Thanks for the response and have a good weekend!
E-mail correspondence to and from this address may be subject to the North Carolina
Public Records Law and may be disclosed to third parties.
Jenifer Carter wrote:
Sarah,
I made an unannounced visit to this facility in Thomasville today. . . the secretary
told me that they had just closed down and let most of the staff go, and will now be a
warehouse only. The manufacturing floor was dark with no employees. . . they' re trying
to sell equipment. They easily qualify for no exposure at least. If 'it didn't still
look like they could start the manufacturing back up, I'd suggest that they rescind
the permit altogether. I would at least mention that you are aware that manufacturing
has stopped, and that if they choose to permanently dismantle the equipment, they
could request that the NCGNE be rescinded. What do you think?
Jenifer Carter
NC DENR Winston-Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Voice: (336) 771-4957
FAX: (336) 711-4630
E-mail correspondence to and from this address may be subject to the North Carolina
Public Records Law and may be disclosed to third parties.
Sarah M. Young <sarah.young(cr),ncmail.net>
DENR
DWQ Wetlands and Stormwter Branch
1 of 1 2/6/2009 2:35 PM

AS,N40 NE Application
Subject: ASM4 NE Application
From: Jenifer Carter <[e-mail]>
Date: Fri, 06 Feb 2009 14:29:47 -0500
To: Sarah Young <[e-mail]>
Sarah,
1 made an unannounced visit to this facility in Thomasville today... the secretary told me that they had just
closed down and let most of the staff go, and will now be a warehouse only. The manufacturing floor was
dark with no employees... they're trying to sell equipment. They easily qualify for no exposure at least. If it
didn't still look like they could start the manufacturing back up, I'd suggest that they rescind the permit
altogether. I .would at least mention that you are aware that manufacturing has stopped, and that if they
choose to permanently dismantle the equipment, they could request that the NCGNE be rescinded. What do
YOU think?
Jenifer Carter
NC DENR Winston-Salem Regional Office
Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Voice: (336)' 771-4957
FAX: (336) 771-4630
E-mail correspondence to and from this address may be subject to the
North Carolina Public Records Law and may be disclosed to third parties.
POf 1 2/12/2009 10:15 ANI

t
FOR AGENCY USE ONLY
+& Division of Water Quality I Surface Water Protection cu hlomhRYa ,,,.
��J >�
NCDENRNational Pollutant Discharge Elimination System � "E c°'S"
,4,,.cmo„ cw ,-a NO EXPOSURE CERTIFICATION for Exclusion
NCC NE(101i0
NO EX OSURE 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-Mg).
You are required to reapply for the No Exposure Exclusion once every five(5) years.
For questions, please contact the DWO 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 ASMO North America
Street Address 470 Crawford Rd
City Statesville State NC ZIP Code 28625
Telephone No. 704-878-6663 Fax: [phone]
2) Location of facility producing discharge:
Facility Name Automotive Motors of Thomasville
Facility Contact John Burke
Street Address 113 Sunrise Center Drive
City Thomasville State NC ZIP Code 27360
County Davidson
Telephone No. 336474-8862 Fax: [phone]
Page 1 of 5
SWU-NE-t to6w Last revised 1110&'07

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 rtumbers,and
distance and direction from a roadway intersection).'rake Interstate 85 to unity Street exit. Go North and take left on
Trinity Street then left on Mason way and the facility will be 100 yards on the left.
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes M No
5) Is this a Federal facility? ❑ Yes KI No
B) Latitude 35,0 52-50.00"N Longitude 80u 03'21.00"w (deg, min, sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
29 Existing Date operation began
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑Yes 10 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 7 0 0
10) Provide a brief description of the types of industrial activities and products produced at this facility:
This facility assembles small motors for the automotive indusirv.
11) Does this facility have any Non-Discharge permits(ex: recycle permits)?
dl No
❑Yes
If yes,list the permit numbers for all current Non-Discharge permits for this facility:
Expos ure 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 N 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 n Yes m No
c.Materials or products from past industrial activity ❑ Yes M No
d. Material handling equipment(except adequately maintained vehides) © Yes N3 No
e. Materials or products during loading/unloading or transporting activities ❑Yes N No
f. Materials or products stored outdoors(except final products intended for outside ❑Yes d 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 11/06M07

NCGNEOOOO No Exposure Certification
g. Materials contained b open,deteriorated or leaking storage drums, barrels,tanks, ❑Yes eg No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes w No
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 d No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not o Yes tv 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 property stored ❑ Yes N 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 I,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 NA ❑ Yes ❑ No
deterioration,or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any NA ❑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 NA ❑Yes o No
(including drums, barrels,etc.)with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored NA❑ Yes ❑ 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 NA❑ Yes ❑ No
Superfund Amendments and Reauthorization Act(SARA)water priority
chemicals?
d. Is secondary containment provided for any amount of hazardous substances? NA❑Yes L7 No
e.Are release valves on all secondary containment structures locked? NA ❑ Yes ❑ No
Page 3of5
SWU-NE-110607 Last revised 111WO7

NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage,or Disposal Facility? o Yes N No
b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste f3 Yes 29 No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste G Yes M 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 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 CaroCrna
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). 1 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 forgathering the
information,the information submitted is to the best of my knowledge and belief true,accurate and complete. l 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. 11 f
Printed Blame of Person Signing. S-fr L/t<
Title: rdct l ".q v, C.,t -
(Signature of applicant) (Data Signed)
Page 4 of 5
SWU-NE-t t0607 Last revised t tl06107

NCGNEf)000 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 arty recording or monitoring device or method required to be operated or maintained under this Article or rules of the
(Environmental Managements 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:
W 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 duality
1617 Mail Service Center
Raleigh, North Carolina 27699-1 61 7
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 yourarea.
DWO Regional Office Contact Information:
Asheville Office ...... [phone]
Fayetteville Office ... [phone] r - Cd
Mooresville Office ... [phone]
Raleigh Office ........ [phone] ` � hlo e,r,r„ re
Washington Office ...[phone] _ o.
Wilmington Office ... [phone]
Winston-Salem ...... [phone] F or+tell°\
Central Office ......... 919{ )733-5083
Wit gran
Page 5 of 5
SWU-Nl=-110607 Last revised 11/0&07

W D
FOR AC&WY USE ONLY
Division of IVater Quality/Surface Wtiter Proteetion k Roccived
Year Momh Day
r�
D
NCDR National Pollutant Discharge Elimination System NICIGc<>tiINIE
Fk—C� NO EXPOSURE CERTIFICATION for Exclusion
NCG NE400U
NO EXPOSURE CERTIRCATION
National Pollutant Discharge Elimination System application for exclusion from a Storrnwater 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 oniy--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 condtions of 40 CFR 1222G(g).
You are required to reapply for the No Exposure Exclusion once every five 5 ears.
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 corresu2ndertce will W mailed):
Name aSNln North:America
Street Address 470 Cranford Rd
city slatesville State INC ZIP Code 28625
Telephone No. 704-878-6663 Fax: [phone]
2) Location of facility producing discharge:
Facility Name Automotive Motors of Thomsville
Facility Contact John Burke
Street Address 113 sunrise Center Drive
city Thomnsville StS1e NC ZIP Code 27360
County Davidson
Telephone No. 336-474-8862 FaX: [phone]
Page 1 of 5
SWU-N&110607 Last revised t 1!0&07

1 * �
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).Take Interstate 85 to Unity Street exit. Go North and take left on
Trinity Street then left on Mason Wav and the facility will be 100 yards on the left.
(A copy of a map with the facility clearly located on it should be included with the certification application.)
4) Is the facility located on Native American Lands?13 Yes M No
5) Is this a Federal facility? Li Yes w No
8) Latitude 35"i2'-90.00"In Longitude SO°03'28.00"jNr (deg, min, sec)
. 7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
N Existing Date operation began
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ©Yes W 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 7 0 o
10} Provide a brief description of the types of industrial activities and products produced at this facility:
'rhis facility assembles small motors ror the automotive industrv.
11) Does this facility have any Non-Discharge permits(ex: recycle permits)?
Nl No
©Yes
If yes,list the permit numbers for all current Non-Discharge permits for this facility:
Exposure Checklists OZ- 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' D9 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 spillsfleaks ❑Yes ®No
c.Materials or products from past industrial activity ❑Yes M No
d. Material handling equipment(except adequately maintained vehicles) o Yes I9 No
e. Materials or products during loadinglunloading or transporting activities ©Yes In No
f. Materials or products stored outdoors (except final products intended for outside n Yes IN No
use[e.g., new cars]where exposure to stormwater does not result in the discharge
of pollutants)
Page 2 of 5
SW1 ENE-110607 Last revised 111065,'07

NCGNEODOO No Exposure Certification
g. Materials contained in open,deteriorated or leaking storage drums,barrels,tanks, ❑ Yes N No
and similar containers
h. Materials or products handledistored on roads or railways owned or maintained by ❑ Yes lr No
the discharger
i.Waste material(except waste in covered, non-leaking containers[e.g.,dumpsters]) ❑ Yes a No
j.Application or disposal of process wastewater(unless otherwise permitted) ❑Yes ter No
k. Particulate matter or visible deposits of residuals from roof stacks and'or vents not ©Yes n.,,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 property stored ❑Yes N}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 NJ 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? tf so, is it free of any ❑ Yes ❑ No
cracks, holes,or evidence of leaks,and are drain valves maintained locked shut?
14) Secondary Containment: ff 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 \A ❑Yes ❑ No
(including drums,barrels,etc.)with a capacity of more than 660-ga6ons?
b. Is secondary containment provided for above ground storage containers stored NA❑Yes ❑ 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 N'A❑Yes ❑ No
Superfund Amendments and Reauthorization Act(SARA)water priority
chemicals?
d. Is secondary containment provided forte amount of hazardous substances? ❑Yes ❑ No
e.Are release valves on all secondary containment structures locked? NA ❑Yes ❑ No
Page 3 of 5
SWU-NE-110607 Last revised t 1106.'07

NCGNEOOOO No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage,or Disposal Facility? 0 Yes M 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. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑Yes M 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'na
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 Mustrial activities,
or materials from the industrial facility or site identified in this document(except as allowed under 40 CFR 122.2e(g)(2)).
I understand that I am obligated to submit a no exposure certification form once eery 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. µ
Printed Name of Person Signing:
Title: C//�f,_ /' ���1Ci{ir- ---
(Signature of Applicant) (Date Srgned)
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NCGNEOOOD No Exposure Certification
Please note: This application for the No Exposure Exclusion Is subject to approval by the
NCOENR Regional Office prior to issuance. The Regional Office may Inspect your facility for
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() provides that:
Any person who knourincly makes arty false statement,representation,or certification in any application,record,report,plan,or other
doc rnent filed or required to be maintained under this Article or a rule implementing tHs Article;or who knowingly makes a false
statement of a material fact in a ndemaking 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 Gass 2 misdemeanor which may include a fine
not to exceed ten thousand dollars($10,Oto1).
There is currently no fee for a No Exposure Exclusion.
Final Checklist
This application should include the following items:
M This completed application and all supporting documentation.
W 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 DWO Regional Office for our area.
DWO Regional Office Contact Information:
Asheville Office ...... [phone] Nra .R
Fayetteville Office ... [phone] z �}
Mooresville Office ... [phone]
Raleigh Office........ [phone]
Washington Office ...[phone] ,. Ape
Wilmington Office ... [phone] r` fur
Winston-Salem ...... (336)771 500D F,z Yyll'
Central Office.........[phone]
MVi gron
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