NCGNE0633_COMPLETE FILE - HISTORICAL_20170419

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /V U& NED
DOC TYPE VHISTORICAL FILE
D MONITORING REPORTS
DOC DATE ❑ �{
YYYYMMDD

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
Energy,Mineral& April 19, 2017 TRACY DAVIS
Land Resources Director
ENVIRONMENTAL QUALITY
Mr. Michael J. Burns
Energizer Manufacturing, Inc.
800 Albemarle Road
Asheboro, N.C. 27203
Subject: Name/Ownership Change Request
No Exposure Certification NCGNE0633
Energizer Manufacturing, Inc.
Formerly Energizer Battery
Manufacturing, Inc.
Randolph County
Dear Mr. Burns:
The Division has reviewed your submittal of the permit name/ownership change form for the
subject No-Exposure Certification. Division personnel have reviewed and approved your
request to transfer the exclusion from NPDES stormwater permitting requirements.
Please note that by our original acceptance of the No-Exposure Certification and by our
approval of your request to transfer it, you are obligated to maintain no-exposure conditions
at your facility. If conditions change such that your facility can no longer qualify for the 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.
Annual re-certification is required, and we have enclosed one blank Annual No Exposure
Exclusion Self Re-Certification form for your use. Your certification of no exposure does
not affect your facility's legal requirements to obtain environmental permits that may be
required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sincerely,
Original Signed by
Richard L. Riddle, Jr.
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land
cc: Winston-Salem Regional Office
('Storm a er Permuting Progra�
Nothing Compares_-,-__�
State of North Carolina I Environmental Quality I Energy,Mineral and Land Resources
512 N.Salisbury Street 1 1612 Mail Service Center ( Raleigh.North Carolina 27699-1612
919 707 9200

Energizer Battery Manufacturing,Inc.
419 Art Bryan Drive
Asheboro,N.C.27203
March 15, 2017
NCDEQ
Stormwater Permitting Program
Raleigh, NC 27699-1612 *P
10
Subject. Permit Name/Owndership Change
To Whom it May Concern.-
Attached is a completed Permit Name/Ownership Change form, which is being submitted due to
the name change. The company name of Certificate of Coverage NCGNE0633, has changed
from Energizer Battery Manufacturing, Inc. to Energizer Manufacturing, Inc.. I am submitting
this form to formalize the name change of the Enerizer facility located at 800 Albemarle Road,
Asheboro, NC.
If you have any questions, please call Scott Boyle, the Environmental Coordinator for
Energizer's Asheboro facilities, at 336/672-4546.
Very truly yours,
40(V
Scott Boyle
Staff Environmental Coordinator

A17. Division of Energy, Mineral & Land Resources FOR AGENCY USE ONLY
Date Received
Land Quality Section/Stormwater Permitting Year Month Day
NCDENRNational Pollutant Discharge Elimination System ` '
NOan-i C6R°IJNL DETER*�EMi O�
EwvinOwrAErrt ui°N4rVVL FESWR«, PERMIT NAME/OWNERSHIP CHANGE FORM Mqp� �o
o:
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage�F'�A �Q;/T�
N C S O N C G N E 1 0 1 6 1 3 3
I I. Permit status prior to requested change.
a. Permit issued to (company name): Energizer Battery Manufacturing, Inc
b. Person legally responsible for permit: Michael J Burns
First M 1 Last
Plant Manager
Title
800 Albemarle Road
Permit Holder Mailing Address
Asheboro NC 27203
City , State Zip
[phone] ( }
Phone Fax
c. Facility name (discharge): Energizer Battery Manufacturing, Inc Plant
d. Facility address: 800 Albemarle Road
Address
Asheboro NC 27203
City State Zip
e. Facility contact person: Scott V Boyle [phone]
First l M1 / Last Phone
Ill. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
® Name change of the facility or owner
If olher please explain:
b. Permit issued to (company name): Energizer Manufacturing, Inc
c. Person legally responsible for permit: Michael J Burns
First M l Last
Plant Manager LLW
Title
800 Albemarle Road
Permit Holder Mailing Address
Asheboro NC 27203
City State Zip
(336 ) 672-3500 MichaeU.Burns ,Energizer.com
Phone E-mail Address w
d. Facility name(discharge): Energizer Manufacturing, Inc Plant I
e. Facility address: 800 Albemarle Road
Address
Asheboro NC 27203
City State Gip
f. Facility contact person: Scott V Bo le
First M1 Last
[phone] ScottV.Boye a,Energizer.com
Phone E-mail Address
Revised Jan.27.2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
• IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: Scott V Boyle
First MI Last
Staff Environmental Coordinator
Title
419 Art Bryan Drive
Mailing Address
Asheboro NC 27203
City State "Lip
[phone] [e-mail]
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
V1. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change. .
........................................................................................................I.......
.....
The certifications below must be completed and signed by both the permit holder prior to the chan�.�e, and
the new applicant in the case of an ownership change request. For a name change request,the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature Date
APPLICANT CERTIFICATION
I. Michael Burns, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
`�w d3. 1 y. �Lo 17
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan.27,2014

4 �
Energizer Keep Cha//Pngln�
Keep C"OWI q
HOUSeha/d Products
Septemeber 2, 2015 RECEIVED
Laura Alexander
SEP 2 9 2015
Administrative Assistant DENR-LAND QUALITY
Stormwater Permitting 8TOR VATER PERMf7,7-ftir,
NCDENR
1612 Mail Service Center
Raleigh, NC 27699
RE: Energizer Manufacturing, Inc. (formerly Energizer Battery Manufacturing, Inc.) '
800 Albemarle Road Asheboro, NC 27203
NPDES No Exposure Exclusion No NCGNE0633
Dear Ms. Alexander:
This is to advise you that the name of our facility will be changing from Energizer
Battery Manufacturing, Inc. to Energizer Manufacturing, Inc., effective July 1, 2015. The
parent company continues to be Energizer Holdings, Inc. with it's headquarters located
in St. Louis, MO. There will be no change in the above-referenced facility's production
processes, raw materials, or operations.
Additionally, there has been a change in the Authorized Contact. The Authorized
Contact is now LaVerne Roberts, Plant Manager.
Should you need further information regarding this name change, please contact (Scott
Boyle, 336-672-4546).
Best regards,
_7),4,V ,f j
LaVerne Roberts
Facility Manager

Division of Energy, Mineral & Land Resources FOR AGE�Rer_ejved
i DatLand Quality Section/Stormwater Permitting Year
National Pollutant Discharge Elimination System
NCDENR
N.-C _D- E -
��R°�M�� -DNS-R�.°_ PERMIT NAME/OWNERSHIP CHANGE FORM
L Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N G S OT7
N C G N E 0 6 3 3
1I. Permit status prior to requested change.
a. Permit issued to(company name): Energizer Battery Manufacturing, Inc.
b. Person legally responsible for permit: Laverne A Roberts
First Ml Last
Plant Manager
Title
800 Albemarle Road
Permit Holder Mailing Address
Asheboro_ NC 27203
City State "Zip
(336)672_-3501 { )
Phone - � -- Fax
c. Facility name(discharge): Energizer Battery Manufacturing, Inc.
d. Facility address: 800 Albemarle Road
Address
Asheboro NC 27203
City State Zip
e. Facility contact person: Scott V. Boyle [phone]
First /MI /Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to(company name): Energizer Manufacturing, Inc.
c. Person legally responsible for permit: Laverne A Roberts
First Ml Last
Plant Manager
RC(�EIvE n Title
Gv nn 800 Albemarle Road
SFP 141 4 1.1 Permit Holder Mailing Address
Asheboro NC 27203
City State Zip
STORMVVATERPERMIIT NO
[phone] [e-mail]
Phone E-mail Address
d. Facility name (discharge): _ Energizer Manufacturing, Inc -
e. Facility address: 419 Art Bryan Drie
Address
Asheboro NC 27203
City State Zip
f. Facility contact person: Scott V Boyle
First Ml Last
{336 ) 672-4546 [e-mail]
Energizer.com
Phone E-mail Address
Revised Jan.27,2014

,Y.
NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
i
Page 2of2
IV, Permit contact information (if different from the person legally responsible for the permit)
Permit contact: Scott V Boyle
First M l Last
Staff Environmental Coordinator
Title
419 Art Bryan Drive
Mailing Address
Asheboro NC 27203
City State Zip
[phone] [e-mail]
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature Date
APPLICANT CERTIFICATION
attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
9—Ile-/ �
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan.27,2014

i'Av
HCDENR Q
North Carolina Department of Environment and Natural Resources \\
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins J,De n
Governor Director o FA tit"
September 15, 2009 ' '
Mr. Tom Bendl, Plant Manager
Energizer Battery Manufacturing, Inc.
800 Albemarle Road
Asheboro, NC 27203
Subject: No-Exposure Certification NCGNE0633
Energizer Battery— Plant#1
800 Albemarle Road, Asheboro, NC
Randolph County
Dear Mr. Bendl:
On September 14, 2009, Mike Mickey of this office toured the above facility with Scott Boyle, Environmental
Coordinator for Energizer Battery. The site visit was prompted by your submittal of a No-Exposure Certification
form requesting exclusion from the NPDES Stormwater Permitting requirements. Based on the inspection and
receipt of the signed certification of no exposure for the Energizer Battery-Plant #1, 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 the 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 (September 15, 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 Mike Mickey of the Winston-Salem Regional
Office at(336) 771-5000.
Sincerely,
for Coleen H. Sullins
cc: Winston-Salem Regional Office
Stormwater Permitting Unit, No-Exposure Files
Wetlands and Stormwater Branch -one
1617 Mail Service Center,Raleigh,North Carolina 27699.1617 -one
Location:512 N.Salisbury St.Raleigh,North Carolina 27604 N�r��
Phone:[phone] FAX 91M07-64941 Customer Service.1-877-623-6748 �atuL `
Internet:www.ncwaterquatity.org
An Equal Opportunity 1 Affirmative Action Employer

r
RCDENK
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Governor Director Secretary
September 15, 2009
Mr. Tom Bendl, Plant Manager
Energizer Battery Manufacturing, Inc.
800 Albemarle Road
Asheboro, NC 27203
Subject: No-Exposure Certification NCGNE0633
Energizer Battery — Plant#1
800 Albemarle Road, Asheboro, NC
Randolph County
Dear Mr. Bendl:
On September 14, 2009, Mike Mickey of this office toured the above facility with Scott Boyle, Environmental
Coordinator for Energizer Battery. The site visit was prompted by your submittal of a No-Exposure Certification
form requesting exclusion from the NPDES Stormwater Permitting requirements. Based on the inspection and
receipt of the signed certification of no exposure for the Energizer Battery-Plant #1, 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 the 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 (September 15, 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 Mike Mickey of the Winston-Salem Regional
Office at(336) 771-5000.
Sincerely,
for Coleen H. Sullins
cc: Winston-Salem Regional Office
Stormwater Permitting Unit, No-Exposure Files
Wetlands and Stormwater Branch One
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 NorthCarofina
Location:512 N.Salisbury St.Raleigh,North Carolina �lttllra!!l�
Phone:[phone]-fi30p 1 FAX:919�07-64941 Customerr Service:1-877�23-6748
Internet:www.ncwaterquality,org
An Equal Opportunity S Affirmative Action Employer

FOR AGENCY USE ONLY
awl if Dale Rcrcircd
Division of Water Quality/Sur1':uc Water Protection Year Moan Da>.
���E�R National Pollutant Discharge Elimination System CuiificatcMCavcragc
v:�rti G� na r;cwrzMe*.a NO EXPOSURE CERTIFICATION for Exclusion Y r Fr
FiNfIOVNr,Ir+U+n N 11d14.r�"]Qi.��
NCGNE0000
NO EXPOSURE CERTIFICATION Please.check.fiere if this is a renewal:;q FtENE►NAL
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit based
on NO EXPOSURE: W�
Submission of this No Exposure Certification constitutes notification that your facility does not req i?a
permit for stormwater discharges associated with industrial activity in the State of North Carolina be e
it qualifies for a no exposure exclusion. A condition of no exposure at an industrial facility means al C n
industrial materials and activities are protected by a storm resistant shelter(with some exceptions) t
prevent exposure to rain, snow, snowmelt, and/or runoff.
en
For permitted facilities in North Carolina, DWQ must approve your application for No
Exposure Certification before this exclusion is effective. Until you are issued a No g r[��1
Exposure Certification and your NPDES permit is rescinded, your facility must contin `� u"'�`
to abide by the terms and conditions of the current permit.
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
storm water discharges(e.g., rock salt).
A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion. In
addition, the exclusion from NPDES permitting is available on a facility-wide basis only—not for individual
outfalls. If any industrial activities or materials are, or will be, exposed to precipitation, the facility is not
eligible for the no exposure exclusion. By signing and submitting this No Exposure Certification form, you
certify that a condition of no exposure exists at this facility or site and are obligated to comply with the
terms and conditions of 40 CFR 122.26(g).
You are required to reapply for the No Exposure Exclusion once every five (5) years.
For questions,please contact the DWQ Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of owner/operator(address to which all certification correspondence will be mailed):
Name Energy, ner Ca++vry !" &Ajk-TWC_ 'ur;nv .Inc .
Contact M }7 d o = c� C% MUIWI:�
Street Address Ono Albemax t
City A66 elooro State G ZIP Code Z T Z 03
Telephone No. 336 (672 - 3501 Fax: :�:3 $q (O-7 2-3 G 19
RPCE:fV�O
N.C.Pepx.of HNR
Page t of 7 SEP 0 3
Win -Safe r. Last revised 2/13i2009
SW U-iVE-021309 Regional Office

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name EAeL-a+ ;��P_e- -Z&-t M&Au-Yac%jr'l 1 TAr,�_,__
Facility Contact To
Street Address b
City b r0 State G ZIP Code Z-4 & 3
County 0 I rb
Telephone No. Fax: _ 33 2 -35a
3) Physical location information:
Please provide a narrative description of how to get to the facility(use street names, st to road umbers and
distance and di ect'son from a roadway,intersec'ion)
ar a-�e . ~� 3 US zzo zf
Ch L e : n S- b r e nr: Ao S+ e
(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 t1O1qo
5) Is this a Federal facility? ❑ Yes E14o
o
6) Latitude 35 a 41' 2911
Longit � `4 ude- 1' +,32 (deg., min., seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin j j
M' Existing Date operation began :7l)2-
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes UK' o
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:a
10) Provide brief description of the types of industrial activities and products produced at this facilit
acIVIA- acKS aMa ink /ie.S h4v' f+Wk1e..s TL,eLa A't/
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
5Ko
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
Page 2 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
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 Oeo ❑ NIA
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 M�No ❑ NIA
c. Materials or products from past industrial activity ❑ Yes Z o ❑ NIA
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes grf4o ❑ NIA
e. Materials or products during loadinglunloading or transporting activities ❑ Yes V�10 ❑ NIA
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes W"No ❑ NIA
use [e.g., new cars]where exposure to stormwater does not result in the discharge
of pollutants)
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes Iflo Q NIA
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes Grq�o ❑ NIA
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes la'No ❑ NIA
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes tlVo ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes Imo ❑ NIA
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 ❑ NIA
(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 ❑ NIA
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 ides ❑ No ❑ NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any DKes ❑ No ❑ NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
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 IF"Yes ❑ No ❑ NIA
(including drums, barrels, etc.) with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored ZYes ❑ No ❑ NIA
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for Title III Section 313 Superfund V(es ❑ No ❑ NIA
Amendments and Reauthorization Act (SARA) water-priority chemicals'?
d. Is secondary containment provided for hazardous substances" designated in 40 BeYeS ❑ No Cl NIA
CFR§116?
e, Are release valves on all secondary containment structures locked? a Yes ❑ No 0 NIA
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes IIeNo ❑ NIA
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes IKNo ❑ NIA
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes M'No ❑ NIA
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:
Footnotes to Questions 14) c. & d.
`Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for de minimis amounts of certain substances,
and/or other qualifiers, as described in the exemptions from reporting requirements of Title III SARA 313 in 40 CFR
§372.38.
"Note that amounts below the 660-gallon (single) and 1,320-gallon (combined) bulk storage minimums require
secondary containment. However, some exceptions may be made for amounts less than the Reportable Quantities
of the hazardous substances listed in 40 CFR §117.3.
Page 4 of 7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
16) Other information: If you answer "Yes"to any of the following items, you might not be eligible for the
no exposure exclusion. A more in-depth evaluation of the site circumstances may be required.
a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? 13 Yes UrfJo ❑ NIA
b. Does your facility have coal piles on site? [] Yes ia'No ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes 5KNo ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ❑ Yes 2"Klo ❑ NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity:
e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? ❑ Yes ❑ No CZ /A
Please specify:
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste :
Permits, etc.)
Permit: .�n us�-r�a�l�ser �el'm► �03b, Program: C.Aj(s-1 4skelooro ._T11J5+1ak Pre+t'ea+Me11f �o�raM
Permit: Program:
Permit- Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5 of 7
SWU-NE-021309 Last revised 2A312009

NCGNE0000 No Exposure Certification
17) 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)).
understand that I am obligated to submit a no exposure certification form once every five(5) years to the North Carolina
Division of Water Quality and, if requested, to the operator of the local municipal separate storm sewer system (MS4) into
which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality,or MS4 operator where the discharge is into the local MS4, to perform inspections to confirm the condition of no
exposure and to make such inspection reports publicly available upon request.
In the event that the site no longer qualifies for a No Exposure Exclusion, I understand that I must obtain coverage under
an NPDES permit prior to any point source discharge of stormwater from the facility. Additionally, I certify under penalty of
law that this document and all attachments were prepared under my direction or supervision in accordance with a system
designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the
information,the information submitted is to the best of my knowledge and belief true, accurate and complete. I am aware
that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for
knowing violations.
I certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true, complete, and accurate.
Printed NaUe of Person Signing: kae4,xj
Title: -V I&A cl r`
9(Zo��
(Signature of Applicant) (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR Regional Office prior to issuance. The Regional Office may inspect your facility for
compliance with no exposure conditions prior to that approval. The Regional Office may also
inspect your facility at any time in the future for compliance with the No Exposure Exclusion.
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 Arlicfe;or who knowingly makes a Use
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.
Page 6of7
SWU-NE-021309 Last revised 2/13/2009

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
T'*' This completed application and all supporting documentation.
5K A map with the location of the facility clearly marked.
F] If this is a renewal, indicated current NCGNE number in Question 7.
❑ If the site currently has an NPDES Stormwater Permit, be sure to indicate the permit number in Question 8.
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 your area.
DWO Regional Office Contact Information:
�•� 1 tan
Asheville Office ...... [phone] win Sale
Fayetteville Office ... [phone] fr`' f�'', ' a alciyh
Mooresville Office ... [phone]
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Raleigh Office ........ [phone] , !!� •' r `
40[dSViC , _,
Washington Office ...[phone] ; ,
Wilmington Office ... [phone]
Winston-Salem ...... [phone] r cricw'lio\
Central Office .........[phone] .
Amon
Page 7 of 7
SWU-NE-021309 Last revised 2/1 312 0 0 9

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Directions and maps are informational only.We make no warranties on the accuracy of their content•road conditions or route usability or expeditiousness,You
assume all risk of use,MapQuest and its suppliers shall not be liable to you for any loss or delay resulting from your use of MapQuest.Your use of MapQuest
means you agree to our Terms of_Use.
http://www.mapquest.com/maps?city=Asheboro&state=NC&address=800+Albemarle+Ro... 8/19/2009