NCGNE0776_COMPLETE FILE - HISTORICAL_20141014

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. IV C&N E' dO 0 Co
DOC TYPE Q/HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ �UI� IU Iy
YYYYMMDD

w
• NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
October 9, 2014
Chris Moore
Advanced Technology
6106 West Market Street f�E�E�VED
Greensboro R, NC 27409
Subject: No Exposure Certification NCGNE0776
OCT 14 2014
Advanced Technology CENTRAL FILES
Guilford County DWR SECTION
Dear Mr. Moore:
On October 8, 2014, Aana Taylor-Smith of the Winston-Salem Regional Office of the Division of Energy, Mineral, and
Land Resources (DEMLR) inspected the Advanced Technology site in Greensboro, Guilford County to determine
compliance with No Exposure Certification NCGNE0776 issued on January 17, 2012. DEMLR file review and site
inspection revealed that the site is compliant with the terms and conditions of this certification. Please find a copy of the
completed form entitled "Stormwater Inspection Report" attached to this letter.
Please note that as per your No Exposure Certification, Advanced Technology is obligated to maintain no exposure
conditions at this facility. If conditions change such that the facility no longer qualifies for no exposure exclusion, you are
obligated to immediately obtain NPDES permit coverage for any stormwater discharge. Otherwise, the discharge
becomes subject to enforcement as unpermitted discharge.
As a reminder, Advanced Technology must recertify the no exposure status annually using the NCDENR self-
recertification form. Any"yes" answer would require that you obtain NPDES permit coverage for stormwater discharge
from the facility. The annual self-recertification form does not need to be submitted to DEMLR, unless requested.
` For extra copies of the form, please visit our website at httpil/portal.ncdenr:org/web/Ir/npdes-stormwater#tab-5 or contact
1 the Winston-Salem Regional Office. Please note that this 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 Aana Taylor-Smith or me at [phone].
Sincerely,
Matthew E. Gantt, PE
Regional Engineer
Land Quality Section
Enclosures:
1. Stormwater Inspection Report
CC: Debbie Shoffner(City of Greensboro Stormwater Management Division,via email:[e-mail])
Central Files - DWR
WSRO Files--Land Quality
Division of Energy, Mineral, and Land Resources
Land Quality Section •Winston-Salem Regional Office
585 Waughtown Street, Winston-Salem, NC 27107 - Phone:[phone] FAX: [phone]

• Compliance Inspection Report
Permit: NCGNE0776 Effective: 01/17/12 Expiration: Owner: Advanced Technology
SOC: Effective: Expiration: Facility: 'Advanced Technology
County: Guilford 6106 VV Market 5t
Region: Winston-Salem
Greensboro NC 27400
Contact Person: Chris Moore Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
i
Related Permits:
Inspection Date: 10/0812014 Entry Time: 02:00PM Exit Time: 02:15PM
Primary Inspector: Aana Taylor-Smith Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge,No Exposure Certificate
Facility Status: ® Compliant ❑ Not Compliant
Question Areas:
® Miscellaneous Questions ® Misc
(See attachment summary)
Page: 1

Permit: NCGNE0776 Owner-Facility:Advanced Technology
Inspection Date: 101fl812014 Inspection Type:Compliance Evaluation Reason for visit: Routine
Inspection Summary:
s
Please refer to attached inspection letter
f
I
Page: 2

Permit: NCGNE0776 Owner-Facility:Advanced Technology
Inspection Date: 1010812014 Inspection Type:Compliance Evaluation Reason for Visit: Routine
Misc Yes No NA NE
Is the facility compliant? ® ❑ ❑ ❑
iComment: Site is in compliance with no exposure requirements.
i
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Page: 3

r4
NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory John E. Skvarla, III
Governor Secretary
October 9, 2014
Chris Moore
Advanced Technology
6106 West Market Street
Greensboro, NC 27409
Subject: No Exposure Certification NCGNE0776
Advanced Technology
Guilford County
Dear Mr. Moore:
On October 8, 2014, Aana Taylor-Smith of the Winston-Salem Regional Office of the Division of Energy, Mineral, and
Land Resources (DEMLR) inspected the Advanced Technology site in Greensboro, Guilford County to determine
compliance with No Exposure Certification NCGNE0776 issued on January 17, 2012. DEMLR file review and site
inspection revealed that the site is compliant with the terms and conditions of this certification. Please find a copy of the
completed form entitled "Stormwater Inspection Report"attached to this letter.
Please note that as per your No Exposure Certification, Advanced Technology is obligated to maintain no exposure
conditions at this facility. if conditions change such that the facility no longer qualifies for no exposure exclusion, you are
obligated to immediately obtain NPDES permit coverage for any stormwater discharge. Otherwise, the discharge
becomes subject to enforcement as unpermitted discharge.
As a reminder, Advanced Technology must recertify the no exposure status annually using the NCDENR self-
recertification form. Any"yes" answer would require that you obtain NPDES permit coverage for stormwater discharge
from the facility. The annual self-recertification form does not need to be submitted to DEMLR, unless requested.
For extra copies of the form, please visit our website at http./Mortal.ncdenr:org/web/Ir/npdes-stormwater#tab-5 or contact
the Winston-Salem Regional Office. Please note that this 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 Aana Taylor-Smith or me at(336) 771-5000.
Sincerely,
Matthew E. Gantt, PE
Regional Engineer
Land Quality Section
Enclosures:
1. Stormwater Inspection Report
CC: Debbie Shoffner(City of Greensboro Stormwater Management Division,via email:[e-mail])
Central Files - DWR
WSRO Files—Land Quality
Division of Energy, Mineral, and Land Resources
Land Quality Section •Winston-Salem Regional Office
585 Waughtown Street,Winston-Salem, NC 27107 - Phone: [phone] FAX: [phone]

Compliance Inspection Report
Permit: NCGNE0776 Effective: 01/17112 Expiration: Owner: Advanced Technology
SOC: Effective: Expiration: Facility: Advanced Technology
County: Guilford 6106 W Market St
Region: Winston-Salem
Greensboro NG 27409
Contact Person: Chris Moore Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s)=
On-Site Representative(s):
Related Permits:
Inspection Date: 1010812014 Entry Time: 02:OOPM Exit Time: 02:15PM
Primary Inspector: Aana Taylor-Smith Phone: 33e-771-5000
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: 5tormwater Discharge,No Exposure Certificate
Facility States: ® Compliant Not Compliant
Question Areas:
® Miscellaneous Questions ® Misc
(See attachment summary)
i
I
Page:
i
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permit: NCGNE0776 owner-Facility:Advanced Technology
Inspection Date: 1OIOa12014 inspection Type:Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Please refer to attached inspection letter
Page: 2

Permit: NCGNE0776 Owner-Facility:Advanced Technology
Inspection Date: 1010812014 Inspection Type:Compliance Evaluation Reason for Visit: Routine
Misc Yes No NA NE
Is the facility compliant? ® ❑ ❑ ❑
Comment: Site is in compliance with no exposure requirements.
Page: 3

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, PE Dee Freeman
Governor Director Secretary
January 17, 2012
Mr. Chris Moore, VP of Manufacturing
Advanced Technology, Inc.
6106 W. Market Street
Greensboro,NC 27409
Subject: No-Exposure Certification NCGNE0776
Advanced Technology, Inc.
6106 W. Market Street
Guilford County
Dear Mr. Moore:
The Division has reviewed your submittal of the No-Exposure Certification form requesting Exclusion from
NPDES stormwater Permitting for the Advanced Technology facility on W. Market Street. Based on your submittal
of the signed certification and the site visit conducted by Mike Mickey with this office on January 12, 2012, the
Division is granting the conditional exclusion from permitting as provided for under 40 CFR 122.26(g), which is
incorporated by reference in North Carolina regulations.
Please note that by our acceptance of the no-exposure certification, Advanced Technology is obligated to maintain
no-exposure conditions at this facility. If conditions change such that the facility can no longer qualify for the no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for any storin%vater
discharge. Otherwise, the discharge becomes subject to enforcement as an un-permitted discharge.
Advanced Technology must re-certify the no-exposure status annually using the attached form. Any "Yes" answer
would require that you obtain NPDES permit coverage for stormwater discharges from the facility. The annual self
re-certification does not need to be submitted to DWQ unless requested. Please note that this 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 at(336) 771-5000.
Sincerely,
for Charles Wakild, PE
cc: Winston-Salem Regional Office
David Phlegar, (Water Quality Supervisor,City of Greensboro,Storrnwater Management Division,P.O.Box 3136,Greensboro,NC 27406)
Stormwater Permitting Unit,No-Exposure Files
Central Files
Wetiands and Stormwater Branch One
1617 Mail Service Center,Rafeigh,North Carolina 27699-1617 NorthCarohna
Location:512 9�N.Salisbury St.Raleigh,No�h4941 Carolina 27e4
Phone:[phone] FAX:[phone] Customer Service:1-877� Naturally
23-6748
Internet:www.nmaterquality.org

a
Central Files: APS SWP
01/17/12
Permit Number NCGNE0776 Permit Tracking Slip
Program Category Status Project Type
NPDES SW Active New Project
Permit Type Version Permit Classification
Stormwater Discharge, No Exposure Certificate 1.00 Individual
Primary Reviewer Permit Contact Affiliation
corey.basinger
Coastal SW Rule
Permitted Flow
Facility
Facility Name Major/Minor Region
Advanced Technology Minor Winston-Salem
Location Address County
6106 W Market St Guilford
Greensboro NC 27409 Facility Contact Affiliation
Owner
Owner Name Owner Type
Advanced Technology Non-Government
Owner Affiliation
Chris Moore
6106 W Market St
Dates/Events Greensboro NC 27409
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
01/17/12 04/11/11 01/17/12 01/17/12
Regulated Activities
Plastics&synthetics manufacturing
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin

NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, PE Dee Freeman
Governor Director Secretary
January 17, 2012
Mr. Chris Moore, VP of Manufacturing
Advanced Technology, Inc.
6106 W. Market Street
Greensboro, NC 27409
Subject: No-Exposure Certification NCGNE0776
Advanced Technology, Inc.
6106 W. Market Street
Guilford County
Dear Mr. Moore:
The Division has reviewed your submittal of the No-Exposure Certification form requesting Exclusion from
NPDES stormwater Permitting for the Advanced Technology facility on W. Market Street. Based on your submittal
of the signed certification and the site visit conducted by Mike Mickey with this office on January 12, 2012, the
Division is granting the conditional exclusion from permitting as provided for under 40 CFR 122.26(g), which is
incorporated by reference in North Carolina regulations.
Please note that by our acceptance of the no-exposure certification, Advanced Technology is obligated to maintain
no-exposure conditions at this facility. If conditions change such that the facility can no longer qualify for the no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for any stormwater
discharge. Otherwise,the discharge becomes subject to enforcement as an un-permitted discharge.
Advanced Technology must re-certify the no-exposure status annually using the attached form. Any "Yes" answer
would require that you obtain NPDES permit coverage for stormwater discharges from the facility. The annual self
re-certification does not need to be submitted to DWQ unless requested. Please note that this 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 at(336) 771-5000.
Sincerely,
for Charles Wakild, PE
cc: Winston-Salem Regional Office
David Phlegar, (Water Quality Supervisor,City of Greensboro,Stormwater Management Division,P.O.Box 3136,Greensboro,NC 27406)
Stormwater Permitting Unit,No-Exposure Files
Central Files
Wetlands and Stormwater Branch One
1617 Mail Service Center,Ralei h,North Carolina 27699.1617 Noi thCarolina
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone:[phone] FAX:91M07-64941 Customer Service:1-877.623-6748 ;Vaturally
Internet:www.ncwaterquality.org

Permit: NCGNE0776 Owner-Facility: Advanced Technology
Inspection Date: 0111 2/2 01 2 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
MISC Yes No NA NE
Is the facility compliant? ■ 0 ❑ Q
Comment: No exposure request received 4/15/11. Inspected first time on 5/6/11.
Sent email that day to Chris Moore explaining that the facility did not meet the no
exposure requirements due to the 1) exposed waste plastic material, 2) uncovered
small dumpster, and 3) used pallets stored outside. Contacted Chris numerous times
over the summer and fall to check on status. He finally confirmed on 1/11/12 that they
were ready for reinspect. Visited site 1/12/12 and confirmed that the three issued listed
above had been solved. A new plallet shed had been constructed against the back of
the building, the plastic waste removed and the small dumpster had been placed under
the overhanging roof for the large roll off dumpster. NCGNE to be issued 1/17/12.
Page: 2

Compliance Inspection Report
Permit: NCGNE0776 Effective: Expiration: Owner: Advanced Technology
SOC: Effective: Expiration: Facility: Advanced Technology
County: Guilford 6106 W Market St
Region: Winston-Salem
Greensboro NC 27409
Contact Person: Chris Moore Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
On-site representative Chris Moore Phone: [phone]
Related Permits:
Inspection Date: 01/12/2012 Entry Time: 10:00 AM Exit Time: 10:15 AM
Primary Inspector: Michael M Mickey Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type. Stormwater Discharge, No Exposure Certificate
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
■Miscellaneous Questions 0 Misc
(See attachment summary)
Page: 1

Mickey, Mike
From: Mickey, Mike
Sent: Friday, May 06, 2011 3:13 PM
To: '[e-mail]'
Subject: No Exposure Certification Request
Chris—This email is a follow-up to my site visit today. At this time the Advanced Technology facility does not qualify for
the no exposure exemption from stormwater permitting due to the following items we discussed:
1) The waste plastic material not under roof[See item 12(f) on page 3 of the no exposure checklist submitted].
2) The uncovered small dumpster [see item 12(i) on page 3 of the checklist].
3) The used pallets stored outside [see item 16(a) of page 5 of the checklist].
It is my understanding that you plan correct the issues above. When that occurs we should be able to issue the no
exposure exemption. I'll wait on your call or email to schedule a time to re-inspect.
Thanks, Mike.
----------------------------------------------------------------------------
Mike Mickey
[e-mail]
NC Division of Water Quality
58S Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
FAX: [phone]
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.
i

Mickey, Mike
From: Chris [[e-mail]]
Sent: Wednesday, January 11, 2012 4:44 PM
To: Mickey, Mike
Subject: RE: No Exposure Request
Sure that works
Chris Moore
VP of Manufacturing
6106 West Market St.
Greensboro, NC 27409
[phone] ext. 2221
[phone] fax
httpl/www.advtechnology.com
Innovation in Decorative Laminates
-----Original Message-----
From: Mickey, Mike [ma ilto:[e-mail]]
Sent: Wednesday, January 11, 2012 4:36 PM
To: Chris Moore
Subject: RE: No Exposure Request
Excellent. Will it work for me to stop by at 10:00 tomorrow?
----------------------------------------------------------------------------
Mike Mickey
Mike.Micker►@NCDENR.gov
NC Division of Water Quality
585 Waughtown Street .
Winston-Salem, NC 27107
Phone: [phone]
FAX: [phone]
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.
From: Chris Moore [mailto:[e-mail]]
Sent: Wednesday, January 11, 2012 4:32 PM
i

To: Mickey, Mike
Subject: Re: No Exposure Request
We are ready for you thanks
Sent from my iPhone
On Jan 11, 2012, at 3:42 PM, "Mickey, Mike" <[e-mail]> wrote:
Ni Chris—Just checking to see if the pallet shed is finished yet? Thanks, Mike.
----------------------------------------------------------------------------
Mike Mickey
Mike.Mickcy(a�NCDENR.gov
NC Division of Water Quality
585 Waughtown Street
Winston-Salem, NC 27107
Phone: [phone]
FAX: [phone]
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.
2

Corety &s l[near•-
�,, W-S izv
FOR AGENCY USE ONLY
Date Received
+� Division of Water Quality/Surface Water Protection Year Mo„d, Da
NCDENR National Pollutant Discharge Elimination System Certificate of Coverage
U)-
.k.,,=„C..y, NO EXPOSURE CERTIFICATION for Exclusion RECEIVED
NCGNE0000 N.C.�,�_. .-
APR 15 2011
NO EXPOSURE CERTIFICATION winscan sdF r; [
Regional nPflce
National Pollutant Discharge_Elimination System application for exclusion from a'Stormwater-Perm it.based
on NO EXPOSURE:
Submission of this No Exposure Certification constitutes notification that your facility does not require a
permit for 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.
For permitted facilities in North Carolina, DWO must approve your application for No
Exposure Certification before this exclusion is effective. Until you are issued a No
Exposure Certification and your NPDES permit is rescinded, your facility must continue
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
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 re uired to self re-certify our No Exposure Exclusion Annually.
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 !`� ✓ullC tele-,L1 H 0 �6 d A -,-s moors
Contact
Street Address
City Gv e PK s State �/C, ZIP Code 2.7 5`4!!�
Telephone No. 3 3 'r, Co O S Fax: J? C- fa if. K CJ-7 13
Email /' Mono—e- Vt,-d4njloq� , c0l2"
Page 1 of 7
APR 1 1 2011
SWU-NE-12Aug2010 NR - WATIER
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NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name dIlezz,C''/ C•�-r AO4 j o/
Facility Contact Ci ��s O 0
Farility Street Address ._ •_/O� c S_� !n a.-,� �� '—e c
City ( " State /C ZIP Code 247 O f-7
County u: Pow
Telephone No. 334 CvG K d c Fax: 3 G
Email e?#1 uaA-e 1211 "oKX/ G0GYj
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). rh aE2 _
(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 E'&o
5 Is this a Federal facility? ❑ Yes 95'No�� i-
6 , y
6) Latitude 36 q 33•W f$ Longitude—7y SYf 2 (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
Existing Date operation began O 066
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwatle�r Permit? ❑ Yes "o
If yes, what is the NPDES Permit Number? OX 0 1?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility c� .Jz
SIC Code:3 o U /�,4 c S 6
10) Provide a brief description of the types of industrial activities and products produced at this facility:
74. 47V5_ oA
11) Does this facility have any Non-Discharge permits(ex: recycle permits)?
O No
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
Page 2 of 7
SWU-NE-12Aug2010

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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 VNo
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 t�No
c. Materials or products from past industrial activity ❑ Yes ®'No
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes "o
e. Materials or products during loading/unloading or transporting activities ❑ Yes O"'No
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes E]�_No
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 2/'No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes O No
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes "o
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes a'lo
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes El IVo
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 Erl o
(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 B 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 and piping free of rust, damaged or weathered coating, pits, or ❑ Yes ❑ No E N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No "/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SW U-N E-12Aug2010

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 all single above ground storage ❑ Yes ❑ No ErN/A
containers (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 eN/A
in close proximity to each other with a combined capacity of more than 1,320-
gallons?
c. Is secondary containment provided for Title ill Section 313 Superfund ❑ Yes ❑ No P-IV/A
Amendments and Reauthorization Act(SARA)water priority chemicals'?
d. Is secondary containment provided for hazardous substances'designated in 40 ❑ Yes ❑ No 2- /A
CFR §116?
e. Are release valves on all secondary containment structures locked? ❑ Yes ❑ No FXN/A
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes E3`No
b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste piles ❑ No
generated per month) of hazardous waste?
c. is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑ Yes *-1 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: /04 ^T W,5-� e
How is material stored: D—u m S
Where is material stored:
Now many disposal shipments per year: 7 Vc,ri
Name of transport 1 disposal vendor: pj e
Vendor address: '3 20 K/, hliF't+s a.�, Oa/ o 7 3-6 6,C��-Q
d -79-7'7
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.
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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? ❑ Yes 17/No
b. Does your facility have coal piles on site? ❑ Yes ®'No
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes A
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity(e.g., a r Yes ❑ No
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: a :n f 5,ove-V L.rn -�-
e. If you answered yes to d., are those emissions per)tted by an Air Quality Permit? ❑ Yes 9'No ❑ NIA
Please specify: 0h1 huh 74 5 piac e Cl
f- Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: g 73 Program: 6 P
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
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NCGNE0000 No Exposure Certification
17) Certification:
certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of"no
exposure"and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that there are no discharges of stormwater contaminated by exposure to industrial activities
or materials from the industrial facility or site identified in this document(except as allowed under 40 CFR 12226(g)(2)).
f understand that I am obligated to annually self re-certify No Exposure and, if requested,submit the re-certification to
DWO or 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. V�
Printed Name of Person S gning: (I !� c-S / f d
Title: (/ 0 A //Yt -e 'L w aC 7",-4 • �1
(Signature of Applicant) (D to 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 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 line
not to exceed ten thousand dollars($10,000),
There is currently no fee for a No Exposure Exclusion.
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SWU-NE-12Aug2010

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
of This completed application and all supporting documentation.
.A map with the location of the facility clearly marked.
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
aleigh, 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.
DWQ Regional Office Contact Information:_
Asheville Office ...... [phone] to sale
Fayetteville Office ... [phone] a11sh
Mooresville Office ... [phone] �' "'
Raleigh Office ..... ( } j�� "�;'
.. 919 791 4200
11' " s lie �` v le
Washington Office ...[phone]
Wilmington Office ... [phone] d"
F yottef
Winston-Salem ...... [phone] illo r
Central Office .........[phone] +
�Vv�l ngfon
a
Page 7 of 7
SW U-NE-12Aug2Q14