NCGNE0839_COMPLETE FILE - HISTORICAL_20120229

f
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /V u&yllEUp,� 9
DOC TYPE CAI HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ �(�lo a�
YYYYMMDD

i
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NC®ENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
February 29, 2012
Mr. Brent Yates
Gotico Furniture and Accents, Inc.
2400 Shore Street
High Point, NC 27263
Subject: No-Exposure Certification NCGNE0839
Gotico Furniture and Accents, Inc.
2400 Shore Street, High Point
Randolph County
Dear Mr. Yates:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater
Permitting application. Based on your submittal of a signed certification of no exposure at the above referenced
facility, and on an inspection by Jenny Graznak of the Winston-Salem Regional office on February 8, 2012, the
Division is granting your 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 your no-exposure certification, you are obligated to maintain no-exposure
conditions at your facility. If conditions change such that your facility no longer qualifies for no-exposure exclusion,
you are obligated to immediately obtain NPDES permit coverage for your stormwater discharges. Otherwise, the
discharges becomes subject to enforcement as un-permitted discharges. You must self re-certify annually using the
included form, or obtain NPDES permit coverage for any stormwater discharges from your facility. The annual self
re-certification does not need to be submitted to DWQ, unless requested.
Your conditional exclusion from permitting does not affect your facilities' 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 Jenny Graznak at [phone], or at
jenny.graznak@ncdenr.g_ov.
Sincerely,
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: WSRO files
Stormwater_Permitting Unit: No-Exposure File
North Carolina Division of Water Quality,Wir;ston-Saiem Regional Once
Location:585 Waughtown St.Winston-Salem,North Carolina 27107 One
Phone:[phone] t FAX:[phone] Customer Service:1-877-623-6748 NorthCarolina
intemet:www.ncwaterquality.org Naturally
ly
An Equal Opportunity l Affirmative Action Employer f�y i t`

! K
Compliance Inspection Report
Permit: NCGNE0839 Effective: Expiration: Owner: Gotico Furniture and Accents Inc
SOC: Effective: Expiration: Facility: Gotico Furniture and Accents
County: Randolph 2400 Shore St
Region: Winston-Salem
High Point NC 27263
Contact Person: Brent Yates Title: Phone: [phone]
Directions to Facility:
Fairfield Rd, turn left on Shore St,come to4-way stop,Bldg on the right
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 02/08/2012 Entry Time: 09:00 AM Exit Time: 10:30 AM
Primary Inspector: Jennifer Graznak Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge,No Exposure Certificate
Facility Status: ® Compliant n Not Compliant
Question Areas:
in Miscellaneous Questions ®Misc
(See attachment summary)
Page: 1

r 4
Permit: NCGNE0839 Owner-Facility: Gotico Furniture and Accents Inc
Inspection Hate: 02/05/2012 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Jenny Graznak visited this site on February S, 2012. Gotico Furniture &Accents occupies a portion of the building
formerly occupied by US Furniture Industries. According to their SIC Code of 2511, they are required to have a NPDES
Stormwater Permit for Furniture. However, Gotico does not have any storage or manufacturing outside the building at all.
The building is owned by IV-S Metal Stamping, which does have some outdoor storage and needs to apply for a NPDES
Stormwater Permit for Metal. Gotico, on the other hand,,definitely has No Exposure status, as they do not even have a
dumpster outside.
Mlisc Yes No NA NE
Is the facility compliant? ® n n n
Comment:
i
i
I
Page: 2

FOR AGENCY UH ONLY
Date Received
A
Division of Water Quality/Surface Water Protection
Year Month
on[h Day
N `�E�� National Pollutant Discharge Elimination System Ceri5CLt!ofCovenge
`�' NO EXPOSURE CERTTFiCATION for Exclusion C G :v E "LVL' ,p
'N"lilN r..r.�_`Lw.w C�"NTnLf.�.•
rnvw:,Nr:.r sxn Nw�.+.0_l7r rar.y t�.C.tit?pt.Qf�.N R
NCGNE0000 ut
iEB 2 3 2012
NO EXPOSURE CERTIFICATION Winston-Salem
Regional Office
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit 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, DWQ 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
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 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 c }-r e r_ FU Y--►,O.+iJ Ire-. Q)ndL' _ _ a'en+5 --Ln(.. h
Contact + � 1 S J.
Street Address Z400 rho `-tt
City ' 4,` a h P0i of State ZIP Code
Telephone No. y Ys, _�260 Fax: 3:3 _'�5?3--
Email ,�pt-i C'•C,fc.lr nt 'IJre-��J�[�!1 C1n')
Page 1 of 7
i" L l tT t J i.f
SWU-NE-1MugKi0 1 {��� t�`�' �i [''lt�wii`' R
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NCGNEOOf]0 No Exposure Certification
2) Location of facility producing discharge:
Facility Name C f to Qrnt-4-am ctrid Reej2-n+s -
Facility Contact _C n t i� -
Facility Street Address ;� o t
City P i State _ZIP Code;27,3(, 3 _
County
Telephone No. Fax: �X C 1
Email 'ci f jr n i, il.r G C ,-I .LcW)
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). 1 Ct ir-f?'e IC c,(gc�40rn te-f-7+o rN�$'h cvy
r
(A copy of a reap wA the facility clearly I ated on it shout be included with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes p-No
5) Is this a Federal facility? ❑Yes E5"No
6) Latitude 3S 1l4b_6 7 Longitude- YD:UU 5ir7 (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
2,Existing Date operation began C'd
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes ❑ No Lki► knc L&n
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 _E !�� U0 JAIC.S}
10) Provide a brief description of the types of industrial activities and products produced at this facility:
irai��dnd 11.)a elt.ea 4
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
OINo
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility:
Page 2 of 7
SWU-NE-12Aug2010

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 19-No
residuals from using, storing or cleaning industrial machinery or equipment remain
and are exposed to stormwater
b. Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑ Yes Q—No
c. Materials or products from past industrial activity ❑ Yes 0,No
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes D"�G
e. Materials or products during loading/unloading or transporting activities ❑ Yes 131No
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes 2 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 f?'No
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g.,dumpsters]) Ij Yes D'No
j. Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes O'No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes E�KN_o
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 0 Yes 93'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 Z"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 ON o CIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No 2"'N/A
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-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 -NIA
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 C IA
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 Superfurd ❑ Yes ❑ No "/A
Amendments and Reauthorization Act (SARA)water priority chemicals'?
d. Is secondary containment provided for hazardous substances—designated in 40 ❑ Yes ❑ No 2r-kIA
CFR §116?
e. Are release valves on all secondary containment structures locked? ❑ Yes ❑-No 2'�1A
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes i�o
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes 2r, o
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes C+ Flo
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 1 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 ill 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-12Aug2010

r
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 t-No
b. Does your facility have coal piles on site? ❑ Yes 12-No
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes 2-No
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity(e.g., r�'Yes I) No
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? Q-1 s ❑ No ❑ NIA
Please specify: ()! 1;
,N
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5 of 7
SW U-NE-1 2Aug2010

NCGN>=0000 No Exposure Certification
17) Certification:
I certify under penalty of law that I have read and understand the e4igibility 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 annually self re-certify No Exposure and,if requested,submit the re-certification to
DWQ or the operator of the local municipal separate storm sewer system (MS4)into which the facility discharges(where
applicable). I understand that l must allow the North Carolina Division of Water Quality,or MS4 operator where the
discharge is into the local MS4,to performs 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 discharee 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.
l 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 Name of Person Signing: r,l '`E TA-�—FS
Title:
(Signature , ppI! ant) (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 13(i) provides that:
Any person who knowingly makes any false statement,representation,or certification in any application,record,report,plan,or other
document filed or required to be maintained under this Article or a rule implementing this Article;or who knowingly makes a false
statement of a material fact in a rulemaking proceeding or contested case under this Article;or who falsifies,tampers with,or knowingly
renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
[Environmental Management)Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine
not to exceed ten thousand dollars($10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SWU-N'E-12Aug2010

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P.E. Dee Freeman
Governor Director Secretary
February 29, 2012
Mr. Brent Yates
Gotico Furniture and Accents, Inc.
2400 Shore Street
High Point, INC 27263
Subject: No-Exposure Certification NCGNE0839
Gotico Furniture and Accents, Inc.
2400 Shore Street, High Point
Randolph County
Dear Mr. Yates:
The Division has reviewed your submittal of the No-Exposure Certification for Exclusion from NPDES Stormwater
Permitting application. Based on your submittal of a signed certification of no exposure at the above referenced
facility, and on an inspection by Jenny Graznak of the Winston-Salem Regional office on February 8, 2012, the
Division is granting your 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 your no-exposure certification, you are obligated to maintain no-exposure
conditions at your facility. If conditions change such that your facility no longer qualifies for no-exposure exclusion,
you are obligated to immediately obtain NPDES permit coverage for your stormwater discharges. Otherwise, the
discharges becomes subject to enforcement as un-permitted discharges. You must self re-certify annually using the
included form, or obtain NPDES permit coverage for any stormwater discharges from your facility. The annual self
re-certification does not need to be submitted to DWQ, unless requested.
Your conditional exclusion from permitting does not affect your facilities' 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 Jenny Graznak at [phone], or at
ienny.graznak(d)_ncdenr.gov.
Sincerely,
W. Corey Basinger
Surface Water Regional Supervisor
Winston-Salem Regional Office
Division of Water Quality
cc: WSRO files
Stormwater Permitting Unit: No-Exposure File
North Carolina division of Water Quality,Winston-Salem Regional Office
Location:585 Waughtown St.Winston-Salem,North Carolina 27107 One
Phone:[phone] FAX:[phone] Customer Service:1-877-623-6748 NorthCarolina
Internet:www.ncwaterquality.org vVahtrallty
An Equal Opportunity V Affirmative Action Employer

Compliance Inspection Report
Permit: NCGNE0839 Effective: Expiration: Owner: Gotico Furniture and Accents Inc
SOC: Effective: Expiration: Facility: Gotico Furniture and Accents
County: Randolph 2400 Shore St
Region: Winston-Salem
High Point NC 27263
Contact Person: Brent Yates Title: Phone: [phone]
Directions to Facility:
Fairfield Rd,turn left on Shore St,come to4-way stop, bldg on the right
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On-Site Representative(s):
Related Permits:
Inspection Date: 02/08/2012 Entry Time: 09:00 AM Exit Time: 10:30 AM
Primary Inspector: Jennifer F Graznak Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Stormwater Discharge, No Exposure Certificate
Facility Status: ® Compliant Q Not Compliant
Question Areas:
®Miscellaneous Questions ®Misc
(See attachment summary)
Page: 1

i
Permit: NCGNE0839 Owner-Facility: Gotico Furniture and Accents Inc
Inspection Date: 02/08/2012 Inspection Type: Compliance Evaluation Reason for Visit: Routine
r
Inspection Summary:
Jenny Graznak visited this site on February 8, 2012. Gotico Furniture &Accents occupies a portion of the building
formerly occupied by US Furniture Industries. According to their SIC Code of 2511, they are required to have a NPDES
Stormwater Permit for Furniture. However, Gotico does not have any storage or manufacturing outside the building at all.
The building is owned by IV-S Metal Stamping, which does have some outdoor storage and needs to apply for a NPDES
Stormwater Permit for Metal. Gotico, on the other hand,.definitely has No Exposure status, as they do not even have a
dumpster outside.
Misc Yes No NA NE
Is the facility compliant? e n n n
Comment:
Page: 2

Mickey, Mike
From: Brent @ Gotico [[e-mail])
Sent: Friday, February 24, 2012 3:46 PM
To: Mickey, Mike
Subject: Re: No Exposure Certification
According to our accountant; the IRS is now using a NA1CS code for the taxes that is # 337122. According to
the website you gave me the link to, the OSHA 4 is 2511.
Brent
On Fri; Feb 24, 2012 at 2:23 PM, Mickey, Mike <[e-mail]> wrote:
Let me check w/Jenny next week and then I will be back in touch,
If you hear back on the SIC please let me know.
Good luck with the dentist. Mike.
----------------------------------------------------------------------------
Mike Mickey
Mike.MickeyPNCIDENR.goy
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: Brent @ Gotico [mailto:goticofurniture(a)gmail.com]
Sent: Friday, February 24, 2012 2:17 PM
t

To: Mickey, Mike
Subject: Re: No Exposure Certification
Mike:
I am not sure if I am going to be available this week. I am going to have to have a dental procedure done and I
do not know exactly which day yet. If you give me an exact time, I will try to be available. I have called the
accountant about the SIC #. She is the one who provided it to us so we will find out why it is wrong.
As for an inspection, we were already inspected by Jenny Graznak. She is one who provided the paperwork for
the No Exposure Certificate. She said the certificate would really apply to the owners of the building who run
the larger of the 2 businesses at this location and have all of the outside dumpsters etc. They are IV-S Metal
Stamping: You may want to contact them to see if you can handle both of us at the same time.
Thanks,
Brent Yates
On Fri. Feb 24, 2012 at 1:29 PM, Mickey. Mike <[e-mail]> wrote:
Hi Brent—Gotico's no exposure request was forwarded to me. We are required to perform a site visit prior to
issuance. I will be in the High Point area next Tuesday and Wednesday. Do you have a time available after
10:00 am on either day?
Also, the SIC code listed on your application (3700) is for motor vehicle, aircraft and guided missile
manufacture. Typically, the first two digits of a SIC code for the furniture industry starts with 25. Could you
recheck the number?
The following site might help. http://www.osha.gov/pls/imis/sicsearch.html
Thanks, Mike.
----------------------------------------------------------------------------
2

FOR AGENCY USE ONLY
Date Received
A70a D1V1510n Of Water Quality/Surface Water Protection Year Mon[h Day
NCDENRNational Pollutant Discharge Elimination System Cea ticateoYCovera¢e
NO EXPOSURE CERTIFICATION for Exclusion C A-
wkin:...�.,,,Gex.nr.E+r�. �., � D
N.C.Dept.of!±N R
�=cG`Eoaoo FEB Z 3 2012
NO EXPOSURE CERTIFICATION Winston-Salem
Regional Office
National Pollutant Discharge Elimination System application for exclusion from a Stormwater Permit 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, DWQ 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 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 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 (_fin--l-er 'Fur-rn[= t_ M Qrtc ('.Pon4_5 TnL,.
Contact + 5 J•
Street Address -- 00_�hal-�
City " oir) StateA_C� ZIP Code �,27.763
Telephone No. IF_b~5300 Fax: 3 3(a _ $S'3- ,?Y-D 1
Email ;�-c,+ i CofurnrfUr-0,3ma►7 ,wrr)
Page 1 of 7 FEB 2 4 2012
DENR-WATER QUALITY
5wU-NE i 2Aug2o i o �L EN AND STORE)WATER WANCH

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge: ,{
Facility Name [ter i f (�fll�=(�LIYG (In �C'C-rrt6 _
Facility Contact +
Facility Street Address �;?4o0 `shot Sfr
City State. ALC, ZIP Code 7,96.3
County
Telephone No. Fax:
0 I
Email C�d}�`r,� �-r1r n t t.0 r ,_ .covo
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). le_C+U r-, Sh ors
`
(A copy of a map w the facility clearly b8aited on it shout be included with the certification application.)
4) Is the facility located on Native American Lands?❑ Yes L;-No
5) Is this a Federal facility? ❑ Yes ET'N-o
6) Latitude 3S j1j:j67 Longitude-- LO,0,05117 (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 _111(4� oi�ODS �T
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes ❑ No unknown
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 s1G -.:: 2-
SIC Code: QQ CIU Al LS�
10) Provide a brief description of the types of industrial activities and products produced at this facility:
i Je f o i 5h 4y' rn r�u re- ci n d-,a av-'ek.o a 14 46r U unm o r e tkk( cul d
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
R(No
❑ Yes
It yes, list the permit numbers for all current Non-Discharge permits for this facility:
Page 2 of 7
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NCGNEa000 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, staring, 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 [II,-No
c. Materials or products from past industrial activity ❑ Yes lii'No
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes >Yl1D
e. Materials or products during loading/unloading or transporting activities ❑ Yes YIN'o
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes 2-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 I;'No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes I'No
the discharger
i. Waste material (except waste in covered, non-leaking containers [e.g., dumpsters]) ❑ Yes D'No
j. Application or disposal of process wastewater (unless otherwise permitted) • ❑ Yes P"No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes 2/—No
otherwise regulated (i.e., under an air quality control permit) and evident in the
stormwater outflow
I. Empty containers that previously contained materials that are not properly stored © Yes ®'No
(Le., 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 eNo
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 2</A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs?- If so, is it free of any ❑ Yes © No eNIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
SWU-NE-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 2-N/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 C+1'9/A
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 ❑ Yes ❑ No P4A
Amendments and Reauthorization Act (SARA) water priority chemicals`?
d. Is secondary containment provided for hazardous substances*designated in 40 ❑ Yes ❑ No 2-NIA
CFR §116?
e. Are release valves on all secondary containment structures locked? ❑ Yes © No "/A
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes Imo
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste ❑ Yes 2"N—o
generated per month) of hazardous waste?
c. is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes CKo
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 1 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
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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. FeNo
b. Does your facility have coal piles on site? ❑ Yes 0-Ho
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑.Yes ONo
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity(e.g., fires ❑ No
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: Zrara,`: Qre ��✓)i`�`l1`Y1r-,
e. If you answered yes to d., are those emissions permitted by an Air Duality Permit? tomes ❑ No ❑ NIA
Please specify: A_r►nl AL 05 3 L R-L f
f. Please list any other environmental program permits (federal, state, etc.) not f
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5 of 7
SWu-NE-12Aug2010

NCGNE0000 No Exposure Certification
17) Certification:
I certify under penalty of iaw 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 122.2E(g)(2)).
I understand that I am obligated to annually self re-certify No Exposure and, if requested, submit the re-certification to
DWQ 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.
certify that I am familiar with the information contained in this application and that to the best of my knowledge and belief
such information is true,complete,and accurate. �y �/r1
Printed Name of Person Signing: 1�1-- - A. T�1IT5
Title:
(Signature , ppli ant) (Dale 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 fins
not to exceed ten thousand dollars($10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
5WU-NE-12Aug2010

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
❑ This completed application and all supporting documentation. _
❑ A map with the location of the facility clearly marked.
I3 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 DWQ Regional Office for your area.
DWQ Regional Office Contact Information:
Asheville Office ...... [phone] +- .win ols 4't
Fayetteville Office ... [phone] `
Mooresville Office ... [phone]
Raleigh Office ........ [phone]
Washington Office ...[phone]
Wilmington Office ... [phone] .. .
Winston-Salem ...... [phone]
Central Office .........[phone]jx
ngton
Page 7 of 7
SWU-NE-12Aug2010

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