NCGNE1072_COMPLETE FILE - HISTORICAL_20150520

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. Iv U& N El Uq
DOC TYPE HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE ❑ U��
YYYYMMDD

FOR-AGENCY USE ONLY
°"`Month ed
Division of Ene rgy. Mineral and Land Resources, Y� M�, b .
Land Quality Section
National Pollutant Discharge Elimination System cc,ir�a,tarc�. �
r
NO EXPOSURE CERTIFICATION for Exclusion
Environmenial Quality NCG N E0000
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, DEMLR 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Exposure Certification and.your NPDES permit is rescinded, your facility must continue.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 most be provided for each facifily 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 922.26(g)..
If approved, your conditional No Exposure Exclusion has no expiration date
BUT MUST BE self re-certified at least annually.
Please look for information about re-certification under the No Exposure section on this page:
https:lldeg,nc.gov/abouVdivisions/energy-mint5ral-land-resourceslen_erciy-mineral-land-perm its/stormwater-
permitslnpdes-industrial-sw
For questions,please contact the DEMLR 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 Leviton Manufacturing Company,Inc.
Contact Tim Lockard
Street Address 618 South Jefferson Ave.
City West Jefferson State NC ZIP Code 28694
Telephone No. 336 W-3246 Fax: 336 846-3244
Page 1 of 7
SWU-NCGNE Last revised 9128/2016

FOR AGENCY USE ONLY
a ' ° Division of Energy Mineral and Land Resources nm Re
ceived
, Year �{auh Pa-
. Land Quality Section
NCDENRNational Pollutant Discharge Elimination System c'�rt�� tra:Coverage
NO EXPOSURE,CERTIFICATION for Exclusion
NCGNE00OO
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 Norih 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, DEiVILR trust 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 an 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 922.26(g).
If approved, your conditional no-exposure exclusion must be self re-certified at least,annually.
Please see information here http.L/portal.n2den.r.p /web/lr/n des-stormwater
For questions,please contact the DEMLR Regional Office for your area. (See page 6)
(Please print or type)
1) Mailing address of ownerloperator(address to which all certification correglaondence.will be mailed):
Name Leviton Manufacturing Company, Inc.
Contact Dan Shatley _
Street Address 618 south Jefferson Ave.
City West Jefferson State NG. ZIP Code 28694
Telephone No. 336-646-3246 Pax: -336-846-3244
Page 1 of 7
SVVU-NCGNE Last revised 515/2015

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name Leviton Manufacturing Company Inc.
Facility Contact Bob Tipton CSP
Street Address 818 South-Jef mn-Ave
City West Jefferson State NC ZIP Code 28694
County Ashe
Telephone No. 336-846-4236 _ __ Fax: ,336-846-3244
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). vs-42, -A,"IsfiR�167nis�jumioftornoNCl#oMya�
162iNC-163.0 1 milaa.NC fttmay 1531NC-163lwornas 5 Jefferam AWUS-271 aus PVNC-184.1.7 miss 61 B 8 JEFFERSON AV E a on irm rah
(A copy of a reap with the facility clearly located or it should be included with the certification application.)
4) is the facility located on Native American Lands? 0 Yes allo
5) is this a Federal facility? ❑ Yes IX No
6) Latitude 36396370 �de9•�Longitude $�.4eaoecs min.,seconds)
7) This NPDES No Exposure Exclusion application applies to which of the following:
❑ New cr Proposed Facility Date operation is to begin
EX Existing Date operation began
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes IYNo
If yes,what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Ctassification Code(SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 3 0 8 9
10) Provide a brief description of the types of industrial activities and products produced at this facility:
The facility has (§compression mold presses making plastic wall plates for toggle switches and receptacles
_A number of packaging lines package the product into plastic bags and are shipped.
11) Does this facility have any Non-Discharge permits (ex: recycle permitsl?
9 No
o 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 6124114

NCGNEOOOO No Exposure Certification
2) Location of facility producing discharge:
Facility Name _Leviton Manufacturing Company Inc.
Facility Contact Bob Tipton, CSP
Street Address 518 South JebMgn Avg_
City West Jefferson State NC ZIPCode 28684
County Ashe
Telephone No, 336-846-4236 Fax: 3315-M-3244 .
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). TLrnr�1O1%;eNr,N�A,16SVO.43mle I L&a&2ZoNC Hbhwft
163dNC-163-9 1 miles.NC Highway 1631NC-163 neccrnes 5 delferson A�b1U5-221 Bus hljNC-194-1 7 m*& Ve S JSFFERSON AVE is on the IeR
(A copy of a map with the facility dearly located on it should be included with the certification application.)
4) is the facility located an Native American Lands? ❑ Yes IYNo
6) Is this a Federal facility? ❑ Yes EX No
6) Latitude 3639 UO Longitude s1,4soos6 (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
M Existing Date operation began
1:1 Renewal of existing No Exposure Certification Certification No., NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes (9 No
If yes, what is the NPDES Permit Number?
9) Standard Industrial Classification:
Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary industrial
activity at this facility
SIC Code: 3 0 8 9
10) Provide a brief description of the types of Industrial activities and products produced at this facility:
The facility has @ 40 compression mold presses making plastic wall plates for toggle switches and receptacles
A number of packa-ging lines Rackaae the product into plastic bags and are shipped
11) Does this facility have any Non-Discharge permits (ex: recycle permits)?
9 No
❑ Yes
If yes, list the permit numbers for all current Non-Discharge permits for this facility.-
Page 2 of 7
5WU-NE-021300 Last revised 6/24114

NCGNEOOOO No Exposure Certification
ixposure 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 tX No ❑ 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 Ot No ❑ NIA
c. Materials or products from past industrial activity 0 Yes EX No Ej NIA
d. Material handling equipment(except adequately maintained vehicles) ❑ Yes A No ❑ N/A
e. Materials or products during loading/unloading or transporting activities ❑ Yes lX No ❑ N/A
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ($No ❑ N/A
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 LXNo ❑ N/A
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes [A No ❑ NIA
the discharger
i. Waste material (except waste in covered, non-leaking containers(e.g., dumpsters]) ❑ Yes EX No t] N/A
j.Application or disposal of process wastewater(unless otherwise permitted) ❑ Yes A No ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not G Yes IN No ❑ NIA
otherwise regulated (i.e., under an air quality control permit)and evident in the
stormwater outflow
t. Empty containers that previously contained materials that are not properly stored ❑ Yes EX 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 EX No i❑ NIA
stored outside, has the faculty 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 Q(Yes L No ❑ N/A
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any EX Yes ❑ No ❑ N/A
cracks, holes, or evidence of leaks, and are drain valves.maintained locked shut?
Page 3 of 7
SWU-NE-021309 Last revised 6124114

NCGNE0000 No Exposure Certification
14) Secondary Containment: If you answer"No"to any of the following items, you are mot eligible for the
no exposure exclusion.
a. Is secondary containment provided for single above ground storage containers 9 Yes ❑ No © N/A
(including drums, barrels, etc.)with a capacity of more than 660-gallons?
b. Is secondary containment provided for above ground storage containers stored Ig Yes ❑ No Cl 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 5uperfund ❑ Yes ❑ No ig NIA
Amendments and Reauthorization Act (SARA)water priority chemicals*?
d. Is secondary containment provided or hazardous substances'*designated in 40 ❑ Yes L1 No [XN/A
CFR§116?
e. Are release valves an all secondary containment structures locked? ❑ Yes ❑ No 19 N/A
18) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes MNo C1 NIA
b. Is this facility a Small Quantity Generator(less than 1000 kg. of hazardous waste 9Yes EXNo ❑ NIA
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator(1000 kg. or more of hazardous waste ❑ Yes IX No C) N/A
generated per month) of hazardous waste?
If you answered yes to questions b, or c., please provide the following information:
Type(s)of waste: At one time facility was a Small Quantity Generator, permit needs to be changed to CESQG
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 thatamounts below the 660-gallon (single) and i,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 exemptians from reporting requirements of Title III SARA 313 in 40 CFR
§372.3&
`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 revi3ed 612404

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? 0 Yes LXNo © NIA
b. Does your facility have coal piles on site? © Yes IN No ❑ NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes M No ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity(e.g., ❑ Yes IN No 0 NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: .� w
e. If you answered ye•s to d., are those emissions permitted by an Air Quality Permit? o Yes ❑ No Elf NIA
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: 07463 Program: Air Permit
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Permit: Program:
Page 5 of 7
SWU-NE-021309 Last revised 6124114

NCGNEOOOO No Exposure Certification
17) Cerfiflcat€on:
I certify under penalty of taw that I have read and understand the eligibility requirements for claiming a condition of'no
exposure'and obtaining an exclusion from NPDES stormwater permitting.
I certify under penalty of law that there are no discharges of stormwater contaminated by exposure to Industrial activities
or materials from the industrial facility or site identified in this document(except as allowed under 40 CFR 122.26(g)(2)).
I understand that I am obligated to submit a no exposure certification form once eveafive(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-k1where applicable). I understand that i must allow the North Carolina Division of Water
Quality,or MS4 operator where the discharge Is Into the iocal 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 directfon 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 of personas 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, inducting 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 game of Person Signing:
Title:Envirnarna tal Heath p_n f a�taflPr _ R
May 20,2b15
(Signature of Applicant) (Date Signed)
Please note; This application for the No Exposure Excluslon is subject to approval by the
NCDrFNR 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 compllance with the No Exposure Exclusion.
North Carolina General Statute 143-215.6 B(f) provides that:
Any person who knowingly makes any false statement, representation,or certification in any application,record,report,plan,or ocher
document filed or required to be maintained under this Article or a rule implementing this Artice: or who knowingly makes a false
statement of a material fact in a nrlemaking 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 gutty of a Class 2 misdemeanor which may include a-fine r
not to exceed ten thousand dollars($I O,OM).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SVVU-NE-021309 Last revised 6124JU

NCGNE0000 No Exposure Certification
Final Checklist
This application should include the following items:
Q� This completed application and all supporting documentation_
IX A map with the location of the facility clearly marked.
0 If this is a renewal, indicated current NCGNE number in Question 7.
0 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 Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions,please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information_
cam,. 4
Asheville Office ...... [phone]
Fayetteville Office`..- [phone] -
Mooresville Office ... [phone]
Raleigh Office ........ [phone]
Washington Office ...[phone] = _ '
Wilmington Office ... [phone] _ m
Winston-Salem ...._. [phone]
Central Office .........[phone] :,
Page 7 of 7
SWU-NE-021309 Last revised 6124114

get
_"•1 '�" ',i "^'-",,- /vSi Ff,^fefSC+II
34 1:
,
!AV@
17
C V
c f t
11
All
-
i.
r