NCGNE1689_Application_20240820

August 14,2024
Brittany Coon
North Carolina Department of Environmental Quality
Division of Energy.Mining.and Land Resources t"C E l.,O VE
D
Stormwater Program
1612 Mail Service Center AUG 2® 2024
Raleigh-NC 27699.1612
Re: Delta MoW,Inc. DD44R
9415 Stockport Place
Charlotte, North Carolina Z9273
NPDFS No Exposure Certification
Dear Ms.Cook,
Delta Mold, Inc.(Delta Mold)is submitting the attached National Pollutant Discharge Elimination
System(NPDES) No Exposure Certification for our facility located at 9415 Stockport Place an
Charlotte, North Carolina. Delta Mold manufactures plastic injection molds and operations at the
facility include machining of steel blocia to make refined plastic injection molds as well as using the
molds to perform quality assurance checks to meet customer specifications.
Enclosed is a check payable to the North Carolina Department of Environmental Quality(NCDEQ)
for the$250 No Exposure evaluation fee,a signed No Exposure Certification Forst a site location
map,and the North Carolina Secretary of State 2023 Annual Report.
If you should have any questions or comments pertaining to the report.please do not hesitate to
contact me at(704) 588-6600 or by email at YmnzerkL• lvlt?srJtia
Sincerely.
Eric Mozer, President
Cc Mary Kennamer,PE-ONE Environmental of Carolina,PLLC
Jenny Tang-ONE Environmental of Carolina.PLLC
Joan Hartley,F.qs- Maynard Nexsen
Enclosures: Figure 1 -USGS Site Location Map
NCDEQ DF.MLR NPDES No Exposure Certification Form
NC Secretary of State FY 2023 Annual Report

FOR AGENCY USE ONLY— — RevisedY0/6/2023—
NCGNE 16 D a
Assigned to: T CoDV\
ARO FRO RO RRO WARO WIRO WSRO
Division of Energy,Mineral,and Land Resources
National Pollutant Discharge Elimination System
No Exposure Certification for Exclusion
NCGNEd00D
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,snowmen,
and/or runoff.Industrial materials oractivities include,but are not limited to:
• material handling equipment or activities, • by-products,
• industrial machinery, • final products,or
• raw materials, • waste products
• intermediate products,
Material handling activities include the storage,loading and unloading, transportation,or conveyance of any raw
material,intermediate product,final
A storm resistant shelter is not regdired for industrial materials stored in the following container types, provided
the containers are not deteriorated and do hot IeSk
• drums. •, tanks,�and
• barrel;;° a
-- "•'"simitarcontainers., .
For new facilities;applicants should apply no earlier than 60.days-before the start oll operation-This will allow
DEMLR staff to verify conditions during active operation. For-facilities that already have an industrial stormwater
permit in North Carolina,DEMLR must approve your application for No ExposurGCertidcation before this exclusion
is effective.Until you are issued a No Exposure Certification and your.NPOES p6rmit is rescinded,your facility must
continue to abide by the terms and conditions of the current permit_ '`�
A No Exposure Certification must be provided for each facility quarifying for the no exposure exclusion.Additionally,
the exclusion from NPDES permitting is available on a facility-wide basis only—not for individual outfalk. If any
industrial activities or materials are,orwill be,exposed to precipitation,the fadfity 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 temrs and conditions of 40 CFR 122.26(g).
NC DEQ Stormwater Program requires a one-time S2SO application fee via check made payable to NC DEC),There
is no annual fee once covered under a No Exposure Certification_ if approved, your conditional No Exposure
Certification has no expiration date but-must-be self-recertified at least annually.-Please look for information about
recertification under the No Exposure section on this page: his://dm.ncnov/about/divisions/enLrpv-mineral.
land-resou rces/npdes-no-exoosurm-
Directions: Print or type all entries on this application form. Send the original,signed application to: NCDEMLR
Stormwater Program, 1612 MSC, Raleigh, NC 27699-161L The submission of this form does not guarantee
exclusion from NPDES stormwater permitting- Prior to exclusion from NPDES stormwater permitting a site
inspection will be conducted.
Page i of 5

1. Owner/Operator(to whom all permit correspondence will be mailed):
Name of legal organizational entity: legally responsible person(as signed in Item 7 below):
Delta Mold,Inc. Eric Mazer
Mailing address: City: State Zip Code
9425StotlportPlace Charlotte NC 2SZ73
Telephone number. Email address:
704-588xZ60 emozer@dehamoldcom
Type of Ownership:
Government
❑County ❑Federal ❑Municipal 0State
Non-government
.2 Business(If ownership is business,a copy of NUO report must be Included with this application)
❑Individual
L Industrial Facility(facility requesting exclusion):
faa7itirname: Facility environmental contact:
Delta Meld,Inc Caitlin Yourish
Street address: Telephone number:
9415 Stockport Place 973-224-2812
Email address:
[e-mail] _ -- -- - _-_- --_-_-- - -- - - _
City County:_, _ - �✓state__ - IPCode _
Charlotte Mecidenburg NC _ 'M_73.-
Latitude or entrance: 35'f7'S7.54"N - ''` _ '-j;
Longitude of enlmnce:6�80'577.7rw _•,,� _
Parcel ldentfi6tionNumber(P{N):
20112427;20112428 -
Date operatiorftiegan -" - -" 1 dard Industrial Cass'driaUari jS9 Code: F
1978 3544, `
Brief description of the types of industrial activities and products produced at this facilityyz:" -'
Machining steel to create plastic Infection molds
3. Consultant(if applicable):
Name of consultant: Consulting firm:
Mary Kennamer,PE ONE Environmental Group of Carolina,PLLC
Street address: City: State and zip code:
1431 West Morehead Street Charlotte NC28208
Telephone number: Email address:
SIZ-417-1837 I mkennamer@oneemccom
4. Exposure Cheddists
Are anyof the following materialsor activities exposed to precipitation,now or in the foreseeable future?If you
-_ answer"Yes'to any of these.items,-you are not eligible for the no exposure exclusion.
Using,stating,or cleaning industrial machinery or equipment,and areas where residuals from
using,storing,or cleaning industrial machinery or equipment remaln and are exposed to. ❑Yes R No❑N/A
stomnvater
Materials or residuals an the ground or in stormivater inlets from spills/leaks ❑Yes 0 No❑N/A
Materials or products from past industrial activity ❑Yes 0 No❑N/A
Material handling equipment(except adequately maintained vehicles) ❑Yes 2 No❑N/A
Page 2 of 5

Materials or productsdufing loadirtg/unloadirg ortransportmgactivities ❑Yes 2 No❑N/A
Materials or products stored outdoors(except final products intended for outside use[e.g.,new Q Yes 12 No❑N/A
arsl where exposure to stomtwater does not result In the discharge of pollutants)
Materials contained in open,deteriorated,non-sealed',or leaking storage dnims barrels,tanks, 0 Yes Gi No❑N/A
and similar containers
Materials or products handled/stored on roads or railways owned or maintained by the discharger ❑Yes 0 No O N/A
Final products that would be mobilized in stormwater discharges(e.g,rock salt) Ci Yes 2 No❑N/A
Waste material(except waste in covered,non-leaking containers(e.g,dumpsters)) 0 Yes 2 No❑N/A
Application or disposal of process wastewater(unless otherwise permitted) ❑Yes 0 No❑N/A
Particulate matter or visible deposits of residuals from roor stacks and/or vents not otherwise ❑Yes 42 No❑N/A
regulated(i.e.under an air quality control permit)and evident in the stormwateroutflow
Empty.containers that previously contained materials that are not properly stored(Le-,not dosed
and stored upside down to prevent precipitation accumulation) ❑Yes Sd No❑N/A
For any exterior ASTs,as well as drums,barrels,tanks and similar containers stored outside„has ❑Yes la No❑N/A
the facility had any releases in the past three(3)years?
'Sealed means banded or otherwise secured and with locoed or nonoperational taps or valves.
Above Ground Storage Tanks(ASTs)and Secondary Containment
if you answer"No"to an of the followib iiterns; uare of el''ible forthe noexposure
ex'�duslon:';
Y Y S .�.., �
Are exterior ASTs or piping free of ros6 damaged'oiweattiered cuaiint'prts,'a deteneration;:or t'. '
evidence of leaks? _ - — i, - ,, QYes❑'No 0 WA
Is secondary conbin.MAt provided for all exteiiorASTs?.I(se is it free`of arty cracks,holes,or
evidence of leaks,and are drain Vah!es,mpintyried to Iihut? - ❑Yes O Noc2 N/A
Is sccon wntainmoi f piovukd for sin leabave r6undsto %omame s duck" - '
' 'Y, g 6 �_ do ngdrin. : OYds O KO❑N/A
barrels,etc.)with a apacityofmore than GWVUom? r �- -- _
B secondary containment provided for aboveground storage containi:rs shared in dose:prfilcoamity 0Yes❑No O N/A
to each other with a combined capacity of more than 1,320 gallons?
Is secondary containment provided for Title Ill Section 313 SupetfundAmenamanl5 i rnd ❑Yes❑No N/A
Reauthorization Act(SARA)water priority chemicals?
Is secondary containment provided for hazardous substances designated in 4o CFR 9136? O YCs O No O N/A
Are release valves on all secondary containment structures locked? 9 Yes❑No❑N/A
Other information
If you answer Wes"to any of the following items,you might not be eligible for the no exposure exclusion.A more
in-depth ev4luation or the site circumstances may be required.
Are vehicles used in material handling in disrepair and/or leakdng fluid? ❑Yes 0 No❑N/A
Does this facility store used,recycled,or_o_therwise reclaimed pallets outside? Q Yes 0 No O N/A
Does this facility have coal piles on site? ❑Yes 0 No❑N/A
Does this facility store other fuel sources outside in piles,such as woad chips,sawdust,etc? O Yes 12 No O N/A
Page 3 of 5

Does this facility have air emissions associated with industrial activity(e.g.,degreasing operations, 0 Yes❑No❑N/A
plating,painting,or metal finishing)?
If Yes:
Describe the Industrial activity:Metal machining to create plastic injection molds.Test run
injections toensure product meets customer specifications Machining building vented to
baghouse for employee safety.
Are those emissions permitted by an Air Quardy Permit? ❑Yes$)No Please specify:
S. Other Facility Conditions(check all that apply and explain accordingly):
❑This fatilityhas other NPDES permits.
If checked,fist the permit numbers for all current NPDES permits:
❑This facility has Non-Discharge permits(e g.recycle permit).
If checked,list the permit numbers for all current No"ischarge permits:
❑This facility stores hazardous waste in the 100-year noodptain.
If checked,describe how the area is protected from flooding:
❑This facility is a(mark all that apply)
❑Hazardous Waste Generation Facility
❑Hazardous Waste Treatment Facility
❑Hazardous waste storage Facility
❑Hazardous Waste Disposal Fa
If checked,indicate:
I(ilegrams of waste era
each month': i
:,
• Typels)ofwasbc -
• HOW mi�ie-�ria,l is stored:.
• Wt*er ,nterialissfined: ", • __ ._ '_`.
• Number of waste shipments per year:
• Name of transpoft/clisposalvendor
r Transport/disposal vendor EPA 10: '
t
vendoraddress:
❑This facility is located on a Brownfield orSUPERFUND site.
If checked,briefly describe the site conditions:
❑This faolity is located on Native American Lands.
6 Required Items(Application will be returned unless all of the foiknuing items have been included):
fa Check for$250 made payable to NCDEQ
•Copy of most recent Annual Report to the NC Secretary of State(if applicable)
12 This completed application and any supporting documentation
lla Copy of county map or USGS quad sheet with the location of the facility clearly marked
Page 4 of 5

7. Applicant Certification
North Carolina General Statute 143-215.68()provides that: Any person who knowingly makes any false statement,
representation,or certification in any application,record,report,plan,at other document filed or required to be maintained
under this Article or a rule Implementing this Article...shall be guilty of a Class 2misdemeanor which may Include fine not
to exceed ten thousand dollars(S10,000),I hereby request exclusion from NPDESstormvrater permitting.
Under penalty of law,I certify that:
yr I am the person responsible for the industrial activity,for satisfying the requirements of this exclusion,and for any civil
or criminal penalties incurred due to violations of this exclusion.
]E I have read and understand the clWbil-rtq requirements for claiming a condition of'no exposure"and obtaining an
J exclusion from NPDES stotmwater permitting.
N 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 under40 CFR 122.26(g)(2)).
I understand that 1 am obligated to maintain no exposure conditions and complete a Self-Recertification form at least
once each year and.If requested,provide this certification to the operator of the local municipal separate storm sewer
system(MS4)into which the facility discharges(where applicabte)-I understand that I must allow the North Carolina
Division of Energy,Mineral,and Land Resources,or M54 operator where applicable,to perform inspections to confirm
the condition of no exposure and to make such inspection reports publicly available upon request I understand I must
keep a ropy of annual recertifications on file at the facility.
I understand that in the event that the she no longer qualifies fora No.Exposure-Exclusi-on that 1 must obtain coverage
underanNPDIF S permI t pricrtoar7Pointsour i ce�ds4itrgcof'stoim w atcrfruni'ttiefaci11ty.
]/ The information submitted in tthis N01 Is,to the best of my knowledge and belief,tnte;accurate,and complete based on
myinquiryof the persono`'r persons who managetfii syVaem ti[rtiosepwsonsdisecdyresponsibleforgathertnethe
information. -
Printed Name of Person
Title: CLO — 1T!$ h��� - •" _. -
Signature of Applicant Date Signed
Mail the entire package to: DEMLR—Stormwater-Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh,NC 27699-1612
Page 5 of 5

1.
3,i3 _ _ ' Y [�. �--•
_...�" g •' .t,�,Bo.5,00 �.,•
p �, rfoodu •,
��'�..°._�-"`{.`.�� '—`+•—,- L, i,�-•�-i _ ��� 'repo '" ":ya" =� ' � -.l
� � T
f�f �
Property Location
35'T57.54'N •Dr q.vR •e`,f'
80'577.72w .'af`�Ca^+ �•
ko
VIP-
-W�XLER DR --7—' - �FpR ,'-, mil'°•' �.f- i
SZ %
GD m • 4 i
`7 /NJ f-i �.�. 1.,-J.l/t(,---{{� �r-� _- t• - GpAis�yr'•
�s."�� ! � t�(� '1 �` -Fi i a' p l ''. • ,R •1 i :V ch':CAt `,,' 4 `'F 1 "• `
Figure 1 ®Property Boundary N '
Site Location Map A »ems '-I I o ttp,
Delta Mold,Inc.
9415 Stockpot Place
Charlotte,NC29273

BUSINESS CORP-ORAT_IONANNUAL-REPORT _ - - -� -
NAME OF BUSINESS CORPORATION: Delta Mold,Inc.
SECRETARY OF STATE ID NUMBER: 0542138 STATE OF FORMATION: h41 E Filed Ama RoW
0542138
RCPORT FOR THE FISCAL YEAR END: 12131/2023 OAM24MIOCS17
W12024 0945
SECTION A:REGISTERED AGENT'S INFORMATION ®Chmur—
1.NAME OF REGISTERED AGENT: MOzer, Eric
2.SIGNATURE OF THE NEW REGISTERED AGENT:
MGRATURE ODt6TrnnES CONSENT'TO THE AMISM1041'
3.REGISTERED AGENT OFFICE STREET ADDRESS a COUNTY 4.R17GISTEREDAGENT OFFICE MAILING ADDRESS
9415 Stockport Place 9415 Stockport Place
Charlotte, NC 28273-4564 Mecklenburg County Charlotte, NC 28273-4564
SECTION B:PRINCIPAL OFFICE INFORMATION
1.DESCRIPTION OF NATURE OF BUSINESS: Manufacturer of Metal Injection IVIelds
2.PRINCIPAL OFFICE PHONE NUMBER. [phone] 3.PRINCIPAL OFFICE EMAIL: Privacy RedaChOn
4.PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
9415 Stockport Place 9415 Stockport Place
Charlotte,NC 28273-4564 Charlotte,NC 28273.4564
6.Select one of the following if applicable.(Optional see Instructions)
❑ The company is a veteran-myned small business
The oompany is a service-disabled vateranownod small business
SECTION c:OFFICERS(Enter additional officers in Section E.)
NAME: Eric Mozer NAME: Eric Mozer NAME:
TITS Chairman Of The Board TITLE President TITLE,
ADDRESS: AODRS.SS: ADDRESS:
9415 Stockport Place 9415 Stockport Place
- -----CharlotterNC28273- Charlotte,-NC28273
SECTION D:CERTIFICATION OF ANNUAL REPORT. Section D most be mnpleted in its ent"by a personlbmkwss
� ricMozer 1/31/2024
Sx=TIJ12E DATE --
Famma-ttn zveE tyaa dr fi;lM C of the arm.
Eric Mozer Chairman Of The Board
Fmi wTlpc NamcdOt1ar RiMaTyp6Ta$sd04ka
This Anr=l Report has been fled electronically.
MM TO:" nofSW4. MWWW aRalne ta,ali6nn.P®OMW Eea Ra1c'y14 No XM2"525