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HomeMy WebLinkAboutNCGNE1694_Application_20240926 FOR AGENCY USE ONLY Revised 10/6 NCGNE1fQ9 Assigned to: 95, G ARO FRO MRO RR ARD W WIRO WSRO Division of Energy, Mineral, and Land Resources National Pollutant Discharge Elimination System No Exposure Certification for Exclusion NCGNE0O0O 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.Industrial materials or activities 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 product,or waste product. A storm resistant shelter is not required for industrial materials stored in the following container types, provided the containers are not deteriorated and do not leak: • drums, • tanks,and • barrels, • similar containers. For new facilities, applicants should apply no earlier than 60 days before the start of 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 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 Until you are issued a No Exposure Certification and your NPDES permit is rescinded,your facility must continue to abide by the terms and conditions of the current permit. A No Exposure Certification must be provided for each facility qualifying for the no exposure exclusion.Additionally, the exclusion from NPDES permitting is available on a facility-wide basis only— not for individual outfalls. If any industrial activities or materials are,orwill 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). NC DEQ Stormwater Program requires a one-time $250 application fee via check made payable to NC DEQ. 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: https://deg.nc.gov/about/divisions/energy-mineral- land-resources/npdes-no-exposure. Directions: Print or type all entries on this application form. Send the original, signed application to: NCDEMLR stormwater Program, 1612 MSC, Raleigh, NC 27699-1612. 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 1 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): S0c_ -( 55e a.c�1 Mailing address: City: State Code 42,2. Wcty A A Zip N C o2S 51 Telephone number: Email address: 2 ?y(o 21 -71 rjte utvt.4lasselb�L� Curt Iccst1cS _Gprv\ Type of Ownership: Government ❑County ❑ Federal ❑ Municipal ❑ State Non-government RrBusiness(If ownership is business,a copy of NCSOS report must be included with this application) ❑ Individual 2. Industrial Facility(facility requesting exclusion): Facility name: Facility environmental cont t: C 1 M Jek iv,(. s+cbch Ss Street address: Telephone number: 2 2- q c�_k t )a M 65 K 30a 7 (C> Email address: StL\JV kQSSGIl�-ac�A (s C.WL' ICLSf-"C-5 _ C-6 h City County State Zip Code h dcv\ 14+ opt Carol Re513 Latitude of entrance: 35. H1H 749 Longitude of entrance: 17,H 3 93d0 Parcel Identification Number(PIN): ?N3b4 Date operation began: Standard Industrial Classification(SIC)Code: 1939 31b100 Brief description of the types of industrial activities and products produced at this facility: ?���1 3. Consultant(if applicable): Name of consultant: Consulting firm: Street address: City: State and zip code: Telephone number: Email address: 4. Exposure Checklists Are any of the following materials or 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,storing,or cleaning industrial machinery or equipment,and areas where residuals from using,storing,or cleaning industrial machinery or equipment remain and are exposed to ❑Yes 9 No ❑ N/A stormwater Materials or residuals on the ground or in stormwater inlets from spills/leaks ❑Yes® No❑ N/A Materials or products from past industrial activity ❑Yes® No❑ N/A Material handling equipment(except adequately maintained vehicles) ❑Yes ® No❑ N/A Page 2 of 5 Materials or products during loading/unloading or transporting activities ❑Yes W No❑ N/A Materials or products stored outdoors(except final products intended for outside use(e.g.,new ❑Yes No ❑ N/A cars]where exposure to stormwater does not result in the discharge of pollutants) Materials contained in open,deteriorated, non-sealed',or leaking storage drums barrels,tanks, ❑Yes ® No ❑N/A and similar containers Materials or products handled/stored on roads or railways owned or maintained by the discharger ❑Yes IN No❑N/A Final products that would be mobilized in stormwater discharges(e.g.,rock salt) ❑Yes® No ❑ N/A Waste material(except waste in covered,non-leaking containers[e.g.,dumpsters]) ❑Yes® No❑ N/A Application or disposal of process wastewater(unless otherwise permitted) ❑Yes %L No ❑N/A Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise ❑Yes f$No ❑N/A regulated(i.e.under an air quality control permit)and evident in the stormwater outflow Empty containers that previously contained materials that are not properly stored(i.e.,not closed ❑yes No ❑ N/A and stored upside down to prevent precipitation accumulation) For any exterior ASTs,as well as drums,barrels,tanks and similar containers stored outside,has ❑Yes Cz�No ❑ N/A the facility had any releases in the past three(3)years? 'Sealed means banded or otherwise secured and with locked or non-operational taps or valves. Above Ground Storage Tanks(ASTs)and Secondary Containment If you answer"No"to any of the following items,you are not eligible for the no exposure exclusion. Are exterior ASTs or piping free of rust,damaged or weathered coating,pits,or deterioration,or A❑No(S N evidence of leaks? ❑Yes / Is secondary containment provided for all exterior ASTs?If so,is it free of any cracks,holes,or ❑Yes❑No INN/A evidence of leaks,and are drain valves maintained locked shut? Is secondary containment provided for single above ground storage containers(including drums, ❑Yes❑No N/A barrels,etc.)with a capacity of more than 660-gallons? Is secondary containment provided for above ground storage containers stored in close proximity ❑Yes❑No N/A to each other with a combined capacity of more than 1,320 gallons? Is secondary containment provided for Title III Section 313 Superfund Amendments and A El Yes❑No L53 N Reauthorization Act(SARA)water priority chemicals? / Is secondary containment provided for hazardous substances designated in 40 CFR§316? ❑Yes❑No N/A Are release valves on ail secondary containment structures locked? ❑Yes❑No 9 r N/A 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. Are vehicles used in material handling in disrepair and/or leaking fluid? ❑Yes IX No ❑ N/A Does this facility store used,recycled,or otherwise reclaimed pallets outside? ❑Yes® No❑ N/A Does this facility have coal piles on site? ❑Yes 09 No❑ N/A Does this facility store other fuel sources outside in piles,such as wood chips,sawdust,etc.? ❑Yes i%No❑ N/A Page 3 of 5 Does this facility have air emissions associated with industrial activity(e.g.,degreasing operations, ❑Yes 51 No❑ N/A plating,painting,or metal finishing)? If yes: Describe the industrial activity: Are those emissions permitted by an Air Quality Permit? ❑Yes❑ No Please specify: S. Other Facility Conditions (check all that apply and explain accordingly): ❑This facility has other NPDES permits. If checked,list 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 Non-Discharge permits: ❑This facility stores hazardous waste in the 100-year floodplain. 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 Facility If checked,indicate: • Kilograms of waste generated each month: • Type(s)of waste: • How material is stored: • Where material is stored: • Number of waste shipments per year: • Name of transport/disposal vendor: • Transport/disposal vendor EPA ID: • Vendor address: ❑This facility is located on a Brownfield or SUPERFUND site. If checked,briefly describe the site conditions: ❑This facility is located on Native American Lands. 6. Required Items (Application will be returned unless all of the following items have been included): Rf Check for$250 made payable to NCDEQ if Copy of most recent Annual Report to the NC Secretary of State(if applicable) 11'This completed application and any supporting documentation 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 143-215.6E(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...shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars($10,000).1 hereby request exclusion from NPDES stormwater permitting. Under penalty of law,I certify that: L/ 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. 1 have read and understand the eligibility requirements for claiming a condition of"no exposure"and obtaining an exclusion from NPDES stormwater permitting. 66 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 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 applicable).I understand that I must allow the North Carolina Division of Energy,Mineral,and Land Resources,or MS4 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 copy of annual recertifications on file at the facility. 1 understand that in the event that the site no longer qualifies for a No Exposure Exclusion that I must obtain coverage / under an NPDES permit prior to any point source discharge of stormwater from the facility. Gd The information submitted in this N01 is,to the best of my knowledge and belief,true,accurate,and complete based on my inquiry of the person or persons who manage the system,or those persons directly responsible for gathering the information. Printed Name of Person Signing: Title: Se,�ttwr6�f—l9, ZoZy nature of Applica 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 BUSINESS CORPORATION ANNUAL REPORT usrzozz NAME OF BUSINESS CORPORATION: Consolidated Models,Inc. 0903450 Feng office Use Orly SECRETARY OF STATE ID NUMBER: STATE OF FORMATION: NJ E-Filed Annual Report 0903450 REPORT FOR THE FISCAL YEAR END: 3/31/2024 CA202419100735 7/9/2024 01:04 SECTION A: REGISTERED AGENT'S INFORMATION ❑K Changes 1. NAME OF REGISTERED AGENT: Consolidated Models, Inc. 2.SIGNATURE OF THE NEW REGISTERED AGENT: SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT 3. REGISTERED AGENT OFFICE STREET ADDRESS&COUNTY 4.REGISTERED AGENT OFFICE MAILING ADDRESS 222 Pepsi Way 222 Pepsi Way Ayden, NC 28513 Pitt County Ayden, NC 28513 SECTION B: PRINCIPAL OFFICE INFORMATION 1-DESCRIPTION OF NATURE OF BUSINESS: Manufacturing 2.PRINCIPAL OFFICE PHONE NUMBER: (252) 746-2171 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction 4. PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS 222 Pepsi Way 222 Pepsi Way Ayden,NC 28513-7609 Ayden, NC 28513-7609 6.Select one of the following if applicable.(Optional see Instructions) ❑ The company is a veteran-owned small business ❑ The company is a service-disabled veteran-owned small business SECTION C:OFFICERS(Enter additional officers in Section E.) NAME: Stephen D HasselbaCh NAME: Mark C Philpott NAME: Steven A HasselbaCh TITLE: President TITLE: Executive Director TITLE: Executive Director ADDRESS: ADDRESS: ADDRESS: 222 Pepsi Way 222 Pepsi Way 222 Pepsi-Way— Ayden,NC 28513 Ayden, NC 28513 Ayden, NC 28513 SECTION D:CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business en 1phen D Hasselbach 7/9/2024 St SIGNATURE DATE Form must be signed by an officer listed under Section C of this form. Stephen D Hasselbach President Print or Type Name of Officer Print or Type Title of Officer This Annual Report has been filed electronically. 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