NCGNE1268_No Exposure Application on EPA Form_20180320

Allison Davis
From: Allison Davis <[e-mail]>
Sent: Thursday, March 08, 2018 4:49 PM
To: '[e-mail]'
Subject: NPDES No Exposure Certification
Attachments: plant 2.pdf, plant 1.pdf
Ms. Alexander,
I have recently become aware that our two facilities should apply for No Exposure NPDES Storm Water Certification. An
application for each of our facilities is attached. In addition, hard copies will be mailed to your attention 3/9/2018.
Please let me know if you have any questions.
Best regards,
14c
Allison Davis, CEF-2
Greensboro Industrial Platers
P.O. Box 4466
Greensboro, NC 27404
Tel [phone]
Fax [phone]
www..gboropf ters.com
aIlison.davis{a)gboroplate rs.com
RECEIVED
MAR 2 0 2018
[)ENR -LAND QUALITY
STORMWATER PERMITTING
This message and any attachment are privileged and confidential. If you are not the intended recipient, please immediately telephone or email the
sender and delete the message and any attachment from your system. If you are not the intended recipient you may not copy this message or
attachment or disclose the contents to any other person.

w &-Iq E/ a � �
NPDES UNITED STATES ENVIRONMENTAL PROTECTION AGENCY Form Approved
FORM I�� WASHINGTON, DC 20460 OMB No, 2040-0211
3510-11 NO EXPOSURE CERTIFICATION FOR EXCLUSION FROM NPDES STORMWATER
PERMITTING
Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit authorization for its
stormwater discharges associated with industrial activity in the State identified in Section B under EPA's Stormwater Multi Sector General Permit
due to the existence of a condition of no exposure.
A condition of no exposure exists at an industrial facility when all industrial materials and activities are protected by a storm resistant shelter 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, 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 without operational taps or valves: RECEIVED
— adequately maintained vehicles used in material handling; and 9
— final products, other than products that would be mobilized in stormwater discharges (e.g., rock salt). MAR 2 O 2018
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 materi r d to
precipitation, the facility is not eligible for the no exposure exclusion,
9TORMWA`ATER
i�R PERMITTING
By signing and submitting this No Exposure Certification form, the entity in Section A is certifying that a condition of no exposure exists at its facility
or site, and is obligated to comply with the terms and conditions of 40 CFR 122.26(g).
ALL INFORMATION MUST BE PROVIDED ON THIS FORM.
Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4.
A. Facility Operator Information
Name:
6MOIN1516101 I01 111HOP151TIM/AA IPItATIfIRI51 2. Phone: 2A-
3.Email: Ir��f �f�l�l^�I ISI I I'Is� l�lal�l�lpl�i�I�iC1RISI,ICIdIMI
4. Mailing Address: j a. Street JP J G16100 xI lgjgJ616I I I ,I I I I I 11111111111111
b. City: �IJ�I�I�IsI I� I�lal I I I I I I I 1 1 III c. State I' I `I d. Zip Code:
B. Facility/Site Location Information L�
1. Facility Name: N S Q 2 a ) tJ (f S f4 L IPILI141TICII5II
2. a. Street Address: 1711M IP�0I(IL-IwI0I9ITI#I I51TIf_IEItK I I I I I I I I I I I L[]
I
b. City: Q L 0 fJ S h O f LL1c. County: ( N O O K
d. State: 141 G e. Zip Code: 7 `YW— L_IL_LI
3. Is the facility located on Indian Lands? ❑ YES �O 3 ti V q3� w 7q
�� ��
4. Is this a Federal facility? ❑YES EEI/NO '
5. a. Latitude: 131 q - 1 J31 5 b. Longitude: W ' "
6. a. Was the facility or site previously covered under an NPDES stormwater permit? ❑ YES E"NO
b. If yes, enter NPDES permit number or tracking number:
7. SIC/Activity Codes: Primary:3 Secondary V
(if applicable): V I I I
8. Total size of site associated with industrial activity: (pt^, acres �/
9. a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure exclusion? ❑ YES E] NO
b. If yes, please indicate approximately how much area was paved or roofed over. Completing this question does not disqualify you for the no
exposure exclusion. However, your permitting authority may use this information in considering whether stormwater discharges from your site
are likely to have an adverse impact on water quality, in which case you could be required to obtain permit coverage.
Less than one acre ❑ One to five acres ❑ More than five acres ❑
EPA Form 3510-11 (09-08) Page 1 of 4

Exposure Checklist
Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future?
(Please check either "Yes" or "No" in the appropriate box.) If you answer "Yes" to any of these questions
(1) through (11), you are not eligible for the no exposure exclusion.
Yes
No
1. 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 stormwater
2. Materials or residuals on the ground or in stormwater inlets from spills/leaks
Q
3. Materials or products from past industrial activity
E
4. Material handling equipment (except adequately maintained vehicles)
❑
5. Materials or products during loadinglunloadtng or transporting activities
❑
6. Materials or products stored outdoors (except final products intended for outside use [e.g., new cars] where
El
a
exposure to stormwater does not result in the discharge of pollutants)
7. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers F1 12/
8. Materials or products handled/stored on roads or railways owned or maintained by the discharger ❑ 0'
9. Waste material (except waste in covered, non leaking containers [e.g., dumpstersl) El E/
10. Application or disposal of process wastewater (unless otherwise permitted) ❑ d
11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated
(i.e., under an air quality control permit) and evident in the stormwater outflow El Ed
D. Certification Statement
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no exposure" and obtaining
an exclusion from NPDES stormwater permitting.
I certify under penalty of law that there are no discharges of stormwater contaminated by exposure to industrial activities or materials from the
industrial facility or site identified in this document (except as allowed under 40 CFR 122,26(g)(2)).
I understand that I am obligated to submit a no exposure certification form once every five years to the NPDES permitting authority and, if
requested, 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 NPDES permitting authority, 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. 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.
Print Name: A LI -11 50INI MAN 15I I I i U
Print Title:
Signature:
Date:
Email:
10161 1 10 A I S
Mo Day Year
BILI' -11 lfl0j�I1IAIVI tlsl l�l�lol�l�l�l „1 J71�l�lsl=I��I I ISI
EPA Form 3510-11 (09-08) Page 2 of 4

he C, -1;2
NPDES UNITED STATES ENVIRONMENTAL PROTECTION AGENCY Form Approved
FORM WASHINGTON, DC 20460 OMB No. 2040-021 t
3510-11 OEP�A NO EXPOSURE CERTIFICATION FOR EXCLUSION FROM NPDES STORMWATER
PERMITTING
Submission of this No Exposure Cerlifcation constitutes notice that the entity identified in Section A does not require permit authorization for its
stormwater discharges associated with industrial activity in the State identified in Section B under EPA's Stormwater Multi Sector General Permit
due to the existence of a condition of no exposure.
A condition of no exposure exists at an industrial facility when all industrial materials and activities are protected by a storm resistant shelter 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, 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 deteriora Ie1 �ki �i1��d
means banded or otherwise secured and without operational taps or valves; REU I V � V
— adequately maintained vehicles used in material handling; and p {�
— final products, other than products that would be mobilized in stormwater discharges (e.g., rock salt). MAR 2 Q 2018
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 materialfIENRPL'Ai 10eQUWsyto
precipitation, the facility is not eligible for the no exposure exclusion. STQRMWATER PERMITTING
By signing and submitting this No Exposure Certification form, the entity in Section A is certifying that a condition of no exposure exists at its facility
or site, and is obligated to comply with the terms and conditions of 40 CFR 122.26(g).
ALL INFORMATION MUST BE PROVIDED ON THIS FORM.
Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4.
A. Facility Operator Information
Name: li,*IIJI5I�I9I11AII-I IPILIAIVILIP,IsI 2.Phone:
3. Email: f.1Son�,�p,4VIS�.GBoKvPLR 12S�cp
4. Mailing Address: a. Street 1plol b
b. City:F 4 M i"N6 p f-101 I I I -LI I I I I I I I c. State d. Zip Code: 2 _�
B. FacilitylSite Location Information
1. Facility Name: &IKILI[h5jgIQIRI0I I+I�DIVISITIFIjIAI[-j. IPIzIAiTIFIKIsf
2. a. Street Address: 13 �PI�NI9I QI J IAI ILKI {1VIFI I f I f I f I 1111 I l I l l l
b. City: 0 0 6 S Q iZ t7 LL.1 I I 111 c. County:
d. State: L e. Zip Code: 7 —1111 J �
0� � 6 V ;?
3. Is the facilitylocated on Indian O J .� 7 0
Lands. ❑ YES [`fNO
4. Is this a Federal facility? ❑ YES u NO
5. a. Latitude: W p161.1 LSv 1__LJ ° b. Longitude: 7 q 5 j ' LL4"
6. a. Was the facility or site previously covered under an NPDES stormwater permit? ❑ YES 2'1\10
b. If yes, enter NPDES permit number or tracking number:
7. SIC/Activity Codes: Primary: Z Secondary
(if applicable):
8. Total size of site associated with industrial activity: '63 acres
9. a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure exclusion? ❑ YES EJ�NO
b. If yes, please indicate approximately how much area was paved or roofed over. Completing this question does not disqualify you for the no
exposure exclusion. However, your permitting authority may use this information in considering whether stormwater discharges from your site
are likely to have an adverse impact on water quality, in which case you could be required to obtain permit coverage.
Less than one acre ❑ One to five acres ❑ More than five acres ❑
EPA Form 3510-11 (09-08) Pagel of 4

C. Exposure Checklist
Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future?
(Please check either "Yes" or "No" in the appropriate box.) If you answer "Yes' to any of these questions
(1) through (11), you are not eligible for the no exposure exclusion.
Yes
No
1. Using, storing or cleaning industrial machinery or equipment, and areas where residuals from using, storing or cleaning
El
industrial machinery or equipment remain and are exposed to stormwater
2. Materials or residuals on the ground or in stormwater inlets from spills/leaks
❑
3. Materials or products from past industrial activity
1
4. Material handling equipment (except adequately maintained vehicles)
E7
5. Materials or products during loading/unloading or transporting activities
6. Materials or products stored outdoors (except final products intended for outside use [e.g., new cars] where
exposure to stormwater does not result in the discharge of pollutants)
7. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers E
8. Materials or products handledlstored on roads or railways owned or maintained by the discharger
9. Waste material (except waste in covered, non leaking containers [e.g.. dumpsters]) El E'
10. Application or disposal of process wastewater (unless otherwise permitted)
11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated
(i.e., under an air quality control permit) and evident in the stormwater outflow El 2111
D. Certification Statement
I certify under penalty of law that I have read and understand the eligibility requirements for claiming a condition of "no exposure" and obtaining
an exclusion from NPDES stormwater permitting.
I certify under penalty of law that there are no discharges of stormwater contaminated by exposure to industrial activities or materials from the
industrial facility or site identified in this document (except as allowed under 40 CFR 122.26(g)(2)).
I understand that I am obligated to submit a no exposure certification form once every five years to the NPDES permitting authority and, if
requested, to the operator of the local municipal separate storm sewer system (MS4) into which the facility discharges (where applicable). 1
understand that I must allow the NPDES permitting authority, 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. 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 Tine and imprisonment for knowing violations.
PrintName: IAILI LI(JSIoj IIpIaIV Isl_. I I I I I I I I I.,,) V I I I! 1_1 I
Print Title: � I IS I� ID DIPJ ITI I I I L, I I I I I I I I I I.,,.I I I I I I I I I I
Signature: dvt,�� L
Date: 101311 10191120 j Is
Mo Day Year
Email: 1ALitLiti I IS 01"V1.1 1141 115K gol01lei 01PILI41rIEIRI51 `IC�11I I I f
EPA Form 3510-11 (09-08) Page 2 of 4