NCGNE1246_Application_20180406

April 3, 2018
T 0 R
RECEIVED
APR 0 S 2018
Stormwater Permitting Program DeNR-E No QUALITY
Division of Energy, Mineral and Land Resources STORMWATER PERMITTING
1612 Mail Service Center
Raleigh, NC 27699-1612
RE: Request for No Exposure Certification
Dear Sir or Madam: J (f 6: h E h02 r J/
Please find enclosed No Exposure Certification requests for our facilities at 110 Wamsutta
Mill Road and 1020 N. Green Street in Morganton. Prior requests were disapproved March
2018 following an inspection by NCDENR Environmental Specialist Isaiah Reed where he
found materials that were exposed or had the potential to be exposed to stormwater
discharge. We believe we have appropriately addressed and resolved these issues;
therefore, we are once again requesting No Exposure Certification for both locations.
Your reconsideration is greatly appreciated. Please do not hesitate to contact me at the
numbers below or via email at terriep!2eiyictor.com if you have any questions or need any
additional information.
Sincerely,
� � /�' -/)- 2 eA -
Terrie N. Peeler
Human Resources Manager
Enclosures (2)
P.O. Box 309, 110 Wamsutta Mill Road, Morganton, NC 28680-0309,[phone],[phone] FAX

a z
FOR AGENCY USE ONLY
Date Received
Division of Energy, Mineral and Land Resources Year Month Day
Land Quality Section
National Pollutant Discharge Elimination System Certificate of Coverage
NO EXPOSURE CERTIFICATION for Exclusion NCGNE RECEIVED
Energy, Mineral NCGNE0000
and Land Resources APR 0 5
ENVIRONMENTAS. QUALITY 2038
DENR-LAND QU LITY .
National Pollutant Discharge Elimination System application for exclusion fromrow"I r
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Exposure Certification and your NPDES permit is rescinded, your facility must continue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 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).
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:
httr)s://deo.nc.00v/abouUdivisions/enerav-mineral-land-resources/enerav-mineral-land-r)ermits/stormwater-
permits/npdes-industrial-sw
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 correspondence wiil be mailed),:
Name: E. J. Victor, Inc.
Contact: Terrie Peeler
Street Address: PO Box 309
City: Morganton State: NC Zip Code
Telephone No.: [phone] Fax: [phone]
Page 1 of 7
28680-0309
Swt I -N( (,NF l act ravigp.d Gf7Ron4F

NCGNEOOOO No Exposure Certification
2) Location of facility producing discharge:
Facility Name: E. J. Victor, Inc.
Facility Contact: Terrie Peeler
Street Address: 1020 N. Green Street
City: Morganton State: NC Zip Code: 28655
County: Burke
Telephone No.: [phone] Fax: [phone]
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). From Raleigh: Take 1-40 W 182.9 Miles). Take the NC -
18 exit EXIT 105, toward Morganton, Shelby (0.2 Miles). Turn right onto NC -181S Sterlinq St. Continue to
follow NC -18 (2.5 Miles).Stay straight to go onto NC -1811N Green St.{2 Miles).Turn right_into N. Green front
parking lot.(A copy of a map with the facility clearly located on it should be included with the
certification application.)
4) Is the facility located on Native American Lands? ❑ Yes ® No
5) Is this a Federal facility? ❑ Yes ® No
6) Latitude 35 deg. 45' 16.88" Longitude -81 deg. 43'4.55" (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 01/01/2000
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes ® 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: 2 5 1 2
10) Provide a brief description of the types of industrial activities and products produced at this facility:
upholstered furniture manufacturing
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
® No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SW[i-NCGNF I apt awked q/9R001 9

NCGNE0000 No Exposure Certification
Exposure Checklists (12.- 94.)
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 N 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 N No ❑ NIA
c. Materials or products from past industrial activity
❑ Yes ® No ❑ NIA
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes N No ❑ NIA
e. Materials or products during load inglunloading or transporting activities
❑ Yes ® No ❑ NIA
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes 21 No ❑ NIA
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 N No ❑ NIA
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes N No ❑ NIA
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes N No ❑ NIA
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes N No ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes N No ❑ NIA
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 N 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 N No ❑ NIA
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 or piping free of rust, damaged or weathered coating, pits, or N Yes ❑ No ❑ NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
N Yes ❑ No ❑ NIA
Page 3 of 7
sw� �-N(-G dF i aqt rpwigpd WROO16

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 single above ground storage containers
(including drums, barrels, etc.) with a capacity of more than 660 -gallons?
b. Is secondary containment provided for above ground storage containers stored
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
Amendments and Reauthorization Act (SARA) water priority chemicals*?
d. Is secondary containment provided for hazardous substances** designated in 40
CFR §116?
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous
waste generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: waste paint, lacquer thinner, used flourescent bulbs
How is material stored: in closed 55 gallon drums
Where is material stored: outside under cover
How many disposal shipments per year: 4-6
® Yes ❑ No ❑ NIA
❑ Yes ❑ No ® NIA
® Yes ❑ No ❑ NIA
® Yes ❑ No ❑ NIA
❑ Yes ® No ❑ NIA
® Yes ❑ No ❑ NIA
❑ Yes ® No ❑ NIA
Name of transport 1 disposal vendor: Freehold Cartage Inc. -transporter, GRR-disposal vendor
Vendor address: Giant Resource Recovery, 755 Industrial Rd., PO Box 1755, Sumter, SC 29150
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 I[[ 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
SW[1-Nr:C'NF ] act rPvkPd gl2817018

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 ® No ❑ NIA
b. Does your facility have coal piles on site? ❑ Yes ❑ No ® NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes ® No ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ® Yes ❑ No ❑ NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: painting furniture,
e. If you answered yes to d., are those emissions permitted by an Air Quality ® Yes ❑ No ❑ NIA
Permit? Please specify: permit #08773
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: NCR000011122 Program: Hazardous Waste
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
" Program:
Permit:
Program:
Page 5 of 7
SWI I-N('('NF I act ravicari A/9 912016

NCGNE0000 No Exposure Certification
17) Certification:
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 maintain no exposure conditions and complete a Self -Recertification form ai„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 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 I
must keep a copy of annual re -certifications on file at the facility.
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.
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 Name of Person Signing: Terrie N. Peeler
Title: Human Resources Manager/MESH
w
`/-? � � 0 6 I8
(Signature of Applicant) (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDEQ 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 anytime 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 fine
not to exceed ten thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
SWI I -Nr C NF I ;;It revisPrl Q17817016

NCGNEU000 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.
❑ 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 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:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 7 of 7
SWl I-N(.f�NF l ;;Rt ravicad 919 819 0 1 6

co
OD (D
4 � �
`J
J
0 C4 N r_
N ch
N
IT is7 0)O
� m �
U
ONr64r00CD
�00ri
Z N W
W Z
I
`°
n
m a
z LEL U 13
� O
y Q N N
O
CL ❑ ❑ ❑
U
a
O
Z
o CY Q
LLOOC3
w
N
a
m
m
d
4o a -c
N
C3
O m v
h 4 �
z
W
O U
U
t U m H
C)
p
O p
O
mvtr,
p U
LL N r
:5
r
fi 'dCL
a
Q
N
co
OD (D
as o rn
c4 v m
`J
J
0 C4 N r_
N ch
N
IT is7 0)O
C] O N p r 000
U
ONr64r00CD
�00ri
Z N W
W Z
I
`°
N
m a
z LEL U 13
� O
y Q N N
O
CL ❑ ❑ ❑
U
a
O
Z
o CY Q
LLOOC3
w
N
a
m
m
U
N
`J
J
N
t2)
wU
Z
�00ri
Z N W
W Z
I
dLLJ
N
z
� O
r
a-
C7 Z
O
Z
o CY Q
LLOOC3
w
N
a
m
d
(7
N
aQ

FOR AGENCY USE ONLY
Date Received
Division of Energy, Mineral and Land Resources Year nia�,e Day
Land Quality Section
National Pollutant Discharge Elimination System Certificate of Coverage
" NO EXPOSURE CERTTFICATION for Exclusion NCGNE
Energy, Mineral NCGNE0000 RECEIVED
and Land Resources �y ry
ENVIRONMENTAL OUALITY APRy� O6 2018
National Pollutant Discharge Elimination System application for exclusion from a StorAtITY
based on NO EXPOSURE: STN1��IIITTING
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 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 122.28(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:
httos:lldea. nc.aov/about/divisions/enerov-mineral-land-resources/enerav-mineral-land-K)ermitslstormwater-
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: E. J. Victor, Inc.
Contact: Terrie Peeler
Street Address: PO Box 309
City: Morganton State: NC
Zip Code: 28680-0309
Telephone No.: [phone] Fax: [phone]
Page 1 of 7
S4Nf f-Nf:f;NF 1 act ravicari G1M9(116

NCGNE0000 No Exposure Certification
2) Location of facility producing discharge:
Facility Name: E. J. Victor, Inc.
Facility Contact: Terrie Peeler
Street Address: 110 Wamsutta Mill Road
City: Morganton State: NC Zip Code: 28655
County: Burke
Telephone No.: [phone] Fax: [phone]
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). From Raleigh: Take 1-40 W (182.9 Miles). Take the NC -
18 exit EXIT 105 toward Morganton, Shelb 0.2 Miles . Turn ri ht onto NC -181S Sterling St. Continue to
follow NC -1$ 2.5 Miles).StaV straight to go onto NC -1811N Green St. 1.1 Miles .Turn left onto Wamsutta Mill
Rd.(0.4 Miles).(A copy of a map with the facility clearly located on it should be included with the
certification application.)
4) Is the facility located on Native American Lands? ❑ Yes ® No
5) Is this a Federal facility? ❑ Yes ® No
6) Latitude 35 deg. 45'50.59" Longitude -81 deg. 42'41.16" (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 01/01/1990
❑ Renewal of existing No Exposure Certification Certification No.: NCGNE
8) Was this facility or site ever covered under an NPDES Stormwater Permit? ❑ Yes ® 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: 2 5 1 1
10) Provide a brief description of the types of industrial activities and products produced at this facility:
wood furniture manufacturing
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
® No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
Page 2 of 7
SwIi_Nrc�ni� I nqt ravi erl gO819016

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 ® 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 ® No ❑ NIA
c. Materials or products from past industrial activity ❑ Yes ® No ❑ NIA
d. Material handling equipment (except adequately maintained vehicles) ❑ Yes ® No ❑ NIA
e. Materials or products during loading/unloading or transporting activities ❑ Yes © No ❑ NIA
f. Materials or products stored outdoors (except final products intended for outside ❑ Yes ® No ❑ NIA
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 ® No ❑ NIA
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes ® No ❑ NIA
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes ® No ❑ NIA
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes ® No ❑ NIA
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not ❑ Yes ® No ❑ NIA
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 ❑ 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 ❑ No ® NIA
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 or piping free of rust, damaged or weathered coating, pits, or ❑ Yes ❑ No ® NIA
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any ❑ Yes ❑ No ® NIA
cracks, holes, or evidence of leaks, and are drain valves maintained locked shut?
Page 3 of 7
wi f_N('('NF I ;;qt revISP.ri g12ROOISro

NCGNEOOOO 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 single above ground storage containers
(including drums, barrels, etc.) with a capacity of more than 660 -gallons?
b. Is secondary containment provided for above ground storage containers stored
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
Amendments and Reauthorization Act (SARA) water priority chemicals*?
d. Is secondary containment provided for hazardous substances** designated in 40
CFR §116?
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous
waste generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste
generated per month) of hazardous waste?
If you answered yes to questions b. or c., please provide the following information:
Type(s) of waste: waste paint, lacquer thinner, used flourescent bulbs
How is material stored: in closed 55 gallon drums
Where is material stored: in diked oil house on drum pad that will hold 55 gallons
How many disposal shipments per year: 4-6
❑ Yes ❑ No ® NIA
❑ Yes ❑ No ® NIA
❑ Yes ❑ No ® NIA
❑ Yes ❑ No ® NIA
❑ Yes ® No ❑ NIA
® Yes :--]No ❑ NIA
❑ Yes ® No ❑ NIA
Name of transport I disposal vendor: Freehold Cartage Inc. -transporter, GRR-disposal vendor
Vendor address: Giant Resource Recovery, 755 Industrial Rd., PO Box 1755, Sumter, SC 29150
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
SWI 1 -NC C,NF 1 ask rpviGar3 Q12812016

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 ® No ❑ NIA
b. Does your facility have coal piles on site? ❑ Yes ❑ No ® NIA
c. Does your facility store other fuel sources outside in piles, such as wood chips, ❑ Yes ® No ❑ NIA
sawdust, etc.?
d. Does your facility have air emissions associated with its industrial activity (e.g., ® Yes ❑ No ❑ NIA
degreasing operations, plating, painting and metal finishing)? If so, describe the
industrial activity: painting furniture
e. If you answered yes to d., are those emissions permitted by an Air Quality ® Yes ❑ No ❑ NIA
Permit? Please specify: permit #06715
f. Please list any other environmental program permits (federal, state, etc.) not
specified earlier in this application (such as Hazardous Waste Permits, etc.):
Permit: NCD986174738 Program: Hazardous Waste
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Permit:
Program:
Page 5 of 7
SM I-Nrr1NF i a,,t romgPri PoRoni s

NCGNEOOOO No Exposure Certification
17) Certification:
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 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). 1 understand that I must allow the North Carolina Division of
Energy, Mineral, and Land Resources, 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
must keep a copy of annual re -certifications on file at the facility.
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.
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 Name of Person Signing: Terrie N. Peeler
Title: Human Resources Manager/MESH
0/Irl ce• 7 Q L U3hYl
(Signature of Applicant) (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDEQ 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 anytime 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 fine
not to exceed ten thousand dollars ($10,000).
There is currently no fee for a No Exposure Exclusion.
Page 6 of 7
,S'viit I-iti(:r��F I ACt rPVISP,Ci QI7RI7n1 ij

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.
❑ 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 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:
Asheville Office ...... [phone]
Fayetteville Office
... [phone]
Mooresville Office
... [phone]
Raleigh Office ........
[phone]
Washington Office
... [phone]
Wilmington Office
... [phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
Page 7 of 7
RWI I-NC'C NF I RRt mvIRpo w9sonl F;

LD
wra
7�t1
P1,, y
al's`
00
w \
�5
CD
L4 Q.
18l4A31,t,'�+4�b�Yti''�7F.
NI
I 1S IlWvti j1di ` — JJ
SCI -71IUp1S�!GQ�IfI
W
r~ r lS7
O Co Ql
M N co co M
UIl- O M � o o M
r0 COUlr Q CD
Z F- ❑ d N Y d tlI
�I Z >. L •.. (.
3 CL
U
m
0u
4
m m
c
�
co
J
J
y U
N
U
foo U
m
z
¢ N W
m
Q2��
Q
Ccc�
Cc)
Z
O
o
r
M
JS2 CX
��
oao
x
¢
¢QUJ
r
U
(D
UJ
C7 a-
m
Q Q
q U C
am
L N r
o q c o
r
11
C a a h
2E
C-'
U m -Z U
..
.
qti
N
6
C
ro
C>
cw
Vi
oma
W
r~ r lS7
O Co Ql
M N co co M
UIl- O M � o o M
r0 COUlr Q CD
Z F- ❑ d N Y d tlI
�I Z >. L •.. (.
3 CL
U
m
c
�
co
J
J
N
U
foo U
U
z
¢ N W
z
Z
O
O
M
0
��
x
¢
¢QUJ
r
U
(D
UJ
C7 a-
m
nQi
O
O
o O of
tLI
a_
2E
a
N
..
N
6
cw
W m
¢
a` a