NCG030112_MONITORING INFO_20081024

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑HISTORICAL FILE
MONITORING REPORTS
DOC DATE
o ano�IDaN
YYYYMMDD

, A
15A
rNy,
NCDENR
�.
Division of Water Quality / Surface Water Protection
National Pollutant Discharge EIirrtinatio s
p C.,
FOR AGENCY USE ONLY
Date Received
Year
5�6K�E
--•
NO EXPOSURE CERTIFICATION for -=-+-
NCGNE0000 NG
OCT 2
NO EXPOSURE CERTIFICATION n
National Pollutant Discharge Elimination System application for exclusion fr-bin a jqtor,�vrate it
'Ji
based on NO EXPOSURE: -4
MAIO R,jP4P^n
Submission of this No Exposure Certification constitutes notice tha your aci r �yo ii6Yft6
`
authorization for its stormwater discharges associated with industrial activity in the State oCarolina because it qualifies for a no exposure exclusion. A condition of no exposure at anaL_
facility means all industrial materials and activities are protected bya storm resistant sheltsom4
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,
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
Certiftication 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).
You are required to reapply for the NoExposureExclusion once every _five (5) Years.
For questions, please contact the DWQ Regional Office for your area. (See page 5)
(Please print or type)
1) Mailing address of owner/operator (address to which all certification correspondence will be mailed):
Name lcxnSct�e 1ru� L��asEsYcx-t� C�c�s `�o�rt�s�-��r
Street Address
City e�a��Y State_ 1VL ZIP Code
Telephone No. saw_-�� _ Fax: row
2) Location of facility producing discharge:
Facility Name 1QM*Sc - � t.0 - Q32Nt +� -tio
Facility Contact Y.-9.} j %S
Street Address�a �r�,.,c�• C-a�; _•
City QL,� ,.,rye State �..c_ ZIP Code :Qa(,tics
County ("A?. -
Telephone No. 4-119k -a-lack, Fax: G*a,6 ti g- y -
Page 1 of 5
5WU-NE-060607
Last reprised 06/06/07
\i

NCGNEOOOO No Exposure Certification
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).Vg�pk
i
(A copy of a map with the facility clearly located on it should be in6luded with the certification application.)
4) Is the facility located on Native American Lands? ❑ Yes 0 No
5) is this a Federal facility? ❑ Yes Ni No
6) Latitude -t I Longitude - CvF,C' E`� (deg, min, sec)
7) This NPDES Permit Application applies to which of the following:
❑ New or Proposed Facility Date operation is to begin
14 Existing Date operation began t`lAA
8) Was this facility or site ever covered under an NPDES Stormwater Permit? N Yes ❑ No
If yes, what is the NPDES Permit Number? Ncco 0 3 u r
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: I --!�
10) Provide a brief description of the types of industrial activities and products produced at this facility:
11) Does this facility have any Non -Discharge permits (ex: recycle permits)?
CQ No
❑ Yes
If yes, list the permit numbers for all current Non -Discharge permits for this facility:
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
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
c. Materials or products from past industrial activity
❑ Yes
No
d. Material handling equipment (except adequately maintained vehicles)
❑ Yes
Iq No
e. Materials or products during loadinglunloading or transporting activities
❑ Yes
Sj No
f. Materials or products stored outdoors (except final products intended for outside
❑ Yes
No
use [e.g., new cars] where exposure'to stormwater does not result in the discharge
of pollutants)
Page 2 of 5
SWU-NE-060607 Last revised W06107

NCGNE0000 No Exposure Certification
g. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, ❑ Yes No
and similar containers
h. Materials or products handled/stored on roads or railways owned or maintained by ❑ Yes No
the discharger
i. Waste material (except waste in covered, non -leaking containers [e.g., dumpsters]) ❑ Yes ANo
j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes fi� No
k. Particulate matter or visible deposits of residuals from roof stacks and/or vents not El Yes 1�(`iVo
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 O No
(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 IYNo
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 NYes 0 No
deterioration, or evidence of leaks?
b. Is secondary containment provided for all exterior ASTs? If so, is it free of any Yes ❑ No
cracks, holes, or evidence of teaks, and are drain valves maintained locked shut?
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 yl Yes ❑ No
(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. Are release valves on all secondary containment structures locked?
k Yes ❑ No
XYes ❑ No
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NCGNE0000 No Exposure Certification
15) Hazardous Waste:
a. Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility? ❑ Yes X IVo
b. Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste KYes ❑ No
generated per month) of hazardous waste?
c. Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste ❑ Yes No
generated per month) of hazardous waste?
If you answered yes to questions b, or c., please provide the following information:
Type(s) of waste:
How is material stored:
Where is material stored:.{,,,„�,,�.
How many disposal shipments per year.
Name of transport 1 disposal vendor �Z�-
Vendor address:c
16) 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 submit a no exposure certification form once every five (5)years to the North Carolina
Division of Water Quality and, if requested, to the operator of the local municipal separate stone sewer system (MS4) into
which the facility discharges (where applicable). I understand that I must allow the North Carolina Division of Water
Quality, 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
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: \ . '-log;
(Signatu're of Applicant) (Date Signed)
Please note: This application for the No Exposure Exclusion is subject to approval by the
NCDENR 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 compliance with the No Exposure Exclusion.
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5WU-NE-050607 Last revised 06/06/07

NCGNE0000 No Exposure Certification
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.
Final Checklist
This application should include the following items:
El' This completed application and all supporting documentation.
C" A map with the location of the facility clearly marked.
Mail the entire package to:
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Note
The submission of this document does not guarantee the issuance of a No Exposure Exclusion.
For questions, please contact the DWQ Regional Office for your area.
DWQ Re Tonal 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 5 of 5
SWU-NE-060607 Last revised 06/06/07

Print Parpel Map
�AT��YVEiA C�QUT�TY, t�',C
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IF -parce —Summar—Y 11 Printed Map Scale 1 inch = 502ft -]I
jParcel ID: 376215633818 Parcel Address: 3642 E US 70 HWY, CL4REMONT
Owner: COMMSCOPE INC OF
Address: CLAREMONT LOCATION
City: HICKORY
NORTH CAROLINA
Owner2: Sddress2: 1100 COMM SCOPE PL State/Zip: NC, 28602-3619
Building(s) Value: $9,839,600 Land Value: $732,200 �ffotal Value. $10,571,800
DISCLAIMER: This map/report product was prepared from the Catawba County, NC Geospatial information Services. Catawba County has made
substantial efforts to ensure the accuracy of location and labeling Information contained on this map or data on this report. Catawba County
promotes and recommends the independent verification of any data contained on this map/report product by the user. The County of Catawba, its
employees, agents, and personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or
consequential which arises or may arise from this map/report product or the use thereof by any person or entity.
http:llwww.gis.catawba.nc.uslwebsite/ParcellprintMap.asp?pint=376215633818&paddy-3642%20E%2... 1/11 /2008

Print Parcel Map
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11 Parcel Summary 11 Printed Map Scale 1 inch = 502ft 11
IlParcel ID: 376215633818 I[Parcel Address: 3642 E US 70 HWY, CLAREMONT !
IOwRTH CARD INAPE INC OF J�ddress: CLAREMONT LOCATIONCity: HICKORY NO11 I
Owner2:
1100 COMM SCOPE PL
State/Zip: NC, 28602-3619
Sddress2:
IBuiiding(s) Value: $9,839,600 ��nd Va1ue: $732,200 ITfotal Value: $10,571,800
DIS UUMER. This map/report product was prepared from the Catawba County, tC Geospatiat Information Services. Catawba County has made
substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County
promotes and recommends the independent verification of any data contained on this map/report product by the user. The County of Catawba, its
employees, agents, and personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct indirect or
consequential which arises or may arise from this map/report product or the use thereof by any person or entity.
http://www. gi s . catawba.ne.uslwebsite/Parc ellprintMap.asp?pinc=3 7621563 3 818&paddy=3642%20E%2 ... 1 / 11 /2008