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Home My WebLink AboutNCGNE0806_Self Inspection Report_20190917Energy, Arlinerat and Land Resources ENVIRONMENTAL QUALITY Division of Energy, Mineral and Land Resources ,and Quality Section — Stormwater Permitting National Pollutant Discharge Elimination System ANNUAL NO EXPOSURE EXCLUSION SELF RE -CERTIFICATION NCGNE0000 Do not submit this form to DEMLR unless requested. For questions, please contact the DEMLR Regional Office for your area or the Central Office. (Please print or type) Facility's No Exposure Exclusion No. no Completed (MM/DD/YYYY) N C G N E® o O® 109 / 1 3 2 D till 1) Has the facility name or owner changed? Yes No (if yes, please submit a separate Name/Ownership Change Form to DEMLR located at: http //deg nc goy/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/stormwater-permits/npdes- industriaksw ) 2) 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 to maintain your no exposure exclusion, and must immediately apply for a permit from DEMLR. 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 to No c. Materials or products from past industrial activity El Yes ® No d. Material handling equipment (except adequately maintained vehicles) ❑ Yes ® No e. Materials or products during loading/unloading or transporting activities ❑ Yes ® 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) g. Materials contained in open, deteriorated or leaking storage drums, barrels, ❑ Yes ® No tanks, and similar containers h. Materials or products handled/stored on roads or railways owned or maintained ❑ Yes ® No by the discharger i. Waste material (except waste in covered, non -leaking containers [e.g., ❑ Yes 2 No dumpsters]) j. Application or disposal of process wastewater (unless otherwise permitted) ❑ Yes " No k. Particulate matter or visible deposits of residuals from roof stacks and/or vents ❑Yes ®No not 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 E] Yes No (i.e., not closed and stored upside down to prevent precipitation accumulation) Page 1 of 3 SWU-NESR-3May2016 NCGNE0000 No Exposure Self Re -Certification m. For any exterior ASTs, as well as drums, barrels, tanks, and similar containers ® Yes No stored outside, has the facility had any releases in the past three (3) years? 3) Above Ground Storage Tanks (ASTs): If you answer No to any of the following items, you are not eligible to maintain your no exposure exclusion, and must immediately apply for a permit from DEMLR. a. Are exterior ASTs and piping free of rust, damaged or weathered coating, pits, Yesto No or deterioration, or evidence of leaks? N/A b. Is secondary containment provided for all exterior ASTs? If so, is it free of any UesR No ❑ cracks, holes, or evidence of leaks, and are drain valves maintained locked N/A shut? 4) Secondary Containment: If you answer "No" to any of the following items, you are not eligible to maintain your no exposure exclusion, and must immediately apply for a permit from DEMLR. a. Is secondary containment provided for all single above ground storage ❑Yes® No ❑ containers (including drums, barrels, etc.) with a capacity of more than 660- N/A gallons? b. Is secondary containment provided for above ground storage containers stored ❑Yes® No ❑ in close proximity to each other with a combined capacity of more than 1,320- N/A gallons? c. Is secondary containment provided for Title II I Section 313 Superfund RYes❑ No El Amendments and Reauthorization Act (SARA) water priority chemicals*? N/A d. Is secondary containment provided for hazardous substances** designated in Yesm No ❑ 40 CFR §116? N/A e. Are release valves on all secondary containment structures locked? ❑Yes® No 0 N/A Footnotes to Questions 4) 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, andtor 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 §11743, 5) Other information: If you answer "Yes" to any of the following items, and the answer if different from how it was answered when originally applying, you might not be eligible to maintain your no exposure exclusion. Please contact the Division if this is the case. a. Does your facility store used, recycled, or otherwise reclaimed pallets outside? b. Does your facility have coal piles on site? c. Does your facility store other fuel sources outside in piles, such as wood chips, sawdust, etc.? d. Does your facility have air emissions associated with its industrial activity (e.g., degreasing operations, plating, painting and metal finishing)? If so, describe the industrial activity: FiY�i31n�w4 o��t-a-�ton e. If you answered yes to d., are those emissions permitted by an Air Quality Permit? Please specify: L.fe now haue tl►nn Air Emiss,oa Sp,,�Rce.S 6�'E��sTir'ftT�oN �iD. 12ZDC�+��{}(®v �0.� ref �e4� ouA f41 r Jl1e .m i ft- p`�,�,L �i �' 1 "1 Page 2 of 3 SW U-NESR-3May2016 NCGNE0000 No Exposure Self Re -Certification 6) 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/maintaining 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)). 1 understand that I am obligated to annually self re -certify No Exposure and, if requested, submit this re -certification to DEMLR or 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 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 provided. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information provided is to the best of my knowledge and belief true, accurate and complete. I am aware that there are significant penalties for providing false information, including the possibility of fine and imprisonment for knowing violations. I certify that I am familiar with the information contained in this document and that to the best of my knowledge and belief such information is true, complete, and accurate. Printed Name of Person Signing: �t4V! D S/4�wv�i5 k 1 (Signafure) (Date Signed) Please note: The Regional Office may inspect your facility at any time 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). This completed form must be kept on file at the facility for at least 5 years. Do not submit this form to DEMLR unless requested. Page 3 of 3 SW U-NESR-3May2016