HomeMy Public PortalAboutCity of Breckenridge Hills MISSOURI DEPARTMENT OF NATURAL RESOURCES
7 WATER PROTECTION PROGRAM
eJ NO EXPOSURE CERTIFICATION FOR EXCLUSION FROM NPDES STORMWATER PERMITTING UNDER
MISSOURI CLEAN WATER LAW
PLEASE READ ALL THE ACCOMPANYING INSTRUCTIONS BEFORE COMPLETING THIS FORM.
SUBMITTAL OF AN INCOMPLETE FORM MAY RESULT IN THE FORM BEING RETURNED UNPROCESSED.
Submission of this No Exposure Certification(NEC)constitutes notice by the facility representative identified in Section 7 of this
form that there is no exposure of the facility's industrial activities,equipment and materials to stormwater in accordance with the
requirements of 10 CSR 20-6.200 Stormwater Regulations.
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 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(including recyclable)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:
• Storage of 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.
• Adequately maintained vehicles used in material handling.
• Final products,other than products that would be mobilized in stormwater discharges(e.g., rock salt).
A NEC must be provided for each facility qualifying for the no exposure exclusion. In addition,the certification of 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,or if the facility discharges any effluent other than stormwater to waters of the state,the facility is
not eligible for the no exposure exclusion.
By signing and submitting this NEC,the facility representative in Section 7 certifies that a condition of no exposure exists at their
facility or site,and is obligated to comply with the terms and conditions of 40 CFR 122.26(g).
1.FACILITY
FACILITY NAME TELEPHONE NUMBER WITH AREA CODE
Breckenridge-Hills Maintenance Shop 314-427-6868
ADDRESS(PHYSICAL LOCATION) CITY COUNTY STATE ZIP CODE
3112 Pasteur Breckenridge St. Louis Mo. 63114
1.2 PLEASE SELECT ONE
a. This facility is now in operation under No Exposure Certification MO—NX and is submitting a certification.
for renewal
✓❑ b. This is a facility submitting a request for a new No Exposure Certification(for a new facility).
nc. This facility is now in operation under Missouri State Operating Permit MO— , is requesting a new NEC,
and wishes to terminate existing operating permit.
nd. This facility is a wastewater treatment plant with a design flow equal to or greater than 1.0 million gallons per day or a
treatment plant required to have an approved pretreatment system and is requesting a NEC.
2.OWNER
NAME EMAIL ADDRESS TELEPHONE NUMBER WITH AREA CODE
City of Breckenridge-Hills gmudd@breckenrdge-hills.mo.us 314-427-6868 ext. 132
ADDRESS(MAILING) CITY STATE ➢P CODE
9623 St.Charles Rock Rd. Breckenridge-Hills Mo. 63114
3.CONTINUING AUTHORITY
NAME EMAIL ADDRESS TELEPHONE NUMBER WITH AREA CODE
George R.Mudd gmudd@breckenrdge-hills.mo.us
ADDRESS(MAILING) CITY STATE ZIP CODE
9623 St.Charles Rock Rd. Breckenridge-Hills Mo. 63114
4.FACILITY CONTACT
NAME TELEPHONE NUMBER WITH AREA CODE
Drew Brauner 314-427-6868
TITLE EMAIL ADDRESS
Street Department Supervisor
780-2828(08-19)
5.ADDITIONAL INFORMATION
5.1 Does the discharge(s)for which you are seeking an exclusion discharge to a combined sewer system? Yes E✓ No
If yes, provide the name of the combined sewer system entity
5.2 Does the discharge(s for which you are seeking an exclusion discharge through a Municipal Separate Storm Sewer System
(MS4)? Yes " No
If yes, provide the name of the MS4 entity
5.3 Primary SIC Code of Facility Other SIC Codes (Optional)Primary NAICS Code of Facility
5.4 Provide an attached list of any materials that are stored outside and exposed to stormwater including wood pallets,empty
storage barrels,waste disposal containers(except for a secured covered dumpster). Materials other than final product such as
raw material or by-product of your industrial activities that can be mobilized by stormwater do not qualify for no exposure
exclusion.
5.5 Attach a 1:1,000 aerial photograph(preferred)or USGS topographic map showing the location of the facility. Indicate on the
map the facility,the property boundaries of the facility,the receiving water body,any septic tanks/lateral lines,stormwater
basins,the location of items stored outside and all outfall locations.
5.6 Is the facility causing an adverse impact on water quality due to major changes at the site to achieve no exposure?
For example,constructing new buildings/shelters or constructing structures to prevent run-on in a formerly vegetated area.
Yes l" I No
If yes,please indicate approximately how much area was paved or roofed over.The department may use this information in
considering whether stormwater discharges from your site are likely to have an adverse impact on water quality,in which you
could be required to obtain permit coverage for land disturbance activities.
n Less than 1 acre 1 to 5 acres (- More than 5 acres
6. NO EXPOSURE CERTIFICATION CHECKLIST
_
The purpose of this checklist is to 1)help you determine whether the exposure of industrial activities,materials,or equipment to stormwater
has been eliminated at the facility,and 2)help department staff evaluate the adequacy of your compliance activities and NEC.For the
purpose of this checklist,"outdoors"are areas of the facility that are not beneath permanent roofed structures where stormwater cannot run
into or out of.
Are any of the following materials or activities exposed to precipitation or occurring on-site,now or in the foreseeable future?Please answer
all questions by checking"Yes"or"No."
Using,storing,or cleaning industrial machinery or equipment,and areas where residuals from using,storing, ❑ Yes ✓ No
or cleaning industrial machinery or equipment remain and are exposed to stormwater.
Materials or residuals on the ground or in stormwater inlets from spills or leaks. n Yes n No
Materials or products from past industrial activity. n Yes a No
Material handling equipment(except adequately maintained vehicles). C Yes n No
Materials or products during loading/unloading or transporting activities. ❑ Yes n No
Materials or products stored outdoors(except final products intended for outside use[e.g.,new cars]where ❑ Yes n No
exposure to stormwater does not result in the discharge of pollutants).
Materials contained in open,deteriorated,or leaking storage drums,barrels,tanks,or similar containers. Yes n No
Materials or products handled/stored on roads or railways owned or maintained by the facility. n Yes I" I No
Waste Material(except waste in covered, non-leaking containers[e.g.,dumpsters]). ❑ Yes n No
On-site land application or discharge of wastewater. El Yes n No
Particulate matter or visible deposits or residuals from roof stacks or vents not otherwise regulated Yes C No
(i.e.,under an air quality control permit)and evident in the stormwater outflow.
If you answered"Yes"to any of these questions,you are not eligible for the no exposure exclusion.
780-2828(08-19)
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7.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 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 property 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.
NAME(TYPE OR PRINT) OFFICIAL TITLE q)
EMAIL �eo TELEPHONE NUMBER AAk yea t.
sr,Ad@ brecl��A.'IAc-fir ��s. \E).tx5 . 31(i- `irk CoFSL,$ tZ 13Z
SIGNATURE DATE SIGNED
0161 ( 7
Lga780-2828(08-19)
GUIDANCE AND INSTRUCTIONS FOR COMPLETING THE NO EXPOSURE CERTIFICATION FOR EXCLUSION FROM NPDES
STORMWATER PERMITTING UNDER MISSOURI CLEAN WATER LAW—FORM 780-2828
For assistance in determining if the facility meets the conditions of"No Exposure"please reference the Missouri Department of
Natural Resources Guidance for No Exposure Certification for Exclusion from Stormwater Permit Requirements, Pub 2729.This
document is available online at https://dnr.mo.gov/pubs/pub2729.htm.
Additionally you may reference the U.S. Environmental Protection Agency's Guidance Manual for Conditional Exclusion from
Storm Water Permitting Based on "No Exposure"of Industrial Activities to Storm Water, June 2000."This document is available at
https://www.epa.gov/npdes/guidance-manual-conditional-exclusion-stormwater-perm ittinq-based-no-exposure-
industrial.
Persons with more than one operating location shall obtain a Missouri State Operating Permit or No Exposure Certification for
each location unless other permitting arrangements are allowed by the terms of the permit.Where multiple discharge points exist
at a single operating location,one application may cover all the applicable discharges.
The no exposure exclusion is conditional.Therefore,if there is a change in circumstances that causes exposure of industrial
activities or materials to stormwater,the operator is required to comply immediately with all requirements of the stormwater
program, including obtaining a permit.Where a facility operator determines that exposure is likely to occur in the future due to
some anticipated change at the facility,the operator shall obtain a permit prior to the discharge of stormwater associated with
industrial activity. Regulated industrial operators must to either apply for a permit or submit a no exposure certification in order to
be in compliance with the NPDES stormwater regulations.
Failure to maintain the condition of no exposure or obtain a permit to discharge can lead to unauthorized discharge of pollutants to
waters of the state. Such a discharge is a violation of the Missouri Clean Water Law and the Federal Water Pollution Control Act
and may be subject to fines and penalties.
Even if the facility operator certifies the condition of no exposure,the department retains the authority to require the facility to
obtain a permit if it is determined that there is exposure at the facility,or that the discharge of stormwater is contributing to the
violation of water quality standards.
Fees:There is no fee associated with No Exposure Certifications; however, if the facility has a current operating permit all
past due fees must be made current in order to terminate the existing permit.
1. Facility name and address.The name by which this facility is locally known. Provide the street address or location of the
facility.If the facility lacks a street name or route number, provide the name of the closest intersection, highway,county
road,accurate geographic description,etc.(e.g., Intersection of Route A and M).
1.2 Check the appropriate box.Do not check more than one.
2. Facility Owner. Provide the legal name,mailing address,work phone,and email address of the owner.
Correspondence will be mailed to the owner address listed on this application.
3. Continuing Authority.A continuing authority is a company,business, entity or person(s)that will be operating the facility
and/or ensuring compliance with the permit requirements.A continuing authority is not, however, an entity or individual
that is contractually hired by the permittee to sample or operate and maintain the system for a defined time period,such
as a certified operator or analytical laboratory.To access the regulatory requirement regarding continuing authority, 10
CSR 20-6.010(2), please visit http://sl.sos.mo.gov/crosimages/adrules/csr/currenU10csr/10c20-6.pdf.A continuing
authority's name must be listed exactly as it appears on the Missouri Secretary of State's(SoS's)webpage:
https://bsd.sos.mo.gov/BusinessEntity/BESearch.aspx?SearchType=0,unless the continuing authority is an individual(s),
govemment,or otherwise not required to register with the SoS
4. Facility Contact. Provide the name,title,work phone and email address of a person who is thoroughly familiar with the
operation of the facility and with the facts reported in this application and who can be contacted by the department.
5. Additional Information.
5.1 A combined sewer system is one in which the sanitary and storm sewers are one pipe. In Missouri,parts of Macon,
Moberly,St.Joseph, Kansas City, Sedalia,and most of the city of St Louis are on combined sewer systems.To find
information, consult with your municipal public works department or, if in St.Louis,the Metropolitan St. Louis Sewer
District(MSD). If this discharge is to a combined sewer system, it is exempt from stormwater permitting requirements in
most cases.Visit http://dnr.mo.gov/env/wpp/permits/index.html to view individual general permits to determine if the
permit you are applying for includes this exemption. If it does,you do not need to file this application.
5.2 If discharge is located within a MS4 permitted authority,provide the name of the authority.
5.3 List the four-digit Standard Industrial Classification (SIC)code that best describes your facility in terms of principal
products or services you produce or provide.The SIC system was devised by the U.S.Office of Management and Budget
to cover all economic activities.The primary SIC code is that of the operation that generates the most revenue,or,
secondly,employs the most personnel.To find the correct SIC code, contact the Missouri Department of Natural
Resources at 573-522-4502 or refer to the following websites:www.osha.gov/pls/imis/sicsearch.html or
siccode.com/en/naicscode/list/directorv. In addition,list the North American Industry Classification System(NAICS)code,
if known.
5.4 List anything stored outside, including wood pallets, empty storage barrels,waste disposal containers,or anything that is
a raw material, by-product,or product of your industrial activities.
5.5 An aerial photograph with appropriate detail,such as Google Earth or Google Maps. U.S.Geological Survey topographic
maps are available from the department's Missouri Geological Survey in Rolla, Mo at 573-368-2100 and online at
http://dnr.mo.qov/geology/adm/publications/topoquads.htm.To the best of your ability,draw property boundaries,outfall
locations,receiving water body(ies)and other significant facility features.
5.6 An increase in impervious area often leads to an increase in volume and velocity of runoff,which,in turn,can result in a
higher concentration of pollutants in the discharge, since fewer pollutants are naturally filtered out.
6. All questions should be answered by checking"Yes"or"No".Please note that if you answer"Yes"to any of these
questions,you are not eligible for the no exposure exclusion.
7. Include the name,title,phone number and email address of the person signing the form and the date of signing.An
unsigned or undated certification will not be considered valid.
The No Exposure Certification form must be signed as follows:
(i) For a corporation: By a responsible corporate officer.For the purpose of this Section,a responsible corporate officer
means:
a. a president,secretary,treasurer,or vice-president of the corporation in charge of a principal business function,
or any other person who performs similar policy-or decision-making functions for the corporation,or
b. the manager of one or more manufacturing,production,or operating facilities,provided,the manager is
authorized to make management decisions which govern the operation of the regulated facility including having
the explicit or implicit duty of making major capital investment recommendations,and initiating and directing other
comprehensive measures to assure long-term environmental compliance with environmental laws and
regulations;the manager can ensure that the necessary systems are established or actions taken to gather
complete and accurate information for permit application requirements;and where authority to sign documents
has been assigned or delegated to the manager in accordance with corporate procedures.
(ii) For a partnership or sole proprietorship:By a general partner or the proprietor, respectively;or
(iii) For a municipality,state,federal,or other public agency: By either a principal executive officer or ranking elected
official.For purposes of this Part,a principal executive officer of a federal agency includes(i)the chief executive
officer of the agency,or(ii)a senior executive officer having responsibility for the overall operations of a principal
geographic unit of the agency(e.g., Regional Administrator of EPA). Include the name and title of the person signing
the form and the date of signing.
If you have any further questions regarding the no exposure certification or this form,contact the appropriate Regional Office.
This completed form and any attachments should be submitted to:
For Site Specific Permits(MO-0000000), MOG05,87,and MOR240:
Central Office,Water Protection Program-Operating Permits Section, (see contact information below)
For General Permits MOG-09, 13, 14,251,35,49,50,64,641,67,69,698, 75,76,821,822,84, 92,94,97, MOR-13,
203,22A,22B,22C,23A,23D,23E,240(renewal),60A,80C,80F,80H:
Regional Offices(see map link below)
Central Office Regional Offices
epartment of Natural Resources Water
Protection Program Please send to the appropriate regional office.A
ATTN:Operating Permits Section map of regional offices with addresses and
P.O. Box 176 Jefferson City, phone numbers are available online at
MO 65102-0176 800-361-4827 or 573- dnr.mo.gov/regions/.
522-4502
Submittal of an incomplete form may result in form being returned.