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61/08/2M4 15:12 9524718436 aiwntal PAGE 84 <br />¥irM 8w sIM «r fMiny praviouslir c««fi«G undw M NPOn ttorm water pMndt? <br />I£ya,eatoNPOESp«t^idntificaitaBBUDibcra«>«GOWaM';__________ <br />I. WMIla Via total aba of alii anodMwWiMuttrtalaeiMty? <br />□Yaa <br />ij^Acfia <br />3. Naaa|aypaMVarraafa4avarafanMf1yaHpaaatf.vantouaarBalnarVartoqiialMyfartliaiio OVaa BNa <br />aapaaiMa aaclualant <br />rtn|frflr|piTi‘*^'iT ^ ~ ------------------------------------1---------- ««-------rr‘TT*1 —1 " <br />4>iiiw lhfamr oalac o»Ml4iilntaltotoriiwwi—M>4iictoncil»w»iyBafi.aiwUiriytofcmini4wmitiia3dOB <br />waar anaUiy. b «hldi ene )(«> couU to iiqaM «B flbain p«mit ca««if& <br />If yas, ^aato todkab ^ area watr^vtd cr noted am.□ Laas Ilian ana acra <br />□ Ona to flva acraa <br />□ Man than flva aoat <br />An any of aw tollaartng aialaflals Of acVvWaa aapaaaV to aj^eipitollan ar alarm watar runoff, now or in ttia <br />lanaaoaab futoro7 <br />lbjB|.iMii«orckaohigtndaatr1aliDachiiiefyorcquipmep',aadaraai«lieranr:dual$ftemuiiBg, BVaa ONa <br />■toriagorclaaBiof iaduiti1a]niochiavyoraqoi|iincntrcflubudareaipes«dto rsfawaier <br />MMarwlaoricaidaalaaolbegnuadorinitonnaalerinkU&smiptlUortcalu DVaa BNa <br />MaMriab or producto from part iadiHtriaIacti\'ity DYaa (3No <br />I4tterial haakmi aquipomt (cicqx adequately nniDtained vehidca) DYaa BN o <br />Mabriala or producta durtof loading or unloadina or trampering activitia DYaa BN o <br />Matcriala or produett stored outdoon (aacqit final products ctndad for outakk»c,nicb as new OVaa QN o <br />can. urhara axpown to itorm water does not rasult in the di tchirge of poIhittDls) <br />JdaMrlabconaiaad in opao,detcriontcd or baking storage drims.lwfTcla. tanks aadabailar □Vaa BNa <br />eofituoan <br />Mabritli or products handled or bond onroadi or raawayi owned or mauitaiocd by the discbancr DY ob BN o <br />Watte nwbfial(cacqit waste in comad, Dofl'bakiflgooautm like a covered ds^star) □Yaa C9N o <br />Applkalioo or diapoaalofprocctt wastewater (unless iNbe^iKpcmiitted) DYaa BN o <br />Pardeulale natter or viaibb deposits of rctidualf from rwfjStacks nd/or vents net otherwise DYaa BN o <br />regulated (t.c. under an air quality contcol pannii) and cvidfc*. is the ttocra water outSowicvidjcti <br />Ifyou checked yes to ANY ofthe ilsns in question E. 4. a'kyc-: ire not cligibbfcrfte no exposure eadusion. SUp to <br />partO. <br />If you checked no to ALL of toe items in ^csttor E. 4. a • k, you a.*c not required to cbtiin pamh comsge. Continue to <br />pset P and sign toe No Bxponre CertifiGatioa. <br />1 ecniiy indcr peashy of law that 1 have read and uodcrstaod the elif:bility icquircmcnta far clatming a cooditioaof *^o <br />expofure ** and ohtainiBg so axchiaioo from NPOES atocB water per=:3iog. I cattily under penalty of law tost there are M <br />discharges of storm svaiw contaminaicd by exposurt to iodaroial setvtfes or msteriab frr=i the industtial toeflity or site <br />ideutiSad to this doeuamt (axcqtt u allowed under 40 CF& 122J6(gX2)). <br />1 uadcretaed toat I am obligated to rabust a oo et^esura ca rtillcatioc fenn ones avtty five v«xn to the MPCA and, if lequeatod, <br />to the opeixiar of the local municipal atparate storm aewer ayslam (MS4) into which toe dischtoga (whert ^beaMt). I <br />undarbaod toat 1 aaist allow tot MPCA, or hlS4 operator where toe (Lscharge ii tote toe local MS4, to pe*r«*»w» u> <br />coaflna the coodHion of no exposure and to make lucb to^ac^ t^ens pitolicly availabb vpoB raquast 1 UBdarstaad toat 1 <br />must obtain comagt uadtr an NPDES paralt prior to any poiai aeurct of stois water from toe tocihty.