2026-01-21_REPORT - M1981043 (3)

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JSAND�=A�N�DDGRAVEL_ No E,"Xiaosure Certification . . (Required by CDPHE for the No Exposure Exclusion) D L 4 n • ,. I3eparttnent of ofi 'h'r�ax►spartatiun At the Myrin facility are any of the following materials or activities are, or will be in the foreseeable future, exposed to precipitation, snow melt, and/or runoff? 1 Using, storing or cleaning industrial machinery or equipment, and areas where residuals from using, storing or cleaning industrial machinery or equipment remain and are exposed to stormwater; ❑ Yes 0 No 2. Materials or residuals on the ground or in stormwater inlets from spills/leaks; ❑ Yes ❑■ No 3. Materials or products from past industrial activity; X Yes ❑ No 4. Material handling equipment (except adequately maintained vehicles); ❑ Yes ❑0 No 5. Materials or products during loading/unloading or transporting activities; ❑ Yes 0 No 63 Materials or products stored outdoors (except final products intended for outside use, e.g., new cars, where exposure to stormwater does not result in the discharge of pollutants); ❑ Yes ❑i No 7. Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers; ❑ Yes ❑■ No 8. Materials or products handled/stored on roads or railways owned or maintained by the discharger; ❑ Yes ❑■ No 9. Waste material (except waste in covered, non -leaking containers, e.g., dumpsters); ❑ Yes 0 No 10. Application or disposal of process wastewater (unless otherwise permitted); ❑ Yes 1 No 11. Particulate matter or visible deposits of residuals from roof stacks/vents not otherwise regulated, i.e., under an air quality control permit, and evident in the stormwater outflow; ❑ Yes FNI No If the answers to ALL 11 questions are "No", then sign and date below -re_c�� 3 —77 Permittee Signature: Title: Date: 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 COPS stormwater permitting; and that there are no discharges of stormwater contaminated by exposure to industrial activities or materials from the industrial facility identified in this document (except as allowed under paragraph (h)(ii)) of this section. i understand that I am obligated to submit a no exposure certification form once every five years to the Division and, if requested, to the operator of the focal MS4 into which this facility discharges (where applicable). I understand that I must allow the Division, 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 COPS permit prior to any point source discharge of stormwater from the facility. 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 upon my inquiry of the person or persons who manage the system, or those persons directly involved in gathering the information, the information Submitted is to the best of my knowledge and belief true, accurate and complete. I am aware there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. Page 4 of 5