Form Epa 4239 – Fill Out and Use This PDF

The EPA 4239 form, also known as the No Exposure Certification for Exclusion from NPDES Storm Water Permitting, is a declaration by a facility in Ohio stating that its stormwater discharges are not exposed to industrial activities or materials, thereby exempting it from requiring a National Pollutant Discharge Elimination System (NPDES) permit under Ohio's industrial stormwater regulations. By submitting this certification, facilities affirm that all industrial materials and activities are sufficiently sheltered to prevent contamination from precipitation, thus not contributing to stormwater pollution. If your facility qualifies for this exclusion, completing and submitting the EPA 4239 form is crucial for staying in compliance with Ohio EPA regulations. Click the button below to access detailed instructions and start the submission process.

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Form Epa 4239 PDF Details

In the intricate framework of environmental regulations, the EPA 4239 form stands out as a specialized document that caters specifically to entities operating within Ohio, aiming to obtain an exclusion from the National Pollutant Discharge Elimination System (NPDES) stormwater permitting process. This certification underscores a scenario where an industrial facility asserts that there is no exposure of its industrial materials and activities to stormwater. Designating a facility as having "no exposure" is contingent upon ensuring that all industrial materials and activities are sheltered from the elements such as rain, snow, and runoff, thereby nullifying the potential for stormwater contamination. It's interesting to note that the form navigates through various requisites, including the disavowal of exposure for materials stored outdoors unless they are securely sealed or inherently meant for outdoor use, and the exclusion also stretches to envelop properly maintained vehicles. The successful submission and acceptance of this form not only serve as a declaration by the facility's operator of adhering to Ohio EPA’s specifications but also initiates a cycle of accountability entailing periodic re-submission and readiness for inspections. This certification process, encapsulated within the lines of the EPA 4239 form, requires meticulous documentation from the facility operators, starting from basic operator and location information to rigorous checks against potential exposure of materials to stormwater, thereby weaving a comprehensive narrative of compliance and environmental stewardship.

Question	Answer
Form Name	Form Epa 4239
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	no_exposure_cer tification_fis epa form 3510 11

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OHIO ENVIRONMENTAL PROTECTION AGENCY

50 WEST TOWN STREET, COLUMBUS, OH 43215

NO EXPOSURE CERTIFICATION FOR EXCLUSION FROM NPDES STORM WATER

PERMITTING

Submission of this No Exposure Certification constitutes notice that the entity identified in Section A does not require permit authorization for its storm water discharges associated with industrial activity in the State of Ohio under Ohio EPA’s Industrial Storm Water General Permit due to the existence of a condition of no exposure.

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/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 without operational taps or valves;

–adequately maintained vehicles used in material handling; and

–final products, other than products that would be mobilized in storm water 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 Certification form, the entity in Section A is certifying that a condition of no exposure exists at its facility or site, and is obligated to comply with the terms and conditions of Ohio Administrative Code (OAC) 3745-39-04(G).

ALL INFORMATION MUST BE PROVIDED ON THIS FORM.

Detailed instructions for completing this form and obtaining the no exposure exclusion are provided on pages 3 and 4.

A. Facility Operator Information
1.	Name:	______________________________________________________________				2. Phone:	( _____ ) _____-_______
3.	Email:	__________________________________________________________________________________________________________
4.	Mailing Address:		a. Street	__________________________________________________________________________________
	b. City:	________________________________________________			c. State _ _	d. Zip Code:	_________________

B. Facility/Site Location Information
1.	Facility Name:		_______________________________________________________________________________________________
2. a. Street Address:			_______________________________________________________________________________________________
	b. City:	_______________________________________________			c. County:	_______________________________________
	d. State:	Ohio	e. Zip Code:	________________________
	d. State:	Ohio	e. Zip Code:	________________________

3. Is this a Federal facility?

YES

4. Facility Location: Latitude: __ __ . __ __ __ __ __ __ Longitude: - __ __ . __ __ __ __ __ __

5.a. Was the facility or site previously covered under an NPDES storm water permit or No Exposure Certification? b. If yes, enter the Ohio EPA NPDES facility permit number or Ohio EPA No Exposure Certification number:

6.	SIC/Activity Codes:	Primary: __ __ __ __	Secondary		__ __ __ __
6.	SIC/Activity Codes:	Primary: __ __ __ __	(if applicable):		__ __ __ __
			(if applicable):
7.	Total size of site associated with industrial activity:			acres

YES

8. a. Have you paved or roofed over a formerly exposed, pervious area in order to qualify for the no exposure exclusion?

YES

b. If yes, please indicate approximately how much area was paved or roofed over. Completing this question does not disqualify you for the no exposure exclusion. However, this information may be used in considering whether storm water discharges from your site are likely to have an adverse impact on water quality, in which case you could be required to obtain permit coverage.

Less than one acre

One to five acres

More than five acres

EPA 4239 (01/11)

Page 1 of 4

C.Exposure Checklist

	Are any of the following materials or activities exposed to precipitation, now or in the foreseeable future?
	(Please check either “Yes” or “No” in the appropriate box.) If you answer “Yes” to any of these questions
	(1) through (11), you are not eligible for the no exposure exclusion.	Yes	No
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 storm water
2.	Materials or residuals on the ground or in storm water inlets from spills/leaks
3. Materials or products from past industrial activity
4.	Material handling equipment (except adequately maintained vehicles)
5.	Materials or products during loading/unloading or transporting activities
6.	Materials or products stored outdoors (except final products intended for outside use [e.g., new cars] where
	exposure to storm water does not result in the discharge of pollutants)
7.	Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers
8.	Materials or products handled/stored on roads or railways owned or maintained by the discharger
9.	Waste material (except waste in covered, non leaking containers [e.g., dumpsters])

10. Application or disposal of process wastewater (unless otherwise permitted)

11. Particulate matter or visible deposits of residuals from roof stacks and/or vents not otherwise regulated (i.e., under an air quality control permit) and evident in the stormwater outflow

D. Certification Statement

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 Ohio NPDES storm water permitting.

I certify under penalty of law that there are no discharges of storm water contaminated by exposure to industrial activities or materials from the industrial facility or site identified in this document (except as allowed under OAC 3745-39-04(G)(2)).

I understand that I am obligated to submit a no exposure certification form once every five years to the Ohio EPA director 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 Ohio EPA director, 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 Ohio NPDES permit prior to any point source discharge of storm water 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 involved in 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.

Print Name:	______________________________________________________________________
Print Title:	______________________________________________________________________
Signature:
Date:	__ __	__ __	__ __ __ __
	Mo	Day	Year
Email:	______________________________________________________________________

Page 2 of 4

Instructions for the NO EXPOSURE CERTIFICATION for Exclusion from NPDES Stormwater Permitting

Who May File a No Exposure Certification

OAC 3745-39-04 prohibits point source discharges of storm water associated with industrial activity to waters of the State without first obtaining a National Pollutant Discharge Elimination System (NPDES) permit. However, NPDES permit coverage is not required for discharges of storm water associated with industrial activities identified at OAC 3745-39-04(B)(15)(a)-(i) and (k) if the discharger can certify that a condition of “no exposure” exists at the industrial facility or site.

Storm water discharges from construction activities identified in OAC 3745-39-04(B)(15)(j) and (B)(16) are not eligible for the no exposure exclusion. Additional guidance on the no exposure exclusion can be obtained by viewing the following USEPA guidance manual: http://www.epa.gov/npdes/pubs/noxguide.pdf

Obtaining and Maintaining the No Exposure Exclusion

This form is used to certify that a condition of no exposure exists at the industrial facility or site described herein. This certification must be re-submitted at least once every five years. The industrial facility operator must maintain a condition of no exposure at its facility or site in order for the no exposure exclusion to remain applicable. If conditions change resulting in the exposure of materials and activities to storm water, the facility operator must obtain coverage under an Ohio NPDES storm water permit immediately.

Where to File the No Exposure Certification Form

Ohio Environmental Protection Agency

Division of Surface Water

Storm Water Unit

P.O. Box 1049

Columbus, Ohio 43216-1049

Upon approval, Ohio EPA will process and mail a letter acknowledging receipt of your No Exposure Certification.

Completing the Form

You must type or print, using uppercase letters, in appropriate areas only. Enter only one character per space (i.e., between the marks). Abbreviate if necessary to stay within the number of characters allowed for each item. Use one space for breaks between words. One form must be completed for each facility or site for which you are seeking to certify a condition of no exposure. Please make sure you have addressed all applicable questions and have made a photocopy for your records before sending the completed form to the above address.

Section A. Facility Operator Information

Section B. Facility/Site Location Information

1.Enter the official or legal name of the facility or site.

2.Enter the complete street address (if no street address exists, provide a geographic description [e.g., Intersection of Routes 9 and 55]), city, county, state, and zip code. Do not use a P.O. Box number.

3.Indicate whether the industrial facility is operated by a department or agency of the Federal Government (see also Section 313 of the Clean Water Act).

4.Enter the latitude and longitude of your facility or site. Coordinates should be taken from the approximate center of the site. The latitude and longitude must be provided in decimal format (6 decimals) as indicated in the following example (i.e., Latitude: 39.958832, Longitude: -83.001022). These coordinates can be determined through the use of global positioning system (GPS) receivers and web-based tools. An example of a web-based tool to determine your facility/site’s latitude and longitude is Google Maps. Here are instructions for Google Maps:

1.Go to http://maps.google.com

2.Zoom the map to the location of your site.

3.Right-click on the map at the approximate center of your site.

4.Select “What’s here?” from the context menu.

5.Left-click on the green arrow. The latitude and longitude of your site will be displayed in the box.

5.Indicate whether the facility was previously covered under an NPDES stormwater permit. If so, include the Ohio EPA NPDES facility permit number.

6.Enter the 4-digit SIC code which identifies the facility’s primary activity and second 4-digit SIC code identifying the facility’s secondary activity, if applicable. SIC codes can be obtained from the Standard Industrial Classification Manual, 1987. Another source is the following website provided by the Occupational Health and Safety Administration: http://www.osha.gov/oshstats/sicser.html.

7.Enter the total size of the site associated with industrial activity in acres. Acreage may be determined by dividing square footage by 43,560, as demonstrated in the following example.

Example: Convert 54,450 ft2 to acres

Divide 54,450 ft2 by 43,450 square feet per acre:

54, 450 ft2 ) 43,560 ft2/acre = 1.25 acres.

1.Provide the legal name of the person, firm, public organization, or any other entity that operates the facility or site described in this certification. The name of the operator may or may not be the same as the name of the facility. The operator is the legal entity that controls the facility’s operation, rather than the plant or site manager.

2.Provide the telephone number of the facility operator.

3.Provide the email address of the facility operator.

4.Provide the mailing address of the operator (P.O. Box numbers may be used). Include the city, state, and zip code. All correspondence will be sent to this address.

8.Check “Yes” or “No” as appropriate to indicate whether you have paved or roofed over a formerly exposed, pervious area (i.e., lawn, meadow, dirt or gravel road/parking lot) in order to qualify for no exposure. If yes, also indicate approximately how much area was paved or roofed over and is now impervious area.

Page 3 of 4

Instructions for the NO EXPOSURE CERTIFICATION for Exclusion from NPDES Stormwater Permitting

Section C. Exposure Checklist

Check “Yes” or “No” as appropriate to describe the exposure condition at your facility. If you answer “Yes” to ANY of the questions (1) through (11) in this section, a potential for exposure exists at your site and you cannot certify to a condition of no exposure. You must obtain (or already have) coverage under an Ohio NPDES storm water permit. After obtaining permit coverage, you can institute modifications to eliminate the potential for a discharge of storm water exposed to industrial activity, and then certify to a condition of no exposure.

Section D. Certification Statement

This application is to be signed as follows:

In the case of a corporation, by a responsible corporate officer.

For these purposes, a responsible corporate officer means:

(i)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

(ii)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;

In the case of a partnership, by a general partner.

In the case of a sole proprietorship, by the proprietor.

In the case of a municipal, State, or other public facility, by either the principal executive officer, the ranking elected official or other duly authorized employee.

For Additional Information

Additional information, general storm water permits and associated forms can be found on our website at: http://www.epa.ohio.gov/dsw/storm/index.aspx.

Any questions about the No Exposure Certification and completing this form can be directed to the Central Office Storm Water Unit at (614) 644-2001.

Page 4 of 4

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1. It's very important to fill out the Form Epa 4239 properly, therefore pay close attention while filling in the areas that contain all of these blanks:

2. Given that the last array of fields is finished, you'll want to insert the essential details in SICActivity Codes, Primary, Secondary if applicable, Total size of site associated, acres, a Have you paved or roofed over a, YES, b If yes please indicate, Less than one acre, One to five acres, More than five acres, EPA, and Page of so you can move on to the next part.

Step number 2 in submitting Form Epa 4239

A lot of people often make some errors while completing EPA in this area. Ensure that you revise what you enter here.

3. The following segment is focused on Please check either Yes or No in, Yes, Using storing or cleaning, industrial machinery or equipment, Materials or residuals on the, Materials or products from past, Material handling equipment, Materials or products during, Materials or products stored, exposure to storm water does not, Materials contained in open, Materials or products, Waste material except waste in, Application or disposal of, and Particulate matter or visible - complete all of these empty form fields.

4. This next section requires some additional information. Ensure you complete all the necessary fields - Additionally I certify under, Print Name, Print Title, Signature, Date, Mo Day Year, Email, and Page of - to proceed further in your process!

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