2021 Multi-Sector General Permit (MSGP) - Appendix K

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2021 MSGP

Appendix K – No Exposure Certification (NEC) Form

Appendix K - No Exposure Certification (NEC) Form
Part 7.2 requires you to use the NPDES eReporting Tool, or “NeT”, to prepare and submit your No
Exposure Certification (NEC) form. However, if you are given a waiver by the EPA Regional Office to
use a paper NEC form, and you elect to use it, you must complete and submit the following form.

NPDES Form 3510-11

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2021 MSGP

Appendix K – No Exposure Certification (NEC) Form
UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
WASHINGTON, DC 20460

NPDES
FORM
3510-11

NO EXPOSURE CERTIFICATION (NEC) FOR EXCLUSION FROM EPA’S MULTI-SECTOR GENERAL PERMIT FOR
STORMWATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY (MSGP)

OMB No. 2040-0004
Exp. Date: 7/31/2026

Submission of this No Exposure Certification (NEC) constitutes notice that the operator identified in Section C does not require permit authorization under EPA’s
Stormwater Multi Sector General Permit for its stormwater discharges associated with industrial activity from the facility identified in Section D of this form 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 stormwater discharges (e.g., rock salt).

A NEC 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 NEC form, the operator in Section C 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 40 CFR 122.26(g).

A. Approval to Use Paper NEC Form
1. Have you been granted a waiver from electronic reporting from the EPA Regional Office*?

 YES  NO

If yes, check which waiver you have been granted, the name of the EPA Regional Office staff person who granted the waiver, and the date of approval:
Waiver granted:



The owner/operator’s headquarters is physically located in a geographic area (i.e., ZIP code or census tract) that is
identified as under-served for broadband Internet access in the most recent report from the Federal Communications
Commission.



The owner/operator has issues regarding available computer access or computer capability

Name of EPA staff person that granted the waiver:
Date approval obtained:

/

/

* Note: You are required to obtain approval from the applicable EPA Regional Office prior to using this paper NEC form. If you have not obtained a waiver,
you must file this form electronically using the NPDES eReporting Tool (NeT) at https://www.epa.gov/npdes/stormwater-discharges-industrial-activities

B. Reason for Submission
Select the purpose for filling out this form (check only 1).




To obtain a new NEC. Fill in Sections C, D, E and F.
To discontinue an existing NEC. Select this option if you would like to discontinue an existing NEC because your facility is no longer subject to
regulation under 40 CFR 122.26 (e.g., the facility has ceased the industrial activity that necessitated the NEC)*. Provide the following information
and fill out Section G.

Provide the existing NPDES ID for the NEC that you would like to discontinue:
1.

Are you a new discharger or a new source as defined in Appendix A?

 YES  NO (If yes, skip to Part C of this form).

* Note that if your facility no longer qualifies for the NEC because permit coverage is required for exposed industrial materials or activities, you should not
check this box, and must instead file for coverage under the Multi-Sector General Permit (MSGP) or an individual permit. Your NEC will be automatically
discontinued after you obtain coverage under the MSGP or an individual permit.

C. Facility Operator Information
1. Operator Name:
2. Mailing Address:
Street:
City:
3. Phone:

State:
-

-

ZIP Code:

-

Ext.

4. E-mail:

NPDES Form 3510-11

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2021 MSGP

Appendix K – No Exposure Certification (NEC) Form

5. Operator Point of Contact Information:
First Name, Middle Initial, Last Name
Title:

D. Facility Information
1. Facility Name:
2, Facility Address:
Street/Location:
City:

State:

-

ZIP Code:

County or Similar Government Subdivision:
3. Latitude/Longitude for the facility:
Latitude:

.

° N (decimal degrees)

 Maps

Latitude/Longitude Data Source:

Longitude:

° W (decimal degrees)

.

 GPS

 Other

 NAD 83

 WGS 84

If you used a USGS topographic map, what was the scale?

 NAD 27

Horizontal Reference Datum:
4.

Is your facility located on Indian Country lands?

 YES

 NO

If yes, provide the name of the Indian tribe associated with the area of Indian country (including name of Indian reservation, if applicable):
5. Are you a “federal operator” as defined in Appendix A?
6. What is the ownership type of the facility?

 YES

 NO

 Federal Facility (U.S.

 Privately Owned Facility

 Municipality

 County Government

 Corporation

 State Government

 Tribal Government

 School District

 District

 Mixed Ownership (e.g.,

 Municipal or Water

Government)

Public/Private)

7. Have stormwater discharges from your facility been covered previously under an NPDES permit?

 YES

District

 NO

If yes, provide the NPDES ID if you had coverage under EPA’s MSGP or the
NPDES permit number if you had coverage under an EPA individual permit:
8. Has your facility previously been covered by a no exposure exclusion?

 YES

 NO

If yes, provide the NPDES ID for your previous no exposure exclusion:
9. Identify the 4-digit Standard Industrial Classification (SIC) code or 2-letter Activity Code that best represents the products produced or services rendered for
which your facility is primarily engaged, as defined in the MSGP, and the applicable sector and subsector of your primary industrial activity (See Appendix D):

 Primary

OR

SIC Code

10. Total size of site associated with industrial activity:

 Primary

Activity Code

(to the nearest quarter acre)

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

 YES

 NO

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, your permitting authority may use this information in considering whether stormwater 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 (1) acre

NPDES Form 3510-11

 One (1) to five (5) acres

 More than five (5) acres

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2021 MSGP

Appendix K – No Exposure Certification (NEC) Form

E. 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, you are not eligible for the no exposure exclusion.
Yes

No

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





Materials or residuals on the ground or in stormwater inlets from spills/leaks





Materials or products from past industrial activity





Material handling equipment (except adequately maintained vehicles)





Materials or products during loading/unloading or transporting activities





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)





Materials contained in open, deteriorated or leaking storage drums, barrels, tanks, and similar containers





Materials or products handled/stored on roads or railways owned or maintained by the discharger





Waste material (except waste in covered, non-leaking containers [e.g., dumpsters])





Application or disposal of process wastewater (unless otherwise permitted)





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





F. Certification Information
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 NEC 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 properly 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.
First Name, Middle, Last Name:
Title:
Signature:

Date:

/

/

E-mail:

G. Discontinuation of NEC Information
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 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.
First Name, Middle, Last Name
Title:
Signature:

Date:

/

/

E-mail:

NPDES Form 3510-11

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2021 MSGP

Appendix K – No Exposure Certification (NEC) Form
Instructions for Completing EPA Form 3510-11
No Exposure Certification (NEC) for Exclusion from Stormwater Discharges
Associated with Industrial Activity Under the NPDES Multi-Sector General Permit
This Form Replaces Form 3510-11 (06/15) OMB No. 2040-0004
MSGP for the definition of “operator”. Provide the operator’s
mailing address, phone number, and e-mail. Correspondence
for the NEC will be sent to this address. Also provide the name
and title for the operator point of contact (note that the point of
contact name may be the same as the operator name).

Who May File a No Exposure Certification (NEC) Form
Federal law at 40 CFR Part 122.26 prohibits point source discharges
of stormwater associated with industrial activity to waters of the
U.S. without a National Pollutant Discharge Elimination System
(NPDES) permit. However, NPDES permit coverage is not required
for discharges of stormwater associated with industrial activities
identified at 40 CFR 122.26(b)(14)(i)-(ix) and (xi) if the discharger
can certify that a condition of “no exposure” exists at the industrial
facility or site.
Stormwater discharges from construction activities identified in
40 CFR 122.26(b)(14)(x) and (b)(15) are not eligible for the no
exposure exclusion.

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 is
only applicable in jurisdictions where EPA is the NPDES permitting
authority and 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 stormwater, the facility
operator must obtain coverage under an NPDES stormwater
permit immediately.
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, but not for punctuation marks unless they are
needed to clarify your response. Please submit original document
with signature in ink - do not send a photocopied signature. 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. Approval to Use Paper NEC Form
You must indicate whether you have been granted a waiver from
electronic reporting from the EPA Regional Office. Note that you
are not authorized to use this paper NEC form unless the EPA
Regional Office has approved its use. Where you have obtained
approval to use this form, indicate the waiver that you have
been granted, the name of the EPA Regional Office staff person
who granted the waiver, and the date that approval was
provided. See https://www.epa.gov/npdes/contact-usstormwater for a list of EPA Regional Office contacts.
Section B. Reason for Submission
You must check your reason for submitting this form. You may
submit this form for obtaining a new NEC, for renewing a previous
NEC, or for discontinuing an existing NEC (for facilities that no
longer need the exclusion from permit coverage for industrial
stormwater discharges).

Section D. Facility Information
Enter the official or legal name and complete street address,
including city, state, ZIP code, and county or similar government
subdivision of the facility. If the facility lacks a street address,
indicate the general location of the facility (e.g., Intersection of
State Highways 61 and 34). Complete facility information must
be provided for permit coverage to be granted.
Provide the latitude and longitude of your facility in decimal
degrees format. The latitude and longitude of your facility can
be determined in several different ways, including through the
use of global positioning system (GPS) receivers and U.S.
Geological Survey (USGS) topographic or quadrangle maps.
Refer to http://transition.fcc.gov/mb/audio/bickel/DDDMMSSdecimal.html/ for assistance in providing the proper
latitude/longitude format. For consistency, EPA requests that
measurements be taken form the approximate center of the
facility. Specify which method you used to determine latitude
and longitude. If a USGS topographic map is used, specify the
scale of the map used. Enter the horizontal reference datum for
your latitude and longitude. The horizontal reference datum
used on USGS topographic maps is shown on the bottom left
corner of USGS topographic maps; it is also available for GPS
receivers.
Indicate whether the facility is on Indian country lands, and if so,
provide the name of the Indian tribe associated with the area of
Indian country (including name of Indian reservation, if
applicable).
Indicate whether you are a “federal operator” as defined in
Appendix A of the MSGP. Also check the facility’s ownership
type.
Indicate whether the facility was previously covered under an
NPDES stormwater permit. If so, include the NPDES ID (i.e., NOI
tracking number).
List the four-digit Standard Industrial Classification (SIC) code or
two character activity code that best describes the primary
industrial activities performed by your facility.
Enter the total size of the site associated with industrial activity in
acres.
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.

Section C. Facility Operator Information
Provide the legal name of the person, firm, public organization, or
any other entity that operates the facility described in this
certification form. An operator of a facility is the legal entity that
controls the operation of the facility. Refer to Appendix A of the

NPDES Form 3510-11

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2021 MSGP

Appendix K – No Exposure Certification (NEC) Form
Instructions for Completing EPA Form 3510-11
No Exposure Certification (NEC) for Exclusion from Stormwater Discharges
Associated with Industrial Activity Under the NPDES Multi-Sector General Permit

This Form Replaces From 3510-11 (06/15) Form OMB No. 2040-0004
Section E. Exposure Checklist
Regulatory Support Division Director, U.S. Environmental
Check “Yes” or “No” as appropriate to describe the exposure
Protection Agency (2821T), 1200 Pennsylvania Ave., NW,
condition at your facility. If you answer “Yes” to ANY of the
Washington, D.C. 20460. Include the OMB control number in any
questions in this section, a potential for exposure exists at your site
correspondence. Do not send the completed form to this
and you cannot certify to a condition of no exposure. You must
address.
obtain (or already have) coverage under an NPDES stormwater
Submitting Your Form
permit. After obtaining permit coverage, you can institute
modifications to eliminate the potential for a discharge of
If you have been granted a waiver from your Regional Office to
stormwater exposed to industrial activity, and then certify to a
submit a paper NEC form, you must send your NEC form by mail
condition of no exposure.
to one of the following addresses:
Section F and G. Certification and Discontinuation of NEC Information
The NEC form must be signed as follows:
For a corporation: By a responsible corporate officer. For the
purpose of this Section, 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.

For Regular U.S. Mail Delivery:
Stormwater Notice Processing Center
Mail Code 4203M, ATTN: MSGP No Exposure
U.S. EPA
1200 Pennsylvania Avenue, NW
Washington, DC 20460
For Overnight/Express Mail Delivery:
Stormwater Notice Processing Center
William Jefferson Clinton East Building - Room 7420
ATTN: MSGP No Exposure
U.S. EPA
1201 Constitution Avenue, NW
Washington, DC 20004
Visit this website for instructions on how to submit electronically:
https://www.epa.gov/npdes/stormwater-discharges-industrialactivities

For a partnership or sole proprietorship: By a general partner or the
proprietor, respectively; or
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.
Include the name, title, and e-mail address of the person signing
the form and the date of signing.
An unsigned or undated NEC form will not be considered valid.
Paperwork Reduction Act Notice
This collection of information is approved by OMB under the
Paperwork Reduction Act, 44 U.S.C. 3501 et seq. (OMB Control No.
2040-0004). Responses to this collection of information are
mandatory (40 CFR 122.26). An agency may not conduct or
sponsor, and a person is not required to respond to, a collection
of information unless it displays a currently valid OMB control
number. The public reporting and recordkeeping burden for this
collection of information is estimated to be 45 minutes per
response. Send comments on the Agency’s need for this
information, the accuracy of the provided burden estimates and
any suggested methods for minimizing respondent burden to the

NPDES Form 3510-11

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