NCG160158_Letter Requesting Rescission_20190911

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
APAC Atlantic Inc.
300 S. Benbow Road
Greensboro, NC 27420
NORTH CAROLINA
Environmental Quality
September 11, 2019
Subject: APAC Atlantic Inc. — North Quarry Plant (42403)
Foisyth County Notai Caloliiia
Stormwater Permit NCG160158
We received your note indicating that the above facility is no longer owned by APAC Atlantic.
Please complete the enclosed Rescission Request Form for the facility. Your assistance in this
matter is greatly appreciated.
Sincerely,
'� M-,Cn
Suzanne McCoy
Administrative Specialist
Enclosure
cc: Winston-Salem Regional Office - T. Eplin
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North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
512 North Salisbury Street 1 1612 Mail Service Center I Raleigh, North Carolina 27699-1612
919.707.9200

FOR AGENCY USE ONLY
Division of Energy, Mineral & band Resources Date Received
411",
Land Quality Section/Stormwater Permitting Program Year Month Day
National Pollutant Discharge Elimination System
Ichll4 onment i
Quality RESCISSION REQUEST FORM
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name
Facility Contact
Street Address
City
County
Telephone No.
State
E-mail Address
Fax:
ZIP Code
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑ Facility closed or is closing on . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
❑ Facility sold to
on . If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner.
❑ Other:
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complete and accurate.
Signature
Print or type name of person signing above
Please return this completed rescission request form to:
Date
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised 20183an10