NCG030290_Rescission Request_20191115

Environmental
Quality
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
NOV 1,5 ma
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permitDENR-LAND QUALITY
STORMWATER PERMITi-ING
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N I C I S I I I I I N I 0 I 0 10 13 10 2 9 0
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Na
Facility Contact
Street Address
City
County
Telephone No.
CIVIC Steel US, LLC
Peter Pozzo
2600 Park Road Ext.
Burlington
Alamance
336 506-1894
State NC
E-mail Address
Fax:
ZIP Code 27215
[e-mail]
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 WJD Holdinq, LLC on 10/1 8f 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 accurst
+ ( / -
Signature Date
Marshal Bonds
Print or type name of person signing above
Please return this completed rescission request form to
Revised 20183an10
Area Manager
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612