NCC191444_Notice of Termination_20200115

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/15/2020 9:20:30 AM (NOT Submittal)
Approve by Georgoulias, Bethany 1/17/2020 8:30:43 AM (NOT Request Review- NCC191444)
• Georgoulias, Bethany reassigned the task to Georgoulias, Bethany 1/17/2020 7:55 AM
. The task was assigned to Farkas, Jim J by round robin distribution 1/15/2020 9:20 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 20, 2020 5:00
PM 1/15/2020 9:20 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC191444
Coverage (COC) Enter the Certificate of Coverage Ninber
No.*
Information associated with this permit
Project Name
Soil Stockpile Removal Volvo North America
Address
7900 National Service Road, Greensboro, NC
County
Guilford
Latitude
36.0000
Longitude
-80.0000
Permittee Listed
Volvo Group North America, LLC
Legally Responsible
Pamela Wray
Individual
NC Reference No.
NCG01-2019-1444
E&SC Plan ID
2950
Original NOI
14960
Tracking No.
Date COC Issued
8/19/2019
Prior Rescission
This field will populate only ff OOChas already been rescinded.
Date
Reason for Rescission/Termination Request:
Reason for F Project Closed -Out
Termination of r Sale (Another Owner/Operator will apply for a new COC)
Coverage * O Mistake or Invalid Coverage
r Other
Addional Mxe inforrration about the basis of this request, if needed.
Explanation
Supporting upload Supporting Docurrentation if applicable.
Documentation Mist beFDFforrrat
Project Close-out Information:
Final Close-out 1/15/2020
Inspection Approval

Project Close-out Closure Letter.pdf 25.71KB
Approval Mast be RYforrrat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules ofthe
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to e)ceed ten thousand
dollars ($10,000).
rJ 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.
*This form must be signed by a responsible corporate officer that owns or operates the construction activity, such as a
president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B,
Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
Type Name* Jason Sims
Title * Director of Field Operations
Organization* Kirkland
Date * 01 /15/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 3364546131
NOT Certification Signed NOT Form.pdf 174.18KB
Form Mast be FDF Forrrat