NCGNE1201_Rescission Request_20200728

FOR AGENCY USE ONLY
• Division of Energy,Mineral& Land Resources Date Received
Land Quality Section/Stormwater Permitting Program Year Month Day
National Pollutant Discharge Elimination System
Environmental
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
C s N C G N E 1 2 0 1
2) Owner/Facility Information: *Final correspondence will be mailed to the address noted below
Owner/Facility Name Donnelley Financial-Silverlake Facility
Facility Contact Charles H.Williamson,CSP,EHS Manager
Street Address 9410 D Ducks Lane
City Charlotte State NC ZIP Code 28273
County Mecklenberg E-mail Address [e-mail]
Telephone No. (717) 475-6302 Fax: (717) 2954252
3) Reason for rescission request(This is required information. Attach separate sheet if necessary):
❑✓ Facility closed or is closing on 9/30/20 . 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, corn lete and ac urate.
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Signature Date 7/23/20
Charles H.Williamson,CSP EHS Manager
Print or type name of person signing above Title
Please return this completed rescission request form to: DEMLR- Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised 2018Jan10

DFIN
391 Steel Way, Lancaster, PA 17601
717.295.4120 (0)
[e-mail]
http://www.DFINSolutions.com
July 23, 2020
DEMLR — Stormwater Program RECEIVED
Department of Environmental Quality JUL 2 8 2020
1621 Mail Service Center
Raleigh, North Carolina 27699-1612 DENR-LAND TY
STORMWATR PERMITTING
RE: NCGNE1201
To Whom It May Concern:
We have decided to close our operations at 9410 D Ducks Lane in Charlotte on
September 30, 2020. I have attached the Rescission Request Form.
Should you have any questions or require additional information, please feel free to
contact me at [phone].
Respectfully,
Charles H. Williamson, CSP
EHS Manager
DF I N 35 W.WACKER DRIVE/CHICAGO, IL 60601