NCC190885_Notice of Termination_20201211

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/11/2020 4:31:05 PM (NOT Submittal)
Approve by Georgoulias, Bethany 12/14/2020 8:16:09 AM (NOT Request Review- NCC190885)
• The task was assigned to Georgoulias, Bethany. The due date is: December 16, 2020 5:00 PM
12/11/2020 4:31 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190885
Coverage (COC) Enter the Certificate of Coverage Nimber
No.*
2020 Annual Fee Status PAID
2021 Annual Fee Status N/A
Information associated with this permit
Project Name
New Hotworking Expansion
Address
Goldmine Road, Monroe, NC
County
Union
Latitude
35.0120
Longitude
-80.6170
Permittee Listed
TDY Industries, LLC
Legally Responsible
Scott Vallandingham
Individual
NC Reference No.
NCG01-2019-0885
E&SC Plan ID
UNION-2019-089
Original NOI
13182
Tracking No.
Date COC Issued
7/9/2019
Prior Rescission
Date populates only if OOC was already rescinded at tirre of submittal.
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
Ad d i o n a I Nbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Docurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 11/19/2020
Inspection Approval
Project Close-out UNION-2019-089_STI Hotworking
Approval 115.77KB
C0_11.19.2020.pdf
Documentation
Mist be FDFforrrat
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes anyfalse 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 knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho falsifies, tampers with, or knowingly renders
inaccurate anyrecording 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 notto exceed 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* Tucker Redford
Title * President
Organization* TDY Industries, LLC
Date * 12/11 /2020
Email for [e-mail]
Confirmation *
Contact Telephone* 7045628510
NOT Certification NCG01 Notice of Termination Certification
Form Form Executed.pdf
Mist be FDF Fornat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Erails
(Optional)
Original Permittee CCd on Wification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]
25.74KB