NCG100027_Ltr sending rescission form_20210601

ROY COOPER
Governor
DIONNE DELLI-GATTI
Secretary
BRIAN WRENN
Director
Linda and Jesse Price
PO Box 1603
Knightdale, NC 27545
Subject: Rescission Request
NCG100027
Price's Auto Parts LLC
Wake County
NORTH CAROLINA
Environmental Quality
June 1, 2021
On May 17, 2021 the Division of Energy, Mineral & Land Quality received your
note indicating the above property has been sold and the business closed
09/08/2020.
Please complete the enclosed Rescission Request form and return it to:
Stormwater Program
Attention: Suzanne McCoy
1612 Mail Service Center
Raleigh NC 27699-1612
Thank you for your attention to this matter. If you have any questions, please
contact me at [phone].
Sincerely,
Suzanne McCoy
Stormwater Program
Administrative Assistant
E Q 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
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FOR AGENCY USE ONLY
NCG
Assigned to:
ARO FRO MRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
Rescission Request Form
Please fill out and return this form if you no longer need to maintain your NPDES storm water permit.
Directions: Print or type all entries on this application form. Send the original, signed application to: NCDEMLR
Stormwater Program, 1612 Mail Service Center, Raleigh, NC 27699-1612. The submission of this form does not
guarantee recission of your NPDES stormwater permit. Prior to the recission of your NPDES stormwater permit, a
site inspection will be conducted.
1. Owner/Operator (to whom all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
Street address:
City:
State and zip code:
Telephone number:
Email address:
2. Industrial Facility (facility requesting rescission):
Facility name:
Street address:
City:
State:
Zip Code:
County:
Permit Number to which this request applies:
3. Reason for rescission Request

4. Applicant Certification:
North Carolina General Statute 143-215.68 (i) provides that: Any person who knowingly makes any false statement,
representation, or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000). I hereby request exclusion from NPDES stormwater permitting.
Under penalty of law, I certify that:
❑ I, as an authorized representative, hereby request recission 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.
Printed Name of Person Signing:
Title:
(Signature of Applicant)
(Date Signed)
Mail the entire package to: DEMLR— Stormwater Program
Department of Environmental Quality
1612'Mail Service Center
Raleigh, NC 27699-1612
Page 2 of 2

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II I I II I I II II I I III II II II I II II
INVOICE * 2 0 2 0 P R 0 1 1 1 5 3
Stormwater Annual Permit Fee Overdue
This Stormwater annual fee is required by the North Carolina Administrative Code 143-215.D(a). It covers the administrat
costs associated with your permit. It is required of any person holding a permit for any time during the annual fee period,
regardless of the facility's operating status. Failure to pay the fee by the due date will subject the permit to revocation.
Operating without a valid permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and you ]at
decide a permit is needed, you must reapply, with the understanding the permit request may be denied due to changes it
environmental, regulatory, or modeling conditions.
Invoice Number: 2020PRO11153
Permit Number: NCG100027
Wake County
Price's Auto Parts L L C
Jesse H. Price
Price's Auto Parts L L C
1900 Old Crews Rd
Knightdale, NC 27545-8478
Annual Fee Period: 2021-01-01 to 2021-12-31
Invoice Date: 12/03/2020
Due Date: 01/02/2021
Annual Fee: $100.00
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14AY 17 2021
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1. Electronic payment is convenient and quick. To pay by ePayment, type "https:/Ideq.nc.gov epayments/stormwater" into your
browser. If you select eCheck, there will be no convenience fee. The convenience fee for a credit card is 2.65% and the
convenience fee for a debit card is $3.95.
2. To pay by mail, please make your check payable to "DEMLR Stormwater Program" and include the invoice number on the check.
Then, detach the invoice below and write the check number on the invoice. A $25.00 processing fee will be charged
for returned checks in accordance with N.C. General Statute 25-3-512.
Remit payments by mail to:
NCDEQ - Division of Energy, Mineral and Land Resources
Attn: Stormwater Billing
512 N. Salisbury Street
1612 Mail Service Center
Raleigh, NC 27699-1612
3. Non-payment of this fee by the payment due date will initiate the permit revocation process.
4. Please include your permit number in all correspondence.
5. Should you have any questions, please contact the Fee Coordinator at aziza.selkane cDncdenr.gov or [phone].
(Return This Portion With Check)
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* 2 0 2 0 P R 0 1 1 1 5 3
ANNUAL PERMIT INVOICE
Overdue
Invoice Nu er: 2020PRO11153 ��`� d� Annual Fee Perio 021-01-01 to 2021-12-31
Permit Number: NCG100027
Invoice Date: 12/3/2020
Wake County
Price's Auto Parts L L C_ �s 9-5\ Due Date: 1/2/2021
Jesse H. Price
Price's Auto Parts L L C
1900 Old Crews Rd
Knightdale, NC 27545-84
Annual Fee: $100.00
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Check Number:
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