NCGNE1352_Rescission Request_20210816

. 14
FOR AGENCY USE ONLY
Assigned to:
ARO FRO MRO RRO
WARO WIRO WSRO
R 0EI V ED
AUG 16 2021
DENR-LAND QUALITY
STORMWATER PERMITTING
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 hermit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
RHF Investments, Inc.
Dennis B. Tart
Street address:
City:
State and zip code:
401 11th Street NW / P.O. Box 608 Hickory NC 28603
Hickory
NC 28601
Telephone number:
Email address:
828 - 326 - 8376
[e-mail]
2. Industrial Facilitv (facilitv reauestine rescission):
Facility name:
CENTURY FURNITURE - TECH CENTER (former operator via RHF Investments, Inc.)
Street address:
25 18 th Street NW
City:
I
State:
Zip Code:
County:
Hickory
NC
28601
Catawba
Permit Number to which this request applies:
NCGNE1352
3. Reason for rescission Request
I IIIJ Ib ICLIUI[CU IIIIUI I I I d LIVI I. HLLd L.II JCFJdIdLC MICCLJ IIIICLt:bbdIy.
0 Facility is closed or closing. All industrial activities have ceased such that no discharges of stormwater are contaminated
by exposure to industrial activities or materials.
Date closed/closing:
0 Facility sold.
Sold to: Runnymede Investment LLC
On date: 5/24/2021
Other (please explain):

4. Applicant Certification:
North Carolina General Statute 143-215.613 (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). 1 hereby request exclusion from NPDES stormwater permitting.
Under penalty of law, I certify that:
Ell 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: DENNIS B. TART
Title: ENVIRONEMNTAL ENGINER - RHF
8)G )2-oZl
(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
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