NCC190458_Notice of Termination_20210902

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/2/2021 10:14:10 AM (NOT Submittal)
Approve by Morman, Alaina 9/3/2021 4:54:53 PM (NOT Request Review- NCC190458)
• The task was assigned to Morman, Alaina. The due date is: September 7, 2021 5:00 PM
9/2/2021 10:15 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC190458
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
PAID
2021 Annual Fee Status
PAID
Nt3y be blank (if not yet billed).
Information associated
with this permit:
Project Name
Kinder Morgan 8RK Expansion Plantation Tank Farm
Address
6811 West Market Street, Greensboro, NC
County
Guilford
Latitude
36.0770
Longitude
-79.9250
Permittee Listed
Kinder Morgan Plantation Pipeline Company (PPL)
Legally Responsible
Ken Brinegar
Individual
NC Reference No.
NCG01-2019-0458
E&SC Plan ID
8RK Expansion Tank Farm - 2942
Original NOI
11682
Tracking No.
Date COC Issued
6/4/2019
Prior Rescission
Cate populates only if COCwas already rescinded at time of submittal.
Date
Reason for Rescission/Termination Request:
Reason for
r Project Closed -Out
Termination of
r Sale (Another Owner/Operator obtained a new COC)
Coverage *
r Mistake or Invalid Coverage
r Other
Addional IVbre information about the basis of this request, if needed.
Explanation
Supporting upload Supporting Documentation if applicable.
Documentation Mist beRYforrrat

Project Close-out Information:
Final Close-out 8/16/2021
Inspection Approval
Project Close-out PPL-GN Kinder Morgan NCG01 Termination of
Approval 279.4KB
Grading Permit.pdf
Documentation
Mist be FDFforrrat
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowingly makes anyfalse 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; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this 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 may include a fine not to 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* Ken Brinegar
Title * Director - Operations
Organization * Kinder Morgan Products Pipeline SE
Date * 09/02/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 770-751-4142
NOT Certification PPL-GN Kinder Morgan NCG01 NOT Certification
Form Form.pdf
Mist be FDF Fornat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional) [e-mail]
Original Permittee CCdonWificationErrails
Email [e-mail]
Original Site Contact CCd on Notificaiton Brrails
Email [e-mail]
190.43KB