NCC192041_Notice of Termination_20210927

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/27/2021 7:58:51 AM (NOT Submittal)
Approve by Morman, Alaina 9/28/2021 10:08:00 AM (NOT Request Review- NCC192041)
• The task was assigned to Morman, Alaina. The due date is: September 30, 2021 5:00 PM
9/27/2021 7:58 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC192041
Coverage (COC) Enter the Certificate of Coverage Ninber
No.*
2020 Annual Fee Status PAID
2021 Annual Fee Status Nbybeblank (if not yet billed)
Information associated with this permit:
Project Name
City of Monroe Natural Gas Marshville Expansion - Edwards Wood Products
Address
US-74 and State Road - 1719, Marshville, NC
County
Union
Latitude
35.0000
Longitude
-80.0000
Permittee Listed
City of Monroe - Energy Services
Legally Responsible
David Lucore
Individual
NC Reference No.
NCG01-2019-2041
E&SC Plan ID
UNION-2020-018
Original NOI
16247
Tracking No.
Date COC Issued
10/7/2019
Prior Rescission
Date populates only if COCwas already rescinded at tirre of subrrittal.
Date
Reason for Rescission/Termination Request:
Reason for
F Project Closed -Out
Termination of
r Sale (Another Owner/Operator obtained a new COC)
Coverage *
O Mistake or Invalid Coverage
r Other
Additional Wre information about the basis of this request, if needed.
Explanation Project has been completed and is ready for
NCG01 Notice of Termination
Supporting Upload Supporting Docurrentation if applicable.
Documentation Mast beFDFforrrat

Project Close-out Information:
Final Close-out 9/13/2021
Inspection Approval
Project Close-out NCG01 Notice of Termination.pdf 148.94KB
Approval Mast be FDFfornat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes any false 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 knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis 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 mayinclude 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* Drew Waravdekar
Title * Natural Gas & Compliance Engineer
Organization * The City of Monroe
Date * 09/27/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 7042824794
NOT Certification NCG01 Notice Of Termination Signed.pdf 138.2KB
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
CCd on Notification Errails
CCd on Notification Bmils
[e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]