NCG210485_Rescission Request_20220907

RECEIVED
FOR AGENCY USE ONLY
Assigned to: t. jt 0
ARO RO MRO RRO WARO WIRO WSRO
DEMLR-Storrnwater Program
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 stormwater 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 Z7699-1612. 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/Ooerator Ito whom all permit correspondence will be mailed):
Name of legal organizational entity:
Active Energy Renewable Power LLC
Legally responsible person as signed in Item l4l) below:
Jennifer G. Scott, £sqx
Street address:
City:
State and zip code:
1885 Alamac Road
Lumberton
NC 28358
Telephone number:
Email address:
919-236-9263
jecotY shlpmanlaw.com
2. Industrial Facility (facility requesting rescission):
Facility name:
Active Energy Renewable Power LLC
Street address:
1885 Alamac Road
City:
State:
Zip Code:
County:
Lumberton
NC
26358
Robeson
Permit Number to which this request applies:
General Permit No. NCG2100000, Certificate of Coverage No. NC210485
3. Reason for rescission Request
Information, AttaCn separate sneets it
Facility is dosed or closing. All industrial activities
by exposure to industrial activities or materials.
® Facility sold.
Sold to: Phoneiz Lumberton Industrial investors LLC
On date: 6/30/2022
such that no discharges of stormwater are contaminated

4. Applicant Certification:
North Carolina General Statute 143-215.68 (1) 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 thisrequest and to the Crest of my knowledge and belief
such information is true, complete, and accurate.
Printed Name of Person Signing: Jennifer D. Scott. Esqx
Title: �A
(Si7'he
Applit ttj ----_.� (Date�Z —
Ki entirepackage to: DEMLR —Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
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