NCC190044_NOT Signed Certification_20230509

NCGO1 Notice of Termination (NOT) Certification Form
Directions:
Print this form,complete,scan and upload to the electronic NOT(Rescission)form.
Then,mail the original signed form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral& Land Resources Stormwater Program
512 N.Salisbury Street,6th Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM UNTIL YOUR NOT REQUEST HAS BEEN REVIEWED AND APPROVED.
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE(NOT DIGITAL) [40 CFR 122.22)
General Permit Certificate of Coverage (COC) No.: NCC1 90044
Name of Project: Wilkinson Solar, LLC
Per NC General Statute 143-215.68(i), 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).
Under penalty of law, I certify that:
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.
Legally Responsible Organizational Entity: Wilkinson Solar, LLC, a subsidiary of Dominion Solar Projects VII, Inc.
*Legally Responsible Person: Michael Kaplan
Title of Legally Responsible Person: Vice President
*Signature: 4 / Date: 5 2,0 L j
Print Name and ' e of Signed (only if Guth. ized individual signing differs from Legally Responsible Person):
Brandon E. Stites - VP Project Construction, signatory authority for Wilkinson Solar, LLC
*IMPORTANT NOTE: 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 8,Item(6)of the NCG010000 permit.
For more information on signatory requirements,see Part IV,Section 8, Item(6)of the NCG010000 permit.