NCG130028_Rescission Request_20230816

FOR AGENCY USE ONLY
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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 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 permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
Waste Management of Carolinas Inc
Keith Eric Wakefield
Street address:
City:
State and zip code:
10411 Globe Rd
Morrisville
NC 27560
Telephone number:
Email address:
321-403-2544 980-337-5331
[e-mail] [e-mail]
2. Industrial Facility (facility requesting rescission):
Facility name:
Raleigh MRF
Street address:
1815 Capital Blvd
City:
State:
Zip Code:
County:
Raleigh
NC
27604
Wake
Permit Number to which this request applies:
NCG130028
3. Reason for rescission Request
❑ 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/closine:
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Sold to: Qyl.itar�u15�t K1
On date: 12. 3
El Other (please explain):

4. Applicant Certification:
North Carolina General Statute 143-215.68 (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:
El 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: Keith Eric Wakefield
Title: Area Director Collection Operations
Aug 8, 2023
(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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