NCG170148_Rescission Request_20240828

FOR AGENCY USE ONLY
Assigned to: 5• P.06-
ARO FRO MRO RRO WARD WIRO WSRO
Division of En_exgy, Mineral, and Land Resources Land Quality Section
al Pollutant Discharge Elimination System
Rescission Request Form
Please fill out and return this fogf �Y10 longer need to maintain your NPDES stormwater permit.
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Directions. r 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:
Parkdale Mills,Inc Charles Heilig
Street address: City: State and zip code:
PO Box 1787 Gastonia 28053
Telephone number: Email address:
704-874-5000 [e-mail]
2. Industrial Facility(facility requesting rescission):
Facility name:
Parkdale Mills/Plant 23
Street address:
100 South Main St
City: State: Zip Code: County:
Landis NC 28088 Rowan
Permit Number to which this request applies:
NCG170148
3. Reason for rescission Request
This is required information.Attach separate sheets if necessary.
0 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/closing:
0 Facility sold.
Sold to: RRLandis,LLC
On date: 15 Feb 2024
DOther(please explain):

4. Applicant Certification:
North Carolina General Statute 143-215.6E(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:
O 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: Charles Heilig
Title: President
(Signature of Applicant) (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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