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HomeMy WebLinkAboutNCGNE1231_RescissionRequest_20180423FOR AGENCY USE ONLY Division of Energy, Mineral & Land Resources Date Received N ' Land Quality Section/Storm water Permitting Program Year Month Day National Pollutant Discharge Elimination System Environmental Quality RESCISSION REQUEST FORM Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit. 1) Enter the permit number to which this request applies: Individual Permit (or) Certificate of Coverage Iv I c I s I I I I I I I I N I C I G IN JE 11 12 13 11 2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below Owner/Facility Name L3 Technologies, Inc. Facility Contact Street Address City County Telephone No. Justin Vacca 7650 Omnitech Place Victor State NY Monroe E-mail Address 585 742-9602 Fax: 585 ZIP Code 14564 justin.vacca@13t.com 742-5469 3) Reason for rescission request (This is required information. Attach separate sheet if necessary): ❑✓ Facility closed or is closing on 3/30/18 . All industrial activities have ceased such that no discharges of stormwater are contaminated by exposure to industrial activities or materials. ❑ Facility sold to on . If the facility will continue operations under the new owner it may be more appropriate to request an ownership change to reissue to permit to the new owner. ❑ Other: 4) Certification: 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. Signature Vacca Print or type name of person signing above Please return this completed rescission request form to RECEIVED APR 2 3 2018 DENR-LAND QUALITY fiTORMWATER PERMITTING Revised 2018Jan10 Date 3/29/2018 Sr. Manufacturing Engineer, Facilities Lead Title DEMLR - Stormwater Program Dept. of Environmental Quality 1612 Mail Service Center Raleigh, North Carolina 27699-1612