NCG050092 Rescission Request

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Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
DENR-LMlD
1) Enter the permit number to which this request applies: 7, UORMWATER Pc;,= wo t
Individual Permit (or) Certificate of Coverage
N I C I S I I I I I I N I C I G 1 0 1 5 1 0 1 ol 9F2
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name Apex Tool Group, LLC
Facility Contact Todd Phillips
Street Address 1000 Lufkin Rd.
City Apex State NC ZIP Code 27539
County Wake E-mail Address [e-mail]
Telephone No. 919 387-2345 Fax:
3) Reason for rescission request (This is reguired information. Attach separate sheet if necessary):
❑ Facility closed or is closing on . 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.
9 Other: The facility moved manufacturing operations to Mexico in 2015. The facility is now an off-site warehouse
and is considered a "Hardware Merchant Wholesaler" under SIC code 5072. Therefore since this SIC code is not covered
by the NPDES Stormwater regulations, we believe the facility is no longer required to maintain a Stormwater Permit.
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 tr e, com le and accurate.
Signature Date Ail1 17,f 7
Ci�{I21ST6p1 K. �w�t I1 1F-tc'DY I�St r�lbwlio"
Print or type name of person signing above Title
Please return this completed rescission request form to: NPDES Permit Coverage Rescission
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
1612 Mail Service Center, Raleigh, North Carolina 27699-1612
Phone: [phone] FAX: [phone]
An Equal Opportunity 1 Affirmative Action Employer 1 3 1 J
V
FOR AGENCY USE ONLY
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Division of Energy, Mineral & Land Resources
Date Received
Land Quality Section/Stormwater Permitting Program
Year Month Da
NCDENRNational
Pollutant Discharge Elimination System
NORTH CAROUNA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
* Dnp
RECEI
RESCISSION REQUEST FORM
Q L i3 i
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
DENR-LMlD
1) Enter the permit number to which this request applies: 7, UORMWATER Pc;,= wo t
Individual Permit (or) Certificate of Coverage
N I C I S I I I I I I N I C I G 1 0 1 5 1 0 1 ol 9F2
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name Apex Tool Group, LLC
Facility Contact Todd Phillips
Street Address 1000 Lufkin Rd.
City Apex State NC ZIP Code 27539
County Wake E-mail Address [e-mail]
Telephone No. 919 387-2345 Fax:
3) Reason for rescission request (This is reguired information. Attach separate sheet if necessary):
❑ Facility closed or is closing on . 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.
9 Other: The facility moved manufacturing operations to Mexico in 2015. The facility is now an off-site warehouse
and is considered a "Hardware Merchant Wholesaler" under SIC code 5072. Therefore since this SIC code is not covered
by the NPDES Stormwater regulations, we believe the facility is no longer required to maintain a Stormwater Permit.
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 tr e, com le and accurate.
Signature Date Ail1 17,f 7
Ci�{I21ST6p1 K. �w�t I1 1F-tc'DY I�St r�lbwlio"
Print or type name of person signing above Title
Please return this completed rescission request form to: NPDES Permit Coverage Rescission
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
1612 Mail Service Center, Raleigh, North Carolina 27699-1612
Phone: [phone] FAX: [phone]
An Equal Opportunity 1 Affirmative Action Employer 1 3 1 J
V