NCG100055_Letter With Rescission Form_20190222

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
interim Director
John Ray
John Ray Inc.
109 Lake Lathan Road
Mebane, NC 27302
Subject: NCGI00055
Dear Mr. Ray:
NORTH CAROLINA
Environmental Quality
February 22, 2019
DBA Riverside Auto Parts Inc.
Alamance County
On December 31, 2018, the Division of Energy, Mineral and Land Resources Stormwater Program
received your handwritten note that Riverside Auto Parts Inc. has been closed since April 30, 2013.
Please complete the enclosed Rescission Request Form and return to:
DEMLR — Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612.
If you have questions about this matter, please contact Suzanne McCoy at 919-707-3640, or the
Stormwater staff in our Winston-Salem Regional Office at 336-776-9800.
Sincerely,
a�"O:vn t
for S. Daniel Smith
Interim Director
cc: Winston-Salem Regional Office — B. Wise
Stormwater Permitting Program
D E Q�� North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
512 North Salisbury Street 1 1612 Mail Service Center I Raleigh, North Carolina 27699-1612
NCMiTH GAROI.INA
919.707.9200

vu; .
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
F
National Pollutant Discharge Elimination System
Quah't < RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
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
N C S` N I C I G-
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name
Facility Contact
Street Address
City
County
Telephone No.
State ZIP Code
E-mail Address
Fax:
3) Reason for rescission request (This is required 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.
❑ 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
Print or type name of person signing above
Please return this completed rescission request form to
Date
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised 20187an10

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY II I I III II I II I I III II II II II I II
INVOICE * 2 0 1 8 P R 0 1 1 1 1 9*
Annual Permit Fee Open
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated with
your permit. It is required of any person holding a permit for any time during the annual fee period, regardless of the facility's
operating status. Failure to pay the fee by the due date will subject the permit to revocation. Operating without a valid
permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and you later decide a permit is
needed, you must reapply, with the understanding the permit request may be denied due to changes in environmental,
regulatory, or modeling conditions.
1.
2.
9
4.
5.
6.
7.
Invoice Number:
2018PR011119
Permit Number:
NCG100055
Alamance County
DBA Riverside Auto Parts Inc
John Ray
John Ray Inc
109 Lake Lathan Rd
Mebane, NC 27302
Annual Fee Period: 2019-01-01 to 2019-12-31
Invoice Date: 12/04/2018
Due Date: 01/03/2019
Annual Fee: $100.00
17C; Rt s
- . v.{
DEC 31 2013
DENR-LAND 01JAI ITY
STORMWATER PEF#MIT'i ING
You may pay either by mail with check/money order OR by electronic payment (eCheck or Credit Card).
If payment is by check/money order, please remit payment to:
NCDEQ - Division of Energy, Mineral and Land Resources
Attn: Stormwater Billing
512 N. Salisbury Street
1612 Mail Service Center
Raleigh, NC 27699-1612
If payment is electronic, please see https://deg.nc.gov/epayments/stormwaterto pay electronically. Payments by eCheck will
debit your checking account. Credit card transactions will incur a convenience fee.
Please include your Permit Number and Invoice Number on all correspondence.
A $25.00 processing fee will be charged for returned checks in accordance with North Carolina General Statute 25-3-512.
Non -Payment of this fee by the payment due date will initiate the permit revocation process.
Should you have any questions regarding this invoice, please contact the Annual Administering and Compliance. Fee
Coordinator at 919-707-9220.
(Return
This
Portion
With
Check) 9111hIIIIIIIIIIIIIIIiIIVIIIiIIIIIIIfIIIIAIIII
ANNUAL PERMIT INVOICE
Open
Invoice Number:
Permit Number:
John Ray
John Ray Inc
109 Lake Lathan Rd
Mebane, NC 27302
2018PROl 1119 ^ Annual Fee Period: 2019-01-01 to 2019-12-31
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NCG100055 s��f S H
Alamance County ,oIzi%lo�t 5'f,71/ Invoice Date: 12/4/2018
DBA Riverside Auto Parts I,,ic�L ` Due Date: 1/3/2019
. 0 3
Annual Fee: $100.00
Check Number: