NCS000037_Rescission Request_20191007

Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
Environmental
Quality 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 I C I s0 10 10 10 1 1 N I c
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Na
Facility Contact
Street Address
City
County
Telephone No.
Clariant Corporation - Mount Holly East Facility
Ken Hausle
4000 Monroe Road
Charlotte
Mecklenburg
704 333-7029
State NC ZIP Code 28205
E-mail Address [e-mail]
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: Chemical Manufacturing operations at the site have been shutdown for many years and only remaining industrial
activity performed by Clariant is the site's waste water treatment plant. Concurrently with this request, Clariant is also requesting coverage
under NC General Permit NCG110000.
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.
i�
Signature / A. ' Date October 7, 2019
Kenneth J. Hausle - Corporate Environmental Engineer
Print or type name of person signing above
Please return this completed rescission request form to:
Revised 20183an10
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612