NCGNE1031_Rescission-20191025

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
I Month
Da
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
DENR-LAND QUALITY
1) Enter the permit number to which this request applies: STORMINATER PERMITTING
Individual Permit (or) Certificate of Coverage
N I C I S I I I I I I I I N I C I GN I E 11 10 13 11
2) Owner/Facility Information: • Final correspondence will be mailed to the address noted below
Owner/Facility Name Curtiss-Wright
Facility Contact David White
Street Address 201 Old Boiling Springs Road
City Shelby State NC ZIP Code 28152
County Cleveland E-mail Address [e-mail]
Telephone No. 704 481-2208 Fax: [phone]
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 McEwen Industries on 6/30/19. 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 i ru co plete an accurate.
Signature Date 9/3i2019
Tad Gray General Manager - Actuation OEM
Print or type name of person signing above Title
Please return this completed rescission request form to
Revised 2018Jan10
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612