NCG080740_Rescission Request_20191101

FOR AGENCY USE ONLY
A7111741arA Division of Energy,Mineral&Land Resources Date Received ��
Land Quality Section/Stormwater Permitting Program Year Month Day
14 NCDENR National Pollutant Discharge Elimination System
NORTH CAROLINA DEPARTMENT OF RECEIVED
ENVIRONMENT AND NATURAL RESOURCES
RESCISSION REQUEST FORM
NOV 01 2019
Please fill out and return this form if you no longer need to maintain your NPDES stormwater Dermtt,uLN. LAND QUALITY
STORMWATER PERMITTING
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N C S N C G 0 8 0 7 4 0
2) Owner/Facility Information: *Final correspondence will be mailed to the address noted below
Rolling Frito-Lay Sales / Morehead City Bin
Owner/Facility Name
Rob Sapienza
Facility Contact
Street Address 2700 Nevada Blvd
City _Charlotte State _NC _ ZIP Code 28273
County Mecklenburg E-mail Address [e-mail]
Telephone No. 704-927-7377 _ 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.
[x Other: Storm water discharges associated with industrial activity (vehicle maintenance)
—have been eliminated
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 t complete and accurate.
Signature Date
°15° Zoe
Rob Sapienza Regional Fleet Manager
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\Affirmative Action Employer

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October 2, 2019
NPDES Permit Coverage Rescission
Division of Water Quality
1612 Mail Service Center
Raleigh,North Carolina 27699-1612
Re: NOT Submittal
Please see attached Rescission Request Forms for the following Rolling Frito-Lay Sales, LP facilities:
Morehead City Bin 123 Horton Drive Morehead City NC NCG080740
Shallotte Bin 119 Forest Drive Shallotte NC NCG080891
Clinton Bin 1127 Russell Street Clinton NC NCG080752
Wallace Bin 3824 NC Highway 11 Wallace NC NCG080892
Operator Information:
Owner/operator: Rolling Frito-Lay Sales, LP
Official Contact Person: Rob Sapienza(Fleet Manager)
Mailing Address: 2700 Nevada Blvd. Charlotte, NC 28273
Phone: [phone]
Email: [e-mail]
Reason for Termination:
Storm water discharges associated with industrial activity(vehicle maintenance) have been eliminated.
"I certify under penalty of law that all storm water discharges associated with industrial activity from the
identified facility that are authorized by an NPDES general permit have been eliminated or that I am no longer
the operator of the industrial activity. I understand that by submitting this notice of termination, that I am no
longer authorized to discharge storm water associated with industrial activity under this general permit, and
that discharging pollutants in storm water associated with industrial activity to waters of the State is unlawful
under the Clean Water Act where the discharge is not authorized by an NPDES permit. I also understand that
the submittal of this notice of termination does not release an operator from liability for any violations of this
permit or the Clean Water Act."
Sincerely
(\l"---
Rob Sapienza NOV 01 2019
Regional Fleet Manager DENR-LAND QUALITY
STORMWATER PERMITTING