NCG050420_Rescission Request_20191125

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 C S N I C I G 1 0 5 0 4 2 1 0
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Nam
Facility Contact
Street Address
City
County
Telephone No.
Robert Bosch Tool Corporation
NOV 2 5 2019
Nicole McQueen DENR-LAND QUALITY
1980 Indian Creek Road b I UK17VVATERTERMITTING
Lincolnton
Lincoln
704 736-8501
State NC ZIP Code 28092
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: Facility's primary Standard Industrial Classification has changed from 39 ( Miscellaneous. Manufacturing
Industries) to SIC 34 (Metal Fabrication) . Rescission form is to terminate coverage under the NCG05000 General Permit.
Facility is submitting a new NOI for coverage under the NCG03000 General 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 true, complete and accurate.
Signature Date I I l 21 / 1
cJ ro r 4 i E�_ �r n M � � � low kkS �7- c_ o o '( &
Print or type name of person signing above Title
Please return this completed rescission request form to
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised 2018]an10

Bosch Tool Corporation
19 September 2019
DEMLR — Storm Water Program
Dept. of Environmental Quality
Dear Sir or Madam,
0 BOSCH
The Robert Bosch Tool Corporation located on 1980 Indian Creek Road,
Lincolnton NC would like to request coverage for storm water discharge under
the NCG03000 General Permit and cease its coverage under the NCG050000
General Permit.
Currently, the Robert Bosch facility has approval for storm water discharges
under Certificate NCG050420, but because the facility's primary activity has
changed to manufacturing of steel saw blades, its operations will now fall
under SIC 34 for Metal Fabrication.
Enclosed is the Rescission Request Form to cease its coverage for
NCG050420 Storm Water General Permit and the Notice of Intent application
for requesting a coverage for the NCG030000 Storm Water General Permit.
Please let me know if you have any questions or need additional information.
Yours sincerely,
Nicole McQueen
Mobile Tel. [phone]
[e-mail]
Robert Bosch LLC
1980 Indian Creek
Lincolnton, NC 28092
Telephone [phone]
Fax [phone]
www.bosch.us
QQ BOSCH are Trademarks of Robert Bosch GmbH, Germany