NCG110159_Rescission Request_20191004

TOM Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
k-n-vironniert'a I
Quality RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
I
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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. 1. C I S 10 10 10 10 13]-7] 1 N I C I G III I I I 1 1
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below RF=r,1=1VED
Owner/Facility Name Clarlant Corporation - Mount Holly East Facility GICT 01+2019
Facility Contact Ken Hausle
Street Address 4000 Monroe Road -LAND QUALITY
City Charlotte State NC ZIP Code 28205 TER PERMITTING
County Mecklenburg E-mail Address [e-mail]
Telephone Nu. 704 333-7029 Fax:
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
El 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.
El 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, Cladant is also requesting coverage
under NC General Permit NCG1 I 0000.
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 October 7, 2019
f I
Kenneth J. Hausle V 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