NCG080784_Rescission Request_20191210

- 4 4
FOR AGENCY USE ONLY
A79111974 A Division of Water Quality I Surface Water Protection Date Received
Year Month Day
National Pollutant Discharge Elimination System
NCDENR NOR,.,cAROLINA DEPARTMENT or RESCISSION REQUEST FORM RF1..�^
PIVED
ENVIRONMENT AND NATURAL RESOURCES
DEC 1 0 2019
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permitOENR-LAND QUALITY
STORMWATER PERMITTING
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N C S NCG 0 8 0 7 8 4
2) Owner/Facility Information: *Final correspondence will be mailed to the address noted below
Owner/Facility Name: Republic Services of NC, LLC-GDS-Plymouth
Facility Contact Joseph Dehner
Street Address 5111 Chin Page Road
City Durham State: NC ZIP Code: 27703
County Washington E-mail Address: [e-mail]
Telephone No. 919-991-1000 • Fax:[phone]
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 Jesse Respass on December 4,2019 . 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 facil . am familiar with the information contained in this request and to the best of my knowledge and belief
such info ation s trueco lete and a urate.
r /
Signatu - tA; Date 422
f'Joseph Dehner > General Manager
Print or type name of person signing above Title
•
Please return this completed rescission request form to: SW NPDES Permit Coverage Rescission
Stormwater Permitting Unit
1617 Mail Service Center
1617 Mail Service Center,Raleigh,North Carolina 27699-1617 Raleigh, North Carolina 27699-1617
Location:512 N.Salisbury St.Raleigh,North Carolina 27604
Phone.[phone] t FAX:[phone] t Customer Service 1-877-623-6748
Internet www.ncwaterquality.org Naturally
An Equal Opportunity Affirmative Action Employer

%,g, 00 REPUBLIC •
d•t% SERVICES
December 6, 2019
Ms. Suzanne McCoy
NC Department of Environmental Quality
Division of Energy, Mineral,and Land Resources
Stormwater Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Subject: SW NPDES Permit Coverage Rescission
Republic Services of North Carolina, LLC—GDS Plymouth
205 NC Highway 45 S
Plymouth, NC 27962
COC Number NCG080784
Dear Ms. McCoy,
Republic Services of North Carolina, LLC is requesting that the referenced certificate for coverage under the
NPDES Stormwater General Permit be rescinded as the facility at the reference address has been sold and is
no longer used by Republic Services. In addition to this request, I have attached a "Rescission Request Form"
signed by the facility's legally responsible official.
Thank you for your consideration of this request. I can be reached by phone at [phone] or by
electronic mail at [e-mail].
Si er
Matt Einsmann, P.
Environmental Manager
cc. Mr. Mike Kavanaugh (Republic Services)
•
jimiammum.
Page 1 of 1