NCG080888_Rescission Request_20200302

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LN 1 C Division of Energy,Mineral&Land Resources Date Received
Land Quality Section/Stormwater Permitting Program Year Month Day
National Pollutant Discharge Elimination System FOR AGENCY USE ONLY
Environmental
Quality RESCISSION REQUEST FORM
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 C 6 0 8 0 8 8 8
2) Owner/Facility Information: *Final correspondence will be mailed to the address noted below
Owner/Facility Name Rolling Frito-Lay Sales/Selma Bin
Facility Contact Rob Sapienza
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):
0 Facility closed or is closing on 2/24/20 . 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:
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
3 Z
ue
, complete and accurate.
Signature A
Date �2" i 0 Z0
Rob Sapienza Regional Fleet Manager
Print or type name of person signing above Title t
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 20183an10
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fritota
Y Frito-Lay
March 2, 2020
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:
Selma Bin 3888 Buffalo Road Selma NC NCG080888
Burnsville Bin 552 East Main Street Burnsville NC NCG080901
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: rob.sapienza'ir pepsico.com
Reason for Termination:
Facilities have closed.
"I certifil 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,
Rob Sapienza
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Regional Fleet Manager