HomeMy WebLinkAboutNCG200452_Rescission Request Form_20200504ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
BRIAN WRENN
Acting Director
Mary Mitchell
Action Al Recycling Inc.
PO Box 98
Clover, SC 29710
NORTH CAROLINA
Environmental Quality
April 20, 2020
Subject: Action Al Recycling, Inc.
Gaston County North Carolina
Stormwater Permit NCG200452
We received your note indicating that in 2017 you called and cancelled this permit.
Please complete and return the enclosed Rescission Request Form for Permit NCG200452.
Your assistance in this matter is greatly appreciated,
Sincerely,
T5-4--� I'll
Suzanne McCoy
Administrative Specialist
Enclosure
D E Q`J/ North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
iie�' vvv 512 North Salisbury Street 1 1612 Mail Service Center I Raleigh, North Carolina 27699-1612
5;w.° .' ""°"" .OuN�� 919.707.9200
Division of Energy, Mineral & Land Resources FOR AGENCY USE ONLY
Date Received
Land Quality Section/Stormwater Permitting Program Year Montn Day
N
National Pollutant Discharge Elimination System
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 SN C G D
2) Owner/Facility informatio : i *Final correspondence will be mailed to the address noted below RECEIVED
Owner/Facility Name \ MAY 0 4 207q
Facility Contact
Street Address
City
County
Telephone No.
State ZIP Code
E-mail Address
Fax:
DENR-LAND QUALITY
STORMWATER PERMITTIN(-
3) Reason for rescission request (This is reauired 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:
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 y`'—
Date Cam'
Print or type name of person signing above Title
Please return this completed rescission request form to
Revised 2018]an10
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612