NCG080591_Rescission Request_20200826

FOR AGENCY USE ONLY
Division of Energy,Mineral&Land Resources Date Received
Land Quality Section/Stormwater Permitting Program Year Month Day
National Pollutant Discharge Elimination System RECEIVED
Environmental
Quality lit RESCISSION REQUEST FORM AUG 2 6 2020
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permitDENR-LAND QUALITY
STORMWATER PERMITTING
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N C S N C 0 0 8 0 5 9 1
2) Owner/Facility Information: *Final correspondence will be mailed to the address noted below
Owner/Facility Name Greyhound Lines, Inc.
Facility Contact Nia Lucas
Street Address 110 Perimeter Park, Suite E
City Knosville State TN ZIP Code 37922
County Knox E-mail Address [e-mail]
Telephone No. 865 539-2077 Fax:
3) Reason for rescission request(This is required information. Attach separate sheet if necessary):
❑✓ Facility closed or is closing on 9/30/19 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.
Sad-Cr Azir.4 r 8 24 2020
Signature _ Date
Susan Kirkpatrick Sr.Env. Project and Program Manager
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 2018Jan10