NCC200099_Notice of Termination_20201026

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/26/2020 7:16:38 AM (NOT Submittal)
Approve by Georgoulias, Bethany 10/26/2020 1:36:46 PM (NOT Request Review- NCC200099)
* Permittee uploaded COC instead of NOT Certification form with the submittal but provided it via e-
mail.
• The task was assigned to Georgoulias, Bethany. The due date is: October 29, 2020 5:00 PM
10/26/2020 7:16 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC200099
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
Information associated with this permit
Project Name
HF Lee 1982 Ash Basin Haul Road Improvements
Address
1677 Old Smithfield Road, Goldsboro, NC
County
Wayne
Latitude
35.0000
Longitude
-78.0000
Permittee Listed
Duke Energy
Legally Responsible
Issa Zarzar
Individual
NC Reference No.
NCG01-2020-0099
E&SC Plan ID
Wayne-2019-032
Original NOI
20307
Tracking No.
Date COC Issued
1/10/2020
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
Date
Reason for Rescission/Termination Request:
Reason for F Project Closed -Out
Termination of r Sale (Another Owner/Operator will apply for a new COC)
Coverage * O Mistake or Invalid Coverage
r Other
Addional Mxe inforrration about the basis of this request, if needed.
Explanation
Supporting upload Supporting Docurrentation if applicable.
Documentation Mist beFDFforrrat
Project Close-out Information:
Final Close-out 10/20/2020
Inspection Approval

Project Close-out 20201020 sed insp report WAYNE-2019-032
Approval 169.43KB
HFLee1982 AshBasin.pdf
Documentation
Mast be FDFforrrat
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules ofthe
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
17 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.
*This form must be signed by a responsible corporate officer that owns or operates the construction activity, such as a
president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B,
Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
Type Name * Issa J. Zarzar
Title * GM - CCP Central Carolina Projects
Organization* Duke Energy - Coal Combustion Products
Date * 10/26/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 919-812-0446
NOT Certification Certificate of Coverage ash basin haul road.pdf 40.72KB
Form Mast be PDF Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCd on Wification BTails
Email [e-mail]
Original Site Contact CCd on Notificaiton Bmils
Email [e-mail]