NCC190302_Notice of Termination_20201120

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 11/20/2020 8:58:28 AM (NOT Submittal)
Approve by Georgoulias, Bethany 11/23/2020 11:06:11 AM (NOT Request Review- NCC190302)
NOT Certification form received via e-mail on 11123.
• The task was assigned to Georgoulias, Bethany. The due date is: November 25, 2020 5:00 PM
11 /20/2020 8:58 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC190302
Coverage (COC) Enter the Certificate of Coverage Ninber
No.*
Information associated with this permit
Project Name
North 301 Solar
Address
15921 Highway 301, Halifax County, NC
County
Halifax
Latitude
36.2138
Longitude
-77.6282
Permittee Listed
Rosendin Electric, Inc.
Legally Responsible
Nathan Williams
Individual
NC Reference No.
NCG01-2019-0302
E&SC Plan ID
HALIF-2019-006
Original NOI
11098
Tracking No.
Date COC Issued
5/17/2019
Prior Rescission
Date populates only if OOCwas already rescinded at tirre of subaittal.
Date
Reason for Rescission/Termination Request:
Reason for r Project Closed -Out
Termination of r Sale (Another Owner/Operator will apply for a new COC)
Coverage * U Mistake or Invalid Coverage
r Other
Add ional Nbre information about the basis of this request, if needed.
Explanation Certified Closeout by Thad Valentine on
10.21.20
Supporting upload Supporting Docurrentation if applicable.
Documentation Mist beFDFfornat
Project Close-out Information:

Final Close-out 10/21/2020
Inspection Approval
Project Close-out North 301 Close Out 10.21.2020.pdf 35.64KB
Approval Mast be FDFforrrat
Documentation
North Carolina General Statute 143-215.613 (i) 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 Artide; 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 device or method required to be operated or maintained under this Article or rules of the
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* James Haber
Title * Division Manager
Organization* Rosendin Electric Inc
Date * 11/20/2020
Email for [e-mail]
Confirmation *
Contact Telephone* 9499391616
NOT Certification North 301 Close Out 10.21.2020.pdf 35.64KB
Form Mist be RY Format
Is this COCAlready Ensure this OOChas not been rescinded since subrrittal!
Rescinded?
Original Permittee CCdonNotificationErrails
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]