NCC205407_Modification Review_20210129

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/29/2021 12:53:45 PM (ADD TO FILE Submittal)
Approve by Georgoulias, Bethany 1/29/2021 2:36:24 PM (Construction COC ADD TO FILE Review- NCC205407)
• The task was assigned to Georgoulias, Bethany. The due date is: February 3, 2021 5:00 PM
1/29/2021 12:54 PM

Y . Ta4M1
NORTH CAPOLINA
EnYlrenmemf& Qualay
Certificate of NCC205407
Coverage (COC) Enter the Certificate of Coverage N nber (Use capital letters)
No.*
Information associated with this permit:
Project Name Stanly Solar Substation
Address Old Aquadale Road, Tyson Township, NC
County Stanly
Latitude 35.2877
Longitude-80.2309
Permittee Listed National Renewable Energy Corporation
Legally Responsible Andrew Giraldo
Individual
NC Reference No. NCG01-2020-5407
E&SC Plan ID
Original NOI
Tracking No.
STANL-2021-005
36842
Date COC Issued* 11/24/2020
Prior Rescission This field will populate only if CCChas already been rescinded.
Date
Modification Information:
Reason for r Closed -Out Lots/Outparcels in E&SC Plan
Modification * r Additional Lots/Outparcels Approved - E&SC Revised
F Other Revision(s) to E&SC Plan
r Legally Responsible Individual and/or Site Contact Has Changed
r Multiple Reasons (List)
Addional Nbre information if needed (e.g., new Site Contact details can be included here)
Explanation Moved the entrance to the project 100' west, so the LOD needed to be moved.
You must upload supporting documentation below. Do not upload E&SC Plans unless specific plan
sheets are the only documentation with approval for revised acres of disturbance, etc. (only upload applicable
sheets).
For changes to the legally responsible individual, you must upload this form

Supporting Upload Supporting Documentation (%vised ERSC Approval, (lose -Out Doc, etc.)
Documentation STANL-2021-005-11242020 (ID 96750).pdf 2.23MB
Mast be FDFformat
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes anyfalse 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 knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho 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 notto exceed ten thousand
dollars ($10,000).
17 I hereby request modification to coverage under the NPDES Stormwater Permit
for the subject project site. 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.
Specify if you are:* r The Legally Responsible Individual
r Authorized Responsible Person*
*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
( a,1413LI P- l '-1t
Type Name* Mark Caddell
Title * Vice President - EPC
Organization* National Renewable Energy Corporation
Date * 01 /29/2021
Email Address* [e-mail]
Errail for confirrration
Telephone Number* 704 307 6663
Contact nun ber if we need to reach you
Note: Original permittee and site contact are copied on modification correspondence.
Additional Email [e-mail]
(Optional) Additional errail for confirrration
Original Permittee [e-mail]
Email
Original Site Contact [e-mail]
Email
Review Date 01/29/2021
Rescinded Since
Submitted?

Request Date 20210129
Formatted
Review Date 20210129
Formatted