NCC201356_Notice of Termination_20210128

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/28/2021 3:09:50 PM (NOT Submittal)
Approve by Morman, Alaina 1/29/2021 4:33:37 PM (NOT Request Review- NCC201356)
• The task was assigned to Morman, Alaina. The due date is: February 2, 2021 5:00 PM
1 /28/2021 3:09 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC201356
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status May be blank (if not yet billed)
Information associated with this permit:
Project Name
Hall Solar
Address
3040 S NC11 Highway, Teachey, NC
County
Duplin
Latitude
34.7954
Longitude
-77.9479
Permittee Listed
A)as Energy, Inc.
Legally Responsible
Jeff Filippo
Individual
NC Reference No.
NCG01-2020-1356
E&SC Plan ID
DUPLI-2019-004
Original NOI
23830
Tracking No.
Date COC Issued
4/3/2020
Prior Rescission
Date populates only if OOC was already rescinded at tirre of submittal.
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
Ad d i o n a I Nbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Docurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 1/27/2021
Inspection Approval
Project Close-out DUPLI-2019-004 NCDEQ E&SC Plan - Close -Out
Approval 243.87KB
Aproved 01-27-2021.pdf
Documentation
Mast be FDFforrrat
North Carolina General Statute 143-215.66 (1) provides that:
Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other
document filed or required to be maintained under this Atide or a rule implementing this Atide; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Prtide or rules of the
Commission implementing this Atcle shall be guiltyofa Class 2 misdemeanor which may include a fine not to exceed ten thousand
dollars ($10,000).
rJ 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* Jorge Diego Valdivia
Title * Project Coordinator
Organization* A)as Energy Inc
Date * 01 /28/2021
Email for dvaldivia@a)as-energyinc.com
Confirmation *
Contact Telephone* 9103664615
NOT Certification Hall Solar NCG01-eNOT-Certification-Form-
Form Signed.pdf
Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional)
Original Permittee CCdonWificationBmils
Email [e-mail]
Original Site Contact 0Cd on Notificaiton Errails
Email jbutler@a)as-energyinc.com
305.37KB