NCG030612_Rescission Request_20210310

McCoy, Suzanne
From: McCollum, Deborah - IP <[e-mail]>
Sent: Wednesday, March 10, 2021 2:55 PM
To: McCoy, Suzanne
Cc: Durnell, James - IP
Subject: [External] Rescission Request Form
Attachments: 20210310144958822.pdf
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Ms. McCoy,
I am attaching a copy of the Rescission Request Form that I will overnight to DEMLR — Stormwater Program. I do have a
question, we have relocated and nothing of ours is at this location. My question is how long will my company be
responsible for what happens at that location. The company that owns the building, Tencarva Machinery, which was
our landlord does not have a stormwater permit and I assume I am responsible until we no longer carry the
permit. Please advise. Thank you for your help.
Debbie McCollum
ESH/Shop Coordinator
NC PRO Services
8511 Norcross Road Colfax, NC 27235
tel: [phone]
fax: [phone] [e-mail]
Goulds Pumps I Bornemann I Engineered Valves I PRO Services I Blakers I C'treat
ITT � R �B��nn E^� far B1a�L_(s CireaL
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1

Environmental
Quality
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
RESCISSION REQiJEST FORiVi
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or)
N C S
Certificate of Coverage
IvI C G 10 3 10 16 1 2
2) Owner/Facility Information: *Final correspondence will be mailed to the address noted below
Owner/Facility NameGOULDS PUMPS, INC.
Facility Contact
Street Address
City
County
Telephone No.
JAMES DURNELL OR DEBBIE MCCOLLUM
1115 PLEASANT RIDGE ROAD
GREENSBORO _ State NC ZIP Code 27409
GUILFORD _ E-mail Address [e-mail]
336 662-0113 Fax: [phone]
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑ Facility closed or is closing on .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: ITT GOULDS PUMPS HAS RELOCATED AND EVERYTHING THAT BELONGED TO ITT HAS BEEN
REMOVED FROM 1115 PLEASANT RIDGE ROAD, GREENSBORO, NC 27409.
4j 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 informaVis ue, complete and accurate.
Signature
®JAMES DURNELL
Print or type name of person signing above
Please return this completed rescission request form to:
Revised 2018Jan 10
Date 3/10/21
FACILITY MANAGER
Title
DEMLR -Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612