NCG030604_Rescission Request_20210316

Division of Energy, Mineral & Land Resources
K` z
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
Environmental
Quality RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
PFr,F1\/FD
MAR 1 6 201
Please fill out and return this form if you no longer need to maintain your NPDES stormwater perrBi NRJLAND QUALITY
STORMWATER PERMITTING
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
Iv I c I s N I 0 I 0 10 13 10 16 0 4
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name Moore's Machine Company of Sanford,
Facility Contact
Street Address
City
County
Telephone No.
Ruby Moore
1901 Columbine Road
Sanford
Lee
919 357-7959
State NC
E-mail Address
Fax:
ZIP Code 27330
[e-mail]
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑✓ Facility closed or -is -do on 12/1 1/19. 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:
4) 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 information is true, complete and accurate.
Signature
Ruby C. Moore
Print or type name of person signing above
Please return this completed rescission request form to:
Date 3/11/2021
Secretary
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised 2018Jan10

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY I
II(II III I III II II II III I III II
INVOICE
* 2 0 2 0 P R 0 0 4 2 2 6
Stormwater Annual Permit Fee Overdue
This Stormwater annual fee is required by the North Carolina Administrative Code 143-215.1)(a). It covers the
administrative costs associated with your permit. It is required of any person holding a permit for any time during the
annual fee period, regardless of the facility's operating status. Failure to pay the fee by the due date will subject the
permit to revocation. Operating without a valid permit is a violation and is subject to a $10,000 per day fine. If the permit
is revoked and you later decide a permit is needed, you must reapply, with the understanding the permit request may be
denied due to changes in environmental, regulatory, or modeling conditions.
Invoice Number: 2020PR004226
Permit Number: NCG030604
Lee County
Moore's Machine Co Sanford Inc
Ruby Moore
Moore's Machine Company Inc
1604 Boone Trl Rd
Sanford, NC 27330
Payment Options:
Annual Fee Period: 2020-06-01 to 2021-05-31
Invoice Date: 05/05/2020
Due Date: 06/04/2020
Annual Fee: $100.00
1. Electronic payment is convenient and quick. To pay by ePayment, type "https://deq.nc.gov/epayments/stormwater" into your
browser. If you select eCheck, there will be no convenience fee. The convenience fee for a credit card is 2.65% and the
convenience fee for a debit card is $3.95.
2. To pay by mail, please make your check payable to "DEMLR Stormwater Program" and include the invoice number on the check.
Then, detach the invoice below and write the check number on the invoice. A $25.00 processing fee will be charged
for returned checks in accordance with N.C. General Statute 25-3-512.
Remit payments by mail to:
NCDEQ - Division of Energy, Mineral and Land Resources
Attn: Stormwater Billing
512 N. Salisbury Street
1612 Mail Service Center
Raleigh, NC 27699-1612
3. Non-payment of this fee by the payment due date will initiate the permit revocation process.
4. Please include your permit number in all correspondence. 37/,o
5. Should you have any questions, please contact the Fee Coordinator at (919) 707>g2ztT
(Return This Portion With Check)
IIfIIYIIIIIIIIIInIIIIIVIIII'AIIIIIiIYIIIV
ANNUAL PERMIT INVOICE
Overdue
Invoice Number: 2020PR004226
Permit Number: NCG030604
Lee County
Moore's Machine Co Sanford Inc
Ruby Moore
Moore's Machine Company Inc
1604 Boone Trl Rd
Sanford, NC 27330
Annual Fee Period: 2020-06-01 to 2021-05-31
Invoice Date: 5/5/2020
Due Date: 6/4/2020
Annual Fee: $100.00
Check Number:

t:.
` 7 � QDepartment f
the Secretary of State
To all whom these presents shall come, Greetings:
I, Elaine F. Marshall, Secretary of State of the State of North Carolina, do hereby certify
the following and hereto attached to be a true copy of
Ka
MOORE'S MACHINE COMPANY O,
the original of which was filed in this office on the 11 th day of December, 2019.
IN WITNESS WHEREOF, I have hereunto set my
hand and affixed my official seal at the City of
Raleigh, this 11 th day of December, 2019.
t
Certification# C201934000414-1 Reference# C201934000414-1 Page: 1 of 2 Secretary of State
Verify this certificate online at httP://www.sosnc.gov/verification

SOSID: 0754065
Date Filed: 12/11/2019 11:09:00 AM
State of North Carolina Elaine F. Marshall
Department of the Secretary of State North Carolina Secretary of State
ARTICLES OF DISSOLUTION BY BOARD OF DIRECTORS AND C2019 340 00414
BUSINESS CORPORATION
Pursuant to §55-14-03 of the General Statutes of North Carolina, the undersigned corporation hereby submits the following Articles of
Dissolution for the purpose of dissolving the corporation.
1. The name of the corporation is: MOORE'S MACHINE COMPANY OF SANFORD, INC
2. The names, titles, and addresses of the officers of the corporation are:
E EUGENE MOORE, PRESIDENT, 310 MCNEIL RD, SANFORD, NC 27330
RUBY C MOORE, SECRETARY, 310 MCNEIL RD, SANFORD, NC 27330
3. The names and addresses of the directors of the corporation are•
E EUGENE MOORE, 310 MCNEIL RD, SANFORD, NC 27330
RUBY C MOORE, 310 MCNEIL RD, SANFORD, NC.27330
4. The dissolution of the corporation was authorized on the 31 St day of OCTOB ER 2019 .
5. Shareholder approval for the dissolution was obtained as required by Chapter 55 of the North Carolina General Statutes.
6. These articles will be effective upon filing, unless a delayed date and/or time is specified:
This the 15th day of NOVEMBER 2019
MOORE'S MACHINE COMPANY OF SANFORD, INC
Name of Corporation
Signa e
RUBY C MOORE, SECRETARY
Type or Print Name and Title
NOTES:
1. c-:iling fee is. $30.1This document must be filed with the Secretary of State:
BUSINESS REGISTRATION DIVISION
(Revised July 2017)
P. O. BOX 29622
RALEIGH, NC 27626-0622
(Form B-06)
Certification# C201934000414-1 Reference# C201934000414- Page: 2 of 2