NCG160115_Rescission Request_20210318

McCoy, Suzanne
From: [e-mail]
Sent: Thursday, March 18, 2021 9:23 AM
To: McCoy, Suzanne
Subject: [External] RE: NCG160115_Rescission of Stormwater permit
Attachments: Stormwater NOT form 210318.pdf
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Ms. McCoy,
The completed and signed form is attached as requested. This site is in Mecklenburg County. Will NC DEMLR or Meck
County inspect?
I will mail the original.
G reg
From: McCoy, Suzanne <[e-mail]>
Sent: Wednesday, March 17, 2021 9:56 AM
To: DAVIS Greg <[e-mail]>
Subject: NCG160115_Rescission of Stormwater permit
Good morning Greg,
I received the attached letter, please complete the Rescission form below, unless the permit should be
transferred to Vulcan Material Company then complete the Name/Ownership change form.
Rescind an Existing Industrial Permit
Complete the Rescission Request Form and mail one hard copy of the form to Suzanne McCoy, 1612 MSC, Raleigh, NC
27699-1612. In addition, e-mail the form to Suzanne McCoy. There is no fee for industrial permit rescissions. Please
note that it can take 1-2 months to process the request because we cannot rescind the permit until DEQ staff conduct a
site visit.
To transfer the permit complete the Name/Ownership Change Form.
Thank you,
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
North Carolina Department of Environmental Quality
Physical: 512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
Mailing: 1612 Mail Service Center, Raleigh, NC 27699-1612
Email: Suzanne. mccoy(jr.ncdenr clov
Phone: [phone]

Website: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
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FOR AGENCY USE ONLY
Date Received:
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
Rescission Request Form
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
Directions: Print or type all entries on this application form. Send the original, signed application to: NCDEMLF
Stormwater Program, 1612 Mail Service Center, Raleigh, NC 27699-1612, The submission of this form does not
guarantee exclusion from NPDES stormwater permitting. Prior to exclusion from NPDES stormwater permitting a
site inspection will be conducted.
1. Owner/Operator (to whom all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
Blythe Construction Inc.
Allen Hendricks
Street address:
City:
State and zip code:
2911 N Graham St
Charlotte
NC 28206
Telephone number:
Email address:
704 375 8474
[e-mail]
2. Industrial Facility (facility requesting rescission):
Facility name:
Blythe Construction Pineville Plant
Street address:
10500 Old Nations Ford Road
City:
State:
Zip Code:
County:
Charlotte
NC
28273
Permit Number to which this request applies:
NCG 160115
3. Reason for rescission Request
This is required information. Attach separate sheets if
J
Facility is
closed or closing. All industrial activities
have ceased such that no discharges of stormwater are contaminated
by
exposure
to industrial activities or materials.
Facility sold.
Sold to:
On date:
Other (please explain):

4. Applicant Certification:
North Carolina General Statute 143-215.6B (i) provides that: Any person who knowingly makes any false statement,
representation, or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may include a fine not
to exceed ten thousand dollars ($10,000). 1 hereby request exclusion from NPOES stormwater permitting.
Under penalty of law, I certify that:
❑ I, as an authorized representative, hereby request recisslon 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.
Printed Name of Person Signing: Allen Hendricks
Title: Vice President
a
(Signature of Applicant) (Date Signed
Mail the entire package to: DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
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