NCG100055_Email sending Rescission Request_20210405

McCoy, Suzanne
From: McCoy, Suzanne
Sent: Monday, April 5, 2021 2:35 PM
To: [e-mail]
Cc: Lucas, Annette
Subject: Stormwater permit Rescission Request
Attachments: NCG100055_NPDES SW Permit Summary Report.pdf, NPDES-Rescission-
Form-20210315-DEM LR-SW.pdf
Good afternoon Mr. Ray.
We received the note regarding the yard at 109 Lake Latham Road, Mebane NC has been closed since 2013.
Please complete the attached Rescission Request form so we may close Stormwater permit NCG100055.
I've also attached a Stormwater permit summary report for your reference.
I greatly appreciate your assistance in this matter.
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�ncdenr.goy
Phone: [phone]
Website: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
D, E
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time.

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for your permit as of 4/5/2021.
Permit Number: NCG100055 Permit Status: Expired
Permit Type: Used Motor Vehicle Parts Stormwater Discharge COC
Facility Name: DBA Riverside Auto Parts Inc
Facility Addressl: 109 Lake Latham Rd
Facility Address2:
City, State & Zip: Mebane, NC 27302
Owner Information Details:
MUST submit a Change of Name/Ownership form to DEMLR to make any changes to this Owner information.
(Click Here for "Change of Name/Ownershka"Form)
Owner Name: John Ray Inc
Owner Type: Non -Government Owner Type Group: Organization
*** Legally Responsible for Permit ***
(Responsible corporate officer/principle executive officer or ranking elected official/general partner or proprietor;
or any other person with delegated signatory authority from the legally responsible person.)
Owner Affiliation: John Ray Title:
Addressl: 109 Lake Lathan Rd
Address2:
City, State & Zip: Mebane, NC 27302
Work Phone: [phone] Fax: [phone]
Email Address: [e-mail]
*** Permit Annual Fee Billing ***
Billing Month: January
Invoice Number Invoice Date Invoice Due Date Invoice Amount Invoice Status
2020PRO11170 12/3/2020 1/2/2021 $100.00 Overdue
2018PRO11119 12/4/2018 1/3/2019 $100.00 Overdue
2017PRO11026 12/5/2017 1/4/2018 $100.00 Overdue
2016PRO11050 12/6/2016 1/5/2017 $100.00 Overdue
2015PRO11416 12/9/2015 1/8/2016 $100.00 Overdue
2014PRO11278 12/10/2014 1/9/2015 $100.00 Overdue
Owner Contact Person(s)
Contact Name Title Address Phone Fax Email
Facility Contact Person(s)
Contact Name Title Address Phone Fax Email
Permit Contact Person(s)
Contact Name Title Address Phone Fax Email
4/5/2021 Page 1

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the followinLy information in our Permit Database for vour Dermit as of 4/5/2021.
Permit Billing Contact(s)
Contact Name Title Address Phone
Fax Email
John Ray 109 Lake Lathan Rd, Mebane, NC 27302 919-563-1062 919-563-0491
Person(s) with Delegated Signatory Authority
Type Contact Name Title Address Phone
Fax Email
Person(s) with Electronic Signature Authority
Type Contact Name Title Address Phone
Fax Email
Outfalls
Outfall #: 001 Outfall Description: UT to Back Creek
Outfall Lattitude: 36.092500 Outfall Longitude:-79.310000
Represented by Outfall:
Stormwater: 100 % Industrial:
Stream Waterbody
Basin Waterbody Name
Index Number Classification
Cape Fear Back Creek (Graham -Mebane Reservoir)
16-18-(1.5) NS-II;HQW,NSW,C/
4/5/2021 Page 2