NCG180006_Rescission Request_20210414

Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
Environmental
Quality RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
I Month-T Da
EIVED
APR 14 2021
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit�TCRMWATER PERMITTING
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
►� c .:S I IG G 1. 1 18 10 10 10
2) Owner/facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name PROGESSIVE FURNITURE, INC.
Facility Contact STEVE WHITTINGTON, HR MANAGER
Street Address 2555 PENNY ROAD
City CLAREMONT State NC ZIP Code 28610
County CATAWBA E-mail Address [e-mail]
Telephone No. 828 459-2695 Fax:
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.
Q Other. Facility no longer manufactures furniture. It now operates as a wholesale warehouse under SIC#5021. No operations under
SIC #25 or SIC#2434 are present. There is little or no vehicle maintence on site, and new oil/hydraulic oil use is <5 gallons per month.
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 islue, complete and accurate.
Signature Date
STEVE WHITTINGTON
Print or type name of person signing above
Please return this completed rescission request form to:
HR Manager
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised 2018JanIO