NCC205067_Notice of Termination_20210416

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 4/16/2021 10:50:12 AM (NOT Submittal)
Approve by Morman, Alaina 4/19/2021 5:37:55 PM (NOT Request Review- NCC205067)
• The task was assigned to Morman, Alaina. The due date is: April 21, 2021 5:00 PM
4/16/2021 10:50 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC205067
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status May be blank (if not yet billed)
Information associated with this permit:
Project Name
Dan River Dam Decommissionng E&SC Addendum 4 (Express Review)
Address
864 South Edgewood Road, Eden, NC
County
Rockingham
Latitude
36.4958
Longitude
-79.7220
Permittee Listed
Duke Energy Carolinas, LLC
Legally Responsible
Mehdi Maibodi
Individual
NC Reference No.
NCG01-2020-5067
E&SC Plan ID
ROCKI-2017-016
Original NOI
35216
Tracking No.
Date COC Issued
11/10/2020
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
Date
Reason for Rescission/Termination Request:
Reason for
F Project Closed -Out
Termination of
r Sale (Another Owner/Operator obtained a new COC)
Coverage *
O Mistake or Invalid Coverage
r Other
Ad d i o n a I Nbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Docurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 4/1/2021
Inspection Approval
Project Close-out 04-01-2021 Dan River Decommissioning Closure
Approval 248.03KB
Inspection Report (ROCKI-2017-016).pdf
Documentation
Mast be FDFforrrat
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules ofthe
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
rJ 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.
*This form must be signed by a responsible corporate officer that owns or operates the construction activity, such as a
president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B,
Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
Type Name* Mehdi Maibodi
Title * General Manager CCP Project Management
Organization * Duke Energy Carolinas LLC
Date * 04/16/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 980-373-6616
NOT Certification eNO1 Dan River Decommissioning Signed.pdf
Form Mast be FDF Forrrat
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional) [e-mail]
Original Permittee CCdonWificationErrails
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]
30.27KB