NCG030005_Rescission Request_20210430

FOR AGENCY USE ONLY
NCG
Assigned to:
ARO FRO MRO WARO WIRO WSRO
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: NCDEMLR
Stormwater Program, 1612 Mail Service Center, Raleigh, NC 27699-1612. The submission of this form does not
guarantee recission of your NPDES stormwater permit. Prior to the recission of your NPDES stormwater permit, 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:
Parker Hannifin
Jerry Nappi (Filtration Group EHS Manager)
Street address:
City:
State and zip code:
6035 Parkland Boulevard
Cleveland
Ohio 44124
Telephone number:
Email address:
440-514-9384
[e-mail]
2. Industrial Facilitv (facility reauestinR rescission):
Facility name:
Clarcor Engine Mobile Solutions LLC
Street address:
230 Clarks Neck Road
City:
State:
Zip Code:
County:
Washington
North Carolina
27889
Beaufort County
Permit Number to which this request applies:
NCG03005
3. Reason for rescission Request

4. Applicant Certification:
North Carolina General Statute 143-215.613(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 NPDES stormwater permitting.
Under penalty of law, I certify that:
0 I, as an authorized representative, hereby request recission 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: Jerry Nappi
Title: Filtration Group EHS Manager
(S' ature of icant)
Mail the entire package to
April 30th, 2021
(Date Signed)
DEMLR— Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, INC 27699-1612
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