NCG070124_Rescission Request_20210503

Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
-a t National Pollutant Discharge Elimination System
RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N I c I s Iv I c I G 10 17 10 1 2 4
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name Hydro Conduit Corp For rescission request (827 Blair Street, Thomasville, NC
Facility Contact
Street Address
City
County
Telephone No.
Brian Carter (Brian Carter information is below)
827 Blair Street
Thomasville
Davidson
336 475.1371 x235
State NC
E-mail Address
Fax: 336
ZIP Code 27360
[e-mail]
476.9200
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑✓ Facility closed or is closing on 6/14/2Cd. All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials.
✓❑ Facility sold to RMX North Carolia on 6/15/2b. 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.
❑ Other:
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 is true, complete and accurate.
Signature . 'Y--1-Date
116 X r
Brian Carter
Print or type name of person signing above
Please return this completed rescission request form to
Revised 20183an10
North Carolina General Manager
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612

Date June 17, 2019
To: DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
►2
RE: Recission of NPDES Stormwater Permit (NCG0701192, 827 Blair Street, Thomasville, NC 27360)
We recently received an invoice for renewal of a stormwater permit which was believed to have been
rescinded in 2018. Attached is the document required to do so. Researching our files, the form may have
either been misdirected or not sent. We apologize for any inconvenience this has caused the department.
This facility was sold to RMX North Carolina on June 15, 2017, and is no longer in the companies
possession.
Thank You,
DJ McKinney
Director of Safety, Rinker Materials