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HomeMy WebLinkAboutNCC202156_Notice of Termination_20210517Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 5/17/2021 12:37:11 PM (NOT Submittal) Approve by Morman, Alaina 5/23/2021 9:23:27 AM (NOT Request Review- NCC202156) • The task was assigned to Morman, Alaina. The due date is: May 20, 2021 5:00 PM 5/17/2021 12:37 PM 1 � NORTH CAROLINA Enrlronmenral Quallly Certificate of NCC202156 Coverage (COC) Enter the Certificate of Coverage Nmber No.* 2020 Annual Fee Status 2021 Annual Fee Status OPEN May be blank (if not yet billed). Information associated with this permit: Project Name AT&T High Point, NC A01 PKA2 Address W Gate City Blvd, High Point, NC County Guilford Latitude 36.0037 Longitude -79.9052 Permittee Listed BellSouth Telecommunications, LLC Legally Responsible Nea Dalton Individual NC Reference No. NCG01-2020-2156 E&SC Plan ID GUILF-2020-021 Original NOI 25764 Tracking No. Date COC Issued 5/26/2020 Prior Rescission Cate populates only if COCwas already rescinded at time of submittal. Date Reason for Rescission/Termination Request: Reason for r Project Closed -Out Termination of r Sale (Another Owner/Operator obtained a new COC) Coverage * r Mistake or Invalid Coverage r Other Addional Nbre information about the basis of this request, if needed. Explanation Supporting Upload Supporting Documentation if applicable. Documentation NtastbeRYforrrat Project Close-out Information: Final Close-out 4/26/2021 Inspection Approval Project Close-out 4-26-2021 Inspection Report GUILF-2020-021 ATT Approval 116.95KB High Point NC.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 deice 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* Valerie Dorrier Title * AT&T Manager Organization* BellSouth Telecommunications, LLC Date * 05/17/2021 Email for g09242@att.com Confirmation * Contact Telephone* 7047996390 NOT Certification eNOT form signed_updated.pdf 51.23KB Form Mast be PDF Forrrst Is this COC Already Ensure this CCChas not been rescinded since subrrittal! Rescinded? Additional Email (Optional) Original Permittee Email CCd on Notification Errails cwatson@apexcos.com CCd on Notification Erails ndl346@att.com Original Site Contact CCd on Notificaiton Errails Email jf7955@att.com