NCG130056_Rescission Request_20210712

FOR AGENCY USE ONLY
NCG__—___ JUL 07 2021
Assigned to:
ARO FRO MRO WARO WIRO WSRO DENR-LAND QUALITY
STORMWATER PERMITTING
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 storm water 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, INC 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 corresoondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
Shotwell Transfer Station II
Josh Daher
Street address:
City:
State and zip code:
103 Rupert Road
Raleigh
NC 27603
Telephone number:
Email address:
919-876-8485
[e-mail]
2. Industrial Facility (facility reauestine rescission):
Facility name:
Shotwell Transfer Station II
Street address:
1506 N. Salem Road
City:
State:
Zip Code:
County:
Apex
NC
27502
Wake
Permit Number to which this request applies:
NCG 130056
3. Reason for rescission Request
i nis is requirea inrormation. wttacn separate sneers IT necessary
El Facility is closed or closing. All industrial activities have ceased such that no discharges of stormwater are contaminated
by exposure to industrial activities or materials.
Date closed/closing: June 2021
® Facility sold.
Sold to:
On date:
® Other (please explain):

4. Applicant Certification:
North Carolina General Statute 143-215.68 (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:
I] 1, 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: Josh Daher
Title: Area President
(Signa 716
Applica (D a Sig d)
Mail the entire package to: DEMI_R— Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
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