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HomeMy WebLinkAboutNCGNE1352_Rescission Request_20210816. 14 FOR AGENCY USE ONLY Assigned to: ARO FRO MRO RRO WARO WIRO WSRO R 0EI V ED AUG 16 2021 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, 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 hermit correspondence will be mailed): Name of legal organizational entity: Legally responsible person as signed in Item (4) below: RHF Investments, Inc. Dennis B. Tart Street address: City: State and zip code: 401 11th Street NW / P.O. Box 608 Hickory NC 28603 Hickory NC 28601 Telephone number: Email address: 828 - 326 - 8376 dennistart@centuryfurniture.com 2. Industrial Facilitv (facilitv reauestine rescission): Facility name: CENTURY FURNITURE - TECH CENTER (former operator via RHF Investments, Inc.) Street address: 25 18 th Street NW City: I State: Zip Code: County: Hickory NC 28601 Catawba Permit Number to which this request applies: NCGNE1352 3. Reason for rescission Request I IIIJ Ib ICLIUI[CU IIIIUI I I I d LIVI I. HLLd L.II JCFJdIdLC MICCLJ IIIICLt:bbdIy. 0 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: 0 Facility sold. Sold to: Runnymede Investment LLC On date: 5/24/2021 Other (please explain): 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: Ell 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: DENNIS B. TART Title: ENVIRONEMNTAL ENGINER - RHF 8)G )2-oZl (Signature of Applicant) (Date Signed) Mail the entire package to: DEMLR — Stormwater Program Department of Environmental Quality 1612 Mail Service Center Raleigh, NC 27699-1612 Page 2 of 2