NCG080608_Rescission Request_20210816

FOR AGENCY USE ONLY
Assigned to:
ARO FRO MRO RO WARO WIRO WSRO
'DECEIVED
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System AUG 16 2021
Rescission Request Form DENR-LAND QUALITY
STORMWATER PERMITTING
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 Ito whom all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
FedEx Freight, Inc.
Brenden Rose
Street address:
City:
State and zip code:
2200 Forward Drive, DC:2219
Harrison
AR 72601
Telephone number:
Email address:
[phone]
[e-mail]
2. Industrial Facilitv (facility requesting rescission):
Facility name:
FedEx Freight, Inc.- RDU
Street address:
646 Roycroft Road
City:
State:
Zip Code:
County:
Creedmoor
NC
27522
Granville
Permit Number to which this request applies:
NCG080608
3. Reason for rescission Request

4. Applicant Certification:
North Carolina General Statute 143-215.66 (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:
All
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: Brenden Rose
Title: Environmental Engineer
ijlt�- 013140 z►
Signature of Applicant) (Date Signed)
Mail the entire package to: DEMLR —Stormwater Program
Department of Environmental Quality����
1612 Mail Service Center N
Raleigh, NC 27699-1612
Page 2 of 2

BLYMYER
E N G I N E E R S
1101 Marina Village Parkway, Suite 100
Alameda, California 94501
Phone: [phone] Fax: [phone]
Suzanne McCoy
NCDEMLR- Stormwater Program
1612 Mail Service Center
Raleieh. NC 27699-1612
We are sending you:
Letter of Transmittal
Date: June 25, 2019
Job No.: 208029- RDU
Via: FedEx 2 Day 11
RECEIVED
AUG 16 2021
DENR-LAND QUALITY
STORMWATER PERMITTING
Copies
Date
No.
Description
1
8/3/2021
NCG080608
Rescission Request Form for FedEx Freight, Inc.-RDU
646 Roycroft Road, Creedmoor, NC, 27522
Remarks:
Enclosed please find a copy of the Rescission Request Form for FedEx Freight, Inc.-RDU. As
mentioned on the attached form, please mail correspondence to the following address:
Brenden Rose
FedEx Freight, Inc.
2200 Forward Drive DC:2219
Harrison, AR 72601
Please call me at 510-747-3074 if you have any questions. Thank you.
Copy To:
Signed:
Brenden Rose, FedEx Freight, Inc.
File
Maribel Topete, Blymyer Engineers, Inc.