NCG080722_Rescission Request_20210816

0
RECEIVED
FOR AGENCY USE ONLY
Assigned to:
ARO FRO MRO RRO
WARO WIRO WSRO
AUG 1 P, 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 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 (to whom all permit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
Fed Ex 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 Facility (facility requesting rescission):
Facility name:
FedEx Freight, Inc.- RGH
Street address:
5210 Trademark Drive
City:
State:
Zip Code:
County:
Raleigh
NC
27610
Wake
Permit Number to which this request applies:
NCG080722
3. Reason for rescission Request
I nis is requirea inrormaiion. Hiiacn separate sneers IT necessary.
ll 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: 8/7/2021
❑ Facility sold.
Sold to:
On date:
❑ Other (please explain):

4. Applicant Certification:
North Carolina General Statute 143-215.6E (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:
011, 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: Brenclen Rose
Title: Environmental Engineer
S 3/w z/
(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
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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 Proeram
1612 Mail Service Center
Raleigh, NC 27699-1612
We are sending you:
Letter of Transmittal
Date: June 25, 2019
Job No.: 208029- RGH
Via: FedEx 2 Day
RECEIVED
AUG 15 2021
DENR-LAND QUALITY
STORMWATER PERMITTING
Copies
Date
No.
Description
1
8/3/2021
NCG080722
Rescission Request Form for FedEx Freight, Inc.-RGH
5210 Trademark Drive, Raleigh, NC, 27610
Remarks:
Enclosed please find a copy of the Rescission Request Form for FedEx Freight, Inc.-RGH. 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.
Maribel Topete, Blymyer Engineers, Inc.
File
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