NCG070011_Rescission Request_20210819

FOR AGENCY USE ONLY
Assigned to:
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Division of Energy, Mineral, and Land Resources Land Quality ScA VINrn
National Pollutant Discharge Elimination System Yj
Rescission Request Form
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DaIR'Imp P RI\AI I NC
Please fill out and return this form if you no longer need to maintain your NPDES stormwater +Q
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:
Lenox Corporation Ramesh Ramachandran
Street address: City: State and zip code:
1414 Radcliffe Street Bristol PA 19007
Telephone number: Email address:
267-525-5071 [e-mail]
2. Industrial Facility(facility requesting rescission):
Facility name:
Lenox Corporation
Street address:
1800 Dobbs Farm Rd
City: State: Zip Code: County:
Kinston NC 28501
Permit Number to which this request applies:
NCG070011
3. Reason for rescission Request
This is required information.Attach separate sheets if necessary.
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: Crown Equipment Corporation
On date:March 30, 2021
0 Other(please explain):

4. Applicant Certification:
North Carolina General Statute 143-215.6B(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). I hereby request exclusion from NPDES stormwater permitting.
Under penalty of law, I certify that:
El 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: Ramesh Ramachandran
Title:VP Finance&Controller
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(Signature of Applicarif (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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