NCC203321_Notice of Termination_20210902

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/2/2021 8:16:55 AM (NOT Submittal)
Approve by Morman, Alaina 9/8/2021 11:52:45 AM (NOT Request Review- NCC203321)
p E&SC plan to remain open and MCB Camp Lejeune will have to submit a newNO1 and obtain a COC
prior to engaging in land disturbing activity.
• The task was assigned to Morman, Alaina. The due date is: September 7, 2021 5:00 PM
9/2/2021 8:17 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC203321
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
OPEN
K/hy be blank (if not yet billed).
Information associated
with this permit:
Project Name
Subtitle D Landfill Closure Phase III
Address
Piney Green Road, Camp Lejeune, NC
County
Onslow
Latitude
34.6906
Longitude
-77.3189
Permittee Listed
MCB Camp Lejeune
Legally Responsible
Neal Paul
Individual
NC Reference No.
NCG01-2020-3321
E&SC Plan ID
ONSLO-2021-002
Original NOI
29239
Tracking No.
Date COC Issued
8/11/2020
Prior Rescission
Cate populates only if COCwas already rescinded at tirre of subrrittal.
Date
Reason for Rescission/Termination Request:
Reason for
f Project Closed -Out
Termination of
r Sale (Another Owner/Operator obtained a new COC)
Coverage *
r Mistake or Invalid Coverage
r Other Project not awarded for construction.

Additional Mxe infornation about the basis of this request, if needed.
Explanation At the time, the Gov't has not yet awarded
this construction contract. Upon award, the
COC will be re -applied for. Construction
activities will not commence until coverage is
re -obtained.
Supporting Upload Supporting DDcurrentation if applicable.
Documentation Mast beFDFformt
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Mist beFDFformat
Approval
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes anyfalse statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; orwho falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine notto exceed ten thousand
dollars ($10,000).
rJ I, as an authorized representative, hereby request rescission 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.
*This form must be signed by a responsible corporate officer that owns or operates the construction activity, such as a
president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B,
Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B,
Item (6) of that permit.
Signature
Taor }
Type Name* Talia Prendergast
Title * PWD Civil Engineer
Organization * MCB Camp Lejeune
Date * 09/02/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 910-451-3234 ext. 3242
NOT Certification 18-
Form 38.17KB
0091_SubtitleDLandfillClosureP3_NOT_08.02.21.p...
Must be RY Format

Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email 0Cd on Notification Errails
(Optional) heather. [e-mail]
Original Permittee 0Cd onNiotificationErrails
Email [e-mail]
Original Site Contact 0Cd on Notificaiton Errails
Email ta lia. ba rraco@usmc. mi I