NCC203435_Notice of Termination_20210909

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/9/2021 10:29:43 AM (NOT Submittal)
Approve by Morman, Alaina 9/15/2021 4:40:56 PM (NOT Request Review- NCC203435)
• The task was assigned to Morman, Alaina. The due date is: September 14, 2021 5:00 PM
9/9/2021 10:29 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC203435
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status OPEN
ivby be blank (if not yet billed).
Information associated with this permit:
Project Name
Camden Solar Farm
Address
345 NC Hwy 343, Camden, NC
County
Camden
Latitude
36.3089
Longitude
-76.1403
Permittee Listed
The Worley Group, Inc.
Legally Responsible
Alfred Wills III
Individual
NC Reference No.
NCG01-2020-3435
E&SC Plan ID
Camde-2020-009
Original NOI
29675
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Cate populates only if COCwas already rescinded at tirre of subrrittal.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 *
F Mistake or Invalid Coverage
r Other

Additional Mxe information about the basis of this request, if needed.
Explanation This COC was superceded by NCC203655 a
few days after it was issued. The reason was
to change the entity from "The Worley
Group, Inc." to "Worley Field Services". This
original COC can be closed out.
Supporting Upload Supporting Documentation if applicable.
Documentation Certificate of Coverage.pdf
Mast be FDFfornat
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:
36.43KB
Pnyperson 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 Atcle; orwho falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the
Commission implementing this Atcle 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
`rt
Type Name* Kirk Neubuer
Title * Project Director
Organization* Worley Field Services
Date * 09/09/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 814-571-2121
NOT Certification NCG01-eNOT-Certification-Form-20210514-
Form 962.33KB
DEMLR-SW.pdf
Mast be FDF Fornat

Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Errails
(Optional)
Original Permittee CCdonNiotificationBmils
Email [e-mail]
Original Site Contact 0Cd on Notificaiton Errails
Email [e-mail]