NCC204924_Notice of Termination_20210929

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/29/2021 8:33:05 AM (NOT Submittal)
Approve by Morman, Alaina 9/29/2021 12:05:44 PM (NOT Request Review- NCC204924)
• The task was assigned to Morman, Alaina. The due date is: October 4, 2021 5:00 PM
9/29/2021 8:33 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC204924
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status May be blank (if not yet billed)
Information associated with this permit:
Project Name
Tull Wooten III Project
Address
Tower Hill Road, Kinston, NC
County
Lenoir
Latitude
35.2550
Longitude
-77.5440
Permittee Listed
Resource Environmental Solutions, LLC
Legally Responsible
Daniel Ramsay
Individual
NC Reference No.
NCG01-2020-4924
E&SC Plan ID
Lenoi-2021-008
Original NOI
34342
Tracking No.
Date COC Issued
11/3/2020
Prior Rescission
Date populates only if OOC was already rescinded at tirre of submittal.
Date
Reason for Rescission/Termination Request:
Reason for
r Project Closed -Out
Termination of
r Sale (Another Owner/Operator obtained a new COC)
Coverage *
U Mistake or Invalid Coverage
r Other
Additional Nbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Docurrentation if applicable.
Documentation Mist beFDFformat

Project Close-out Information:
Final Close-out 9/28/2021
Inspection Approval
Project Close-out TWIII_ncgo1_Terminate Report.pdf 458.56KB
Approval Mast be FDFforrrat
Documentation
North Carolina General Statute 143-215.66 (1) provides that:
Anyperson who knowinglymakes any false 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 knowingly makes a false statement
of a material fact in a rulemaking proceeding or contested case underthis Article; or who 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 ofthe
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to 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
Type Name* Paul Dunn
Title * Construction Manager
Organization* RES
Date * 09/29/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9105742629
NOT Certification Tull Wooten III eNOT_Signed.pdf 65.24KB
Form Mast be FDF Format
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email
(Optional)
Original Permittee
Email
CCd on Notification Errails
[e-mail]
CCd on Notification Erails
[e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]