NCS000244_Rescission Request_20211007

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October 5t' 2021
DEMLR — Stormwater Program
Department of Environmental Quality
Attn: Suzanne McCoy
1612 Mail Service Center
Raleigh, NC 27699-1612
Re: Individual Stormwater Permit Termination: NCS000244
American Distillation Inc.
1690 Royster Road NE
Leland, NC 28451
Suzanne,
Please find attached the documentation to terminate the individual stormwater permit for American
Distillation Inc. located the address above.
The termination has been discussed with Annette Lucas, Brianna Young, Sydney Carpenter, Paul
Clark, and Bethany Georgoulias. Brianna Young provided guidance to terminate the stormwater
permit as well as the general wastewater permit and apply for an individual wastewater permit.
If you have any questions regarding this submittal or need further documentation, please contact
me at [phone] or via email at jnowicki [e-mail].
Sincerely,
Jesse Nowicki, CHMM
Environmental Specialist III
US Compliance
cc — Donald Outlaw American Distillation Inc.
Enclosures
888-897-8681 1 620 Third Street, 4100, Excelsior, MN 563311 uscompliance.com

FOR AGENCY USE ONLY
Assigned to:
ARO FRO
MRO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
Rescission Request Form
Pl ease 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 recession of your NPDES stormwater permit. Prior to the recission of your NPDES stormwater permit, a
site inspection will be conducted.
2. Owner/Operator (to whom all nerrnit corresnondanrp will hp mnilpril-
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
American Distillation Inc.
Gwen Mantooth
Street address:
City:
State and zip code:
1690 Royster Road NE
Leland
NC 28451
Telephone number:
Email address:
910-371-0993
[e-mail]
2. Industrial Facility (facility rpriupctina rpericcinnl-
Facility name:
American Distillation Inc.
Street address:
1690 Royster Road NE
City:
State:
I
Zip Code: County:
Leland
NC
28451 Brunswick
Permit Number to which this request applies:
NCS000244
3. Reason for rescission Request
i nis is requirea Intormation. Attach separate sheets it necessary
© 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:
On date:
El Other (please explain):
Per the discussion with the NC DEQ, the facility was instructed to terminate the individual stormwater permit as well as terminate
the general wastewater permit. The facility is to apply for an individual wastewater permit in place of these
permits.

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:
0 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: Gwen Mantooth
Title: Vice President
'&"L J-
,S�igriature
of Appli a t) (Date Siined)
Mail the entire package to: DEMLR —Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
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