NCC202127_Notice of Termination_20211011

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/11/2021 8:58:56 AM (NOT Submittal)
Approve by Morman, Alaina 10/12/2021 12:06:34 PM (NOT Request Review- NCC202127)
• The task was assigned to Morman, Alaina. The due date is: October 14, 2021 5:00 PM
10/11 /2021 8:58 AM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of NCC202127
Coverage (COC) Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status PAID
Nt3y be blank (if not yet billed).
Information associated with this permit:
Project Name
North Carolina State Ports Upgrades to south gate complex
Address
2202 Burnett Blvd, wilmington, NC
County
New Hanover
Latitude
34.0000
Longitude
-78.0000
Permittee Listed
North Carolina State Ports Authority
Legally Responsible
Paul Coaa
Individual
NC Reference No.
NCG01-2020-2127
E&SC Plan ID
NEWHA-2020-020
Original NOI
25895
Tracking No.
Date COC Issued
5/21/2020
Prior Rescission
Cate populates only if COCwas already rescinded at time of submittal.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 *
r Mistake or Invalid Coverage
r Other
Additional IVbre information about the basis of this request, if needed.
Explanation
Supporting Upload Supporting Documentation if applicable.
Documentation MstbeRYforrrat

Project Close-out Information:
Final Close-out 9/23/2021
Inspection Approval
Project Close-out NEWHA-2020-020 20210923.pdf 114.27KB
Approval Mast be FDFforrrat
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
c ,tr�W , J, 'C' - t'6
Type Name* Brian E Clark
Title * Executive Director
Organization * north Carolina State ports authority
Date * 10/11 /2021
Email for [e-mail]
Confirmation *
Contact Telephone* 9107466460
NOT Certification 20211011090301158.pdf
Form Mast be FDF Forrrst
Is this COC Already Ensure this CCChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Erails
(Optional)
Original Permittee CCd on Notification Bmils
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]
30.87KB