NCC204554_Notice of Termination_20211013

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/13/2021 4:15:35 PM (NOT Submittal)
Approve by Morman, Alaina 10/13/2021 5:08:11 PM (NOT Request Review- NCC204554)
• The task was assigned to Morman, Alaina. The due date is: October 18, 2021 5:00 PM
10/13/2021 4:15 PM

1 �
NORTH CAROLINA
Enrlronmenral Quallly
Certificate of
NCC204554
Coverage (COC)
Enter the Certificate of Coverage Nmber
No.*
2020 Annual Fee Status
2021 Annual Fee Status
OPEN
May be blank (if not yet billed).
Information associated
with this permit:
Project Name
NFRC East
Address
2300 John Mewborne Road, Kinston, NC
County
Lenoir
Latitude
35.3311
Longitude
-77.6031
Permittee Listed
NC Global Transpark
Legally Responsible
John Rouse
Individual
NC Reference No.
NCG01-2020-4554
E&SC Plan ID
Lenoi-2021-010
Original NOI
32724
Tracking No.
Date COC Issued
10/12/2020
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Cate populates only if COCwas already rescinded at time of submittal.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 Nbre information about the basis of this request, if needed.
Explanation
Supporting upload Supporting Documentation if applicable.
Documentation NtastbeRYforrrat

Project Close-out Information:
Final Close-out 10/12/2021
Inspection Approval
Project Close-out 20211012 sed insp report LENOI-2021-010 NFRC
Approval 452.07KB
East Facility.pdf
Documentation
2021-10-13 - eNOT Cert. Form - Executed.pdf 69.08KB
Wst be FDFforrrat
North Carolina General Statute 143-215.613 (i) 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 Artide or a rule implementing this Artide; 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 device or method required to be operated or maintained under this Artide or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
17 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* Richard W. Barkes
Title * Airport Director
Organization* North Carolina Global TransPark
Date * 10/13/2021
Email for [e-mail]
Confirmation *
Contact Telephone* 919-621-8413
NOT Certification 2021-10-13 - eNOT Cert. Form - Executed.pdf
Form Mist be FDF Format
Is this COC Already Ensure this COChas not been rescinded since subrrittal!
Rescinded?
Additional Email CCd on Notification Bmils
(Optional) [e-mail]
Original Permittee CCd on Wification BTails
Email [e-mail]
Original Site Contact CCd on Notificaiton Errails
Email [e-mail]
69.08KB