NCC203655_Notice of Termination_20220106

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/6/2022 1:59:43 PM (NOT Submittal)
Approve by Morman, Alaina 1/7/2022 4:49:43 PM (NOT Request Review - NCC203655)
• The task was assigned to Morman, Alaina. The due date is: January 11, 2022 5:00 PM
1/6/2022 1:59 PM

NORTH CAROLINA
Rrf OmFkm&tral Qualrly
Certificate of NCC203655
Coverage (COC) No.* Enter the Certificate of Coverage Number
2020 Annual Fee Status
2021 Annual Fee Status PAID
May be blank (if not yet billed).
2022 Annual Fee May be blank (if not yet billed).
Status
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
Worley Field Services
Legally Responsible
Alfred Wills III
Individual
NC Reference No.
NCG01-2020-3655
E&SC Plan ID
Camde-2020-009
Original NOI Tracking
30188
No.
Date COC Issued
8/21/2020
Prior Rescission Date
Date populates only if COC was already rescinded at time of submittal.
Reason for Rescission/Termination Request:
Reason for • Project Closed -Out
Termination of Sale (Another Owner/Operator obtained new COC)
Coverage* Mistake or Invalid Coverage
Other

Additional
More information about the basis of this request, if needed.
Explanation
The project is complete. James Edwards from
the NC DEQ inspected the completed project
site on January 4, 2022 and approved the site
for permit close-out. He submitted the
attached report confirming the permits can be
closed out and no additional self -monitoring
or inspections are required.
Supporting
Upload Supporting Documentation if applicable.
Documentation
Must be PDF format
Project Close-out
Information:
Final Close-out 1/4/2022
Inspection Approval
Project Close-out 211228 CAMDEN SOLAR CAMDE-2020-009
Approval 35.91 KB
PRINT.pdf
Documentation
CO 113 Sand Hills Rd.pdf 88.65KB
Must be PDF format
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; or who knowingly makes a false statement of a material
fact in a rulemaking proceeding or contested case under this 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 Article or rules of the Commission 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, 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* Alfred Wills III
Title* Vice President of Power and New Energy
Organization * Worley Field Services
Date * 01 /06/2022
Email for [e-mail]
Confirmation *
Contact Telephone* 8145712121
NOT Certification NCG01-eNOT-Certification-Form-20210514-DEMLR-
Form 961.98KB
SW (NCG01).pdf
Must be PDF Format

Is this COC Already Ensure this COC has not been rescinded since submittal!
Rescinded?
Additional Email CC'd on Notification Emails
(Optional) [e-mail]
Original Permittee CC'd on Notification Emails
Email [e-mail]
Original Site Contact CC'd on Notificaiton Emails
Email [e-mail]