NCG030232_Rescission Request_20220204

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FOR AGENCY USE ONLY
Assigned to: & C49SOAl
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Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
Rescission Request Form
Please 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 recission of your NPDES stormwater permit. Prior to the recission of your NPDES stormwater permit, a
site inspection will be conducted.
1. Owner/Operator (to whom all permit correspondence will he mailecil:
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
Apex Tool Group, LLC
David E. Sturgess
Street address:
City:
State and zip code:
13620 Reese Blvd, Suite 410
Huntersville
NC, 28078
Telephone number:
Email address:
980-441-4097
[e-mail]
2. Industrial Facility (facility reauestine rescissfanl:
Facility name:
Apex Tool Group - Monroe Facility
Street address:
Mason Street
City:
State:
Zip Code:
County:
Monroe
NC
28110
Union
Permit Number to which this request applies:
NCG030232
3. Reason for rescission Request
i ms is requireo imormavon. Attacn separate sneets IT necessary
0 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:
El Facility sold.
Sold to: City of Monroe, NC
On date: November 30, 2021
E3Other (please explain)

4. Applicant Certification:
North Carolina General Statute 143-215.65 (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). 1 hereby request exclusion from NPDES stormwater permitting.
Under penalty of law, I certify that:
O 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: David Sturgess
Title: Senior Vice President
gnature of Applicant)
Mail the entire package to:
January 31, 2022
(Date Signed)
DEMLR— Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
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