HomeMy WebLinkAboutNCC200581_NOT Signed Certification_20220316NCG01 Notice of Termination JNOT
) Certification Farm
Directions:
Tit this faint, [ortiRlctc soon and uaia.td to the riart►orrir Not IHatiGssron1 form
T1rrr+ mail the ovrlprnpl tr nod farm to the Wy 1"LN Stprmrrairr 1'ragrarn+t.
Owwon at LvK-AV, At'nrrai i6 Land Nasourtss Sr4rrrrr41" Nragram
"UN Salisbury mrowl' W" Floor
11"Mix1 96nrrre Crew
Rateigh. NC 21699,1to12
OL] #IQT fiRAlk TFtlS. Fr3RlIrR tJA1T1L T}tl; FO1 wC111 MAri WOUR %0T QMUf4T ►HAS atFV 4EVEWC13 AMD Appg;DVyt).
1M'tM So CDAWM!Q VO M ANORt6+IMAL INGNATURE PYOT MdrALI (40CFIR U2.'Uj
General Permit Certlfscale a# Coverage 1COCJ No., Nr-C200591
Name of Project. rnan a St., • Pe—, NC
Per AIC Ciim va+3Ictute J43 215'68 P( any IAR'san who knowl"9010 makes airy fakir stafemenf representahori, or
rrrrrfinotsan on ary appbcat.w. McOnct report Fior, a orher documerit flied or requ,rea ra be rnasnrarned under this
Arron1e or a rude urtpienmrn c; rhrs Artxle ... srPali hr pulley a! a loss 1 rn�sdprncanar whreh t+intludc a fine nor [v exceed ten thousand pi7riars i$10 00M
UrtdcY Oen4Sty of "-, 1 CrrtlfV that:
I, as an autharited rMresentauve, hereby request resnssion of ra74rcr*v under the NRDLS Stcvmwater Permit for
the subpect facility I ann familiar '&"" tree inform abcon cdrrtais Od in thla rvque:t, and to the nest of m+Y knowledge
arrd he*C4, such iriFarrnation rs true, complete, arsd accurate.
Legally itesaar4lbie Orgaartrratidnal intrty: J.H.RReabrn Oil & Suppiy Cv_ Inc.
"Leg 21IV ftespon%Ibic Psersan: J. Hall Waddell
Tide of LsegaMlrResponsib I Per n_ Presidanl
'Stg<iaturc: F'�i► _ tlute: �11fli22
P-it 14arr,- and 1 elc & Sgned I&Vy if authrxlrrdtndLurdwI siamn? Offers from t•rgalyr Frespons+ble Person}:
` fJldposmttfr Nord: ;his ftrrm may be signed f7e v responsAble corporate that alms or owores she
cart rq tsar, acOwly, st.%:h 0.10 prrsident, serrerary freasurer Err vi:e pres.sdrnr, or a rrunager few �S ou?M,..vd Frr
oeeo►darrre with Burt IV, 3mectioi=19, item f61 of the KG00L1Cr]permit.
F.ar Fmrrr informaribn or signcrwy regrArerrsents, see fart !V, 5rrthori H. Nerrn ; 6) a( the h1CW1LXM'prnn t.