NCC200943_Notice of Termination_20220324

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/24/2022 12:24:20 PM (NOT Submittal)
Approve by Morman, Alaina 3/29/2022 8:37:22 AM (NOT Request Review - NCC200943)
* Duplicate COC -- verified documentation with NCC205045.
• The task was assigned to Morman, Alaina. The due date is: March 29, 2022 5:00 PM
3/24/2022 12:24 PM

NORTH CAROLINA
Rrf OmFkm&tral Qualrly
Certificate of NCC200943
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 OPEN
Status May be blank (if not yet billed).
Information associated with this permit:
Project Name
Fairfax Meter Lab/Trans-Mobile Transformer Storage Shelter
Address
Fairfax Road, Greensboro, NC
County
Guilford
Latitude
36.0385
Longitude
-79.8748
Permittee Listed
Duke Energy Progress
Legally Responsible
Mark Dalton
Individual
NC Reference No.
NCG01-2020-0943
E&SC Plan ID
GUILF-2020-023
Original NOI Tracking
22900
No.
Date COC Issued
3/12/2020
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Date populates only if COC was already rescinded at time of submittal.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 Duplicate COC
Additional More information about the basis of this request, if needed.
Explanation COC (NCC200943) is a duplicate of COC
(NCC205045) which has been closed out

Supporting Upload Supporting Documentation if applicable.
Documentation EOI.pdf
Must be PDF format
Project Close-out Information:
Final Close-out
Inspection Approval
Project Close-out Must be PDF format
Approval
Documentation
North Carolina General Statute 143-215.613 (i) provides that:
918.54KB
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 NCGO10000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item
(6) of that permit.
Signature
Type Name* Zach Huett
Title* Real Estate Portfolio Manager - Carolinas East
Organization* Duke Energy Carolinas LLC
Date * 03/24/2022
Email for [e-mail]
Confirmation*
Contact Telephone* [phone]
NOT Certification 2022-03-24 NCG01-eNOT-Certification-Form-
Form 20210514-DEMLR-SW. SIGNEDpdf.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]
921.31 KB

Original Site Contact cc'd on Notificaiton Emails
Email [e-mail]