NCG240022_Rescission Request_20220616

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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 Dermit correspondence will be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
Wall Recycling, LLC
Dan Wall
Street address:
City:
State and zip code:
2310 Garner Road
Raleigh
NC
Telephone number:
Email address:
[phone]
[e-mail]
2. Industrial Facility (facilitv reauestine rescission):
Facility name:
Wall Recycling C&DLandfill
Street address:
385 Gold Hill Road
City:
State:
Zip Code:
County:
Asheboro
NC
27203
Randolph
Permit Number to which this request applies:„
NCG240022 %
3. Reason for rescission Request
i nis is regunea mtormauon. Httacn separate sneets tt necessary
❑ 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:
Q Facility sold.
Sold to:
p Other (please explain):
No longer need compost permit which belonged to former owner, was replaced with permit # NCG120118.
RECEIVED
JUN 15 2M
DENR•LAND QUALITY
STORWVATERPERMITTING

4. Applicant Certification:
North Carolina General Statute 143-215.68 (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, 1 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: Dan Wall
Title: Manager/member
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(Signature of A pica (Date Signed)
Mail the entire package to: DEMLR —
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