NCGNE0289_Rescission Request_20220711

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6/29/2022
Brittany Carson
1612 MSC
Raleigh, NC 27699-1612
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RECEIVED
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DEMLR-Stormwater Program
Re: Request to Terminate Storm Water No Exposure Certification (NCGNE0289)
Leggett & Platt Components Company, Inc. Matrex Seating 899 E. Lindsay Street Greensboro, NC
To Whom It May Concern:
Matrex Seating would like to request termination of the Storm Water No Exposure Certification at our
Lindsay Street location. All operations were ceased on 06/30/2022.
Please contact 1-336-379-7777 if you require additional information. Please send written response to 911
Northridge Street Greensboro, NC.
Regards,
General Manager
Leggett & Platt, Inc.
Cc: Randi Preece
911 Northridge Street O PO. Box 444 0 Greensboro NC 27403 O 336-379-7777

RECEIVED
FOR AGENCY USE ONLY
Assigned to:
ARO FRO MRO RRO WARO WIRO WSRO
JUL i I ilip'
DEMLR-Stormwater Program
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 be mailed):
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
Leggett & Platt Components Company, Inc.
Janet Walker
Street address:
City:
State and zip code:
911 Northridge Street
Greensboro
NC
Telephone number:
Email ad r
1-336-379-7777
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2. Industrial Facility (facility;,sting res
Facility name:
Leggett& Platt Components Company, Inc. r'
Street a s.
899 E. LSL
City: State: Zip Code:
Greensboro NC 27405`
Permit Number to which this request applies:
No Exposure Certification (NCGNED289)
3. Reason for rescission Request
I nis IS requ l rea InTOrmaxion. Attacn separate sneets IT necessary
m 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: 6/30/2022
f 3 Facility sold.
Sold to:
On date:
0 Other (please explain)

4. Applicant Certification:
North Carolina General Statute 143-215.6E (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:
I] 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:
Title: Branch Manager
(Signature of Applicant)
Mail the entire package to: DEMLR—Stormwater Progl
6/30/2022
(Date Signed)
Depa men-of.Envlronmentalr —Ii
1612 Mail Service Center- r� i
aleigh, NC 27699-1612
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