NCS000258_Rescission Request_20220823

1.
FOR AGENCY USE ONLY
Assigned to:
ARO FRO MRO RRO
WARO WIRO WSRO
RECEIVED
AUG 2 3 2079
DENR-LAND QUALITY
STORMWA?FR PERMITTING
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 NPDE5 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_ofyour NPDES_stormwater permit. Prior to the recission of your NPDES stormwater permit, a
site inspection will be conducted.
r... ...r...... -.0 ..e..,.:. c..rmcnnndenro will ha mailedl-
Name of legal organizational entity:
Legally responsible person as signed in Item (4) below:
Apnnnova LLC.
Charles Kraft
Street address:
City:
State and zip code:
2271 Andrew Jackson Hwy
Leland
28451
Telephone number:
Email address:
910-371-2234
[e-mail]
Facility name:
Apnnnova I.I.C.
Street address:
2271 Andrew Jackson Hwy
Cry:
State:
Zip Code:
County:
Leland
NC
28451
Brunswick _.
Permit Number to which this request applies:
NCS000258
3. Reason for rescission Request
rhis is required Intormation Attacn separate sneers 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.
Sold to:
(please explain):
now covered under General

4. Applicant Certification:
North Carolina General Statute 143-215.66 (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:
D 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: Charles Kraft
Title: SVP Manufacturing
(Signature of Applicant) (Date Signed
Mail the entire package to: DEMLR — Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
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