NCC203493_NOT Signed Certification_20220822

NCG01- Notice of Termination (NOT) Certification Form
Directions0
:
Phnos. this form, �Qmp1��,�� ��an and upload to the electronic ��QT (P.escis.)ion) farm.
Thin, mail the �rr'pinQl signed form to the NC OFFOLR Stormwater Progri-rim at;
Dn"'Isson of Enefgy, Mineral & Land Pesources Stormwater Program
512 M. Salisbury Street, 6"' Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
DO
NOT
MAIL
THIS FORM UNTIL YOUR NOT
REQUEST HAS BEEN REVIEWED
AND APPROVED.
THE FOt-,r-'.'.
YOU
MAIL
MUST BE COMPLETED WITH
AN ORIGINAL SIGNATURE (NOT
DIGITAL) [40 CFR 122-221
General Permit Certificate of Coverage (COC) tJo.: NCC203493
Name of Project:
Dude Ener
Stamey to Statesville Tie to Marshall ft 80 OPGW
FerfiCCeneralStofute 14:?-215.,68 (1). uny persan who knowingly mokes any false statemerrt, representation, or
certi�xti'on in any application, record, report, plan, or other documentfiled or rewired to be maintained under this
Artide or o rule implementing [his Article ... shall he guilty of a Class 2 misdemeanor which may include ❑ fin e nor
to exceed ten thou.; orad dollar Jo, 0 I0,040).
Undr,:r penalty of lalvi, I c � rtif'� x�i��:
I, a: on authorize.-P id rf_p rr.:� ntafive. her,.-Pby request resdls-52ion of coverage under the rqPDES Stormwater Permit for
the sub,e% ;` facollit-I 1 am familiar a/ith thevinformation contained in this request, and to the hest of my knowledge
and fir•' t-{, :UCh ionforrroa-"t'l'on fS true, complete,, and accurate..
L I ly k, r i b I 10 r a n I za t of o n a I E n t I t y
Dine Energy Carolinas, LLC
U:palfy Ra,,.,-,r0,pons'1*b1e F111,.*r5on-.o, Rand y Veltri
Iidy of LE�ally R :P onsirl` Pcr�on: Director Transmission Permittina
•Signature; Date: U
Senior Transmission Permitting Manager
Print flarne and Title of ivned (only if authgilzed in dIvIduol signing differs from Legally Responsible Person):
• IMPORTANT NOTE: Thisf�rrr► must be,51gned by u re�n�nslbl� corporate officer that owns or operates the
& 0
crrlstrucrlan uctr"vity, much r�s r� presldente��ecret,a�y, t�rer�surer, r�r vJCpre sldenr, or a manager ghat rs authar►red in
accordon ce wit to [IIII r It IV, Sectlon 8, 1 j,-P., rn (6) of th P, NCG01 0000 permit-,
['or more inforrnotion on �lynutory requfremenis, 5ee Part IV, Section A, Itern (6) of the NCG010000 permit.