NCC203671_NOT Signed Certification_20220823

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Notice of Termination (NOT) Request - NPDES
Stormwater Permit for Construction Activities
Use this form to submit a Notice of Termination (NOT) request for a project covered under the N.C. NPDES
General Permit for Construction Activities NCGO10000 (or NCG250000). If approved, the Certificate of Coverage
(COC) will be rescinded.
Certificate of NCC203671
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
Information associated with this permit:
Project Name Magellan Selma Tank Expansion; Project ID: JOHNS-2020-026
Address 4414 Buffalo Road, Selma, NC
County Johnston
Latitude 35.5555
Longitude-78.2967
Permittee Listed Magellan Terminals Holdings, L.P.
Legally Responsible Kyle Krshka
Individual
E&SC Plan ID JOHNS-2020-026
Original NOI Tracking 30271
No. *
Date COC Issued* 08/28/2020
Prior Rescission Date
This field will populate only if COC has already been rescinded.
Reason for Rescission/Termination Request:
Reason for Q Project Closed -Out
Termination of O Sale (Another Owner/Operator obtained new COC)
Coverage* O Mistake or Invalid Coverage
Q Other Project never started
Additional More information about the basis of this request, if needed.
Explanation This project was never started. There was no land disturbance at this site. The
facility was sold to Buckeye LLC on June 8, 2022.
Supporting Upload Supporting Documentation if applicable.
Documentation Upload
JOHNS-2020-026_20220811_lnspRpt.pdf (blob:htt... 36.56KB
Must be PDF format
X

North Carolina General Statute 143-215.613 (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; 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).
Q 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.
Important: The person who electronically signs this Certification must be the same person who signs the paper NOT
Certification Form (uploaded below). If that person is signing on behalf of the Permittee, that individual must be an
authorized responsible person within the same organization as the Permittee.
*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 NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item
(6) of that permit.
Signature* Sign
Type Name* Kyle Krshka
Title* VP Marine Independent Terminals
Organization* Magellan Midstream Partners, LP
Date* Date will be captured on form submission
Email for [e-mail]
Confirmation*
Contact Telephone* 918-574-7560
YOU MUST MAIL THE ORIGINAL SIGNED NOT CERTIFICATION FORM (click on this link)
(https://files.nc.gov/ncdeq/Energy%20M ineral%20and%20Land%20Resources/Stormwater/NPDES%20General
eNOT-Certification-Form-20210514-DEMLR-SW.pdf) to The Stormwater Program at the address on the form for the
application to fulfill federal requirements. You must also upload a copy of that completed below:
NOT Certification Upload
Form * Must be PDF Format
Additional Email [e-mail]
(Optional)
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