NCC204180_NOT Signed Certification_20221031

Clark, Paul
From: Goto, Jeff <[e-mail]>
Sent: Monday, October 31, 2022 10:29 AM
To: Clark, Paul
Subject: [External] NCC204180 - NOT Request for Abandon 9W4121 Telecom - Change of
Legally Responsible Person
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Good morning Paul,
I wanted to reach out regarding the NOT Request for Abandon 9W4121 Telecom (NCC204180) that I submitted. I am the
new legally responsible person that has been managing this permit, among others. Randy Veltri was originally listed on
the NOI, but our organizational structure has since changed. Let me know if this email is sufficient to denote that
change. We have several NOTs being submitted that will have this change in legally responsible person and we're trying
to find the easiest way to minimize questions / comments back.
Should I also add this to the "Additional Explanation" section of the NOT going forward?
Best regards,
Jeff Goto, P.E.
Lead Transmission Permitting Manager
Transmission Permitting — Carolinas West
526 S Church St. I EC09Q
Charlotte, NC 28202
O: [phone]
C: [phone]
www.duke-energv.com
DUKE
ENERGY.

NCG01 Notice of Termination (NOT) Certification Form
Directions:
Print this form, complete, scan and upload to the electronic NOT (Rescission) form.
Then, mail the original signed form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 611 Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM UNTIL YOUR NOT REQUEST HAS BEEN REVIEWED AND APPROVED.
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.22)
General Permit Certificate of Coverage (COC) No.: NGL 204 1 �0
Name of Project: Aba�ndan 41 VJ 9-, —te4MM
Per NC General Statute 143-215.6B (i), 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).
Under penalty of law, I certify that:
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.
Legally Responsible Organizational Entity: TUVA, ear e'y-Dkina6 ue,
*Legally Responsible Person: �G�CYG 67,b4-o
Title of Legally Responsible Person: �C� fra�15Mi55C�Y� ��+mIeY
Date: 10/3112aI.2
*Signature:
Print Name and Title of Signed (only if authorized individual signing differs from Legally Responsible Person):
* IMPORTANT NOTE: 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 NCGO10000 permit.
For more information on signatory requirements, see Part 1V, Section B, Item (6) of the NCGO10000 permit.