NCG140496_Rescission Request_20221220

FOR AGENCY USE ONLY
Assigned to: 6_ r 0 0 k
ARO F O MRO RRO WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
DEG 2 0 2022 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 27699-1622. 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:
RC Construction Co., Inc.
Edward Murchison
Street address:
City:
State and zip code:
818 Walnut St.
Greenwood
MS 38930
Telephone number:
Email address:
662-453-2424 ; 919-632-5202
[e-mail]
2. Industrial Facility (facility requesting rescission):
Facility name:
Runway & Parallel Rehabilitation Batch Plant
Street address:
Hurst Drive
City:
State:
Zip Code:
County:
Pope Army Airfield
NC
28310
Cumberland
Permit Number to which this request applies:
NCG140496
3. Reason for rescission Request
This is required information. Attach separate sheets 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.
Date closed/closing: 11/01/2022
❑ Facility sold.
Sold to:
On date:
❑ Other (please explain):

4. Applicant Certification:
North Carolina General Statute 143-215.68 (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:
O 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: Edward B. Murchison
Title: Quality Control ManagedEnvironmental Inspector
Edward Murchison Edward Murchison
082225-05'00' 16Dec2022
(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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