HomeMy WebLinkAboutNCC211371_NOT Signed Certification_20230313NCGOI Notice of Termination (NOT) Certification Form
Directions:
Print this form, complete, scar: 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, 6" floor
1612 Mail Service Center
Raleigh, NC 27699-1612
CEO NOT MAIL THIS FORM, UNTIL YOUR NOT REQUEST HAS BEEN REVIEWED AND APPROVED.
THE FORMYOU MAIL M ST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CPR 122.221
General Permit Certificate of Coverage'COC) No.: NCC211371
Name of Project: Fayetteville - Fayetteville Dupont SW St. 115kV Replace STIR 207, STIR 208, SW 211
Per NC General Statute 143-215.5B (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:
€, 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:
Duke Energy Progress, LLC
*Legally Responsible Person: Randy Ve€tri
Title of Legally Responsible Person: Director, Transmission Permitting
*Signature
te: 3 Z13 L0 2-3
Print Name and Title of Signed (only if authorized individual signing differs from Legally Responsible Person):
Nuwan Wijesuriya, Lead Transmission Permitting Manager
IMPORTANT NOTE. This farm 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 outhori2ed in
accordance with Part IV, Section 3, Item (6) of the NCGO10000 permit.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCGO10000 permit.