NCG080887_Rescission Request (Recovered)_20230405

FOR AGENCY USE ONLY
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Assigned to: CPO
ARO FRO MRO FRO ARO IRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
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, INC 27699-1612. 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:
Rollin Frito-Lay Sales LP
Rob Sapeinza
Street address:
City:
State and zip code:
2700 Nevada Blvd.
Charlotte
NC 28273
Telephone number:
Email address:
704-927-7377
[e-mail]
2. Industrial Facility (facility requesting rescission):
Facility name:
AHOSKIE BIN
Street address:
330 NC HIGHWAY 42 WEST
City:
State:
I
Zip Code:
County:
AHOSKIE
NC
27910
Hertford
Permit Number to which this request applies:
NCG080887
3. Reason for rescission Request
This is required intormation. Attach separate sheets it necessary
El 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: 3/28/2023
❑ Facility sold.
Sold to:
On date:
❑ Other (please explain):

4. Applicant Certification:
North Carolina General Statute 143-215.613 (1) 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 ($30,000). ]hereby request exclusion from NPDES stormwater permitting.
Under penalty of law, I certify that:
l 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: Rob Sapienza
Title: Regional Fleet Manager
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(Signature of Applicant) (Date Signed)
Mail the entire package to:
DEM LR — Stormwater
Page 2 of 2
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Frito-Lay
°`whepm•
May 5, 2020
SUBJECT: SIGNATURE DELEGATION AUTHORIZATION
To Whom It May Concern:
In accordance with State and/or Federal regulations and in accordance with our corporate
procedures, I hereby authorize the individuals with the position of Regional Fleet Manager to
sign permit applications (notices of intent), notices of termination, registrations, and other
certifications as necessary for stone water permitting and compliance activities.
If you require any further documentation or if you have any questions, please contact me at
972-334-5527. Thank you for your assistance in this matter.
Sincerely,
:u u n 7XIMORT11i
Title Supply Chain Vice President
Signature

e°aehoeNrm°N°old
Frito-Lay
March 28, 2023
Stormwater Permitting Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: Notice of Rescission Submittal
Please accept this letter and attached form as a notice of termination for the following Rolling Frito-
Lay Sales, LP facility:
AHOSKIE BIN
1 330NCHIGHWAY42WEST
AHOSKIE
NC
NCG080887
BURLINGTON BINS
770 TROLLINGWRDOOD HAWFIELD
Mebane
NC
NCGO80743
Operator Information:
Owner/operator: Rolling Frito-Lay Sales, LP
Official Contact Person: Rob Sapienza (Fleet Manager)
Mailing Address: 2700 Nevada Blvd. Charlotte, NC-28273 -
Phone: [phone]
Email: rob.sapienza(q)pgpsico.com
Reason for Termination:
Storm water discharges associated with industrial activity (vehicle maintenance) have been eliminated
and facility has closed.
"I certify under penalty of law that all storm water discharges associated with industrial activity from the
identified facility that are authorized by an NPDES general permit have been eliminated or that I am no longer
the operator of the industrial activity. I understand that by submitting this notice of termination, that I am no
longer authorized to discharge storm water associated with industrial activity under this generalpermit, and that
discharging pollutants in storm water associated with industrial activity to waters of the State is unlawful under
the Clean Water Act where the discharge is not authorized by an NPDES permit. I also understand that the
submittal of this notice of termination does not release an operator from liabilityfor any violations of this permit
or the Clean Water Act. "
Sincerely,
Rob Sapienza
Regional Fleet Manager