NCC204107_NOT Signed Certification_20231009

NCGO1 Notice .y::f Term ° ion (N in C- rtific k>t ' Et ri-
tirect o;':s:
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,6th Floor
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM UNTIL YOUR NIT REQUEST HAS BEEN REVIEWED AND APPROVED.
THE FORM YOU MAIL MUST BE COMPLETED WITH AN OIUGIHAL SIGNATURE(NOT DIGITAL)[40 CFR 122.12]
General Permit Certificate of Coverage (COC) No.: NCC204107
Name of Project: PNG Fayetteville Operations Center
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 IVPDES 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: Piedmont Natural Gas Company Inc
*Legally Responsible Person: Zach Huett
Title of Legally Responsible erson: Real Estate Portfolio Manager—Carolinas East
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*Signature: Date: 10/09/2023
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 NCG010000 permit.
For more information on signatory requirements,see Part IV,Section B, Item(6)of the NCG010000 permit.