NCG210363_Rescission Request_20231108

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Assigned to: B- COOv-
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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:
MW Manufacturers,Inc. Todd Harbour
Street address: City: State and zip code:
5020 Weston Pkwy Cary NC 27513
Telephone number: Email address:
281-897-7788 [e-mail]
2. Industrial Facility (facility requesting rescission):
Facility name:
MW Manufacturers
Street address:
408 Pine St
City: State: Zip Code: County:
Fayetteville - NC 28301 `. Cumberland
Permit Number to which this request applies:
NCG210363
3. Reason for rescission Request
This is required information. Attach separate sheets if necessary.
©+ 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: 9/29/23
0 Facility sold.
Sold to:
On date:
iI Other(please explain):

4. Applicant Certification:
North Carolina General Statute 143-215.613(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). I hereby request exclusion from NPDES stormwater permitting.
Under penalty of law, I certify that:
❑ 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: Todd Harbour
Title: Director,Environmental Affairs and Sustainability
(Signature of Applica (Datene
Mail the entire package to: DEMLR—Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh, NC 27699-1612
Page 2 of 2

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STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY,MINERAL,AND LAND RESOURCES
GENERAL PERMIT NO.NCG210000
Certificate of Coverage No.NCG210363
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
N compliance with the provision of North Carolina General Statute 143-215.1,other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission,and the
Federal Water Pollution Control Act,as amended, .
M W Manufacturers
is hereby authorized to discharge'stotmwalerfrom a site located at:
M W Manufacturers
408 Pine St
Fayetteville
Cumberland County
to receiving waters designated as Blounts Creek,class C waters in the Cape Fear River Basin,in accordance
with the effluent limitations,monitoring requirements,and other conditions set forth in N.C.General Permit No.
NCG210000,issued on 7131/2018.
This Certificate of Coverage shall become effective on 811/2018.
This Certificate of Coverage shall remain in effect for the duration of the General Permit
an v6 e, .Lsccay
for William E.(Toby)Vinson,Jr.,P.E.,CPM
Interim Director,Division of Energy.Mineral,and Land Resources
By the Authority of the Environmental Management Commission