NCG080755_Rescission Request_20240604

Frito-Lay
May 14, 2024
NPDES Permit Coverage RescissionDivis RECE�CEO
116121on ofMail Se viceater Quity Center ANb 1Dj4
Raleigh, North Carolina 27699-1612
Re: NOT Submittal
Please see attached Rescission Request Forms for the following Rolling Frito-Lay Sales, LP facilities:
Forest City Bin 168 Meadowbrook Forest City NC NCG080755
Elkin Bin 4213 Wilhelm Rd. Boonville NC NCGON81
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: [e-mail]
Reason for Termination:
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 general permit, and that
dischargingpollutants 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 liability for any violations of this permit
or the Clean Water Act."
Sincerel
Rob Sapienza
Regional Fleet Manager

FOR AGENCY USE ONLY
Assigned to:
ARO FRO MRO RRO WARO WIRO WSRO R
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Division of Energy, Mineral, and Land Resources Land Quality Section ✓pNoV/"?e
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 27699-1612. 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.
L. 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]
Industrial Facility(facility requesting rescission):
Facility name:
Forest City Bin
Street address:
168 Meadowbrook
City: State: Zip Code: County:
Forest City NC 28043 Rutherford
Permit Number to which this request applies:
NCG080755
i. Reason for rescission Request
This is required information. Attach separate sheets if 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: 5/14/2024
❑Facility sold.
Sold to:
On date:
❑Other(please explain):

4. Applicant Certification:
North Carolina General Statute 143-215.66(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: Rob Sapienza
Title: Regional Fleets Manager
(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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