NCG200501_Rescission Request_20240628

FOR AGENCY USE ONLY
4ssigned-to:--0--000. Rk'`/!
ARO FRO MR RRO WARO WIRO WSRo RECEIVED JUN 2 g 1�4
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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, 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.
1. Owner/Operator(to wham all permit correspondence will be mailed):
Name of legal organizational entity: Legally responsible person as signed in Item(4)below:
MV Enterprises LLC Mark Vestal
Street address: City: State and zip code:
708 martin luther king jr dr thomasville nc 27360
Telephone number: Email address:-
910-322-5000 w _. taI
.'�-' y graham [e-mail] �a
2. Industrial Facility(facilityrequesting resnssion)i'�
Facility name
MVEnterpnses=' - -f
Street address: c = - 5'r
281 Lane-Parkwa -
City: - State:G.,:"' .- _Zip{ode - - County
Salisbury ? 'a ru ,NC, .,.; 1:..28146 a - Rowan
n
Permit N=6&' 6WIilch tliis-requesf applies
NCG200501 - - _�- r
3. 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:2019
I❑Facility sold.
Sold to:
_ On date:
10Other(please explain): roc!I;(,r was 4CVfr 6"/I7'

—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). 1 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: Mark Vestal
Title: President
6.25.24
(Signature of Applicant) (Date Signed)
Mail the entire package to: DEMLR—Stormwater Program_
Departm f Environ'ritehtal Quality — qy
1612,Mail iSerwce�Center r" �* S-
i , Raleigh,,NC 27699-1612
, a .
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