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HomeMy WebLinkAboutNCG030028_Rescission Request_20180207FOR AGENCY USE ONLY �`� • Division of Energy, Mineral & Land Resources Date Received �r Land Quality Section/Stormwater Permitting Program Year I Month Da RCDENRNational Pollutant Discharge Elimination System NORM CAROLINA DEPARTMENT OF ENVIRONMENT ANO NATURAL RCSOURCCS RESCISSION REQUEST FORM Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit, 1) Enter the permit number to which this request applies: Individual Permit (or) Certificate of Coverage N I C I S N I C I G 1 0 1 3 1 0 1 0 1 2 1 8 2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below Owner/Facility Na Facility Contact Street Address City County Telephone No. Minuteman Powerboss Incorporated j �wti. &A 14N845 U.S. Route 20 Pinaree Grove State IL KANE 847 264-5400 ZIP Code 60140 E-mail Address kamp.q@rninuti2manin!l.com Fax: 847 683-5207 3) Reason for rescission request (This is reguired information. Attach separate sheet if necessary): ❑ Facility closed or is closing on . All industrial activities have ceased such that no discharges of stormwater are contaminated by exposure to industrial activities or materials. ❑ Facility sold to on . If the facility will continue operations under the new owner it may be more appropriate to request an ownership change to reissue to permit to the new owner. ® Other: Minuteman Powerboss Inc has ended its industrial activities in Aberdeen, NC as of 8/31/2016 when its lease ended at this location. If the facility will continue operations under the new owner it may be more appropriate to request an ownership change to reissue to permit to the new owner. 4) Certification: I, as an authorized representative, hereby request rescission 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. Sig "� ___5- 4, � L"" ,, zv dZ Print or type name of person signing above Date Sr, Title Please return this completed rescission request form to: NPDES Permit Coverage Rescission Stormwater Permitting Program 1612 Mail Service Center Raleigh, North Carolina 27699-1612 1612 Mail Service Center, Raleigh, North Carolina 27699-1612 Phone: 919-807-6300 \ FAX: 919-807-6492 An Equal Opportunity \ Affirmative Action Employer