NCG030193 Rescission Request

FOR AGENCY USE ONLY
Division of Energy, Mineral & Land Resources Date Received
;� Year Month Da
Land Quality Section/Stormwater Permitting Prograin
National Pollutant Discharge Elimination System
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Quality 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
KC71 S N LCJ G I 1J 9 1 3
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name Lee Iron & Metal Co. , __Znc . dLa Hollmet Recyt~1_i.nc1
Facility Contact Scot Carpenter
Street Address 700 Freedom Drive
City Raleigh State N— ZIP Code 27610
County Wake E-mail Address [e-mail]
Telephone No. 919 775-7951 Fax: 919 7,75-561
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
FXI Facility closed or is closing on 2 21 18 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:
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.
Signature
Date 5/11/18
Pnesident
Print or type name of person signing above Title
Please return this completed rescission request form to
Revised 2018Jan10
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail -Service Center
Raleigh, North Carolina 27699-1612