NCG170171 Rescission Request

McROBERTS & HARTIS, P.C.
ENVIRONMENTAL LAW SERVICES
June 19, 2018
NPDES Permit Coverage Rescission
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Re: Rescission Request Form
Beulaville Spinning Plant
To whom it may concern,
Please find enclosed the Rescission Request Form.
Please contact Jackie Hartis with any questions. Ms. Hartis can be reached at 816-285-6048 or
[e-mail].
Thank you,
9acqueli'ne H. Hartis
CC: Tom Murray (via email only)
Gregory Schain (via email only)
4520AlainSoreet Seventi floor Kansas Go, Missouri 64.111 816.661.0123 is%swmerobertslaw.com

FOR AGENCY USE ONLY
AW
• Division of Energy, Mineral & Land Resources Date oath --ed
"A Land Quality Section/Stormwater Permitting Program Year Month Day
NCDENRNational Pollutant Discharge Elimination System
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
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 C I S i� N I C G -1 O I -1111
2) Owner/Facility Information:
Owner/Facility Name
Facility Contact
Street Address 3.
City �$
County
Telephone No. 292
* Final correspondence will be mailed to the address noted below
rr% BQulowi Ile LLC ab New ell
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AQl[1l1Ylg5I Lbl
State N_ ZIP Cod Z S 5 1Y
E-mail Address r IA202 L yrta; G
Fax:
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
VU'2.+tM14V— 911 2A 1-7
Facility closed or is closing on _ . All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure g industrial activities or materials.
Facility sold to mAA RUIMil ton IT. 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
6reg0r14 SC.1 6 in
Print or type 4meperson signing above 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: [phone] FAX: [phone]
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