NCG030663_Rescission Request_20180627

FOR AGENCY USE ONLY
Division of Energy, Mineral & Land Resources i Date Received
KC Land Quality Section/Stormwater Permitting Program Year Month oa
National Pollutant Discharge Elimination System
Environmental
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
N c sI I I I N I C I G 10 13 0 6 6 3
2) Owner/Facility Information: ' Final correspondence will be mailed to the address noted below
Owner/Facility
Facility Contact
Street Address
City
County
Telephone No.
Select Stainless Products. LLC
Mr. Richard J. Murphy
11145 Monroe Rd
Matthews
State
Mecklenburg E-mail Address
302 632-8770 Fax: 302
ZIP Code 28105
[e-mail]
653-2702
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑✓ Facility closed or is closing on 5/25/18 . 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
subject facility. -co
such inforrr~ is
Signature
Richard J.
hereby request rescission of coverage under the NPDES Stormwater Permit for the
the information contained in this request and to the best of my knowledge and belief
Print or type name of person signing above
Please return this completed rescission request form to:
Revised 20183an10
Date a % /-;�r1
Facilities Engineer
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612