NCGNE0605_Rescission Request_20190404

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DEMLR — Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 2669-1612
March 26, 2019
Ms. McCoy,
Please find enclosed the Rescission Request Form for the closed Flint Group facility located at
120 Regent Drive, Winston-Salem, NC 27103. Certificate of Coverage: NCGNC0605.
I've included the above address, which is the facility address because the facility will be
unattended and mail will not be picked up.
I've included my address in Section 2 for mailing the final correspondence.
Thank you for your assistance in this matter,
4;� A_r,4�
Martin Schneider
HSE Manager
2675 Henkle Drive
Lebanon, OH 45036
APR 04 2019
DENR-LAND QUALITY
STORIVIVIIATER PERPO1 f ONG

Division of Energy, Mineral & Land Resources
A I. M1_ Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
Environmental
Quality RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
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 I I I I I I N I C I GNE0 6 0 5
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Faculty Name rout CrOul3
Facility Contact
Street Address
City
County
Telephone No.
Martin Schneider
2675 Henkle Drive
Lebanon
513 934-6515
State OH
E-mail Address
Fax:
ZIP Code 45036
[e-mail]
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑✓ Facility closed or is closing on 3/29/19 . 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 an, 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
- 1.26/,?0
Martin Schneider HSE Manager
Print or type name of person signing above
Please return this completed rescission request form to:
Revised 2018Jan10
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
RI=r,FIN/ F1r)
DENR-LAND QUALITY
STORMWATER PERMIT 11NG