NCG170098_Ltr sending Rescission form_20190524

ROY COOPER
Governor
M C - AEL S. RE AN
Secretary
S. DANIEL SMITH
ITH
Interim director
Bruce O. Stacy
3262 Greentree Acres
Valdese, NC 28690
Subject: NCG170098
Valdese Warehouse LLC
Burke County
Dear Mr. Stacy:
NORTH CAROLINA
Environmental Quality
May 21, 2019
On May 21, 2019 you communicated that you no longer own the Valdese Warehouse LLC. Per that
conversation, enclosed please find a Rescission form to be signed by you. Once we receive the signed
request to rescind your coverage under NPDES Stormwater Permit NCG170098 we will process the
request and send a letter confirming rescission of the permit.
Our regional office staff will inform the new owner of their potential need for NPDES permit coverage.
If you have questions about this matter, please contact the Stormwater staff in our Central Office at 919-
707-3 640.
S' cerely,
,
for S. Daniel Smith
Interim Director
cc: Asheville Regional Office —1. Reed
Stormwater Permitting Program
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Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting Program
National Pollutant Discharge Elimination System
Environmental
Quality RESCISSION REQUEST FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
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 G 1 7 0 0 9 8
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name Valdese Warehouse LLC
Facility Contact
Street Address
City
County
Telephone No.
Bruce O. Stacy
3262 Greentree Acres
Valdese
Burke
828 439-5624
State NC
E-mail Address
Fax:
ZIP Code 28690
3) Reason for rescission request (This is required 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: Facility was sold several years ago. No longer have documentation of sale.
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
Bruce O. Stacy
Print or type name of person signing above
Please return this completed rescission request form to:
Revised 20183an10
Date
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612