NCG080964_Rescission Request_20190523

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
MAY 2 3 2014
Please fill out and return this form if you no longer need to maintain your NPDES stormwater Bt%R_I:.AND OIIALIT(
STORMWtifIEK PEKiv i I I ING
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
N I C I S N I C I G 10 8 0 9 16 4
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name Amazon.com Services, Inc
Facility Contact
Street Address
City
County
Telephone No.
NA Environmental Department (ATTN: Eric Chapman)
PO Box 80842
Seattle
King
206 413-4526
State WA
E-mail Address
Fax: NA
ZIP Code 98108
[e-mail]
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: Request to transfer coverage from Permit NCG080000 to Permit NCG060000 for Amazon.com Services, Inc - RDU5/DRD1
located at 1805 TW Alexander Drive, Durham, Durham County, NC 27703. NOI for coverage under Permit NCG060000 is attached.
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 inforrndlion is true, complete cirld dccurdle.
Signature 9—"�'
?dDate 5/1512019
Kevin Winston
Print or type name of person signing above
Please return this completed rescission request form to
Revised 20181an10
Global Field Environmental Lead
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612