NCGNE0105_Letter to Owner_20190619

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Interim Director
NORTH CAROLINA
Environmental Quality
June 19, 2019
Dan Harpole
Branch Manager
Leggett & Platt Inc.
1 Leggett Road
Carthage, MO 64836
Subject: NCGNE0105
3040 Junior Order Home Rd
Davidson County
Dear Mr. Harpole,
We received your letter dated June 11, 2019 regarding operations at your facility located at the above
address. Enclosed please find a Rescission Request Form to be completed and returned.
If you have questions about this matter, please contact Suzanne McCoy in our Central Office at 919-707-
3 640.
Sincerely,
for S. Daniel Smith
Interim Director
Enclosure
North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
512 North Salisbury Street 1 1612 Mail Service Center I Raleigh, North Carolina 27699-1612
O TH (.AROI. NA
919.707.9200

FOR AGENCY USE ONLY
Date Received
Year
Month
Day
National Pollutant Discharge Elimination System
E-rndronmen U'a
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 I C I S I I I I I I I I N I C I G'
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name
Facility Contact
Street Address
City
County
Telephone No.
State ZIP Code
E-mail Address
Fax:
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:
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
Print or type name of person signing above
Date
Title
Please return this completed rescission request form to: DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised 2018Jan10