NCG100066_Rescission_20190709

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
I F4�FFI D
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit
UL 9 2019
1) Enter the permit number to which this request applies: F ENR-LAND QUALITY
Individual Permit (or) Certificate of Cgve cif F PERiLj1iTTING
N I C I S N I C I G 11 10 10 10 6 16
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name Wendell Louia / Louia Motor company
Facility Contact
Street Address
City
County
Telephone No.
Wendell Louia
2647 East Highway 67
Lexington
Davidson
800 927-0564
State NC ZIP Code 27292
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: Facility is no longer in the "Used Motor Vehicle Parts and Wrecking for Scrap" business.
Facility has transitioned into vehicle repair and used vehicle sales. All vehicles stored for parts or scrap have been removed from the property.
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.
J
jol
Signature Date
// 'dt' ll 1 10
Print or type name of person signing above Title
Please return this completed rescission request form to
Revised 20183an10
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612