NCG080312_Ltr Requesting Rescission Form_20190827

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH
Director
David T. Fesperman
514 Linwood Road
Mooresville, NC 28115
NORTH CAROLINA
Environmental Quality
August 27, 2019
Subject: Iredell Milk Transportation
Iredell County North Carolina
Stormwater Permit NCG080312
We received your note indicating that the Iredell Milk Transportation facility is out of business.
Please complete the enclosed Rescission Request Form for the facility that was located at 604
Linwood Road, Mooresville NC.
Your assistance in this matter is greatly appreciated.
Sincerely,
Suzanne McCoy
Administrative Specialist
Enclosure
cc: Mooresville Regional Office — Z. Khan
��--AE Q�� North Carolina Department of Environmental Quality Division of Energy, Mineral and Land Resources
�r 512 North Salisbury Street i 1612 Mail Service Center I Raleigh, North Carolina 27699-1612
one».""»iV a,.0 �"� 919.707.9200

FOR AGENCY USE ONLY
Division of Energy, Mineral & band Resources _ Date Received
Land Quality Section/Stormwater Permitting Program Year Mnn6 _ Day
National Pollutant Discharge Elimination System
Env ol-Meet
t all 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 C, G° 11
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name
Facility Contact
Street Address
City State ZIP Code
County E-mail Address
Telephone No. 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
Please return this completed rescission request form to
Date
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised 20181an10

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY
INVOICE
Annual Permit Fee
II'III III!IIIIII I I IIII IPIIIII'JIII IIII
Open
This annual fee is required by the North Carolina Administrative Code. It covers the administrative costs associated with
your permit. It is required of any person holding a permit for any time during the annual fee period, regardless of the facility's
operating status. Failure to pay the fee by the due date will subject the permit to revocation. Operating without a valid
permit is a violation and is subject to a $10,000 per day fine. If the permit is revoked and you later decide a permit is
needed, you must reapply, with the understanding the permit request may be denied due to changes in environmental,
requlatory, or modeling conditions.
Invoico Numbor ?019PR007043
Permit Number: NCG080312
Iredell County
Iredell Milk Transportation
David T. Fesperman
A G Trucking Inc of North Carolina
PO Box 1318
Mooresville, NC 28115
Payment Options:
Annual Fee Period: 2019-09-01 to ?0?0-08-31
Invoice Date: 08/08/2019
Due Date: 09/07/2019
Annual Fee: $100.00
1. Electronic payment is convenient and quick. To pay by ePayment, type"https://deq.nc.gov/epayments/stormwatee' into your
browser. If you select eCheck, there will be no convenience fee. The convenience fee for a credit card is $2.65 and the
convenience fee for a debit card is $3.95. You will receive a receipt immediately after payment via email.
2. To pay by mail, please make your check payable to "DEMLR Stormwater Program" and include the invoice number on the check.
Then, detach the invoice below and write the check number on the invoice. A $25.00 processing fee will be charged
for returned checks in accordance with N.C. General Statute 25-3-512.
Remit payments by mail to:
NCDEQ - Division of Energy, Mineral and Land Resources
Attn: Stormwater Billing
512 N. Salisbury Street
1612 Mail Service Center
Raleigh, NC 27699-1612
3. Non-payment of this fee by the payment due date will initiate the permit revocation process.
4. Please include your permit number in all correspondence.
5. Should you have any questions, please contact the Fee Coordinator at [phone].
(Return This Portion With Check)
ANNUAL PERMIT INVOICE
Invoice Number: 2019PR007043
Permit Number: NCGO80312 \ Rj
Iredell County
Iredell Milk Transportation
David T. Fesperman
A G Trucking Inc of North Carolina
PO Box 1318 %
Mooresville, NC 28115
II I I II I I I I II I I II II IIII IIII II
* 2 0 1 9 P R 0 0 7 0 4 3
Open
Annual Fee Period: 2019-09-01 to 2020-08-31
Invoice Date: 8/8/2019
Due Date: 9/7/2019
Annual Fee: $100.00
Check Number:

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