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HomeMy WebLinkAboutNCS000348_Rescission Request_20221205Ita r._.. r. ,.._. Y s. - --*' DEC a 5 2022 FOR AGENCY USE ONLY V Assigned to: (O ARO FRO MRO RRO WARO IRQ JISRO Division of Energy, Mineral, and Land Resources Land Quality Section National Pollutant Discharge Elimination System Rescission Request Form Please fill out and return this form if you no longer need to maintain your NPDE.S stormwater permit. Directions: Print or type all entries on this application form. Send the original, signed application to: NCDEMLR Stormwater Program, 1612 Mail Service Center, Raleigh, NC 27699-1612. The submission of this form does not guarantee recission of your NPDES stormwater permit. Prior to the recission of your NPDES stormwater permit, a site inspection will be conducted. 1. Owner/Operator Ito whom all permit correspondence will be mailed): Name of legal organizational entity: Legally responsible person as signed in Item (4) below: CPI USA North Carolina 1-LC-Southport Plant Charles R Musselwhite Street address: City: State and zip code: 1281 Powerhouse Drive Southport NC 28461 Telephone number: Email address: 910-477-7090 cmusselw@capitalpower.com 2. Industrial Facility (facility requesting rescission): Facility name: CPI USA North Carolina LLC-Southport Plant Street address: 1281 Powerhouse Drive City: State: I Zip Code: County: Southport NC 24861 Brunswick Permit Number to which this request applies: NCS000348 3. Reason for rescission Request 4. Applicant Certification: North Carolina General Statute 143-215.613 (i) provides that: Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other document filed or required to be maintained under this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). 1 hereby request exclusion from NPDES stormwater permitting. Under penalty of law, I certify that: 0 1, as an authorized representative, hereby request recission 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. Printed Name of Person Signing: Charles R Musselwhite Title: Advisor, Environment, Health & Safety - Capital Power 11/22/2022 (Signature of Applicant) (Date Signed) Mail the entire package to: DEMLR—Stormwater Program Department of Environmental Quality 1612 Mail Service Center Raleigh, NC 27699-1612 Page 2of2