NCS000352_Rescission Request_20180723

FOR AGENCY USE ONLY
Division of Energy, Mineral & Land Resources Date Received
`'a Land Quality Section/Stormwater Permitting Program Year Month Day
w National Pollutant Discharge Elimination System
Envirronmentat
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 5 10 10 10 13 15 2 lu I c
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name North Carolina Renewable Power, LLC
Facility Contact Mark Fowler
Street Address 2100 Southbridge Parkway, Suite 540
City Birmingham State AL ZIP Code 35209
County Jefferson E-mail Address [e-mail]
Telephone No. 205 403-5287 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: The facility never operated under North Carolina Renewable Power, LLC (NCRP). NCRP only owned the physical plant
located on the premises. In July 2017, the owner of the property locked NCRP out from entering the premises. The North Carolina Division of Air
Quality Rescinded the Air Quality Permit No. 05455T22 on June 29, 2018.
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, CiLOLta �nri arr�Irate, ___-
rin or type name of person signing above
Please return this completed rescission request form to
Revised 20183an10
Date I v 20— FE3
V L /uc
Title
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612