NCG080990_Permit Name-Ownership Change Form_20220317

ROY COOPER
MICHAEL S. REGAN
LINDA CULPEPPER
Water Resources
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RECEIVED
PERMIT NAME/OWNERSHIP CHANGE FORM ,.AP 17 Z022
I. CURRENT PERMIT INFORMATION: N(�n
Permit Number: NC00_/_/_/ /_ or NCGO_8_/_0_/_9_/_J_T"pEQ/DWR/NPDES
1. Facility Name: Sloan Construction Co — Granite Shop
II. NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
a. Change in ownership of property/company
_X_b. Name change only
c. Other (please explain):
2. New owner's name (name to be put on permit):
Reeves Construction Co — Metrolina Shop
3. New owner's or signing official's name and title: Mickev O'Shields
(Person legally responsible for permit)
Assistant Secretary
(Title)
4. Mailing address: 18606 Northline Dr City: Cornelius
State:NC_ Zip Code:28031. Phone: [phone]
E-mail address: moshields(a)reevescc com
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles of
incorporation, or sales agreement)
[see reverse side of this page for signature requirements]
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deq.nc.gov/about/divisions/water-resources/water-resources-perm its/wastewater-branch/npdes-wastewater-permits

NPDES Name & Ownership Change
Page 2 of 2
Applicant's Certification:
I, Mickey O'Shields , attest that this application for a
name/ownership change has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this application are not completed and that
if all required supporting information and attachments are not included, this application
package will be returned as incomplete.
Signature: ZL&I Z. z
Date:
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 1112017