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HomeMy WebLinkAboutNCS000594_Permit Contact Update Request_20220927Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 9/27/2022 1:33:08 PM (Permit Contact Update Request) Approve by Tran, Kieu M 9/29/2022 9:18:09 AM (Contact Update Review) • The task was assigned to Tran, Kieu M. The due date is: November 8, 2022 5:00 PM 9/27/2022 1:33 PM Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number. Number* NCS000594 Begins with NCS, NCG, or NCGNE (no exposure) Facility Name* Sepro Research & Technology Campus (Used to verify permit number) Check permit contact information for your permit by running a Stormwater Permit Summary Report. Guidance for COC holders: Do not enter the General Permit number with all 0's (for example, NCG030000) but instead your Certificate of Coverge (COC) number. Check all that Owner Affiliation (Legally Responsible Individual) Update apply: * Permit Ownership Transfer or Facility Name Change Delegation of Signature Authority (DOSA) Permit Contact Update Billing Contact Update Facility Contact Update Other Contact Update Owner Affiliation (Legally Responsible Individual) Change Upload a copy of the completed and signed Permit Owner Affiliation Designation Form below. We can begin making updates with this submittal, but please note that you must mail in the original signed copy to our office, in accordance with requirements in 40 CFR 122.22. Staff may contact you to confirm the requested change if this Owner is also associated with other permits in our system. Changes to Owner Affiliation affect all permits tied to that Owner. Owner Affiliation Please upload the signed "Permit Owner Affiliation Designation Form" Change Form Upload Permit Owner Affiliation Designation Form, Sepro 125.47KB 20220927.pdf pdf only Facility Contact Update Provide new facility contact information This person should REPLACE the current facility contact. This person should just be added as another facility contact. New Contact Name* E-mail Address* First and Last Name Jon -Joseph Armstrong joea@sepro.com Phone No.* 317-473-6681 Mailing Address* 11550 N Meridian St Suite 600 Carmel, IN 46032 Physical Address If different than mailing address Add another facility contact if needed by clicking the 'Add' button below Submitter's Name* Please enter your FIRST and LAST name Jon -Joseph Armstrong Phone Number* Please enter your phone number 314-473-6681 Any format is fine. Email Address* Please enter a valid e-mail address joea@sepro.com A confirmation of submission will be e-mailed to this address. * By checking the box and signing below, I certify that: I have given true, accurate, and complete information on this form; I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act"); I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act"); I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature (except for any uploaded Owner Affiliation Change or Delegation of Signature of Authority forms, which also must be mailed in with original signature); AND I intend to electronically sign and submit this Permit Contact Update Request form. Signature Date 9/27/2022 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCS000594