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HomeMy WebLinkAboutNCG020858_Name-Owner Change Request_20221129Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 11/29/2022 12:49:45 PM (Name Owner Change Request) Approve by Tran, Kieu M 12/6/2022 8:52:13 AM (Name Owner Change Review) • The task was assigned to Tran, Kieu M. The due date is: January 10, 2023 5:00 PM 11/29/2022 12:49 PM Application Facility Name* Daurity Springs Quarry NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number. Number* NCG020858 Begins with NCS, NCG, or NCGNE (no exposure) 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 current owner and facility information for the permit by running a Stormwater Permit Summary Report. Name/Owner Change Application Upload Upload a copy of the completed and signed Permit Name/Owner Change 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. Name/Owner Change Please upload the signed "Permit Name/Owner Change Form" Form Upload BWI Daurity Springs Quarry - Ownership Change 959.04K6 Form.pdf pdf only Supporting Please upload any supporting documents (if separate from above) Documents Upload Bill of Sale - FSC 11, LLC - BWI ETN, LLC 195.2KB (Executed).pdf pdf only Submitter's Name Please enter your FIRST and LAST name Walt Hillis Phone Number* Please enter your phone number 8655127628 Any format is fine. Email Address* Please enter a valid e-mail address whillis@bluewaterindustries.com A confirmation of submission will be e-mailed to this address. *v 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 the completed Name/Owner Change Form, which also must be mailed in with original signature); AND I intend to electronically sign and submit this Name/Ownership Change Request form. Signature /a Date * 11 /29/2022 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCG020858 Review Date* 12/6/2022