NCC205997_Contact Update Request (Legally Resp Change)_20230417

Use this form when:
The person who is legally responsible for the permit has changed, but there is NO CHANGE in the project name
or ownership.
**If the project name has changed, or if the ownership of the project has changed, do NOT use this form.**
Instead, you must submit a new NCG01 electronic Notice of Intent (eNOI).
Directions:
Print this form, complete, scan and upload to the Construction Stormwater Permit MODIFICATION Form.
Then, mail the original form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6th Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM UNTIL YOUR MODIFICATION HAS BEEN REVIEWED AND ACCEPTED AS COMPLETE.
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.22]
Certificate of Coverage (COC) Number: NCC205997
Name of Project: PV Transport, Inc.(Truck Wash Facility)
Legally Responsible Organizational Entity: PV Transport, Inc.
PREVIOUS Legally Responsible Individual: Robert "Bob" Drygas
NEW Legally Responsible Individual: Mark Licwinko
The following section is to be completed and signed by the NEW Legally Responsible Individual.
Per NC General Statute 143-215.68 (i), 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).
Page 1 of 2

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THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.221
Under penalty of law, I certify that (check all boxes to indicate your agreement):
IX I am the person responsible for the construction activities of this project, for satisfying the
requirements of this permit, and for any civil or criminal penalties incurred due to violations of this
permit.
® I will abide by all conditions of the NCGO10000 General Permit and the approved Erosion and
Sediment Control Plan.
CK If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCGO10000 General Permit I will nonetheless ensure that all conditions of
Part II of the permit are met on the project at all times.
�1 I understand that coverage under this permit will constitute the permit requirements for the
discharge(s) and is enforceable in the same manner as an individual permit.
EX This form has been reviewed and is accurate and complete to the best of my knowledge.
*Signature: Date: 41i ?3 r
Print Name of Signed: Mark Liminko
Title: VP - PVT
Mailing Address: 2500 Clemens Road, Hatfield, PA 19440
Street Address: 2500 Clemens Road, Hatfield, PA 19440
Email Address. [e-mail]
Phone Number: 215 - 368 - 2500
* IMPORTANT NOTE. This form must be signed by a responsible corporate officer that owns or operates the
construction activity, such as a president, secretary, treasurer, or vice president, or a manager that is
authorized in accordance with Part IV, Section B, Item (6) of the NCGO10000 permit.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCGO10000 permit.
Page 2 of 2

Georgoulias, Bethany
From: Fink, William C. <[e-mail]>
Sent: Monday, April 17, 2023 12:09 PM
To: Georgoulias, Bethany; [e-mail]
Cc: Holloman, Tevye L
Subject: [External] RE: Construction SW Permit NCC205997 - IMPORTANT - Legally Resp
Person Update
Attachments: doc18370120230417105948.pdf
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Original is in the mail
From: Georgoulias, Bethany <[e-mail]>
Sent: Monday, April 17, 2023 11:13 AM
To: Fink, William C. <[e-mail]>; [e-mail]
Cc: Holloman, Tevye L <[e-mail]>
Subject: RE: Construction SW Permit NCC205997 - IMPORTANT - Legally Resp Person Update
Importance: High
Good morning,
This is our last attempt to contact you. We have still not received the form to change the legally responsible person for
this permit. Please send that as soon as possible, or correspondence will continue to go to Mr. Drygas, who remains the
legally responsible person for this permit. It is best to have the legally responsible person up to date for the permit
record.
Thank you!
From: Georgoulias, Bethany
Sent: Tuesday, March 14, 2023 6:48 AM
To: Fink, William C. <[e-mail]>; [e-mail]
Cc: Holloman, Tevye L <[e-mail]>
Subject: RE: Construction SW Permit NCC205997 - IMPORTANT - Legally Resp Person Update
Importance: High
Good morning,
We have still not received the form to change the legally responsible person for this permit. Please send that as soon as
possible, or correspondence will continue to go to Mr. Drygas, who remains the legally responsible person for this
permit.
Thank you!
From: Georgoulias, Bethany
Sent: Monday, February 20, 2023 7:11 AM
To: Fink, William C. <[e-mail]>; [e-mail]
1

Cc: Holloman, Tevye L <[e-mail]>
Subject: RE: Construction SW Permit NCC205997 - IMPORTANT - Legally Resp Person Update
Importance: High
Good morning,
I was reviewing older emails this morning, and we have never received a request to update the legally responsible
person from Mr. Drygas to someone else. Mr. Drygas is still listed as the legally responsible person for this permit. We
sent information about what to do earlier this month — please see below. The new legally responsible person should fill
out this form and return it to us (email me a scanned copy, but also submit the paper copy).
Thank you,
Bethany Georgoulias (she/her)
Environmental Engineer, Stormwater Program
DEMLR Laserfiche Administrator
Division of Energy, Mineral, and Land Resources
N.C. Department of Environmental Quality
From: Georgoulias, Bethany
Sent: Thursday, February 2, 2023 12:44 PM
To: Fink, William C. <[e-mail]>; [e-mail]
Cc: Holloman, Tevye L <[e-mail]>
Subject: RE: [External] RE: Construction 2023 Annual Fee Invoice for NCC205997 Due
Hi, William,
Mr. Drygas is still listed as the legally responsible person. Please have someone in the organization who is appropriate to
replace that fill out this form (that may be you) and return us the original signed hard copy so we can update it. You can
also scan a copy and email it to me so I can record it in the electronic file and make the changes.
Best regards,
Bethany Georgoulias, Environmental Engineer
NCDEQ / DEMLR / Stormwater Permitting Program
1612 Mail Service Center, Raleigh, NC 27699-1612
512 N. Salisbury Street, Raleigh, NC 27604
919 / 707-3641 (phone); 919 / 807-6494 (fax)
Website: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stonnwater
E-mail correspondence to and from this address may be subject to the North Carolina Public Records law and may be disclosed to third parties.
From: Fink, William C. <[e-mail]>
Sent: Thursday, February 2, 2023 6:11 AM
To: [e-mail]; [e-mail]
Cc: Holloman, Tevye L <[e-mail]>; Georgoulias, Bethany<[e-mail]>
Subject: [External] RE: Construction 2023 Annual Fee Invoice for NCC205997 Due
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.

Payment made today, Looking back through emails, please remove [e-mail] and switch to
[e-mail]. Mr. Drygas has retired. Bill
William C. Fink
Facility Manager
COUNTRY VIEW FAMILY FARMS
an affiliate of CLEMENS FOOD GROUP
1301 FULLING MILL ROAD I MIDDLETOWN, PA 17057
M 717.725.0105
[e-mail]
countryviewfamilyfarms.com
clemensfoodgroup.com
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COMPANIES
STATEMENT OF CONFIDENTIALITY
This electronic mail transmission contains confidential information intended only for the person(s) named. Any use, distribution, copying or disclosure by another person is
strictly prohibited.
From: [e-mail] <[e-mail]>
Sent: Thursday, February 2, 2023 12:01 AM
To: [e-mail]
Cc: [e-mail]; [e-mail]; Fink, William C. <[e-mail]>
Subject: Construction 2023 Annual Fee Invoice for NCC205997 Due
The 2023 annual fee for Invoice No. NCC205997-2023 was due on 2/1/2023. Please address the outstanding
fee for this Construction Stormwater NPDES permit as soon as possible.
To pay electronically, go to: https:Hdeq.nc.gov/SW-epayments and enter the permit number. You will also find
details about the project listed there.
This COC is for PV Transport, Inc.(Truck Wash Facility) in Martin County, issued to PV Transport, Inc..
If this project has been closed -out, it is important that you submit a Notice of Termination request here:
https:Hedocs.deq.nc.gov/Forms/NCGO 1-Termination
For questions, contact the Stormwater Program at [phone] or tev.hollomankncdenr.gov
This email was automatically generated by Laserfiche. Please do not respond to this email address, as
responses are not monitored.