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Home My WebLink AboutNCG050060_Name-Owner Change Request_20230502 Action History (UTC-05:00)Eastern Time(US&Canada) Submit by Anonymous User 5/2/2023 3:13:04 PM(Name Owner Change Request) Approve by Kieu Tran 5/2/2023 3:30:25 PM(Name Owner Change Review) • The task was assigned to DEMLR SW Admin General.The due date is:June 13,2023 5:00 PM 5/2/2023 3:13:05 PM • The task was assigned to Joyce Sanford by round robin distribution 5/2/2023 3:13:05 PM • Kieu Tran reassigned the task to Kieu Tran 5/2/2023 3:23:46 PM DEQIwo NPDES Stormwater - Name/Ow Request Application Facility Name* Carolina Color Corporation NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number. Number* NCG050060 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 NPDES Storm Water Name Change Form REV 1 1.02MB 5.2.23.pdf pdf only Supporting Please upload any supporting documents(if separate from above) Documents Upload Chroma Color Corp Certificate.pdf 850.13KB pdf only Submitter's Name Please enter your FIRST and LAST name Yvonne Baker Phone Number* Please enter your phone number 3363084237 Any format is fine. Email Address* Please enter a valid e-mail address ybaker@chromacolors.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 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 �eA,w,O em"t Date* 5/2/2023 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCG050060 Review Date* 5/2/2023