NCG030571_Owner Affiliation Change_20181015

Norton
BY UPS OVERNIGHT MAIL
October 10, 2018
Division of Water Resources
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: Norton Door Controls
Certificate of Coverage No. NCG03-0571
Letter of Introduction
To Whom It May Concern:
Norton Door Controls
3000 Highway 74 East
Monroe, NC 28112
Tel: [phone]
Fax: [phone]
www.nortbadoorcontrols.com
" F
izz
OCT _% 5 2018
f}ENR-CAAID Qlj'j',Ll'ry
This letter is to introduce myself and inform you that Mr. Chris Mosby is no longer General
Manager of our Norton Door Controls facility. I have assumed that position, and am now
the responsible official for certifying all reports and other requirements for storm water
activities under certificate of Coverage No. NCG03-0571.
If you have any questions or concerns, please contact) me at 704-233-1556 or at
[e-mail]
Very truly yours
d
Kenya Moses
General Manager
Copy: Norton 2018 Stormwater Monitoring Report File
ASSAABLOY, the global leader indoor opening solutions

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy. Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
FOR AGENCY USE ONLY
Date Received
Year I Month I Day
IJU I
V
Use this form if there has been:
NO CHANGE in facility ownership or facility name but the individuar " "
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit (or) Certificate of Coverage
N I C I S I I I I I I I I N C I G 0 3 0 5 F7 1
2) Facility Information:
Facility name: Norton Door Controls Plant -Yale Security Inc
Company/Owner Organization: Yale Security Inc
Facility address: 3000 Hwy 74 East
Address
Monroe NC 28112
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
http://deg.ne.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/stormwater-program
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Chris W Mosby
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Kenya A Moses
First MI Last
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S WU-OWNERAFFIL-23March2017

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
5) Reason for this change:
A result of:
If other please explain:
General Manager
Title
3000 Hwy 74 East
Mailing Address
Monroe NC 28112
City State Zip
( /Uff ) Z331006 Kenya.rflUbUb W_a55aaL)iUy.c;c{H
Telephone E-mail Address
Fax Number
❑Z Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
1 Kenya Moses , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processed.
10/11/2018
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website
at: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
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S WU-OWNERAFFIIr23Mar2017