NCS000292_Owner Affiliation Change_20201222

_ • resinallo cor
P
o Quality Resins for Industry
December 21, 2020
DEMLR — Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Subject: Permit Owner Affiliation Designation Form
Er_gon Chemicals LLC — Resinall Corp
Permit No. NCS000292
Permit No. NCG500289
Dear DEMLR Stormwater Program staff:
An Ergon@ Company
P.O. Box 195
Severn, NC
27877 USA
1.800.421.0561
resinall.com
Please find attached two Permit Owner Affiliation Designation Forms for the above
referenced permits. There has been NO CHANGE in facility ownership for facility, but the
individual who is legally responsible for the permit has changed. Should you have any
questions please feel free to contact me.
Sincerely,
V--�-
� _ ---
Paul Pearce
Plant Manager
P.O. Box 195
Severn, NC 27877
ppearce(d-) resi nail. com
252-585-1445
Enclosures: Permit Owner Affiliation Designation Form (NCS000292)
Permit Owner Affiliation Designation Form (NCG500289)
CC:

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
r National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
ENVIRONMENTAL QUALITY (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
NO CHANGE in facility ownership or facility name, but the individual
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
N I C I S 0 0 0 12 19 12
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage or No Exposure
N C G
Resinall Corp
Ergon Chemicals LLC.
302 N Water Street
Address
Severn NC 27877
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https:Hdeg.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/npdes-industrial-
rp ogram and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual:
Kris
First MI
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Paul
Page 1 of 2
First MI
Patrick
Last
Pearce
Last
S WU-O WNERAFFILANov2019

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
5) Reason for this change:
A result of:
If other please explain:
Plant Manager
Title
P.O. Box 195
Mailing Address
Severn NC 27877
City State Zip
252 ) 585-1445 [e-mail]
Telephone E-mail Address
(,;zS2 ) .S,YS i
Fax Number
❑ Employee or management change
® Inappropriate or incorrect designation before
❑✓ Other
Changing to manager with direct responsibilities for the facility
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
1, Paul Pearce , 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
proc sed.
4
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
Page 2 of 2
S WU-O WNERAFFIL-4Nov2019

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
r National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
ENVIRONMENTAL QUALITY (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
NO CHANGE in facility ownership or facility name, but the individual
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
N I C I S
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(01) Certificate of Coverage or No Exposure
N I C I G 15 10 10 2 8 9
Resinall Corp
Ergon Chemicals LLC.
302 N Water Street
Address
Severn NC 27877
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https:Hdeg.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/npdes-industrial-
rp ogram and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Kris
First MI
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit
Paul
First MI
Pagel of 2
Patrick
Last
Pearce
Last
S WU-O WNERAFFIL4Nov2019

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
Plant Manager
Title
P.O. Box 195
Mailing Address
Severn NC 27877
City State Zip
(252 ) 585-1445 [e-mail]
Telephone E-mail Address
(252 ) 585-1448
Fax Number
5) Reason for this change:
❑ Employee or management change
A result of: ❑ Inappropriate or incorrect designation before
Q Other
If other please explain: Changing to manager with direct responsibilities for the facility
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
1 Paul Pearce , 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.
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
Page 2 of 2
S WU-O WNERAFFIL-4Nov2019