NCG030689_Contact and Outfall Updates_20210625

McCoy, Suzanne
From: Payne, Ben <[e-mail]>
Sent: Friday, June 25, 2021 7:38 AM
To: McCoy, Suzanne
Cc: Turpin, Stephen
Subject: [External] Storm Water Permit Information Update/eDMR Registration
Attachments: Stormwater Permit Delegation of Signature Authority Form.pdf, Permit Owner Affiliation Designation Form.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to Report Spam.
Good morning,
We have had some personal changes here at AWNC and are doing some information updates. I also noticed much of our outfall information is missing in the
database so I have completed that as well. We would also like to register for eDMR. I believe I have attached all the necessary paperwork. I understand for the
PDFs I have attached I also need to mail the hard copies into the stormwater office as well. Please let me know if you will need anything else.
Please see information below,
1: Owner Contact Person
- Steve Turpin - 4112 Old Oxford Hwy Durham, NC 27712 - 919-308-9678 - [e-mail]
2. Facility Contact Person
- Steve Turpin - 4112 Old Oxford Hwy Durham, NC 27712 - 919-308-9678 - [e-mail]
3. Permit Contact Person
- Benjamin Payne - 4112 Old Oxford Hwy Durham, NC 27712 - 919-519-3379 - [e-mail]
4. Permit Billing Contact
- Benjamin Payne - 4112 Old Oxford Hwy Durham, NC 27712 - 919-519-3379 - [e-mail]
Outfalls

Outfall #: 001
Outfall Description: Outlet from Retention Pond
Outfall Latitude:36.089761 Outfall Longitude:-78.840413
Stormwater: 100
Basin: Neuse
Waterbody Name: NEUSE RIVER (Falls Lake below normal pool elevation)
Stream Index Number— 27-(1)
Waterbody Classification — WS-IV;NSW,CA
Outfall #: 002
Outfall Description: Outlet from Retention Pond
Outfall Latitude:36.089205 Outfall Longitude:-78.835305
Stormwater: 100
Basin: Neuse
Waterbody Name: NEUSE RIVER (Falls Lake below normal pool elevation)
Stream Index Number— 27-(1)
Waterbody Classification — WS-IV;NSW,CA
Outfall #: 003
Outfall Description: Outlet from Retention Pond
Outfall Latitude:36.094145 Outfall Longitude:-78.833657
Stormwater: 100
Basin: Neuse
Waterbody Name: NEUSE RIVER (Falls Lake below normal pool elevation)
Stream Index Number— 27-(1)
Waterbody Classification — WS-IV;NSW,CA
Thanks,
Benjamin Payne
EHS Coordinator
AW North Carolina
4112 Old Oxford Hwy.
Durham, NC 27712
919-519-3379
[e-mail]
2

This electronic mail (including any attachments) may contain information that is privileged, confidential, and/or otherwise protected from disclosure to anyone other
than its intended recipient(s). Any dissemination or use of this electronic email or its content (including any attachments) by persons other than the intended
recipient(s) is strictly prohibited. If you have received this message in error, please notify us immediately by reply email so that we may correct our internal records.
Please then delete the original message (including any attachments) in its entirety.

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
. C1_ National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
ENVIRONMENTAL QUAL„Y (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:
(or) Certificate of Coverage or No Exposure
N I C G 0 3 0 6$ 9
AW North Carolina
AW North Carolina
4112 Old Oxford Hwy
Address
Durham NC 27712
City State zip
To find the current legally responsible person associated with your permit, go to this website:
httpsa/deg.nc.gov/abotit/divisions/ener y-mineral-land-resources/ener y-mineral-land-permits/npdes-industrial-
program and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Susumu Kasai
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Shigeo Tsuzuki
First MI Last
Page 1 of 2
S WU-OWNERAFFIL4Nov20 i 9

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
President
Title
4112 Old Oxford Hwy
Mailing Address
Durham NC 27712
City State Zip
919 ) 381-0299 [e-mail]
Telephone E-mail Address
Fax Number
5) Reason for this change:
❑� Employee or management change
A result of: ® Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I Shigeo Tsuzuki , 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: h :llde .ne. ov/about/divisions/ener -mineral-land-resources/stormwater
Page 2 of 2
S WU-O WNFRAFFIL-4Nov20 i 9