NCG060378_Contact Update_20211012

Division 1Resources
1 Quality Section1Program i
NationalPollutant Discharge EliminationPD
Energy, Afteml & PERMIT LondResources
OWNER AFFILIATIONDESIGNATION FORM
Ye
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
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.
I)
Enter the
permit number
for which this change in
Legally
Responsible Individual
("Owner Affiliation")
applies:
Individual Permit (or)
N I:'C I SJ
2) Facility Information:
Certificate of Coverage or No Exposure
N C I G' 0 6 0 3 7
Facility name: Revlon Consumer Products
Company/Owner Organization:
Facility address: - 1501 Williamsboro street
Address
Oxford NC 27565
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https://deq.nal;ov/about/divisions/enemy-mineral-land-resources/energy -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: Matthew Savage
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: David
Page 1 of 2
Hamilton
S WU-O WNERAFFIlANov20 t 9

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
Title
1501 Williamsboro Street
Mailing Address
Oxford NC 27565
City State Zip
( 919 ) 603-2216 Dave, [e-mail]
Telephone E-mail Address
( 919 ) 603-2270
1=20 inert
5) Reason for this change:
A result of: ❑✓ Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
Ifotherplease explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I David J. Hamilton ,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
processe
/o //'R
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,
at: http://deq.nc.eov/about/divisions
call [phone] or visit the website
FY:Ld�4:/.Idc7.�ayL1�L6SryttIC]
Page 2 of 2

McCoy, Suzanne
From: Lawson, Mayumi <[e-mail]>
Sent: Tuesday, October 12, 2021 3:45 PM
To: McCoy, Suzanne
Subject: [External] Name/Ownership Change - Revlon (NCG060378)
Attachments: Permit Owner Affiliation Designation Form - Revlon 101221.pdf; Stormwater
eReporting Registration Form A and E Revlon 101221.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Hi Suzanne,
Please see attached, the Permit Owner Affiliation Designation Form and the completed stormwater eReporting
Registration form (A & E) for responsible official change notice for Revlon (NCG060378).
Matthew Savage is still listed as Owner Affiliation for Revlon... so I put previous legally responsible individual as Matthew
for the Permit Owner Affiliation Designation Form. I might have omitted (?) to submit the Permit Owner Affiliation
Designation Form for Renzo.
The new Responsible Official is now (again) David J. Hamilton.
NC Divisian of Energy, Mineral and Land Resources
NFIDES Starmwater Permit Summary
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The completed Permit Owner Affiliation Designation form and Stormwater eReporting Registration form in hard copy
with original signature will be submitted to
DEMLR Stormwater Program
Dept. of Environmental Quality
1

Attn: Suzanne McCoy
1612 Mail Service Center
Raleigh, NC 27699-1612
If you have any questions or concerns, please contact me at [phone] or at [e-mail].
Sincerely,
Mayumi Lawson, CHMM
Environmental, Health, & Safety Engineer
1501 Williamsboro St I Oxford I NC 127565 1 919-603-2305
From: McCoy, Suzanne <[e-mail]>
Sent: Wednesday, August 4, 2021 9:26 AM
To: Lawson, Mayumi <[e-mail]>
Subject: RE: [External] Name/Ownership Change - Revlon (NCG060378)
EXTERNAL Email from: [e-mail]
This is an EXTERNAL email. Exercise caution. DO NOT open attachments or click on links from unknown
senders or unexpected email.
Thank you.
It may be several days before entered.
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
North Carolina Department of Environmental Quality
Physical: 512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
Mailing: 1612 Mail Service Center, Raleigh, NC 27699-1612
Email: Suzanne. mccoy�ncdenr.goy
Phone: [phone]
Website: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
D, E QR & - '-�
6pp�r�mmt{ral �nrironmpn inl gNa11Yy
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Before printing this email, please consider your budget and the environment.
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your
requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.

From: Lawson, Mayumi [mailto:[e-mail]]
Sent: Tuesday, August 3, 20214:00 PM
To: McCoy, Suzanne <[e-mail]>
Subject: [External] Name/Ownership Change - Revlon (NCG060378)
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Hi Suzanne,
Thank you for your help!
Please see attached, the completed stormwater eReporting Registration form (A & E) for responsible official change
notice for Revlon (NCG060378).
The completed Stormwater eReporting Registration form in hard copy with original signature will be submitted to
DEMLR Stormwater Program eDMR
Attn: Suzanne McCoy
1612 Mail Service Center
Raleigh, NC 27699-1612
If you have any questions or concerns, please contact me at [phone] or at [e-mail].
Sincerely,
Mayumi Lawson, CHMM
Environmental, Health, & Safety Engineer
1501 Williamsboro St I Oxford I NC 127565 1 919-603-2305
From: McCoy, Suzanne <[e-mail]>
Sent: Monday, August 2, 2021 3:04 PM
To: Lawson, Mayumi <[e-mail]>
Subject: RE: [External] Question! Name/Ownership Change - Revlon (NCG060378)
EXTERNAL Email from: [e-mail]
This is an EXTERNAL email. Exercise caution. DO NOT open attachments or click on links from unknown
senders or unexpected email.
Yes, you are correct Renzo only needs to complete A & E.
In the future it will be incorporated into the ownership change form.
Thank you,
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
North Carolina Department of Environmental Quality
Physical: 512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
Mailing: 1612 Mail Service Center, Raleigh, NC 27699-1612
Email: Suzanne. mccoy�ncdenr.goy
Phone: [phone]
Website: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater

D, E QR & 7, A-
6pp�r�mmH of �nrironmpn inl gpaliYy
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Before printing this email, please consider your budget and the environment.
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your
requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.
From: Lawson, Mayumi [mailto:[e-mail]]
Sent: Friday, July 30, 20214:41 PM
To: McCoy, Suzanne <[e-mail]>
Subject: RE: [External] Question! Name/Ownership Change - Revlon (NCG060378)
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Hi again Suzanne,
Revlon's VP, Renzo Anchirayco, told me that he was able to sign the Name/Ownership Change Form (Thank you for your
assistance!). According to the Step 6: we must also complete the Stormwater eReporting Registration Form. I
understand that Renzo has to complete sections A (Owner Information) & E (Responsible Official Signature); however,
do we need to re -submit the sections B,C & F. The facility administrators' have not changed since we last submitted the
form in April.
Please advise.
Thanks,
Mayumi Lawson, CHMM
Environmental, Health, & Safety Engineer
1501 Williamsboro St I Oxford I NC 127565 1 919-603-2305

- Step 6, Maintain User Data
At some point In the future, you may need to add or deLste eDMR Users. The method
for updating users will depend on the user type a$ follows;
User Type How to Ul date this laser Tyre
ResponsibLe To change the Responsible Official. complete
Offlclal the NamerCwnershlp Change Form. Part V requires you to
complete the Stormwater eReporting Registration Form 0 .
From: McCoy, Suzanne <[e-mail]>
Sent: Wednesday, July 21, 2021 7:54 AM
To: Lawson, Mayumi <[e-mail]>
Subject: RE: [External] Question! Name/Ownership Change - Revlon (NCG060378)
EXTERNAL Email from: [e-mail]
This is an EXTERNAL email. Exercise caution. DO NOT open attachments or click on links from unknown
senders or unexpected email.
Good morning Mayumi,
When you saved it, did the system have you create a password for the form?
If so, forward the email you received with the link to the form and the password.
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
North Carolina Department of Environmental Quality
Physical: 512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
Mailing: 1612 Mail Service Center, Raleigh, NC 27699-1612
Email: Suzanne. mccoyQncdenr.gov
Phone: [phone]
Website: http://deg.nc.gov/about/divisions/enemy-mineral-land-resources/stormwater
N�iT i i C:Al�D7. �rvxt '
UtPutlIYMt d EtwOonn I&In,o I.
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Before printing this email, please consider your budget and the environment.

Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your
requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.
From: Lawson, Mayumi [mailto:[e-mail]]
Sent: Tuesday, July 20, 2021 3:38 PM
To: McCoy, Suzanne <[e-mail]>
Subject: [External] Question! Name/Ownership Change - Revlon (NCG060378)
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Hi Suzanne,
I need your help!
Revlon Oxford (NCG060378) has a new VP, Renzo Anchirayco, so I need to submit a name change request. I entered the
information in the system and saved it. Then, I sent the link to Renzo, but he could not get in... What does Renzo have
to do? Is there anything I needed to do? Will you be able to assist?
Thank you,
Mayumi Lawson, CHMM
Environmental, Health, & Safety Engineer
1501 Williamsboro St I Oxford I NC 127565 1 919-603-2305
From: Lawson, Mayumi
Sent: Monday, July 19, 2021 2:21 PM
To: [e-mail]
Subject: Question!! Your Name/Ownership Change form has been saved.
Hi,
I'm trying to submit a permit name change request for the facility. As instructed, I've Saved as Draft and received an
email from [e-mail]. Then, I sent the link to my VP, new owner, but he could not get in...
What does the new owner have to do? Does he need to create a user name and password?
Please advise.
Thanks,
Mayumi Lawson, CHMM
Environmental, Health, & Safety Engineer
1501 Williamsboro St I Oxford I NC 127565 1 919-603-2305
From: [e-mail] <[e-mail]>
Sent: Monday, July 19, 2021 1:58 PM
To: Lawson, Mayumi <[e-mail]>
Subject: Your Name/Ownership Change form has been saved.

EXTERNAL Email from: laserficheCo)ncdenr.gov
This is an EXTERNAL email. Exercise caution. DO NOT open attachments or click on links from unknown
senders or unexpected email.
Your form has been saved.
Click here to complete your form