NC0051161_Owner (Name Change)_20220405

Water Resources
ENVIRONMENTAL OUALITY
ROY COOPER
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MICHAEL S. REGAN
LINDA CULPEPPER
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PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NC0051161 or NCG5 / / / /
1. Facility Name: PPL-Greensboro Breakout Tank Farm RECEIVED
II. NEW OWNER/NAME INFORMATION: 0 2022
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1. This request for a name change is a result of:
a. Change in ownership of property/company NCDEQ/DWRINPDES
_X_b. Name change only
c. Other (please explain):
2. New owners name (name to be put on permit):
Products (SE) Pipe Line Corporation (PPL)
3. New owners or signing official's name and title: Jimmy Stamev
(Person legally responsible for permit)
Manager - Operations
(Title)
4. Mailing address: 6907-A W. Market Street City: Greensboro
State: NC_ Zip Code: 27419 Phone: [phone]
E-mail address: Jimmy Stamey(a.Kinder Morgan.com
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles of
incorporation, or sales agreement)
[see reverse side of this page for signature requirements]
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deg. nc.gov/aboubdivisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

NPDES Name & Ownership Change
Page 2 of 2
Applicant's Certification:
I, , )tet nw 3 L .771.-rv►e, attest that this application for a
name/ownership change has beeri reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this application are not completed and that
if all required supporting information and attachments are not included, this application
package will be returned as incomplete.
Signature:
0A/v1041 J2f2
Date: 3 a 9 . e a a
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 11/2017