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HomeMy WebLinkAboutNCG160235_Permit Contact Update Request_20220405Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 4/5/2022 4:53:21 PM (Permit Contact Update Request) Approve by Tran, Kieu M 4/7/2022 10:32:47 AM (Contact Update Review) IN BIMS has been updated 4/7/2022 • Georgoulias, Bethany A reassigned the task to Tran, Kieu M 4/5/2022 5:00 PM The task was assigned to Georgoulias, Bethany A. The due date is: May 17, 2022 5:00 PM 4/5/2022 4:53 PM Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number. Number* NCG160235 Begins with NCS, NCG, or NCGNE (no exposure) Facility Name* Reeves Construction Co - Bonds Asphalt Plant (Used to verify permit number) Check permit contact information for your permit by running a Stormwater Permit Summary Report. Guidance for COC holders: Do not enter the General Permit number with all 0's (for example, NCG030000) but instead your Certificate of Coverge (COC) number. Check all that Owner Affiliation (Legally Responsible Individual) Update apply: * Permit Ownership Transfer or Facility Name Change Delegation of Signature Authority (DOSA) Permit Contact Update Billing Contact Update Facility Contact Update Other Contact Update Permit Contact Update Provide new permit contact information This person should REPLACE the current permit contact. This person should just be added as another permit contact. New Contact Name* First and Last Name Jake Flores E-mail Address* jflores@reevescc.com Phone No.* 7046825393 Mailing Address* 248 Plemmons Rd. Duncan, SC 29334 Physical Address If different than mailing address ................................................................................................................................ Add another permit contact if needed by clicking the'Add' button below Stormwater Program's Billing Specialist will be notified about the billing update request by email upon approval. Billing Contact Update Provide new billing contact information ................................................................................................. . 4 This person should REPLACE the current billing contact. This person should just be added as another billing contact. New Contact Name* First and Last Name Jake Flores E-mail Address* jflores@reevescc.com Phone No.* 7046825393 Mailing Address* 248 Plemmons Rd. Duncan, SC 29334 Physical Address If different than mailing address Facility Contact Update Provide new facility contact information • This person should REPLACE the current facility contact. This person should just be added as another facility contact. New Contact Name* First and Last Name Jake Flores E-mail Address* jflores@reevescc.com Phone No.* 7046825393 Mailing Address* 248 Plemmons Rd. Duncan, SC 29334 Physical Address If different than mailing address This person should REPLACE the current facility contact. This person should just be added as another facility contact. New Contact Name* First and Last Name Allen Gambill E-mail Address* agambill@reevescc.com Phone No.* 7046823518 Mailing Address* 18606 Northline Dr. Cornelius, NC 28031 Physical Address If different than mailing address Add another facility contact if needed by clicking the 'Add' button below Submitter's Name* Please enter your FIRST and LAST name Jake Flores Phone Number* Please enter your phone number 7046825393 Any format is fine. Email Address* Please enter a valid e-mail address jflores@reevescc.com A confirmation of submission will be e-mailed to this address. * By checking the box and signing below, I certify that: I have given true, accurate, and complete information on this form; I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act'); I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act'); I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature (except for any uploaded Owner Affiliation Change or Delegation of Signature of Authority forms, which also must be mailed in with original signature); AND I intend to electronically sign and submit this Permit Contact Update Request form. Signature Date 4/5/2022 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. N CG 160235