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HomeMy WebLinkAboutNCG140185_Name-Owner Change Application_20220502NC DEPARTMENT OF ENVIRONMENTAL QUALITY DIVISION OF Energy, Mineral, and Land Resources STORMWATER PROGRAM NORTH CAROLINA Environmental Quality NPDES STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM CURRENT PERMIT INFORMATION: Permit Number: NCS����_ /_ or / 5 1. Facility Name (prior to change): Ready Mix Concrete - Scotts Hill Plant #67 NEW OWNER/NAME INFORMATION: 2. This request for a name change is a result of: X a. Change in ownership of property/company b. Name change only (Facility and/or Company) c. Other (please explain): (for example, facility address update. Include additional attachments if necessary.) 3. New owner's name (name to be put on permit as Permittee): Smyrna Ready Mix Concrete, LLC 4. New owner's or signing official's name and title: Jeff Hollingshead (Person legally responsible for permit) CEO 5. Mailing address: 1000 Hollingshead Circle State: TN zip Code: 37129 E-mail address: Jeff@smyrnareadymix.com (Title) City: Murfreesboro Phone:( 615 ) 355-1028 6. New facility name (if applicable): Wilmington - Plant 20015 7. Effective date of transfer or name change: 04/01/2022 North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources _ 512 North Salisbury Street 1 1612 Mail Service Center I Raleigh. North Carolina 27699-1612 aew.m��ca%nn�.+W un�h 919.707.9200 NPDES Stormwater Permit Name/Ownership Change Page 2 of 2 PERMIT AND FACILITY CONTACT INFORMATION 8. New permit contact's name and title: Jim White CSO 9. Mailing address: 1000 Hollingshead Circle State: TN Zip Code: 37129 E-mail address: Jwhite@smyrnareadymix.com (Permit Contact) (Title) City: Murfreesboro Phone: ( 615 ) 355-1028 10. New facility contact's name and title: Quinn Vaughan (Facility Contact) Environmental and Safety Manager (Title) 11. Mailing address: 1020 East 5th Street city: Washington State: NC Zip Code: 27889 Phone: ( 252 ) 717-0318 E-mail address: gvaughan@smyrnareadymix.com 12. New billing contact's name: North Carolina Accounts Payable 13. Mailing address: 1000 Holli (Billing Contact) head Circle Murfreesboro State: TN Zip Code: 37129 E-mail address: apsrmnc@smyrnareadymix.com Y• Phone: ( 615 ) 355-1028 IV. FACILITY ACTIVITIES AND DISCHARGE INFORMATION 1. Will industrial activities at the facility remain the same asunder the previous owner? Yes 12 No ❑ 2. Will the stormwater discharge location(s) remain the same? Yes B No ❑ NOTE: If either of these questions is answered "No," then more information is needed to review the request. Please attach documentation to describe and explain the changes to the facility activities, stormwater discharges, and/or outfall location. Depending on the information provided, the Division may require that the new owner file a new permit application. Last Revised 3/13/2022 NPDES Stormwater Permit Name/Ownership Change Page 2 of 2 THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE ITEMS LISTED BELOW ARE INCLUDED. REQUIRED ITEMS: 1. This completed application form (with original signature) 2. Legal documentation of transfer of ownership (such as relevant pages of a deed or a bill of sale) is required for an ownership change request. Articles of incorporation are not sufficient for an ownership change but can be provided for a name change. 3. Information to document facility, industrial activities, stormwater discharges, or outfall changes as noted in item IV above (if appropriate) Why is this information needed? Regulations in 40 CFR §122.63 allow for minor modifications to NPDES permits for a change of ownership or operational control of a facility, provided that information supports that no other change in the permit are necessary. Why does this form need to be mailed in? Permittees and applicants must fulfill signatory requirements in the NPDES federal regulations in 40 CFR §122.22 (please see those regulations for guidance). Until NCDEQ's electronic submission process meets Cross -Media Electronic Reporting (CROMERR) requirements, this original signed (not digital signature) form must be mailed to the address below. The uploaded copy is stored as part of the permit record in the Division's digital repository. Applicant's Certification: I, Jeff Hollingsheac , attest that the application for a name and/or ownership change submitted has been reviewed and is accurate and complete to the best of my knowledge. I understand that if all re uired parts of this application are not completed, or if all required supporting informV}�(n isdot included, this application package will be considered incomplete and rn'yfie Signature; Date: 04/29/2022 THE COMPLETED APPLICATION AND ALL SUPPORTING INFORMATION SHOULD BE SENT TO: DEMLR Stormwater Program 512 North Salisbury Street, 6th Floor (Office 640K) 1612 Mail Service Center Raleigh, NC 27699-1612 Last Revised 3/13/2022