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HomeMy WebLinkAboutNCG030006_Permit Contact Update Request_20220817Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 8/17/2022 12:08:50 PM (Permit Contact Update Request) Approve by Tran, Kieu M 8/19/2022 8:34:16 AM (Contact Update Review) • The task was assigned to Tran, Kieu M. The due date is: September 28, 2022 5:00 PM 8/17/2022 12:08 PM Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number. Number* NCG030006 Begins with NCS, NCG, or NCGNE (no exposure) Facility Name* ABB Inc-Edgecombe (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 Other Contact Updates Only use this section if none of the categories above apply. Provide details about Request to delete existing "Owner Contact Person" and add the following "Owner another contact Contact Person(s)" update: * Contact Name: Israel Flores Address: 3022 N C 43 N, Pinetops, NC 27864 Phone: 252-366-4122 Email: israel.flores1@us.abb.com AND Contact Name: Harshal Rathod Address: 3022 N C 43 N, Pinetops, NC 27864 Phone: 252-366-5021 Email: harshal.rathod@us.abb.com Submitter's Name* Please enter your FIRST and LAST name Harshal Rathod Phone Number* Please enter your phone number 2523665021 Any format is fine. Email Address* Please enter a valid e-mail address harshal.rathod@us.abb.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 8/17/2022 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCG030006