NCG140003_Name-Owner Change Confirmation_20220819

Tran, Kieu M
From: Tran, Kieu M
Sent: Friday, August 19, 2022 1:44 PM
To: [e-mail]
Subject: Stormwater Permit Name/Owner Change Confirmation for NCG140003
Attachments: NCG140003 NPDES SW Permit Summary Report (1).pdf
Good afternoon,
We have processed the Name/Ownership change for this permit. Please review the attached Permit Summary Report
and verify that the new information is accurate. Please let me know if there are any other necessary updates.
Thank you,
Mrs. Kieu Tran
Stormwater Program Administrative Assistant
Office: (919) 707- 3640
Kieu.Tran @ncdenrgov
North Carolina Department of Environmental Quality
Division of Energy, Mineral, and Land Resources Stormwater Program
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
Website: http//deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwatgr
QEQ
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed
to third parties

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for your permit as of 8/19/2022.
Permit Number: NCG140003 Permit Status: Active
Permit Type: Ready Mix Concrete Stormwater/Wastewater Discharge COC
Facility Name: Childers Concrete Co
Facility Addressl: 200 Wise Ave
Facility Address2:
City, State & Zip: High Point, NC 27260
Owner Information Details:
MUST submit a Change of Name/Ownership form to DEMLR to make any changes to this Owner information.
(Click Here for "Change of Name/Ownershka"Form)
Owner Name: Childers Concrete Co
Owner Type: Non -Government Owner Type Group: Organization
*** Legally Responsible for Permit ***
(Responsible corporate officer/principle executive officer or ranking elected official/general partner or proprietor;
or any other person with delegated signatory authority from the legally responsible person.)
Owner Affiliation: Mitchell Childers, Jr Title:
Addressl: PO Box 777
Address2:
City, State & Zip: High Point, NC 27261
Work Phone: [phone] Fax: [phone]
Email Address:
*** Permit Annual Fee Billing ***
Billing Month: August
Invoice Number Invoice Date Invoice Due Date Invoice Amount Invoice Status
Owner Contact Person(s)
Contact Name Title Address Phone Fax Email
Facility Contact Person(s)
Contact Name Title Address Phone Fax Email
Permit Contact Person(s)
Contact Name Title Address Phone Fax Email
Mitchell Childers, PO Box 777, High Point, NC 27261 336-841-3111 336-841-8703
Jr
Permit Billing Contact(s)
Contact Name Title Address Phone Fax Email
Mitchell Childers, PO Box 777, High Point, NC 27261 336-841-3111 336-841-8703
Jr
8/19/2022 Page 1

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for your permit as of 8/19/2022.
Person(s) with Delegated Signatory Authority
Type Contact Name Title Address Phone Fax Email
Person(s) with Electronic Signature Authority
Type Contact Name Title Address Phone Fax Email
Outfalls
Outfall #: 001 Outfall Description: UT to richland creek
Outfall Lattitude: 35.947220 Outfall Longitude:-80.000830 Represented by Outfall:
Stormwater: 100 % Industrial:
Stream Waterbody
Basin Waterbody Name Index Number Classification
Cape Fear Richland Creek 17-22 C
8/19/2022 Page 2