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Home My WebLink AboutNCG140073_SW Permit DOSA_20221205NC Department of Environmental Quality is 7 ,g. Division of Energy, Mineral and Land Resources NORTH CAROLINA Environmental Quality Stormwater Permit Delegation of Signature Authority Form Directions are in red. => This form shall be used to delegate signature authority from the permit Owner (Permittee) to another party. Only the Responsible Official defined below may submit permit applications and reports required by the permit (such as Data Monitoring Reports and Annual Reports) until this form is completed and submitted to the DEMLR Stormwater Program. Please note that delegating signature authority does not relieve the Permit Owner from the responsibility for permit compliance. The permit Owner is the legal entity to which/whom a permit has been issued, and may be an individual or an organization such as a company or government agency. Every Owner is required to have a Responsible Official who meets the legal signature authority requirements in 40 CFR 122.22, summarized below. • For a corporation, the Responsible Official shall be a president, secretary, treasurer, or vice- president in charge of a principal business function, or another individual who performs similar functions for the corporation, or the manager of one or more manufacturing, production, or operating facilities who is authorized to make management decisions about the facility operation. • For a partnership or sole proprietorship, the Responsible Official shall be a general partner or the proprietor, respectively; or • For a municipality, State, Federal, or other public agency, the Responsible Official shall be either a principal executive officer [CitylCounty Manager] or ranking elected official [Mayor]. => Even if delegated signatory authority has been delegated to another individual, the Responsible Official retains responsibility for compliance with permit conditions. Organization Name: Argos USA, LLC Responsible Official Name: Travis Reed Responsible Official Title: Sustainability Director Email Address: tjreed@argos-us.com I Phone: 678-368-4300 Mailing Address: 3015 Windward Piz, Ste 300 City: Alpharetta I State: GA Zip: 30005 Stormwater Delegation of Signature Authority Form Page 1 A. Persons to Receive Signatory Authority => The signatures of the persons listed below indicates their acceptance of signatory authority. Delegated Party Name: Benjamin Hartman Delegated Party Title: Environmental Manager Permit Number: See Attached Email Address: bhartman@argos-us.com I Phone: 470-612-0193 Mailing Address: 3015 Windward Piz, Ste 300 City: Alpharetta I State: GA Zip: 30005 Signature of Delegated Party indicating acceptance of Signatory Authority: Date: I1 3D ZZ_ Delegated Party Name: Delegated Party Title: Permit Number: Email Address: Phone. Mailing Address: City: State: Zip: Signature of Delegated Party indicating acceptance of Signatory Authority: Date: Delegated Party Name: Delegated Party Title: Permit Number: Email Address: Phone: Mailing Address: City: State: L77ZIP- Signature of Delegated Party indicating acceptance of Signatory Authority: Date: Delegated Party Name: Delegated Party Title: Permit Number: Email Address: Phone: Mailing Address: City: State: Zip: Signature of Delegated Party indicating acceptance of Signatory Authority: Date: Stormwater Permit Delegation of Signatory Authority Form Page 2 B. Responsible Official Signature The Responsible Official, as identified in accordance with 40 CFR 122.22, is the appropriate individual with the authority to sign and submit reports for the organization. As the Responsible Official, I, Travis Reed have the authority to enter into this Agreement for Argos USA LLC (Owner/Organization Name). (printed name), I request that the DEMLR Stormwater Program include the persons listed in Part A of this form signatory authority for the above -named permit. I acknowledge that I, and the persons listed in Part A of this form work at/for my organization and have authority to act as a signatory for purposes of the NCDEQ's electronic document systems. By submitting this application, I, Travis Reed (printed name), have read, understand, and accept the terms and conditions of the stormwater permit(s) for which I am the Responsible Official. �/lsw�Z'4�ignature Responsible Office Sustainability Director Title November 30, 2022 Date Stormwater Permit Delegation of Signatory Authority Form Page 3 SW Permit Facility Name �C�i40073 Apex, Plant 6 NCG140128 Butner, Plant 13 NCG140075 Cary, Plant 4 Denver, Plant _81' �q NCG140348 rc Hebron Rd, Plant 105 NCG140173 Hickory, Plant 80 �C_Gi40215 High Point,- Plant 75 jkG140250 Hillsborough Plant 53 riCG140671 Louisburg, Plant 9 NCG140137 Sims, Plant 30 1\166i401�72 Statesville, Plant 90 NCG140076 Westgate Rd, 3 NCG140072 'Plant White, Plant 8 NCG140116 Winston Salem, Plant 79 Street -___ __ Hwy 55 1SO1EVKUianait �� lD[��22ndSt '--- -- --- 3]1Reedy Creek Rd 563OHolly 3he)te/Rd -- ZO1GutherieAve 3411 Apex Hwy 312 S Plum St 604 Old Garner Rd 325 E Hebron St 2001 Main St SE 50-6Tomli—nson St 411 Vly Forge Rd 13,16 Indian TO Waxhaw Rd 120 Seaboard St 11509 Reams Rd 9017 Mile Branch Rd 633 Angus St Hwy 70 VV Parrish Dr 2289 Salisbury Rd 79 Railroad St 6112 Westgate Rd 1801 N White St 1590 Williams St Kougernunt RuralHaU Sims Smithfield State Zip County Wake Granville Wake Forsyth Mecklenburg Catawba Guilford Orange ion Forsyth Wake Franklin Wayne Forsyth Wilson Johnston NC 27502 NC 27509 27511 NC NC NC NC NC 27127 28273 28603 27260 27278 NC NC 28105 NC 27284 27604 27549 NC NC 27530 NC NC NC 27045 27880 _27577 27612 Wake Forsyth NC A2