NCG100232_SW Permit DOSA_20221216

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' NC Department of Environmental Quality
" °-.^°' 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 Storm water 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, summanzed
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 manufactunng, production, or operating
facilities who is authonzed to make management decisions about the facility operation
• For a partnership or sole proprietorship, the Responsible Official shall be a general partner or the
propnetor, respectively, or
• For a municipality, State, Federal, or other public agency, the Responsible Official shall be either a
principal executive officer(City/County Manager]or ranking elected official[Mayor]
Even if delegated signatory authonty has been delegated to another individual, the Responsible Official
retains responsibility for compliance with permit conditions
Organization Name Triangle Auto Recyclers
Responsible Official Name Alberto Diaz
Responsible Official Title Owner
Email Address Alberto deltadesign@gmail corn Phone [phone]
Mailing Address 4502 Denfield St
City Durham State NC Zip 27704
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 Katherine Boyer
Delegated Party Title Regulatory Compliance Manager
Permit Number NCG100232
Email Address kathyboyeroiboyer-enterprises-east corn Phone [phone]
Mailing Address 127 Red Hill Church Road
City Dunn State NC Zip 28334
Signacceptance
of Delegated Party Authority
indicating
acceptance of Signatory Authority
Date 08/31/2022
Delegated Party Name Paul Spangenberg
Delegated Party Title EH&S Director
Permit Number NCG100232
Email Address pauispangenberg@boyar-en(erpnses-east corn Phone [phone]
Mailing Address 127 Red Hill Church Road
City Dunn /// State NC Zip 28334
Signature of Delegated Party indicating /
acceptance of Signatory Authority
Date 08/31/2022
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 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, Alberto Diaz (printed name),
have the authority to enter into this Agreement for
Triangle Auto Recyclers (Owner/Organization 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, Alberto Diaz (printed name),
have read, understand, and accept the terms and conditions of the stormwater permit(s) for
which I am the Responsible Official
Response le Offi al Signature
Owner c151Y ess WYt Q f L2/1.2/ 2�--
Title Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3