NCGNE1608_Other_20240105

'mODEQ1) NPDES StormwaterPer:
Request
NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number.
Number* NCGNE1608
Begins with NCS,NCG,or NCGNE(no exposure)
The information below is auto-filled after the permit number is entered and you click outside the box:
Permittee* Southeastern Freight Line
Facility Name* Southeastern Freight Lines-Asheville
County* Henderson
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
6_ Delegation of Signature Authority(DOSA)
Q Permit Contact Update
Q Billing Contact Update
FA Facility Contact Update
Other Contact Update
Permit Contact Update
Provide new permit contact information
* This person should REPLACE the current permit contact.
This person should just be added as another permit contact.
New Contact Name* First and Last Name
Susan Yates
E-mail Address* [e-mail]
Phone No.* 7043239288
Mailing Address* 9300 Piper Road
Punta Gorda, FL 33982
Physical Address If different than mailing address
Add another permit contact if needed by clicking the'Add'button below
Billing Contact Update
Provide new billing contact information
Note:This person will REPLACE the current billing contact.We can only designate one billing contact in our
permitting database.

New Contact Name* First and Last Name
Susan Yates
E-mail Address* [e-mail]
Phone No.* 7043239288
Mailing Address* 9300 Piper Road
Punta Gorda, FL 33982
Physical Address If different than mailing address
Facility Contact Update
Provide new facility contact information
* This person should REPLACE the current facility contact.
This person should just be added as another facility contact.
New Contact Name* First and Last Name
Joshua Wilson
E-mail Address* [e-mail]
Phone No.* 8286812930
Mailing Address* 200 Mills Gap Road
Fletcher, NC 28732
Physical Address If different than mailing address
Add another facility contact if needed by clicking the'Add'button below
Person(s) with Delegation of Signature Authority (DOSA)
Complete and sign this Stormwater Permit Delegation of Signature Authority Form.Then upload it below.We can
begin making updates with this submittal, but please note that you must mail in the original signed copy to our office
in accordance with requirements in 40 CFR 122.22.
Mail the hard copy to: DEMLR Stormwater Program(Attn: Stormwater Program Administrative Specialist), 1612
MSC,Raleigh,NC 27699-1612
Delegation of Please upload the signed"Stormwater Permit Delegation of Signature Authority Form"
Signature Authority* NC Delegation of signature jan0524.pdf 957.26KB
pdf only
Submitter's Name* Please enter your FIRST and LAST name
Susan Yates
Phone Number* Please enter your phone number
7043239288
Any format is fine.
Email Address* Please enter a valid e-mail address
[e-mail]
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 1/5/2024
Questions? Contact [e-mail].