NCG210457_Name-Owner Change Application_20240426

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NPDES STORMWATER PERMIT NAVIE/OWNERSHIP CHANGE FORM
|' CURRENT PERMIT |NFORpN/4T{ON:
Permit Number: NCS / /_ / / / _ or NC{G_2 / 1 / O /_ �./ � / 7
1. Facility Name (prior tochange):_BW1C_EaStiLC
NEW OWNER/NAA8E !NF0RMAThON:
l. This request for a name chan�eisa /esu1tof:
_a. Change in ownership ofproperty/company
)( b, Name change only (Facility and/or Company)
c. Other(please exp|ain):__________
(for example,facility addreSS Update, include aoditional attachments if necessary.)
l New owner's name (name tobe put on permit usPennittee):
BFS Operations LLC
4. New owner's or signing official's norne and t|t|e: Phillip E. Cobbs
(Person legally responsible for permit)
Oir�CtOr. E�GuirODDlenta) CO[np|iaOC8
-- ---- ------'
(Tide)
5. Mailing address: 6031 C0Onecd0n L'�,ke, SUite 400__C)ty: Irving
State: TX Zip Code: 75039 phone: ( 615 )868-80�,9
E'maUaddress: PhiUip/QObb(,,,8�8kj/cOOl
6. New facility nanme(if app|icab|e NA
7. Effective date nftransfe'or name change: January 1 2021
North Carolina Department a Environmental Quality / Division aEnergy,Mineral and Land Resources
su North Salisbury Street / /uz Mail Service Center | Raleigh,North Carolina z76vv'/^o
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8. New permit contact's name and title: Chad Jordan
(Permit Contact)
G8Oe[3| Manager
(Title)
�4�1 P|2D�[ W1iU RoadMiddlesex9� Mailing address: [|�y�__
State: NC Zip Code: 27557 Phone: ( 252 ) 314-0251
<�h@d jOFdaM�B�}1d[COnl
E-mail address: �
10. New facility contact's name and tit|e: Chad Jordan
(Facility Contact)
GeO�[8| Manager
(Title)
�4�1 P|�88r K�iU ��0@d Middlesex,
Mailing address. [�ty�
State: NC Zip Code: 27557 Phone: ( 252 ) 31
E-mail address: ChedJorden(&B|droon)
l]. New billing contact's name: ACCOUOt9 Payable
(Billing Contact)
13. Mailing address: 8401 Planer Mill Road _--__- —IhY:_Middlesex
State: NC Zip Code: 27557 Phone: ( 252 )235-4,930
E-mail address: /\P(@B|dr.cOnm
|V. FACILITY ACTIVITIES AND DISCHARGE :INFORMATION
1. Will industrial activities at the facility remain the same as unde/the previous om/ner?
Yes 0 No []
2. will the stormwaterdischarge location(s) remain the same? Yes No []
NOTE: /f either of these quest/uns is answered 'Yu,"then more information is needed toreview
the request. Please ottochdocumentobootodzsribe and exp/o/n /'lechongesto�hefacility
activities, stonnmo/er discharges, ond/oruutfb8/ocotion. Depcnd/,/gon the information
provided, the Division moy require that the new ownerfide a newpermitopplicotion.
Last Reviyed3/l3/Z022

REQUIRED ITEMS:
1. This completed application form (with original signature)
2. Legai documentation of transfer of ownership(such as relevant pages of a deed or a bill of sale) is
required for an ownership change request. Articles of incorporation are not sufficient for an
ownership change but can be provided for a name change.
3. Information to document facility, industrial activities,stormwater discharges, or outfall changes
as noted in item IV above (if appropriate)
Why is this information needed?
Regulations in 40 CFR §122.63 allow for minor modifications to NPDES permits for a change of
ownership or operational control of a facility, provided that information supports that no other change
in the permit are necessary.
Why does this form need to be mailed in?
Permittees and applicants must fulfill signatory requirements in the NPDES federal
regulations in 40 CFR §122.22 (please see those regulations for guidance). Until NCDEQ's
electronic submission process meets Cross-Media Electronic Reporting (CROMERR)
requirements, this original signed (not digital signature) form must be mailed to the
address below. The uploaded copy is stored as part of the permit record in the Division's
digital repository.
Appiica o is Certification:
I, Phillip. E. Cobbs attest that the application for a name and/or ownership
change submitted has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this application are not completed, or if all
required supporting information is not included, this application package will be considered
incomplete may be returned.
Signature: Date:March 15, 2024
THE COMPLETED PLICATION AND ALL SUPPORTING INFORMATION SHOULD BE SENT TO:
DEMLR Stormwater Program
512 North Salisbury Street, 6th Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
Last Revised 3/13/2022