NC0003760_Owner (Name Change)_20150320

Y �
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory Donald R.van der Vaart
Governor WATER QUALITY PERMITTING SECTION Secretary
PERMIT NAME/OWNERSHIP CHANGE REQUEST
This form is for ownership changes or name changes of NPDES wastewater permits.
• "Permittee"references the existing permit holder
• "Applicant"references the entity applying for the ownership/name change.
1. NPDES Permit No.(for which the change is requested): N C 0 0 3 7 6 0
or
Certificate of Coverage#: N C G 5
II. Existing Permittee Information:
a. Permit issued to(company name): DuPont-Kinston
b. Person legally responsible for permit: Harold R Thomas
First MI Last
Plant Manager
Title
RECEIVED/DENR/DwP PO Box 800
Permit Holder Mailing Address
MAri `) f1 'Ci Kinston NC 28501-
Water Quality
City State Zip
Permitting Sectio, [phone] [phone]
Phone Fax
c. Facility name: DuPont- Kinston Plant
d. Facility's physical address: 4693 Hwy 11 N
Address
Kinston NC 28502-
City State Zip
e. Facility contact person: Jeffrey A White [phone]
First / MI / Last Phone
III. Applicant Information:
a. Request for change is a result of: El Change in ownership of the facility
Name change of the facility or owner
If other please explain:
b. Permit issued to(company name): DuPont- Kinston Plant
c. Person legally responsible for permit: George T Xenakis
First MI Last
Plant Manager
Title
PO Box 800
Permit Holder Mailing Address
Kinston NC 28501-
City State Zip
[phone] [e-mail]
Phone E-mail Address
Page 1 of2 Revised 7/01/2014

r d. Facility name: DuPont-Kinston Plant
e. Facility's physical address: 4693 Hwy 11 N
Address
Kinston NC 28502
City State Zip
f. Facility contact person: Jeffrey A White
First MI Last
ORC
Title
[phone] [e-mail]
Phone E-mail Address
IV. Will the permitted facility continue to conduct the same commercial/industrial activities conducted prior to
this ownership or name change?
® Yes
0 No(please explain)
If applicable,the applicant shall submit a major permit modification request to DWR.A major modification shall be
defined as one that increases the volume,increases the pollutant load,results in a significant relocation of the
discharge point,or results in a change in the characteristics of the waste generated.
V. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE
INCOMPLETE OR MISSING:
1. This completed application is required for both name change and/or ownership change requests.
2. Legal documentation of the transfer of ownership(such as relevant pages of a contract deed,or a bill of sale)is
required for an ownership change request. Articles of incorporation are not sufficient for an ownership change.
Applicable regulations:40 CFR 122.41,40 CFR 122.61 and 15A NCAC 02H.0114
The certifications below must be completed and signed by both the permit holder prior to the change(Permittee),and the
new applicant in the case of an ownership change request. For a name change request,the signed Applicant's Certification
is sufficient.
PERMITTEE CERTIFICATION(Permit holder prior to ownership change):
I, ,attest that this application for a name/ownership change 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 and that if all required
supporting information is not included,this application package will be returned as incomplete.
Signature Date
APPLICANT CERTIFICATION
I,George T Xenakis,attest that this application for a name/ownership change 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 and that if
all required supporting information is not included,this application package will be returned as incomplete.
3 / 16 / �S
Signature Date
**************************
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Resources
Water Quality Permitting Section
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
NPDES PERMIT NAME/OWNERSHIP CHANGE REQUEST
Page 2 of 2 Revised 7/01/2014

3/15/2015
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Signature Authority RECEIVEDIDENRIDimp
DuPont-Kinston
NPDES Number NC0003760 � (l `
•
Water Quality
To Whom It May Concern: Perrnittina fir
By notice of this letter, I hereby delegate signatory authority to each of the following
individuals for all permit applications,discharge monitoring reports, and other
information relating to the operations at DuPont-Kinston as required by all applicable
federal, state, and local environmental agencies specifically with the requirements for
signatory authority as specified in 15A NCAC 2B.0506.
Alex Torres SHE Manager
Jeffrey A White ORC /Wastewater Tech
Lindsay R Cox HR Manager
If you have any questions regarding this letter,please feel free to contact me at 252-522-
6217.
Sincerely,
Plant Manager
cc: Washington Regional Office, Water Quality Permitting Section

3/15/2015
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh,NC 27699-1617
RECEIVEDIDENRIDWR
Subject: Delegation of Signature Authority
DuPont-Kinston MP-( (! i
NPDES Number NC0003760 Water Quality
Perrnittina
To Whom It May Concern:
By notice of this letter, I hereby delegate signatory authority to each of the following
individuals for all permit applications, discharge monitoring reports, and other
information relating to the operations at DuPont Kinston as required by all applicable
federal, state, and local environmental agencies specifically with the requirements for
signatory authority as specified in 15A NCAC 2B.0506.
Alex Torres SHE Manager
Jeffrey A White ORC /Wastewater Tech
Lindsay R Cox HR Manager
If you have any questions regarding this letter,please feel free to contact me at 252-522-
6217.
Sincerely,
Plant Manager
cc: Washington Regional Office,Water Quality Permitting Section