NC0028614_NOV2015LV0239_20150409

NCDENR
North Carolina Department of Environment and Natural Resources '
I Division of Water Resources
Pat McCrory Donald R.van der Vaart
Governor WATER QUALITY PERMITTING SECTION Secretary
PEPtAR`F NAME/ '"T
This form is for ownership changes or name changes of NPDES wastewater permits.
a "Permittee"references the existing permit holder
0 "Applicant"references the entity applying for the ownership/name change.
I. NPDES Permit No.(/or which the change is requested): N C 0 0 5 8 2 7 1
or
Certificate of Coverage#: N C G 5 '
II. Existing Permittee Information:
r _
a. Permit issued to(company name): Coastal Carolina Clean Power
t b. Person legally responsible for permit: Kyle P Michael
RECEIVEDIDENR/DWR First MI Last
Plant Manager
' APR — 9 20i� Title
` �, •, 1838 NC 11 & 903
Water Quality Permit Holder Mailing Address
-yX Permittin4 Sed0l
Kenansville NC 28349-
' City State Zip
[phone] [phone]
Phone Fax 'r
c. Facility name: Coastal Carolina Clean Power LLC
d. Facility's physical address: 1838 NC 11 &903
Address
r" Kenansville NC 28349-
a� }
City State Zip
e. Facility contact person: Michael/A/Houston [phone]
- First / MI / Last Phone
III. Applicant Information:
a. Request for change is a result of: ❑ Change in ownership of the facility
`P ® Name change of the facility or owner
K Ifother please explain: Change of designated representative _
b. Permit issued to(company name): Coastal Carolina Clean Power
c. Person legally responsible for permit: Michael C Wood
First MI Last
Plant Manager ti
Title
1838 NC 11 &903
Permit Holder Mailing Address -
r Kenansville NC 28349-
city State Zip
r [phone] [e-mail]
Phone E-mail Address
Revised 710112014

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