NCS000049_IGM Resins USA, Inc Name Ownership Change_20171127

I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C•, S;I 0 10 10 10 4 9 N; C G
II. Permit status prior to requested change.
a. Permit issued to (company name): IGM Resins Charlotte, Inc
b. Person legally responsible for permit: Scott C Massey
R E C E I VIEn®
NOV 2q 2011
DENR-LAND QUALITY
STORMWATER PERMITTING
c. Facility name (discharge)
d. Facility address:
e. Facility contact person
First MI Last
Plant Manager
Title
3300 Westinghouse Blvd.
Permit Holder Mailing Address
Charlotte NC 28273
City State Zip
( 704 ) 588-2500 ( 704 ) 945-8721
Phone Fax
IGM Resins Charlotte, Inc
3300 Westinghouse Blvd
Address
Charlotte NC 28273
City State Zip
Gerald W. Walker ( 704 ) 945-8702
First / MI /Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
❑E Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge)
e. Facility address:
f. Facility contact person:
IGM Resins USA Inc
Division of Energy, Mineral & Land Resources FOR AGENCY USE ONLY
iii
Date Received
Land Quality Section/Stormwater Permitting Year I Month I Day
NCDENR
National Pollutant Discharge Elimination System
No- GRO1JNADFP
EOFS
NVIRONR0NMENT AND NMIRAL RE50UR RCSO
PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C•, S;I 0 10 10 10 4 9 N; C G
II. Permit status prior to requested change.
a. Permit issued to (company name): IGM Resins Charlotte, Inc
b. Person legally responsible for permit: Scott C Massey
R E C E I VIEn®
NOV 2q 2011
DENR-LAND QUALITY
STORMWATER PERMITTING
c. Facility name (discharge)
d. Facility address:
e. Facility contact person
First MI Last
Plant Manager
Title
3300 Westinghouse Blvd.
Permit Holder Mailing Address
Charlotte NC 28273
City State Zip
( 704 ) 588-2500 ( 704 ) 945-8721
Phone Fax
IGM Resins Charlotte, Inc
3300 Westinghouse Blvd
Address
Charlotte NC 28273
City State Zip
Gerald W. Walker ( 704 ) 945-8702
First / MI /Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
❑E Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge)
e. Facility address:
f. Facility contact person:
IGM Resins USA Inc
Scott
C
Massey
First
MI
Last
Plant Manager
Title
3300 Westinghouse Blvd
Permit Holder Mailing Address
Charlotte
NC
28273
City
State
Zip
_(704 ) 945-8738
s.massey(a_igmresins.com
Phone
E-mail Address
IGM Resins USA Inc
3300 Westinghouse Blvd
Address
Charlotte
NC
28273
City
State
Zip
Gerald
W
Walker
First MI Last
_(704 ) 945-8702g.walker0igmresins.com
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit) 60,
Revised Jan. 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: Gerald W Walker
First MI Last
Environmental Health and Safety Manager
Title
3300 Westinghouse Blvd
Mailing Address
Charlotte, NC 28273
City State Zip
( 704 ) 945-8702 [e-mail]
Phone E-mail Address
V Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
❑E Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ 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.
The certifications below must be completed and signed by both the permit holder prior to the change, 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
APPLICANT CERTIFICATION
Date
1, Massey '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.
Lea V.,//J'
j 7//
Signat Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014