NCG030063_Ownership Change Form_20180517

GE Energy Management
/ Industrial Solutions
Dominic Pitocco
Plant Leader
6801 Industrial Drive
Mebane, North Carolina, 27302
USA
T 919-563-7578
C 513-378-5842
Dominic. [e-mail]
May 11, 2018
RECEIVED
Division of Water Quality MAY 17 2018
Attention: DWQ Central Files
512 N. Salisbury Street, Raleigh, NC 27604 DENR-LAND QUALITY
1617 Mail Service Center STORMWATER PERMITTING
Raleigh, North Carolina 27699-1617
RE: Request for Transfer of NPDES Stormwater Permit No. NCG030063 from
General Electric Company to Industrial Connections & Solutions LLC
To Whom It May Concern:
I am writing to request a transfer of NPDES Stormwater Permit No. NCG030063 to General Electric
Company transfer of ownership of the 6801 Industrial Drive to Industrial Connections & Solutions
LLC on August 1, 2017. The operations at the 6801 Industrial Drive facility will remain the same
as a result of this asset transfer; however, Industrial Connections & Solutions LLC should be
reflected as the owner/operator of the site and permit due to this change in ownership. Please direct
the transferred permit to: Dominic Pitocco, Plant Manager.
Should you have any questions regarding this request, please do not hesitate to contact Natalie L.
Stennis at natalie.stennis(a e.c�om or at 919-563-7521.
Sincerely,
�S
Dominic Pito'
Plant Manager

Permit Name/Ownership Change
PERMITTEE Certification Signature Supplement Form
Why is this signed form needed?
Permittees and/or applicants must fulfill signatory requirements in the NPDES federal
regulations in 40 CFR §122.22. Until electronic submittal meets Cross -Media Electronic
Reporting (CROMERR) requirements, this signed form must either be submitted with the
application or mailed separately to:
DEMLR Stormwater Program
1612 Mail Service Center
512 North Salisbury Street
Raleigh, NC 27699-1612
❑ CHECK HERE IF PERMITTEE WILL MAIL IN SIGNED FORM INSTEAD.
Permit Number 't C' c�DoL' ))
North Carolina General Statute 143-215.6 b (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any
application, record, report, plan, or other document filed or required to be maintained under
this Article or a rule implementing this Article; or who knowingly makes a false statement of a
material fact in a rulemaking proceeding or contested case under this Article; or who falsifies,
tampers with, or knowingly renders inaccurate any recording or monitoring device or method
required to be operated or maintained under this Article or rules of the [Environmental
Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor
which may include a fine not to exceed ten thousand dollars ($10,000).
Permittee Certification (Permit holder prior to the ownership change or permit
holder authorizing name change)
I a° , attest that this application for a name or 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
ormation is not included, this appli ation package will be returned as incomplete.
J -
z
Signature/ Date

0
July 1, 2017
To Whom It May Concern:
Energy Connections
Industrial Connections & Solutions LLC
4200 Wildwood Parkway
Atlanta, GA 30339
DELEGATION OF AUTHORITY
For purposes of executing all documents required under federal, state, provincial, or local
environmental laws and regulations, I hereby delegate to each Plant Leader in the Industrial
Connections & Solutions LLC's business supply chain, authority to execute such documents on behalf
of his/her respective facilities. For purposes of specificity, but without limitation, authority is delegated
to review and sign environmental reports, permit applications, discharge monitoring reports, and any
other documents requiring the signature or certification of a responsible corporate official or his duly
authorized representative.
This delegation of authority shall apply to any person holding the position of Plant Leader in the
Industrial Connections & Solutions LLC business supply chain either on a permanent or interim basis as
the individuals having responsibility for the overall operation of a regulated facility and activity.
Stephanie K. Mains, CEO
Industrial Connections & Solutions LLC
Note: It is the site's obligation to confirm the requirements in their state, provincial or local for federal requirements where the program is
administered at the federal level, for authority to sign permit applications, certifications and reports for all media to ensure that this
delegation meets the applicable requirements and that there are no additional requirements (for example a requirement to file the
delegation with the state or to have a corporate seal).
If there are any questions after reviewing the applicable rules, please consult with the business EHS Counsel.
App,.piate Legal Entity