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HomeMy WebLinkAboutNCG030284_Name-Owner Change Form_12/18/2018Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 12/10/2018 6:18:37 PM (Name Change Submission) Approve by Georgoulias, Bethany 12/19/2018 12:53:45 PM (Initial Review) * Verified company on Secretary of State website; updated BIMS on 1211912018. • The task was assigned to Georgoulias, Bethany 12/10/2018 6:18 PM � ST1V{ NORTH C:Ft iO�INA ErtYfranminlQf QYQiff}� I. Permit Information I. Please enter the permit number for which the change is requested. NPDES Stormwater Individual Permit #: NC SX XX XX X -OR- General Permit Certificate of Coverage (COC) #: NCG030284 NC GC XX XX X Use this link to check the permit contact information that is currently in our database. II. Permit Status 11. Permit status prior to requested change. a. Permit issued to: Gerdau Ameristeel US Inc Company Nlarre b. Person legally responsible for permit: First name:* Middle name Rodrigo Title: Permit holder's mailing address:* Phone #:* 704- 596- 0361 c. Facility name:* d. Facility address:* Fax #: Last name:* Canova Street Address PO Box 481980 Address Line 2 oty State / Ftovince / Fbgion Charlotte NC Fbstal / Zip Code Country 28269 USA Charlotte Rebar Division Street Address 301 Black Sachel Dr. Address Line 2 oty State / Ftovince / Fbgion Charlotte NC Fbstal / Zip Code Country 28216 USA e. Facility contact person (prior to change, optional): First name: Middle name: Last name: LUIS A NIEVES Phone #: 813-503-1619 III. Requested Change Information 111. Please provide the following for the requested change (revised permit). a. Request for changes is a result r Change in ownership of facility of: * r Name Change of the facility or owner b. Permit to be issued to: CIVIC Steel US, LLC Corrpany Nacre c. Person to be legally responsible for permit: First name:* Middle name: Last name:* Greg Brandon Title: Permit holder's mailing address:* Street Address 6565 N. MacArthur Blvd. Address Line 2 Suite 800 City State / Province / Pegion Irving TX Wstal / Zip Code Country 75039 United States Phone #:* Email address:* 803- greg.bra 567- ndon@c 4515 mc.com d. Faciltiy name:* CIVIC Rebar e. Facility address:* Street Address 301 Black Satchel Dr. Address Line 2 City State / Province / Fbgion Charlotte NC Wstal / Zip Code Country 28216 USA Is the FACILITY contact different than the person legally responsible above?* r Yes r No f. Facility contact person: First name:* Middle name: Last name:* Tom McDowell Phone #:* 813-478-1678 Email address:* Thomas. McDowell@cmc.com IV. Permit Contact Information Is the PERMIT contact different than the person legally responsible above? r Yes r No IV. Permit contact information (if different form the person legally responsible for the permt) ................................................................................................................................................................................. First Name:* Middle Last Name:* Peter Name: Poao Title: Mailing Address:* Street Address 2600 Park Road Ext. Address Line 2 City State / Rovince / Fbgion Burlington North Carolina Fbstal / Zip Code Country 27215 United States Phone #:* 336-506-1894 Email Address:* peter.poao@cmc.com V. Permit Facility Activities V. Will the permitted facility continue to conduct the SAME industrial activities conducted prior to this ownership or name change:* r Yes r No VI. Signature In the case of an ownership change request, certifications must be signed by both the permit holder prior to the change and the new applicant. For a name change request, the signed Permittee's Certification is sufficient. This completed application is required for both name change and/or ownership change requests. Legal documentation of 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. File Upload:* Upload supporting docurrentationfor ownership change NC Mecklenburg Cty_Deed_Gerdau.pdf 168KB pdr only 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: I attest that this application for a name and/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, or if all required supporting information is not included, this application will be considered incomplete. Permittee Signature F2rrrit-holder prior to the ownership change, or pernit-holder authorizing the narre change Applicant Certification: I attest that this application for a name and/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, or if all required supporting information is not included, this application will be considered incomplete. Applicant Signature To w horn the pernit is to be transferred Will another person need to complete or sign this form before it can be submitted? No problem! Simply CLICK the "Save as Draft" button below and send the URL link to the other party to access the form. Questions? Call The Stormwater Program at (919) 707-3639 or e-mail Annette Lucas at annette.lucasancdenr.gov. Initial Review Project ID: * Fbviewer may revise perrrit number here if incorrect. NCG030284