NCS000462_NAME-OWNERSHIP CHANGE_20161031

STORMWATER DIVISION CODING SHEET
PERMIT NO.
DOC TYPE
p FINAL PERMIT
❑ MONITORING INFO
APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ Za((o I o 'b 1
YYYYMMDD

w
Energy, Mineral
and Land Resources
ENVIRONMENTAL QUALITY
Mr. James Murphree
Matheson Tri-Gas, Inc.
1700 Scepter Road
Waverly, TN 37185
Dear Mr. Murphree:
PAT MCCRORY
RECEIVED
Governor
DONALD R. VAN DER VAART
NOV 0 L+ 2016
Secrelary
CENTRAL FILES
DWR SECTION
TRACY DAVIS
Director
October 31, 2016
Subject: NPDES Stormwater Permit NCS000462
Matheson Tri-Gas, Inc.
Formerly Air Liquide Industrial US LP
Wake County
Division personnel received your request to revise your stormwater permit to accurately
reflect your new company and/or facility name. However, the permit coverage expired
November 30, 2016. Individual NPDES stormwater permits typically expire 5 years from
the date of issuance and are subject to a renewal process at that time. Part III, Section B.1.
directs the permittee to apply for renewal no later than 180 days prior to expiration. We
cannot transfer an expired permit. We can, however, both transfer and renew at the same
time.
In order to renew NCS000462, please complete the attached three forms and mail to the
DEMLR Central Office in Raleigh. Once we receive the completed documents, we can
begin the renewal process. Because the process includes a staff report from the regional
office and a 30-day public notice period, you can expect a 75-90 day turn around time from
the date we receive completed documentation.
We will hold your name/ownership change request until the renewal application comes in.
As long as there are no outstanding annual fees for this permit, there is no fee associated with
the renewal.
State of North Carol'ma Environmental Quality I Energy, Mineral and land Resources
1612 Mail Service Center S 12 North Salisbury Street I Raleigh, North Carolina 27699-1612
919 707 9220 T

If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sincerely,
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land
cc: Wake County
VAIC.i Yl__ Regional Office
Stormwater Permitting Program Files
Central Files
Enclosures (Renewal Forms)

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
PERMIT NO. NCS000462
TO DISCHARGE STORMWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Matheson Tri-Gas, Inc.
is hereby authorized to discharge stormwater from a facility located at
Matheson Tri-Gas, Inc.
326 Forestville Road
Wake Forest
Wake County
to receiving waters designated as Smith Creek, a class C; NSW stream in the Neuse River Basin,
in accordance with the discharge limitations, monitoring requirements, and other conditions set
forth in Parts I, II, III, IV, V and VI hereof.
Signed this day October 31, 2016.
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

Gr,',A,V Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
`�+ National Pollutant Discharge Elimination System
NCDENR
' mDN �Re'OF PERMIT NAME/OWNERSHIP CHANGE FORM
EIM�IOMM[M INo NPU�hL ReeOul.Ges
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
C 5 0 0 10 14 1 6 12 C G
11. Permit status prior to requested change.
a. Permit issued to (company name): Air Liquide Industrial US LP
b. Person legally responsible for permit: Donna M Smith
c. Facility name (discharge):
d. Facility address:
First MI Last
Director of Environmental Compliance, Air Liquide USA LLC
'title
9811 Katy Freeway. Ste 100
Permit Holder Mailing Address
Houston TX 77024
Citv State Zip
( 713 ) 402.2399 (713 ) 402.2os4
Phone Fay;
Air Liquide Industrial U.S. LP
326 Forestville Road
Address
Wake Forest NC 27587
City State Zip
e. Facility contact person: Brett Phillips (919 ) 556-6461
First / MI / Last Phone
Ill. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: [K] Change in ownership of the facility
❑ Name change of the facility or owner
If wher please explain:
b. Pen -nit issued to (company name): Matheson Tri-Gas, Inc.
c. Person legally responsible for permit: James Murl2hree
First MI Last /
Corporate Director of Environmental Compliance
RECEIVED
Mir, 18 2016
DENR-LAND QUALITY
STORMWATER PERMITTING
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
Title
1700 Scepter Road
Permit Holder Mailing Address
Waverly TN 37185
City State Zip
( 931 ) 296-81.5_1___ [e-mail]
Phone E-mail Address
Matheson Tri-Gas, Inc.
326 Forestville Road
Address
Wake Forest NC 27587 _
City State Zip
Brett Phillips
First MI. Last
919-556-6461 [e-mail]
Phone
G-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan. 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: James Mu hree
First MT Last /
Corporate Director of Environmental Compliance_ ✓/
Title
1700 Scepter Road
Mailing Address
Waverly TN 37185
City State Zip
{ 931 ) 296-8151 [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?
❑x Yes
❑ No (please explain)
Vl 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.
❑x 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, Donna M Smith, 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 ports of this application are
not completed and that if all required supporting information is not included, this application package
will be returned as incomplete.
t
12 August 2016
Signature Date
APPLICAN CF,R�ICATION
1, �k�7 , sejat 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. .
V Ik b
ignature 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

MATHESON
ask ... The Gas Professionals'
August 11, 2016
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
RE: Permit Name/Ownership Change Form
NPDES Stormwater Permit
Permit No. NCS000462
To Whom It May Concern,
1700 Scepter Road
Waverly, TN 37185
Tel: [phone]
[e-mail]
RETCEJVE'D
er1�
8 201
Sr RMWA ,FR pQUAL11y
ERPogTT1lyC
Please find attached the Permit Name/Ownership Change Form for National Pollutant Discharge Elimination
System Stormwater Permit to provide notification of a change in ownership. The facility is located at 326
Forestville Road, Wake Forest, Wake County, North Carolina. The current permittee is Air Liquide USA,
LLC. The new owner is Matheson Tri-Gas, Inc. The property transfer is scheduled for approximately
August 22, 2016.
Please do not hesitate to contact me if you have any questions or concerns either via electronic mail at
[e-mail] or by telephone at 931-296-8151.
Regards,
cc
ames Murphree, Corporate Director of Environmental Compliance
Matheson Tri-Gas, Inc.
Attachments
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