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Home My WebLink AboutNCG200482_COMPLETE FILE - HISTORICAL_20140522STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /V �� a k)o `� a DOC TYPE ❑MISTORICAL FILE ❑ MONITORING REPORTS DOC DATE ❑ �� I L,l 'h 5 �� YYYYMM DD IF Division of Energy, Mineral & Land Resources Land Quality Section/Stormwater Permitting National Pollutant Discharge Elimination System NCDENR PERMIT NAMEIOWNERSHIP CHANGE FORM FOR AGENCY USE ONLY Date Recerved Year Month De I Please enter the permit number for which the change is requested NPDES Permit (or) Certificate of Coverage N I C I S 10 1 1 1 N I G I G 2- JWJ O 1x 11 Permit status prior to requested change. a Permit issued to (company name) b Person legally responsible for permit _ Aizg-V JfGxKi.rs RECEIVED MAY 77 2014 DENR-LAND QUALITY STORMWATER PERMITTING c Facility name (discharge) d Facility address e Facility contact person First Ml Last /� Title k Permit Holder Marling Address C fi co W �'�v.{y /l C S'117 City State Zip Gum) Phone Fax 10 ,• At.a Q64� FRc e�e•4X Address hocaW IV4- W2 City State Zip 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 ❑ Name change of the facility or owner Ifo+herplease explain iWq Tfle OLd V9R -I-/,e pro,y49 /: 1*11^trod b Permit issued to (company name) c Person legally responsible for permit d Facility name (discharge) e Facility address f Facility contact person z 1.+rn,'pek - -7-'oh4 C e+v +� First MI Last Q UyNe. R Title Permit Holder Mailing Address Gha co 1y;7 yAk ��!7 City State Zip Phone -mail Address 5- L f-rvr/?(a Address .J iCstate First MT Lag Phone E-mail Address IV Permit contact information (if different from the person legally responsible for the permit) Revised Jan 27, 2014 NPDES PERMIT NAMEIOWNERSHIP CHANGE FORM Page 2 of 2 Permit contact First MI last Title Mailing Address City state Zip Phone E-mail Address V Will the permitted facility continue to conduct the same industrial activities conducted prior to th ownership or name change? Ler 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 ncomplete 3ignagre Date APPLICANT CERTIFICATION 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 r i Signature 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 Reused Jan 27 2014 Georgoulias, Bethany From. Larry Jenkins <larry244Jenkins@embargmail com> Sent Tuesday, May 20, 2014 12 42 PM To Georgoulias, Bethany Subject Re Permit Contact Updates NCG200482 Bethany ------- the owner of this facility is and has been John Jenkins I do not know how I became the Owner Affiliation I am just a office employee here that assisted with the permitting process I should be listed as the Facility Contact and John Jenkins should be the Owner Contact and Owner Affiliation Let me know what I need to do to make this change and I will provide you with the information Thank you, Larry Jenkins From: "Bethany Georgoulias" <bethany aeorAouliasOD-ncdenr gov> To- "Larry Jenkins" <1arry2441enkins _.embargmall com> Cc: "Bradley Bennett" <bradley bennetta-ncde_nrgov> Sent. Tuesday, May 20, 2014 11 00 54 AM Subject. RE Permit Contact Updates NCG200482 Mr Jenkins, Are you asking us to change the "Owner Affiliation" name to John Jenkins, or Just the "Facility Contact"'? If you are requesting that the "Owner Affiliation" be changed from your name to John Jenkins, we need you to fill out the Name/Ownership Change form to document this change We can only process that change after we receive a hard copy with the signature This is necessary because it designates the person legally responsible for the permit Permit Contact, Facility Contact, and Owner Contact may be changed with a simple e-mail to me There is no need to provide two signatures on the Name -Ownership change form unless there has been a transfer of ownership Only the applicant's name is necessary in that case If there has been a transfer, please follow the instructions and provide the information on the form Thank you, Bethum, (.i('01gO1 has, I.,nwi ooinieniul LP7gmeei NCDFNR / Division of I ncagy, Mineral, and (land ResourCO, StonnWdiLl Peimitting Piogram 16l2 MaEI ")L1V1CC Centel Raleigh NC 27699-1612 512 N Sallsbuiy 5uect, Raleigh, NC 27604 919 / 807-6372 (phont) 1)19 / 807-6494 (lax) Wcbslle http //portal nL&nr org/web/lr/storniwatet 1 rnar! cnrt, �pomlurtt to mid Jiour!hrs adnc( ss rnaj he sit I to the Norlh Lmolow l'uhlrc Recnr,ls km and out) he disc lased hi 1hfrd1)111rn � From: Larry Jenkins [mallto larry2441enkins0embargmatl com] Sent: Monday, May 19, 2014 4 34 PM To: SVC DENR stormwater Sub]ect: Permit Contact Updates NCG200482 Name Changes Was Larry Jenkins Now John Jenkins Email. Was I r e Now is@_ obiliniQs com Thank you, 081 Limited t , NCDENR North Carolina Department of Environment and Natural Resources Beverly Eaves Perdue Governor Division of Water Quality Charles Wakild, P E Director September 14, 2012 Ms John Curtis Jenkins, Owner OBI Limited 904 Frederick Road Chocowinity, North Carolina 27817 Dear Mr Jenkins Subject General Permit No NCG200000 OBI Limited COC No NCG200482 Beaufort County Dee Freeman Secretary In accordance with your application for a discharge permit received on February 27, 2012, we are forwarding herewith the subject certificate of coverage (COC) to discharge under the subject state — NPDES general permit This permit is issued pursuant to the requirements of North Carolina General Statute 143-215 1 and the Memorandum of Agreement between North Carolina and the US Environmental Protection Agency dated October 15, 2007 (or as subsequently amended) If any parts, measurement frequencies, or sampling requirements contained in this permit are unacceptable to you, you have the right to request an individual permit by submitting an individual permit application Unless such demand is made, this certificate of coverage shall be final and binding Please take notice that this certificate of coverage is not transferable except after notice to the Division of Water Quality The Division of Water Quality may require modification or revocation and reissuance of the certificate of coverage This permit does not affect the legal requirements to obtain other permits which may be required by the Division of Water Quality or permits required by the Division of Land Resources, Coastal Area Management Act or any other federal or local governmental permit that may be required If you have any questions concerning this permit, please contact Bill Diuguid, Stormwater Staff Planner at telephone number (919) 807-6369 Sincerely, cc Washington Regional Office Central Files Stormwater Permitting Unit Files Attachments 1617 Mad Service Center Raiegh North Carolina 27699 1617 Location 512 N Salisbury SI Raleigh North Carolina 27604 Phone 919 807 31001 FAX 919 807 61921 Customer Service 1 �`7 623 674E Internet www rimaterauahty org KEm SIGNED N B� PICKLE Charles Wakild, P E None rthCarohna �aturra!!ty An Equate Opi Wily i Mfrmative Asho^ Err ,,c er STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES DIVISION OF WATER QUALITY GENERAL PERMIT NO NCG200000 CERTIFICATE OF COVERAGE No. NCG200482 STORMWATER DISCHARGES 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, OBI Limited is hereby authorized to discharge stormwater from a facility located at OBI Limited 904 Frederick Road Chocowmity Beaufort County to receiving waters Unnamed tributary to unnamed tributary to Maple Branch, a Class C, Sw, NSW waterbody, Tar - Pamlico River Basin, in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts 1, 11, 111, IV, V and VI of General Permit No NCG200000, as attached This Certificate of Coverage shall become effective September 14, 2012 This Certificate of Coverage shall remain in effect for the duration of the General Permit Signed this day September 14, 2012 ORMMsIGNEM KEN PICKLE Charles Wakild, P E , Director Division of Water Quality By Authority of the Environmental Management Commission vlyTopo Free Online T-opo Maps- . Page I of 2 .a ,1 M�t.Dpo 1 ■ ■LE ■ ANY .Horne r'r�rtt�dzM�ps Mzp, flware Elam r A6out Us ;. nny Acco< Online Topo Map Viewing SEARCH: Search > Search by city, town, zip code, address, or geographic feature name in the US and Canada LLa=n Coordinate Search I � it (0 ' J w I Y i r 1 5 f , ~ `= y GUYTopo (Togo Ma. Tetnts�oP �3se��- Location 35 4953380, -77 1111491 Change Formal Browse and view US Geological Survey, US Forest Service, and NRCan topo maps for the US and Canada Click here to get a link for this map Print from your computer Landscaoe I Portrait Print link opens In a new window, and may take a few seconds to process Note that the MyTopo U 5 map layer is the only one available for printing Knout Us I Partner Procirarn I Contact Us I Prryacy Polic�cy j Return Poiicv tp //www mytopo com/maps/tn-dex cfm?search_strmg=904+frednck+road+%2Cnc+27817 9/30/2on Online Topo Map Viewing SEARCH. Search > I Search by city, town, zip code, address, or geographic feature name in the US and Canada 1 t_at/Lon Looroinate Search I Browse and view US Geological Survey, US Forest Service, and NRCan topo maps for the US and Canada' Click here to get a link for this map Pint from your computer LandSLaoe R Portrait Print link opens in a new window, and may take a few seconds to process Note that the MyTopo U S map layer is the only one available for pnnbng About t1sI Partner Proararn l Contact -Us j Pr va P f l Return Poiicv f p //www mytopo comlmaps/index cfm?search—strmg=904+frednck+road+°/o2Cnc+27817 9134/20 SUBSTITUTE FORM W-9 VENDOR REGISTRATION FORM NORTH CAROLINA DEPARTMENT OF TRANSPORTATION Pursuant to Internal Revenue Service (IRS) Regulations, vendors must furnish their Taxpayer Identification Number (FIN) to the State. If this number is not provided, you may be subject to a 20% withholding on each payment. To avoid this 20% withholding and to insure that accurate tax information is reported to the Internal Revenue Service and the State, please use this form to provide the requested information exactlyas it appears on file with the IRS. INDIVIDUAL AND SOLE PROPRIETOR ENTER NAME AS SHOWN ON SOCIAL SECURITY CARD CORPORATION OR PARTNERSHIP ENTFR YOUR LEGAL BUSINESS NAME NAME '--J n n t LA [ T r_S �—T L h _ MAILING ADDRESS STREET/PO BOX CITY, STATE, ZIP l l n C1��7 DBA 1 TRADE NAME (IF APPLICABLE) BUSINESS DESIGNATION 054DIVIDUAL (use Social Security No) ❑SOLE PROPRIETER (use SS No or Fed ID No ) ❑ CORPORATION (use federal ID No) ❑PARTNERSHIP (use Federal ID No ) ❑ ES FATEIIRUST (use Federal ID no ❑ STATE OR LOCAL GOVT (use Federal 1D No) ❑ OTHER / SPECIFY SOCIAL SECURITY NO do - (j / (Social Security #) OR FED EMPLOYER IDENTIFICATION NO - (Employer Identification #) COMPLETE THIS SECTION IF PAYMENTS ARE MADE TO AN ADDRESS OTHER THAN THE ONE LISTED ABOVE REMIT TO ADDRESS STREET / PO BOX CITY, STATE, ZIP - Participation to this section is voluntary You are not required to complete this section to become a registered vendor The information below will in no way affect the vendor registration process and its sole purpose is to collect statistical data on those vendors doing business with NCDOT I€you choose to participate circle the answer that best fits your firm s group definition What is your firm's ethuieity9 (❑ Prefer Not To Answer, ❑ African American, ❑ Native American, ❑ Caucasian American, ❑ Asian Amencan, ❑ Hispanic American, ❑ Asian -Indian American, ❑ Other ) What is your f rm's gender9 (C] Prefer Not to Answer,0 Male, ❑ Female) Disabled -Owned Business9 (❑ Prefer Not to Answer, ❑ Yes,[:] No) IRS Certification Under penalties of perjury I certify that The number shown on this form is my correct taxpayer identification and I am not subject to backup withhoiding because (a) I am exempt from backup withholding, or (b) I have not been notified by the IRS that I am subject to backup withholding as a result ofa failure to report all interest or dividends or (c) the IRS has notified me that I am no longer subject to backup withholding and I am a U S person (including a U S resident alien) The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding, For complete certification instructions please see IRS FORM W A at MID I/www irs trovinublirs-odflfw9 odf K01 l� � rl ef rr- _ TITLE (Pent or Type) DATE PHONE NUMBER 10126 0.B.1 LININGS, INC. SCRAPYARD P 0 BOX 326 CHOCOWINITY, NC 27817 (252) 946 6176 Wells Fargo, N A 66 162 531 2/21 /2012 PAY TO THE ORDER OF NC DENR ++100 00 One Hundred and 001100+++++++++++++++w+++++wwwwww+++w+++++++++++++wwww++w++w++++ww*wwww+++++rwwwwwwrww++++++wwwwwwww++++++t NC DENR Stormwater Permitting Unit Division of Water Quality 1617 Mail Service Center MEMO Raleigh, NC 27699-1617 AUTHORIZED SIGNATURE i fi DOLLARS 8 Online Topo Map Viewing SEARCH: ; Search > Search by city, town, zip code, address, or geographic feature name in the US and Canada LLa gn_c.00rdinate Searcn l r • • tip' �� t 4� �N, t 1 1 ^ r� *r r V~ 4 _- �� j I `� WMyrpo (Toro Maps Teems ofyk5 d- Location 35 49533380,-771111491 cjianga rormat Browse and view US Geological Survey, US Forest Service, and NRCan topo maps for the US and Canada Click here to get a link for this map Print from your computer Landscape I Portrait Print link opens in a new window, and may take a few seconds to process Note that the MyTopo U S map layer is the only one available for printing About Us I Partner Proofam I Contact Q I Privacy Poiicv I gwturn Policy tp //www mytopo com/mapshn--dex efin'�search_stnng=904+frednck+road+%2Cnc+27817 9/30/20n