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HomeMy WebLinkAboutNCG050373_Name-Owner Change Form_11/11/2019Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 11/11/2019 10:08:03 AM (Name Change Submission) Approve by McCoy, Suzanne 11/25/2019 8:20:37 AM (Notification to Admin) • The task was assigned to McCoy, Suzanne 11/11/2019 10:08 AM NORTH CAROLINA EmlmnmerrW Quality I. Permit Information I. Please enter the permit number for which the change is requested. NPDES Stormwater Individual Permit #: NC SX XX XX X WTZIE General Permit Certificate of Coverage (COC) #: NCGO50373 NC GX 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: Pactiv LLC Conpany I brre b. Person legally responsible for permit: First name:* Middle name: Last name:* Robert Fix Title: Plant Manager Permit holder's mailing address:* Phone #:* 704- 371- 5578 c. Facility name:* d. Facility address:* Fax #: Street Address 14201 Meacham Farm Drive Address Line 2 City State / Rovince / Fbgion Huntersville NC Fbstal / Zip Code Country 28078-8000 us Pactiv, LLC - Huntersville Plant Street Address 14201 Meacham Farm Drive Address Line 2 City State / Rovince / Region Huntersville NC Fbstal / Zip Code Country 28078-8000 us e. Facility contact person (prior to change, optional): First name: Middle name: Last name: Andrew Allen Phone #: 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:* Reynolds Consumer Products LLC Company femme c. Person to be legally responsible for permit: First name:* Middle name: Last name:* Dave Watson Title: Permit holder's mailing address:* Street Address 1900 West Field Court Phone #:* 847- 482- 3155 d. Faciltiyname:* e. Facility address:* Address Line 2 city Lake Forest Fbstal / Zip Code 60045 Email address:* David.W atson@R eynoldsB rands.co m State / Province / Region IL Country us Reynolds Consumer Products - Huntersville Plant Street Address 14201 Meacham Farm Drive Address Line 2 city Huntersville Fbstal / Zip Code 28078-8000 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:* Adam Brockway Phone #:* 704-371-5536 Email address:* ABrockway@Pactiv.com State / Province / Region NC Country us IV. Permit Contact Information Is the PERMIT contact different than the person legally responsible above?* r Yes No IV. Permit contact information (if different form the person legally responsible for the permit) First Name:* Middle Last Name:* Dennis Name: Krause Title: Environmental Director Mailing Address:* Street Address 2001 Reymet Road Address Line 2 City State / R'ovince / R-egion Richmond VA Fbstal / Zip Code Country 23237-3721 us Phone #:* 804-743-6637 Email Address:* Dennis.Krause@ReynoldsBrands.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 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 documentation for ownership change Assignment and Transfer Huntersville.pdf 973.6KB pdf 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 fr�rrzrW. met. Perrrit-holder prior to the ownership change, or permit -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 ��eIGkK v�dt���0 To whom the permt 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.lucas(@ncdenr.gov. Initial Review Project ID:* Pleviewer may revise permt nurrber here if incorrect. NCG050373