NCG180224_COMPLETE FILE - HISTORICAL_20190206

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
N UG ff)() v'
DOC TYPE
9-HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ aU 1 q i),� ( ,
YYYYMMDD

:.i
Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral& PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources .. .. .. .. .. _ .. .
FOR AGENCY USE ONLY
Dme Received
Year
Month
Du
RECEIVED
Use this form if there has been: DtRtENR-LAND QUALITY
NO CHANGE in facility ownership or facility name, but the indlvWdAuaIPERM1TTl
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
`.*,hat dces "legally respor-Me individual" mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Pennit (or) Certificate of Coverage
N .0 S N C G- 1 8 0 2 2 4
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
Masterbrand Cabinets - Plt 9
Masterbrand Cabinets
651 Collier -Loftin Rd
Address
Kinston NC 28504
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
http://deg.nc.gov/about/divisions/energy-mineral-land-resources/enerev-mineral-land-permits/stonTiwater- rp o �r�atn
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual:
Timothy Singley
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit:
George Lemerise
First MI Last
Page t of 2
SWtJ-0WNERAFFIIr23Mumh20l7

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
General Manager II
Title
651 Collier -Loftin Rd
Mailing Address
Kinston NC 28504
City State Zip
( 252 ) 559 2223 [e-mail]
Telephone E-mail Address
Fax Number
5) Reason for this change:
A result of: L✓v] Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
tf other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I, V e o �— q e, l Q_ wl �_r i S e— , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
proc sed.
2QL�C
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website
at: h"://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
Page 2 of 2
S w U-owNERAF F 11-23 Nb r2o 17

MI-IMA
Division of Energy, Mineral & Land Resources
�I
Land Quality Section/Stormwater Permitting
NCDENR
National Pollutant Discharge Elimination System
EwiaWneirt u.o Nnunu fl[acuncca
PERMIT NAME/OWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
Date Received
Year
I Month
Day
t. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N lio, IS. I o-1 IN 10 G 1 1 1 K72 2 H
It. Permit status nlikE to requested change.
a. Permit issued to (company name):
b. Person legally responsible for permit: L on5
First MI last
Mu PjiaDDg�P
W.
DEN�DSZ��
V001@5 acility name (discharge):
d. Facility address:
e. Facility contact person:
Title
Est cell;e__-LvRol
Permit Holder Mailing Address
ex NL 24'.5_01/-68117
City State
Zip
(2SZ)SSq'2549 (2SZ
)SS' q-zSjS
Phone
NJ'd -"rc oJ Lsbt;iIrb
Fax
- Pli, C1
6 rl Col%ri- L„ 4.,^
Rw
Address
Y,, ns+o.. N L
2 bSoN
City State
Zip
First / MI / Last Phone
111. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ �hange in ownership of the facility
V Name change of the facility or owner
1j'orher please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge):
e. Facility address:
C,L "n e 47
First MI Last '
irtn try l O mn a S L�
Title
d.rl coIh'v-LR�
Permit Holder Mailing Address
a^ NL 2ySoy 69'V7
City State Zip ,
(z� 2)SYO)-ZZ23 ex1 25-Y_� �Sins�ey�rn�{I_v rm J
Phone � E-mail Address ,
Corti
Address
CityI State Zip
f. Facility contact person: /S r; T4on C .
First MI Last
(2sl)04)-7rvti
Phone E-mail Address com
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
Pennit contact: r i �? o,. C S M � X
First MI / last
ENs S24 C( C/, 3�
Title
Gsi coy/,'� LoRd
Mailing Address
/V c 2 eJ 0
City State. Zip
Phone E-mail Address
V. ��Yes
ermitted facility continue'to'conduct the same industrial activities conducted prior
tnership or name change?
0 No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARFjINCOMPLETE OR MISSING:.
0 This completed application is required for both name change and/or ownership change
requests.
0 :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.
PERM ITTEE CERTIFICATION (Permit holder prior to ownership change): N) Q
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.
Signature Date
APPLICANT CERTIFICATION
I, attest ,that.this.application for a na�te/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
.,retuned as incomplete.
Signature
Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stonnwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27. 2014

Tow
State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Bill Holman, Secretary
Kerr T. Stevens, Director
June 9, 2000
Mr. Bill Fortney
Master Brand Cabinets, Inc.
P.O. Box 3567
Kinston, NC 28502-3567
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: General Permit No. NCG 180000
Master Brand Cabinets, Inc.
COC NCG 180224
Lenoir County
Dear Mr. Fortney:
In accordance with your application for a discharge permit received on February 17, 2000
we are forwarding herewith the subject certificate of coverage to discharge under the subject state
— NPDES general permit. This permit is issued pursuant to the requirements of North Carolina
General Statute 143-215 . t and the Memorandum of Agreement between North Carolina and the
US Environmental Protection agency dated December 6, 1983.
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 of -
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 Aisha Lau at telephone
number [phone] ext. 578.
Sincerely
ORIGINAL SIGNED BY
WILLIAM C. MILLS
Kerr T. Stevens
cc: Washington Regional Office
Central Files
tStormwater and_ General. P.ermits_Unit_Files)
1617 Mail Service Center, Raleigh, NC 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

T 4W
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG180000
CERTIFICATE OF COVERAGE No. NCG180224
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,
Master Brand Cabinets, Inc.
is hereby authorized to discharge stormwater from a facility located at
Master Brand Cabinets, Inc.
651 Collier -Loftin Road
Kinston
Lenoir County
to receiving waters designated as an unnamed tributary to Southwest Creek, a class C SW NSW stream in the Neuse
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. NCGI80000 as attached.
This Certificate of Coverage shall become effective June 9,2000.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 9, 2000.
ORIGINAL SIGNED BY
WILLIAM C. MILLS
Kerr T. Stevens, Director
Division of Water Quality
By Authority of the Environmental Management Commission

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Markers
Name: NCG180224 Master Brand Cabinets Plant 9
Short Name: 180224
Coordinates: 0350 13'45.6" N, 0770 34'36.0" W
Comment: County: Lenoir, Map #: G28NE, Subbasin: 03-04-05, Recv Str: UT Southwest
Creek, Class: C SW NSW