NCG210185_COMPLETE FILE - HISTORICAL_20150625

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V U& a j D I V S
DOC TYPE
-�l HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ 00) 5 D) a 5
YYYYMMDD

12 ✓
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Ashton Lewis Lumber Company, Inc.
Gatesville, NC 27938
252-357-0050
TO: NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
SUBJECT: NAME CHANGE ON STORMWATER PERMIT
PERMIT NUMBER: NCG210185
Please remove the name 'Thomas Coxe' on Ashton Lewis Lumber Company, Inc.'s Stormwater Permit
and add 'Michael Lancaster'.
Remove: Thomas Coxe
Add: Michael Lancaster
Thank you for your attention and promptness.
Conner Good
Controller
Ashton Lewis Lumber Company, Inc.
252-357-0050
cgood Cdashton-lewis.com
RECEIVED
J U N ?.5 2015
DENR-LAND QUALITY
RTQRMWATER PERMITTING
$ 06 95
0 6 5('�

NCDENR
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
National Pollutant Discharge Elimination System
PERMIT NAMEIOWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
Date Received
Year Month
OBY
Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C S 10 1 1 1 1 1 1 1 N C G 1 al IQ
11. Permit status QEj2r to requested change. 1
a. Permit issued to (company name): Coke, l._Fa )-,c, &r, - �S t l �avt Le toc�
b. Person legally responsible for permit: 1- Ito„x c, S L Lox'a
First MI Last
Title
�0• (3aX S
Permit older mailing Address
sl�le N•C.
City State Zip
(152-) 25z) r•7-O0
'\ Phone Fax
c. Facility name (discharge): NS\Aioh LQ-tn),� �ti'/\\-A c co
d. Facility address: 9(e LeLo.S Yv)�\� f) o
Gc�s �ll� AddreN Sc. X)CI 33?
Cin State Lip
e. Facility contact person: cwVllnS C 11 1[P ( ZSZ) - 3s> - Z)0 r>J
First / MI / Last Phone
111. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Clt,�nge in ownership of the facility
ame change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit: I�t r,
I'itic
,{'yrmitIfold cr, actin Address
�3a�eSy'\le �7C
City Slate Zip "
1'h ne E-mail Address ^ - t Qw' 3 • C"
d. Facility name (discharge):
e. Facility address: 94 �I
6,ke r'(11, d�r-essl c� i c—
1- City• State v 'Lip,/
f. Facility contact person:-1y\6VVN&) l nXe_ ca
First MI Last
(�S�) 55-7 - o,)Sb 4Cae; as1,�h�1:1.0_t.dlI
Phone E-mail Address CA"
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan.27, 201d

NPDES PERMIT NAME/OWNERSHIP 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 this wnership or name change?
Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
AR EIN 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.
PFKRMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, �, attest that this application for a name/ownership change has been reviewed and is accurate and
com ete to the best of my knowledge. I understand that if all required parts of this application are not
comp eted and that if all required supporting information is not included, this application package will be
retu d as incomplet I
Date
APPLICANT CERTIFICATION
attest that this application for a name/ownership change has been reviewed and is accurate and
comp to to the best of my knowledge. 1 understand that if all required parts of this application are not
complt ed and that if all re '"red supporting information is not included, this application package will be
retu as incomplete.
, t nature Dale
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