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HomeMy WebLinkAboutNC0003875_Owner (Affiliation Change)_20200501ROY COOPER Governor �'� MICHAEL S. REGAN Secretary LINDA CULPEPPER Welter Resources Interim Director ENVIRONMENTAL QUALITY PERMIT NAME/OWNERSHIP CHANGE FORM I. CURRENT PERMIT INFORMATION: Permit Number: NC00 0 / 3 / 8 / 7 / 5 or NCG5 / / / / 1. Facility Name: Elementis Chroumium II. NEW OWNER/NAME INFORMATION: 1. This request for a name change is a result of: x a. Change in ownership of property/company b. Name change only c. Other (please explain): Change in Responsible Official 2. New owner's name (name to be put on permit): 3. New owner's or signing official's name and title: 4. Mailing address: 469 Old Trenton Rd State: NJ Zip Code: 08512 E-mail address: Steve Ridge (Verson legally responsiaie for permit) SVP Global Manufacturing and Supply Chain (Title) City: East Windsor Phone:( 609 ) 443-2503 THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL. REQUIRED ITEMS: 1. This completed application form 2. Legal documentation of the transfer of ownership (such as a property deed, articles of incorporation, or sales agreement) [see reverse side of this page for signature requirements] State of North Carolina I Environmental Quality I Water Resources 1617 Mail Service Center I Raleigh, NC 27699-1617 919 807 6300 919-807-6389 FAX https: //deq.nc. gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits NPDES Name & Ownership Change Page 2 of 2 Applicant's Certification: Steve Ridge , 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 and attachments are not included, this application package will be returned as incomplete. Signature: C�� Date: 4/28/2020 THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS: NC DEQ / DWR / NPDES 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Version 1112017