NCG020227_Email re Ownership change_20200923

McCoy, Suzanne
From: Scott Ross <[e-mail]>
Sent: Wednesday, September 23, 2020 2:02 PM
To: McCoy, Suzanne
Subject: [External] FW: West Jefferson Water Permit
Attachments: D00092320.pdf
External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
[e-mail]
Suzanne,
This was much faster than I expected. Will this suffice?
-Scott
From: Sean Mackey [mailto:[e-mail]]
Sent: Wednesday, September 23, 2020 1:58 PM
To: Scott Ross <[e-mail]>
Subject: RE: West Jefferson Water Permit
Scott — See if this works.
Thank you,
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Maymead, Inc.
423-571-7159
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www.maymead.com
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From: Scott Ross <[e-mail]>
Sent: Wednesday, September 23, 2020 1:49 PM
To: Sean Mackey <[e-mail]>
Subject: West Jefferson Water Permit
Sean,
NC is renewing all water permits in the state and asked for us to review the information on each permit. When I looked
up our permit at Smethport Quarry, it has Maymead Materials and Wiley's name on it. I have submitted an
Ownership/Name Change form because of this, but need Wiley's signature on it for it to go through. I've attached the
online form. Could you get him to sign the form next to my name and put Maymead Materials under it?
1

Please let me know if this will take any time to do. I'd like to have it back as soon as possible.
Thank you,
-Scott

I. Please enter the permit number for which the change is requested.
...............
NPDES Stormwater Individual Permit #: Begins with NCS
Wife
General Permit Certificate of Coverage (COC) M NCG020227
Begins with NCG or NCGNE
(no exposure)
Use this link to check the permit contact information that is currently in our database.

11. Permit Status
------------------------- - -------------- --
11. Permit status prior to requested change.
.............
a. Permit issued to:*
Maymead Materials
Company Name
b. Person legally responsible for permit:
First name: Middle name:
Wiley B
Title:
Last name:
Roark
Permit holder's mailing address:* Street Address
PO Box 911
Address Line 2
City
State / Province / Region
Mountain City
TN
Postal / Zip Code
Country
37683
USA
Phone #:
423-727-2000
c. Facility name:*
Fax #:
423-727-2023
Smethport Quarry
d. Facility address:* Street Address
1200 Claybank Rd
Address Line 2
City
State / Province / Region
West Jefferson
NC
Postal / Zip Code
Country
28694
USA
e. Facility contact person (prior to change, optional):
First name: Middle name: Last name:
Tony Landreth

Phone #: [phone]

III. Requested Change Information
III. Please provide the following for the requested change (revised permit).
a. Request for changes is a result Change in ownership of facility
of: * 0 Name Change of the facility or owner
b. Permit to be issued to: * Cardinal Quarries, LLC
Company Name
c. Person to be legally responsible for permit:
First name:* Middle name: Last name:
M. J. O'Brien, Jr.
Title: President
Permit holder's mailing address:* street Address
PO Box 1620
Address Lino 2
city State / Province I Region
Dublin VA
Postal / Zip Code Country
24084 USA
Phone #: * Email address: *
540-674-5556 [e-mail]
d. Faciltty name:* Smethport Quarry
Is the FACILITY contact different than the person legally responsible above?* 0 Yes
No
f. Facility contact person:
First name:
A
Phone #: *
Middle name:
Scott
540-765-8157
Last name:
Ross
Email address:* [e-mail]

IV. Permit Contact Information
Is the PERMIT contact different than the person legally responsible above?* 0 Yes
No
IV. Permit contact information
{if different form the person legally responsible for the permit}
............... .... .... ....... ...................... .................. ....... ........................... .................... ................. ......... ...................... .... .........................:............ ...............................................
First Name: * Middle Name: Last Name:
A Scott Ross
Title: Director of Engineering & IT
Mailing Address:* street Address
PO Box 1620
Address Line 2
City
Dublin
Postal / Zip Code
24084
Phone #: * 540-674-5556
Email Address: * [e-mail]
State / Province / Region
VA
Country
USA

V. Permit Facility Activities
V. Will the permitted facility continue to conduct the SAME industrial activities conducted prior to this
ownership or name change:
0 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.
North Carolina General Statute 143 - 216.6 b (1) 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.
In addition, I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act"); and I agree to conduct this transaction by electronic means
pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
Permittee Signature*
Permit -holder prior to the ownership change, or permit -Folder authorizing the name
change
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 [phone] or e-mail Annette Lucas at [e-mail].