NCG030504_Contact Update_20201109

McCoy, Suzanne
From:
Stephanie Sprock <[e-mail]>
Sent:
Monday, November 9, 2020 10:44 AM
To:
McCoy, Suzanne
Cc:
Jones, Austin
Subject:
[External] NCG030504 Flowserve US Inc.- Raleigh Contact Update
Attachments:
NPDES-Owner-Affiliation-Change-NCG030504-Flowserve US Inc.pdf
27`17'rExternal email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
[e-mail]
Suzanne,
On behalf of the Flowserve US Inc. -Raleigh facility located at 1900 South Saunders Street, Raleigh, NC operating under
Certificate of Coverage No. NCG030504, please accept this updated submittal of contact information.
Please remove the following personnel:
Sharon Owens 919-831-3227 [e-mail]
The following personnel should be added:
Austin Jones, HSE Manager [phone] [e-mail]
Additionally, I have attached the Owner Affiliation Change form for the same facility. A physical copy of this form has
also been mailed to the DEMLR — Stormwater Program office.
Please let me know if you have any questions.
Thank you,
-Steph
Stephanie Sorock
Environmental Scientist
[phone] cell
[phone] main
[phone] direct
5724 Summer Trees Drive
Memphis, TN 38134
MySAFE creative thinking I custom solutions
1

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
:NVIRONW:NIAL QUALITY (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Datc Received
Year
Month
Day
NO CHANGE in facility ownership or facility name, but the individual
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.
What does "legally responsible 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 ither 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 Permit (or) Certificate of Coverage or No Exposure
N I C I S I I I I I N I C I G 10 13 10 5 0 4
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
Flowserve US, Inc - Raleigh
Flowserve US, Inc
1900 South Saunders Street
Address
Raleigh NC 27603
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https:Hdeg.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/npdes industrial -
program and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual:
Helm Hansen
First
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Scott
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MI Last
Bailey
MI Last
S WU-O WNERAFFIL4Nod2019

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
5) Reason for this change:
A result of:
If other please explain:
Director, Plant Manager
Title
1900 South Saunders Street
Mailing Address
Raleigh NC 27603
City State Zip
(919 ) 831-3314 [e-mail]
Telephone E-mail Address
(919 ) 831-3284
Fax Number
❑✓ Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
1, Scott Bailey , 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
processed.
/o-/9-2-2a,
,S'ign ture
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: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
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S W U-O W N E RAFFIL-4Nov2019