NCS000332_Owner-Affiliation-Change-Morganton_20201116

Division of Energy, Mineral, and Land Resources 1 FOR AGENCY USEONLY
Dale Received
Land Quality Section / Stormwater Program I year I Mash I Day
National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
ENVIRONMENTAL QUALITY (individual Legally Responsible for Permit)
Use this form if there has been:
NO
CHANGE
in facility ownership or
facility name,
but the individual
who is
legally responsible for
the permit has
changed.
lithe 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 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 Permit
nano
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage or No ExposureWNWEEMEME
Hexion Morganton Facility
Hexion, Inc.
114 Industrial Blvd.
Morganton NC 28655
City State Zip
To find the current legally responsible, person associated with your permit, go to this website:
https://deg.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-perm its/npdes-industrial-
rp ogram and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Craig Rogerson
Firs[ MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit:
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McDaniel
First MI Last
F3Pli3iI r7.1:It7:1t1yIIf3PYZeL7

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
Site Leader
114 Industrial Blvd.
Title
Mailing Address
Morganton NC 28655
City State Zip
(828 )219-3503 [e-mail]
Telephone E-mail Address
Fax Number
5) Reason for this change:
❑ Employee or management change
A result of: ❑ Inappropriate or incorrect designation before
❑ Other
Lf other please explain:
..................................................................................................................
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I Jeffrey McDaniel ,attest that thls 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.
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://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
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S WU-OWNERAFFIL-4Nov2019