NCG120064_Owner Affiliation Change_20210202

McCoy, Suzanne
From: Tyler Fitzgerald <[e-mail]>
Sent: Tuesday, February 2, 2021 2:16 PM
To: McCoy, Suzanne
Subject: RE: [External] RE: NCG120064 Stormwater Permit Anson Waste Management Facility
Attachments: Permit Owner Affiliation Designation Form.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Great— it's attached.
Thanks you
From: McCoy, Suzanne <[e-mail]>
Sent: Tuesday, February 02, 2021 11:35 AM
To: Tyler Fitzgerald <J. Fitzgerald @WasteConnections.com>
Subject: RE: [External] RE: NCG120064 Stormwater Permit Anson Waste Management Facility
To me
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
North Carolina Department of Environmental Quality
Physical: 512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
Mailing: 1612 Mail Service Center, Raleigh, NC 27699-1612
Email: Suzanne. mccoyQncdenr.goy
Phone: [phone]
Website: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
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Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Before printing this email, please consider your budget and the environment.
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your
requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.

From: Tyler Fitzgerald [mailto:[e-mail]]
Sent: Tuesday, February 2, 2021 10:30 AM
To: McCoy, Suzanne <[e-mail]>
Subject: RE: [External] RE: NCG120064 Stormwater Permit Anson Waste Management Facility
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Thanks for getting back to me so quickly.
I like email —where can I email the form.
Thnaks again!
From: McCoy, Suzanne <[e-mail]>
Sent: Tuesday, February 02, 2021 10:26 AM
To: Tyler Fitzgerald <J. Fitzgerald @WasteConnections.com>
Subject: RE: [External] RE: NCG120064 Stormwater Permit Anson Waste Management Facility
https://deg.nc.gov/about/divisions/energy-mineral-land-resources/npdes-industrial-stormwater
Above is a link to the portion of our website that had "Manage Information for an Existing Industrial Permit"
There is a link to an upload form.
However, emailing it works also.
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
North Carolina Department of Environmental Quality
Physical: 512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
Mailing: 1612 Mail Service Center, Raleigh, NC 27699-1612
Email: Suzanne. mccoyQncdenr.goy
Phone: [phone]
Website: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
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Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Before printing this email, please consider your budget and the environment.
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your
requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.

From: Tyler Fitzgerald [mailto:[e-mail]]
Sent: Tuesday, February 2, 2021 10:06 AM
To: McCoy, Suzanne <[e-mail]>
Subject: [External] RE: NCG120064 Stormwater Permit Anson Waste Management Facility
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Good morning Suzanne — I hope you are well.
I called the office phone number and got your message to email you.
I have a "Permit Owner Affiliation Designation Form" completed and attached. I have not been able to find directions
on how to get this submitted, other than mailing it in. However with so many working from home, I thought best to
reach out to you and ask for direction.
Please let me know the best way to submit this form.
Thank you for your help!
From: McCoy, Suzanne <[e-mail]>
Sent: Thursday, December 17, 2020 3:13 PM
To: Tyler Fitzgerald <J. Fitzgerald @WasteConnections.com>
Subject: NCG120064 Stormwater Permit Anson Waste Management Facility
WARNING: This email is from outside of Waste Connections; Exercise caution.
Good afternoon.
Upon review of information in our database, it came to our attention that there is not an individual designated at the
Owner Affiliation (legally responsible person) for your organization.
Please review the attached NPDES Stormwater Permit Summary for accuracy.
Please visit the link to our Industrial Stormwater Program page and complete the required forms.
https://deg.nc.gov/about/divisions/energy-mineral-land-resources/npdes-industrial-stormwater
Scroll down to "Manage Information for an Existing Industrial Permit"
Choose the Legally responsible person, complete Owner Designation/Affiliation Form.
I would also like to take bring to your attention the updated process for submitting Data Management reports.
Scroll to "How to Submit Paper DMRs Before eDMR is Implemented".
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
North Carolina Department of Environmental Quality
Physical: 512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
Mailing: 1612 Mail Service Center, Raleigh, NC 27699-1612
Email: Suzanne. mccoyCa.ncdenr.gov
Phone: [phone]

Website: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
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Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties.
Before printing this email, please consider your budget and the environment.
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your
requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy. Minerul & PERMIT OWNER AFFILIATION DESIGNATION FORM
Lund Resources (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
NI) 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 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 (07) Certificate of Coverage or No Exposure
N C SI i Ial o o b N I C G
2) Facility Information:
iaNSon (ouvA 1 v+1ASt[ �AHALE11f1VL,_N nGtl1T Facility name: '1
Company/Owner Organization: CAP �ryS v a( UWW n(3,nti p, 'TAM -
Facility
address: 31 S 1)o-*t2 iin-
Address
Lk'i[K'1
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- mi:ieral-land-resources/energy-inineral-land-permi industrial-
programis/npdes-and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: P W C RE
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: 17Y L tk V 0,26 It ti,p LO
First N t 1 Last
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S WU-O WNERAFF1L4Nov2019

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
Abt-
(� Title
Mailing Address
NL CA 115
City State} Zip
(70l j cpLq-" C�ja a !G' b,,, GA-X . 0lt t�
Telephone E-i)roil Address
Fax Number
5) Reason for this change:
A result of: Employee or management change
Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I, -L- ,,ll.p , 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.
a-I-a6�1
Signat 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: htt ://de .nc. ov/about/divisions/ener -mineral-land-resources/stormwater
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S WU-O WNERAFFIL-4Nov2019