NCGNE0758_Approval of Ownership Change_20170906

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
Energy,Mineral& September 6, 2017 T RACY DAVIS
L an d R esourees Director
ENVIRONMENTAL QUALITY
Mr. Jeremy S. Hall
Axalta Coating Systems U.S.A., LLC
1647 English Road
High Point, NC 27262
Subject: Name/Ownership Change Request
No Exposure Certification NCGNE0758
Axalta Coating Systems U.S.A., LLC
Formerly Engineered Polymer Solutions
DB/A Valspar
Guilford County
Dear Mr. Hall:
The Division has reviewed your submittal of the permit name/ownership change form for the
subject No-Exposure Certification. Division personnel have reviewed and approved your
request to transfer the exclusion from NPDES stormwater permitting requirements.
Please note that by our original acceptance of the No-Exposure Certification and by our
approval of your request to transfer it, you are obligated to maintain no-exposure conditions
at your facility. If conditions change such that your facility can no longer qualify for the no-
exposure exclusion, you are obligated to immediately obtain NPDES permit coverage for
your stormwater discharge. Otherwise, the discharge becomes subject to enforcement as an
un-permitted discharge.
Annual re-certification is required, and we have enclosed one blank Annual No Exposure
Exclusion Self Re-Certification form for your use. Your certification of no exposure does
not affect your facility's legal requirements to obtain environmental permits that may be
required under other federal, state, or local regulations or ordinances.
If you have any questions or need further information, please contact the Stormwater
Permitting Program at [phone].
Sincerely,
f
f for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land
cc: Winston-Salem Regional Office
Stormwater Permitting Program
--Nothing Compares—,-,
State of North Carolina I Environmental Quality I Energy,Mineral and Land Resources
512 N.Salisbury Street 11u12 Mail Service Center � Raleigh,North Carolina 27699-1612
919 7079200

. Division of Energy, Mineral&Land Resources FOR AGENCY USE ONLY
Date Received
��
�,...` a Land Quality Section/Stormwater Permitting Year Month Day
NC� National Pollutant Discharge Elimination System
NCDENR
NORTH CAROUNA DEPARTMENT OF
ENVIRONMENTANDNARIRALREoURCE PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
t` N � E � O � 7 � 5 � 8 �
II. Permit status prior to requested change.
a. Permit issued to(company name): Engineered Polymer Solutions DB/A Valspar
b. Person legally responsible for permit: Jeremy S Hall
First MI Last
Manufacturing Director
Title
1647 English Road
Permit Holder Mailing Address
High Point NC 27262
City State Zip
[phone] ( )
Phone Fax
c. Facility name(discharge): Engineered Polymer Solutions D/B/A Valspar
d. Facility address: 1647 English Road
Address
High Point NC 27262
City State Zip
e. Facility contact person: W Mark Schau [phone]
First /MI/Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result o£ ® Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to(company name): Axalta Coating Systems U.S.A., LLC
c. Person legally responsible for permit: Jeremy S Hall
First MI Last
Manufacturing Director
Title
1647 English Road
Permit Holder Mailing Address
High Point NC 27262
City State Zip
[phone] [e-mail]
Phone E-mail Address
d. Facility name(discharge): Axalta Coating Systems U.S.A., LLC
e. Facility address: 1647 English Road
Address
High Point NC 27262
City State Zip
f. Facility contact person: W Mark Schau
First MI Last
[phone] [e-mail]
Phone E-mail Address
Revised Jan.27,2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information(if different from the person legally responsible for the permit)
Permit contact: W Mark Schau
First MI Last
Ehs Manager
Title
1717 English Road
Mailing Address
High Point NC 27262
City State Zip
[phone] [e-mail]
Phone )-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No(please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership(such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change,and
the new applicant in the case of an ownership change request. For a name change request,the signed
Applicant's Certification is sufficient.
PERMITTER CERTIFICATION(Permit holder prior to ownership change):
I,Jeremy S Hall,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 is not included,this application package will be
returned as incomplete.
Signature Date
APPLICANT CERTIFICATION
I,Denise Trabbic-Pointer,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 is not included,this application
package will be returned as incomplete.
Signature Date
...................................
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy,Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh,North Carolina 27699-1612
Revised Jan.27,2014