NCG140477_Email re change of address_20210504

McCoy, Suzanne
From: Lambe, Brian
Sent: Tuesday, May 4, 2021 12:58 PM
To: McCoy, Suzanne
Subject: FW: Send data from Annex 05/04/2021 12:43
Attachments: D00050421-05042021124334.pdf
We received this form for NCG140477 Thomas Concrete. Yes they used the wrong form, but they are just trying to
change their address.
Brian Lambe
Environmental Specialist
910-796-7313
919-268-1678 cell
State of North Carolina I Environmental Quality I Energy, Mineral and Land Resources
127 Cardinal Drive Extension I Wilmington, NC 28405
910 796 7215 T 1 910 350 2004 F I http://portal.ncdenr.org/web/Ir/
-----Original Message -----
From: [e-mail] [mailto:[e-mail]]
Sent: Tuesday, May 4, 2021 12:44 PM
To: Lambe, Brian <brian.lam [e-mail]>
Subject: Send data from Annex 05/04/2021 12:43
Scanned from Annex
Date:05/04/2021 12:43
Pages:1
Resolution:200x200 DPI
1

Date Received u� Fee Paid ., Permit Number
STATE STORMWATER:
PERMIT INFORMATION UPDATE APPLICATION FORM
RECEIVED
MAR 01 2021
There is NO FEE for updating project name or permittee information. NCDEO
This form is to only to be used by the current permittee to notify the Division of. WILMINGTON RO
1) changes to the Point of Contact (signing official) for the current permittee (LLC, Corporation, HOA or POA);
2) changes to the mailing address, phone number or email address of the current permittee;
3) changes to the name of the project; and
4) changes to the legal corporate name as documented by a Name Change or Merger filed with the NCSOS.
A. NEW PERMIT INFORMATION
State Stormwater Permit Number: NCG140477
Are you updating
(check all that apply):
If so, please provide the updated information:
❑ Project name
❑ Corporation Name'
❑ Permit Contact Name2,3
❑ Permit Contact Title
® Mailing Address3
2500 Cumberland Parkway, Suite 200, Atlanta, GA 30339
❑ Phone number
❑ Email address
Provide documentation such as a Name Change/Merger filed with the NCSOS.
Provide supporting documentation such as NCSOS filing. The permit contact's position must be in accordance
with 15A NCAC 02H .1040(1).
If more than one point of contact or mailing address is being changed, please attach a separate sheet.
B. CERTIFICATION OF PERMITTEE
I, Jim Ryder, the current permittee, hereby notify DEMLR that I am making the changes as listed in Section A above. I
further attest that this application for an update to the permit information currently on file is accurate and complete to the
best of my knowledge.
Signatu
I, A-ad"1wn Cl a' ), a Notary Public for the State of 1>en t^G I O`
County of
ELL) r1nAO XY� do hereby certify that .)II
Y1ti
personally appeared before me this the t4i day of
ua r 20Z and acknowledge the due
execution of the forgoing instrument. Witness my hand and official seal,
(Notary Seal)
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Notary Signature t'� )Y�lla"rafl
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My commission expires rfl
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Stormwater Permit Information Update Form Page 1 of 1
11 1110 May 11, 2017