NCG030151_SW Permit Delegaton of Signature Authority_20210506

AIRM NC Department of Environmental Quality
IV
Division of Energy, Mineral and Land Resources
N RIM PRCINP
GNn .'OfQ.fir,
Stormwater Permit Delegation of Signature Authority Form
Directions are in red.
o This form shall be used to delegate signature authority from the permit Owner lPerruttee) to
another party. Only the Responsible Official defined below may submit permit applications and
reports required by the permit (such as Data Monitoring Reports and Annual Reports) until this
form is completed and submitted to the DEMLR Stormwater Program. Please note that delegating
signature authority does not relieve the Permit Owner from the responsibility for permit
compliance.
the permit Owner is the legal entity to whichrwhom a Perot has been issued, and may be an individual
or an organization such as a company or govemment agency Every Owner is required to have a
Responsible official who moots the legal signature authority requirements in 40 CFR 12Z summarized
below
• For a corporation. the Responsible Official shall be a president, secretary, treasurer or vice-
president in charge of a principal business function or another individual who performs similar
functions for the corporation. or the manager of one or more manufacturing, production. or operating
facilities who is authorized to make management decisions about the facility operation.
• For a partnership or sole proprietorship, the Responsible Olhcral shall be a general partner or the
proprietor, respectively, or
• For a munirapahty. State, Federal. or other public agency, the Responsible Official shall be either a
principal executive officer (City/County Managerl or ranking elected official (Mayor/.
Even if delegated signatory authority has been delegated to another individual, the Responsible Official
retains responsibility for compliance with permit conditions.
Permittee: Ted Robison
Permit Number. NCG030151
Responsible official Title: Global Director EHS & Security
Email Address: _ [e-mail] Phone: [phone]
Mailing Address: 1600 Technology Way
City: Latrobe State: IPA Zip: I15650
Stormwater Delegation of Signature Authority Form
Page 1

A. Persons to Receive Signatory Authority
o the signatures of the persons listed below indicates their acceptance of signatory authority.
Delegated Party Name:
Delegated Party Title.
Delegated Party Organization:
Email Address:
Melling Address:
City:
Signature of Delegated Parry Indicating
Date:
Ronald Seay
'Plant Manager _
Kennametal Inc.
ronald.seay(�a kennametal.com
7100 Kennametal Rd.
Phone: I423-434-1206
State., INr. I Zlo: 6
Delegated Parr Name: William Bolinger
Delegated Party Title. EHS Manager
Delegated Party Organizallo Kennametal Inc.
Email Address: [e-mail] Phone: f 252-536-2064
_Mailing Address: _ 100 Kennametal Rd. _
City: .Weldon Slate: INC ZIP: 127890
Signature of Delegated Party Indicating / �f
acceptance of Signatory Authority: ` y.��a.n A%✓LD\yti
Dale: I514f2021
Delegated Party Name: (David Kannianen _
_Delegated Party Tide: EHS Lead
Delegated Party Organization Kennametal Inc.
Email Address: d_kanmananrHk.
Mailing Address:
Rd.
,comi Phone: i317-965-3776
State: INC I ZIP:
Delegated Party Name: Austin Shock
Delegated PattyTGlob al_EHS Manager _
Delegated Party Organizatlo_n: -Kennametal Inc.
EmallAddress: auslin.shockey®kennametal.c_om�hone: 1614-907-2477 _
Mailing Address: _ 100 Kennametal Rd.
City: (Weldon - —Mate: INC Zip: �ng0
Signature of Delegated Parry indicating AA �`�L�
aceeplance of Signatory Authark'ry c_ &Cy: Aq-
Date:
Storrnwater Permit Delegation of Signatory Authority Fonn
Page 2

B. Responsible, Official Signature
The Responsible Of ieia', as Aentified in accordance win 40 CFR 122,22. is the appropnate
individuat with the author" to sign and submit- reports for 0te organization.
As the Responsbe Official, I, Ted Robison (printed name),
have the authority to enter into this Agreement for
Kernametsl Inc_ _ _ (Owner/Organization Wind)
I •equesl that the DEMLR Stom,water Program ncwde Inc persons listed in Part A of this form
signatory authority for the above -named permit -
I acknowledge that I, and the persons listed In Part A of this form work atlfor my organization
and have authority to act as a signatory for purposes of the NCDEO's electronic document
systems
By su0rnitting this applicetlon, I, Ted Rooraon (pnnted name).
have read, understand. and accept the terms and conditions of the stormwater pennd(s) for
which aom tth-epR-esponsible OfFctel
PAkS rtalbib Official Signature
Global DYetaor ENS a Security OU041 1
Too Date
Rtt mwarcr Permit Der!gstion of Sgnsfory Authority Form
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