NCG060390_Information updates_20210708

McCoy, Suzanne
From:
McCoy, Suzanne
Sent:
Thursday, July 8, 2021 11:54 AM
To:
Newton, Kyle
Cc:
Harris, Robert; Debrito, Ruth; Lawyer, Mike
Subject:
RE: [External] NCG 060390 Changes
Good morning.
I have updated the information per your request.
I have also updated the ownership and facility name per the online request form.
Please check our Industrial Permit website for updates and instructions on how to obtain the renewal Certificates of
Coverage in August:
NPDES Industrial SW page: deg.nc.gov/SW-industrial
Thank you for your patience.
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
Department of Environmental Quality
512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
1612 Mail Service Center, Raleigh, NC 27699-1612
919-707-3640
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.
D, E QR " - '-�
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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.
From: Newton, Kyle <[e-mail]>
Sent: Tuesday, July 6, 2021 2:48 PM
To: McCoy, Suzanne <[e-mail]>
Cc: Harris, Robert <[e-mail]>; Debrito, Ruth <[e-mail]>; Lawyer, Mike
<m i ke.lawyer@ ncden r.gov>
Subject: [External] NCG 060390 Changes
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Report Spam.
Suzanne,

Attached are further changes to the Smithfield Tar Heel Distribution Center NCG 060390. Name and owner changes.
Just wanted to make you aware since we already talked about changes for the eDMR setup process. I will remit to the
Stormwater Program Offices in Raleigh as required by the form.
Regards,
iim
Kyle Newton
Environmental Coordinator
p: [phone]
e: [e-mail]
15855 Hwy 87 West P.O. Box 99
Tar Heel, NC 28392
smithfieldfoods.com
This communication (including any attachments) is confidential and is intended to be privileged pursuant to applicable law. If you are not the intended
recipient, or the employee or agent responsible for delivering it to the intended recipient, then you are hereby notified that the dissemination, distribution
or copying of this communication is prohibited. If you received this communication in error, please notify Smithfield Foods, Inc. immediately by telephone
([phone]) and then delete this communication and destroy all copies thereof.

Smithfield
May 26, 2021
Tar Heel Distribution Center
16261 NC 87 West
PO Box 443
Tar Heel NC 28392
TO: All Individuals/Parties Concerned
Subject: GPO60390 Stormwater Permit Signatures
The Smithfield Tar Heel Distribution Center with GP 060390 has a transition in
management. The facility currently has no General Manager, corporate representative
Paulo Delgado (Director of Distribution) filling in the role temporarily/until the position of
General Manager is filled.
Kyle Newton (Environmental Coordinator) has signature authority over Discharge
Monitoring Reports(DMR) for the Tar Heel Distribution Center under General Permit
060390 for the purposes of simplifying the process of submitting DMR's.
Corporate Rep Signature:
Paulo Delgado, Director of
Date:
Signature: Date:
Kyle Newton, Environmental Coordinator

s •9 i NC Department of Environmental Quality
' t
Division of Energy, Mineral and Land Resources
bORTH CAROL INA
Fnvhonmrnfal Quolip
Stormwater Permit Delegation of Signature Authority Form
Directions are in red
This form shall be used to delegate signature authority from the permit Owner (Permittee) 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.
_o The permit Owner is the legal entity to which/whom a permit has been issued, and may be an individual
or an organization such as a company or government agency. Every Owner is required to have a
Responsible Official who meets the legal signature authority requirements in 40 CFR_ 122.22, 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 Official shall be a general partner or the
proprietor, respectively; or
For a municipality, State, Federal, or other public agency, the Responsible Official shall be either a
principal executive officer (City/County Manager) or ranking elected official [Mayor]
Even it delegated signatory authority has been delegated to another individual, the Responsible Official
retains responsibility for compliance with permit conditions
Perrnittee:
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Permit Number.
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Responsible Official Title:
Email Address:
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Phone:
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Mailing Address:
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City:
Stormwater Delegation of Signature Authority Form
Page 1

A. Persons to Receive Signatory Authority
� The signatures of the persons listed below indicates their acceptance of signatory authority.
legated Party Name:
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legated Pa Title:legated
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Party Organization:ail
Address:
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Mailing Address:
City:
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State:
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Zip:
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
- --
State:
Zip:
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
Stale:
Zip:
Signature of Delegated Party indicating
acceptance of Signatory Authority.
Date:
Email Address:
Of
Date:
Phone:
State:
Stormwater Permit Delegation of Signatory Authority Form
Page 2

B. Responsible Official Signature
The Responsible Official, as identified in accordance with 40 CFR 122.22, is the appropriate
individual with the authority to sign and submit reports for the organization.
As the Responsible Official, I, i�2 , �`� �9 �� (printed name),
have the autho ity to enter into thisAgreement for
1r�c (Owner/Organization Name).
I request that the DEMLR Stormwater Program include the 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 at/for my organization
and have authority to act as a signatory for purposes of the NCDEQ's electronic document
systems.
By submitting this application, 1, �n X' r (printed name),
have read, understand, and accept the t rms and conditions of the stormwater permit(s) for
which I am the Responsible Official.
Title
e Offal Signature
-S
11 Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
K, "Iry National Pollutant Discharge Elimination System (NPDES)
Energy, Miners! & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
ENVIRONMENTAL QUALITY (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
NO 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 (or) Certificate of Coverage or No Exposure
N C S N C GO 6 0 13 9 0
2) Facility Information:
Facility name: Smithfield Distribution LLC
Company/Owner Organization: Smithfield Foods
Facility address: 16261 NC 87
Address
Tar Heel NC 28392
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https:Hdeg.nc. gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/npdes-industrial-
rp ogram and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Charles Johnson
First Nil Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Paulo Delgado
First MI Last
Page 1 of 2
S WU-OWNERAFF11ANov2019

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
Director of Distribution
Title
16261 NC 87
Mailing Address
Tar Heel NC 28392
City State Zip
( 910 ) 241-2016 [e-mail]
Telephone E-mail Address
( )
Fax Number
5) Reason for this change:
A result of: Employee or management change
® Inappropriate or incorrect designation before
Ej Other
If other please explain:
The certification below must be completed and signed by the permit holder.
191170VI101011[y117111y[OF.%01130
1, Paulo Delgado , 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.
Signature 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: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
Page 2 of 2
S WU-O WNERAFFIL-4Nov2019