NCG030170_Delegation of Signature Authority_20210729

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n<ry NC Department of Environmental Quality
Division of Energy, Mineral and Land Resources
NORTH CAROLINA
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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
anotherparty. 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 whichAvhom a permit has been issued, and may be an individual
or an organization such as a company orgovemment agency. EveryOwneris 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, oranother individual who performs similar
functions forthe corporation, or the manager of one ormore 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.
Permittee:
IMC-MetalsAmerica, LLC
Permit Number.
NCG030170
Responsible official Title:
Brian Freeman, Technical Manager
Email Address:
[e-mail]
I Phone:
17044716550
Mailing Address:
135 Old Boiling Springs Road
City:
Shelby NC
I State:
INC
I Zip:
128152
Slonnwater Delegation of Signature Authority Fonn
Page 1

A. Persons to Receive Signatory Authority
� The signatures of the persons listed below indicates their axeptance of signatory authority.
Delegated Party Name:
Claude Dube
Delegated Party Title:
President
Delegated Party Organization:
IMC-MetalsAmedca, LLC
Email Address:
[e-mail]
I Phone:
17044716587
Mailing Address:
135 Old Boiling Springs Road
City:
Shelby
I State:
INC
I Zip:
28152
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
July 7, 2021
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:
Delegated Party Name:
Delegated Party Title:
Delegated Party Organization:
Email Address:
Phone:
Mailing Address:
City:
Stale:
Zip:
Signature of Delegated Party Inckating
acceptance of Signatory Authority.
Date:
Stornwater 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, Brian Freeman
have the authority to enter into this Agreement for
IMC-MetalsAmerica, LLC (Owner/Organization Name).
(printed 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 attfor my organization
and have authority to act as a signatory for purposes of the NCDEQ's electronic document
systems.
By submitting this application, I, Brian Freeman (printed name),
have read, understand, and accept the terms and conditions of the stormwater permit(s) for
which I am the Responsible Officia
Responsible iture
Technical Manager July 6, 2021
Title Date
Storwater Permit Delegation of Signatory Authority Form
Page 3