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HomeMy WebLinkAboutNCG030541_Name-Owner Change Form_20211013Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 10/13/2021 11:19:50 AM (Name Change Submission) Approve by McCoy, Suzanne 10/15/2021 2:35:12 PM (Notification to Admin) • The task was assigned to McCoy, Suzanne 10/13/2021 11:19 AM I� 1 NORTH CAROLINA Enrlmnmrnfat Quality I. Permit Information I. Please enter the permit number for which the change is requested. NPDES Stormwater Individual Permit #: NC SX XX XX X -OR- General Permit Certificate of Coverage (COC) #: NCG030541 NC GX XX XX X Use this link to check the permit contact information that is currently in our database. II. Permit Status II. Permit status prior to requested change. ..................................................................................................................................................................................................... a. Permit issued to:* Cree, Inc Company Name b. Person legally responsible for permit: First name:* Middle name Thomas Title: Permit holder's mailing address:* Phone #: * 919- 407- 5875 c. Facility name:* d. Facility address:* Fax #: Last name:* Agron Street Address 4600 Silicon Dr Address Line 2 city State / Province / Region Durham NC Postal / Zip Code Country 27703 United States Cree RTP Street Address 3028 Cornwallis Rd Address Line 2 city State / Province / Region Research Triangle Park NC Postal / Zip Code Country 27709 United States e. Facility contact person (prior to change, optional): First name: Middle name: Last name: Robin Housh Phone M 919-407-6103 III. Requested Change Information III. Please provide the following for the requested change (revised permit). ................................................................................................................................................................................................................................................................................................................................................... a. Request for changes is a result of: * Change in ownership of facility • Name Change of the facility or owner b. Permit to be issued to: * Wolfspeed, Inc. Company Name c. Person to be legally responsible for permit: First name:* Middle name: Last name: Thomas Agron Title: Permit holder's mailing address:* Street Address 4600 Silicon Dr Address Line 2 city State / Province / Region Durham NC Postal / Zip Code Country 27703 United States Phone #: * Email address:* 919- tom.agro 407- n@wolfs 5875 peed.co m d. Faciltiy name:* Wolfspeed Incorporated - RTP Is the FACILITY contact different than the person legally responsible above?* Yes No f. Facility contact person: First name: * Middle name: Last name:* Robin Housh Phone #: * 919-407-6103 Email address: * robin.housh@wolfspeed.com IV. Permit Contact Information Is the PERMIT contact different than the person legally responsible above?* Yes No IV. Permit contact information (if different form the person legally responsible for the permit) First Name:* Middle Name: Last Name:* Robin Housh Title: Mailing Address: * Street Address 4600 Silicon Dr Address Line 2 city Durham Postal / Zip Code 27703 Phone #: * 919-407-6103 Email Address: * robin.housh@wolfspeed.com State / Province / Region NC Country United States V. Permit Facility Activities V. Will the permitted facility continue to conduct the SAME industrial activities conducted prior to this ownership or name change: Yes No VI. Signature In the case of an ownership change request, certifications must be signed by both the permit holder prior to the change and the new applicant. For a name change request, the signed Permittee's Certification is sufficient. This completed application is required for both name change and/or ownership change requests. North Carolina General Statute 143 - 215.6 b (i) provides that: Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or other document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article or rules of the [Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). Permittee Certification: I attest that this application for a name and/or 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, or if all required supporting information is not included, this application will be considered incomplete. In addition, I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act"); and I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act'); Permittee Signature 9%WKCat, tlew Permit -holder prior to the ownership change, or permit -holder authorizing the name change Will another person need to complete or sign this form before it can be submitted? No problem! Simply CLICK the "Save as Draft" button below and send the URL link to the other party to access the form. Questions? Call The Stormwater Program at (919) 707-3639 or e-mail Annette Lucas at annette.lucas@ncdenr.gov. Initial Review Project ID: * Staff Member Email for Reminder CC of Next Step Reviewer: Revise permit number here if incorrect. NCG030541 Reviewer may revise if needed. brittany.carson@ncdenr.gov