HomeMy WebLinkAboutNCG060402_Owner Affiliation Change Request_20211230Georgoulias, Bethany
From:
EJZD (Jessie Darby) <EJZD@novonordisk.com>
Sent:
Thursday, December 30, 2021 9:33 AM
To:
McCoy, Suzanne; Georgoulias, Bethany
Cc:
JRKT (Jeremy Keltner); Selkane, Aziza
Subject:
[External] FW: Owner Verification - NCG060402
Attachments:
Stormwater Permit Owner Affiliation.pdf, NPDES SW Permit Summary Report.pdf,
NPDES SW eDMR Owner Verification.pdf
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Good morning all,
I just wanted to check on the status of this request? I haven't seen anything updated in database as of yet. Please
let me know or please forward me the email of someone I can reach out to to help update the contact and address
information. Matt Kuntz is no longer a Novo Nordisk employee, and I fear he may be getting important emails that
need to be transferred to myself or Jeremy.
Thanks,
-J
Jessica Darby
Environmental Coordinator
EHS - DAPI
EJZD@novonordisk.com
From: JRKT (Jeremy Keltner) <JRKT@novonordisk.com>
Sent: Tuesday, October 26, 2021 9:49 AM
To: McCoy, Suzanne <suzanne.mccoy@ncdenr.gov>; aziza.selkane@ncdenr.gov
Cc: EJZD (Jessie Darby) <EJZD@novonordisk.com>
Subject: Owner Verification - NCG060402
Good Morning -
Suzanne,
If I need to call I can, but could I please work with you for the following
The `Stormwater Permit Owner Affiliation' pdf designates me (Jeremy Keltner) as owner affiliate and
removes David Bright (who no longer works for the company)
Could this be updated for the owner verification and Stormwater Permit Summary please. This only
applies to NCG060402
o This then should also reflect me as the responsible official for NCG060402
On the Stormwater Permit Summary for NCG060402:
o Update Owner Affiliation to Jeremy Keltner
o Update Facility Contact Person(s):
■ The facility address should be 3611 Powhatan Rd. NOT 3612
■ Remove and replace Matthew Kuntz with —
• Jessie Darby
• Phone — 919-901-7208
• EJZD(a)-novonordisk.com
o Update Permit Contact Persons:
■ Remove and replace Matthew Kuntz —
• Use same info from Facility contacts — Jeremy Keltner and Jessie Darby
Aziza,
For Permit Billing (NCG060402) :
• Please remove Matthew Kuntz (no longer employed here)
Replace with
o Jeremy Keltner -- 3611 Powhatan Rd, Clayton, NC 27520 — 919-410-5333 —
JRKT(aD-novonordisk.com
Thanks!
Jeremy Keltner
Environmental Coordinator
919-410-5333 (mobile) I JRKT@novonordisk.com
From: McCoy, Suzanne <suzanne.mccov@ncdenr.gov>
Sent: Thursday, August 26, 2021 1:46 PM
To: JRKT (Jeremy Keltner) <JRKT@novonordisk.com>
Cc: EJZD (Jessie Darby) <EJZD@novonordisk.com>; RDMO (Paul Morris) <rdmo@novonordisk.com>
Subject: RE: [External] Owner Verification - NCG060402
Caution: This email originated from outside of the Novo Nordisk email system. Use caution when clicking on links or
opening attachments.
Jeremy,
Please provide Paul's phone number and mailing address.
I have updated the permit status to active. Fees must have been past due at the time of the renewal.
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
North Carolina Department of Environmental Quality
Physical: 512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
Mailing: 1612 Mail Service Center, Raleigh, NC 27699-1612
Email: Suzanne. m000V�ncdenr.goy
Phone: 919-707-3640
Website: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
D4)WdIWZLi of Ens rwmWial QrjallYy
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From: JRKT (Jeremy Keltner) [mailto:JRKT@novonordisk.com]
Sent: Thursday, August 26, 2021 1:16 PM
To: McCoy, Suzanne <suzanne.mccov@ncdenr.gov>
Cc: EJZD (Jessie Darby) <EJZD@novonordisk.com>; RDMO (Paul Morris) <rdmo@novonordisk.com>
Subject: [External] Owner Verification - NCG060402
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Report Spam.
Hi Suzanne —
I'm stepping through eSubmit process for Stromwater — in Step 1 it asks to verify content in `Owner verification'.
Looks like some potential items to reconcile:
1) There are two facilities under one owner — and each facility has it's own permit and responsible individual,
so on:
a. Page 1 (Permit NCG060048)
i. Owner/Permittee & Address: No Change
ii. Responsible Individual: Change to Paul Morris
iii. Facility Name & Address: No change
iv. ALSO NOTE: states permit is expired — Paul Morris will address separately
b. Page 2 (Permit NCG060402)
i. Owner/Permittee & Address: No Change
ii. Responsible Individual: Change to Jeremy Keltner
iii. Facility Name & Address: No change
Thank you
Jeremy Keltner
Environmental Coordinator
919-410-5333 (mobile)
JRKT@novonordisk.com
Novo Nordisk Pharmaceutical Industries, LP 1 3612 Powhatan Road I Clayton, NC 27527-9217 1 +1 919-550-2200 (switchboard) I novonordisk-
clayton.com
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Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & 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 I C S N I C G 10 16 10 4 0 2
2) Facility Information:
Facility name: Novo Nordisk - DAPI-US
Company/Owner Organization: Novo Nordisk Pharmaceuticals Industries LP
Facility address: 3611 Powhatan Rd
Address
Clayton NC 27527
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https: //deg .nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/npdes-industrial-
program and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: David Bright
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Jeremy Keltner
First MI Last
Page 1 of 2
S WU-O WNERAF FIL4Nov2019
NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
Title
3611 Powhatan Rd
Mailing Address
Clayton NC 27527
City State Zip
(919 ) 4105333 jrkt@novonordisk.com
Telephone E-mail Address
(
Fax Number
5) Reason for this change:
❑✓ Employee or management change
A result of. ❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
1, Leonardo Costa Siqueira , 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.
/ C Digitally signed by LSIQ
� W Date:2021.08.26
15:46:17-04'00'
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 (919) 707-9220 or visit the website
at: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stonnwater
Page 2 of 2
S WU-O WNERAFFIL-4Nov2019
NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for your permit as of 26/08/2021.
Permit Number:
NCG060402 Permit Status: Active
Permit Type:
Food/Tobacco/Soaps/Cosmetics/Public Warehousing Stormwater Discharge COC
Facility Name:
Novo Nordisk - DAPI-US
Facility Addressl:
3611 Powhatan Rd
Facility Address2:
City, State & Zip:
Clayton, NC 27527
Owner Information Details:
MUST submit
a Change of Name/Ownership form to DEMLR to make any changes to this Owner information.
(Click Here for "Change of Name/Ownershka"Form)
Owner Name:
Novo Nordisk Pharmaceuticals Industries LP
Owner Type:
Non -Government Owner Type Group: Organization
*** Legally Responsible for Permit ***
(Responsible corporate officer/principle executive officer or ranking elected official/general partner or proprietor;
or any other person with delegated signatory authority from the legally responsible person.)
Owner Affiliation:
David Bright Title:
Addressl:
3612 Powhatan Rd
Address2:
City, State & Zip:
Clayton, NC 27520
Work Phone:
919-550-2215 Fax: 919-550-3670
Email Address:
dbri@novonordisk.com
*** Permit Annual Fee Billing ***
Billing Month: November
Invoice Number
Invoice Date Invoice Due Date Invoice Amount Invoice Status
Owner Contact Person(s)
Contact Name Title Address Phone Fax Email
Facility Contact Person(s)
Contact Name Title Address Phone Fax Email
Jeremy Keltner 3612 Powhatan Rd, Clayton, NC 27520 919-410-5333 JRKT@novonordisk.
com
Matthew Kuntz 3612 Powhatan Rd, Clayton, NC 27520 919-437-9691 mwkn@novonordisk
.com
Permit Contact Person(s)
Contact Name Title Address Phone Fax Email
Matthew Kuntz 3612 Powhatan Rd, Clayton, NC 27520 919-437-9691 mwkn@novonordisk
.com
26/08/2021 Page 1
NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the followin! information in our Permit Database for vour hermit as of 26/08/2021.
Permit Billing Contact(s)
Contact Name Title Address
Phone Fax
Email
Matthew Kuntz 3612 Powhatan Rd, Clayton, NC 27520
919-437-9691
mwkn@novonordisk
.Corn
Person(s) with Delegated Signatory Authority
Type Contact Name Title Address
Phone Fax
Email
Person(s) with Electronic Signature Authority
Type Contact Name Title Address
Phone Fax
Email
Outfalls
Outfall #: 001 Outfall Description: Stormwater #1
Outfall Lattitude: 35.618330 Outfall Longitude:-78.408330
Represented by Outfall:
% Stormwater: 100 % Industrial:
Stream
Waterbody
Basin Waterbody Name
Index Number
Classification
Neuse Little Poplar Creek
27-41-1
WS-IV;NSW
Outfall #: 002 Outfall Description: Stormwater #2
Outfall Lattitude: 35.616670 Outfall Longitude:-78.401390
Represented by Outfall:
% Stormwater: 100 % Industrial:
Stream
Waterbody
Basin Waterbody Name
Index Number
Classification
Neuse Little Poplar Creek
27-41-1
WS-IV;NSW
Outfall #: 003 Outfall Description: Stormwater
Outfall Lattitude: 35.615000 Outfall Longitude:-78.398060
Represented by Outfall:
% Stormwater: 100 % Industrial:
Stream
Waterbody
Basin Waterbody Name
Index Number
Classification
Neuse Little Poplar Creek
27-41-1
WS-IV;NSW
26/08/2021 Page 2
eDMR Owner Verification Report
Permit No.: NCG060048
Owner/Permittee
Owner/Permittee
Address:
Responsible Official
Resp. Official Title:
Version: 6.00 Permt Status: Expired
Novo Nordisk Pharmaceuticals Industries LP
3612 Powhatan Rd
Clayton, NC 27520
David Bright
Facility Name : Novo Nordisk Pharmaceuticals Industries, LP
Facility Address: 3612 Powhatan Rd
Clayton, NC 27527
Registered for eDMR? : No
Page # : 1
Date : 26/08/2021
Permit No.: NCG060402
Owner/Permittee
Owner/Permittee
Address:
Responsible Official:
Resp. Official Title:
Facility Name :
Facility Address:
Version: 3.00 Permt Status: Active
Novo Nordisk Pharmaceuticals Industries LP
3612 Powhatan Rd
Clayton, NC 27520
David Bright
Novo Nordisk - DAPI-US
3611 Powhatan Rd
Clayton, NC 27527
Registered for eDMR? : No
Page # : 2
Date : 26/08/2021