NCG140320_Contact Info Update_20220301

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 2/2312022.
Permit Number: NCG140320 Permit Status: Active
Permit Type: Ready Mix Concrete Stormwater/Wastewater Discharge COC
Facility Name: EaglC Rock Concret - Rgckv Mount
/ Facility Addressl: 4541 Dozier Rd
y/ Facility Address2:
City, State & Zip: Rocky Mount, NC 27801
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 Namel0wnershi�" Form )
/ Owner Name: Eagle Rock Concrete
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: Adam Loftin Title:
Addressl: 8311 Bandford Way Ste 003
Address2:
City, State & Zip: Raleigh NC 27615
Work Phone: [phone] Fax:
Email Address: adam[teaglerockconcrete.com
*** Permit Annual Fee Billing ***
Billing Month: May
invoice Ng_Mb2E Invoke Date Invoice Due Date Invoice Amount Invoice Status
Owner Contact Person(s)
Contact Name Tit Address Phone EM Emu
flarx 11kT" 83tI&MOAM AAY, Sad3
R �IG,d it/G 276ts � -,,✓am
Facility Contact Person(s) /
Contact Name Title Address Phone fax— ail
4641 pie -2F86-t'
,.:�}450 �i c�eagierleeerrer�
Permit Contact Person(s)
Contact Name Mlle Address phone f" Emai
'A&M
i mq�
2/23/2022

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 2./23/2022.
Permit Billing Contact(s)
Contact Name Tit e Addres Phone Fax ICnlail
`Rick-­Prmcta page , Wilson, NC 2=- 93-0500 -2 293-08-38-
Person(s) with Delegated Signatory Authority��% _
Type Contact Name Title Address Phone Fax Email
0,07 - 7-Je r- sVS- M6 e g31/ &&-Ofe1W S7L- 6" q/�/ clelkrooYet
Person(s) with Electronic Signature Authority
Type Contact Name Title Address Phon Fpxx Email
Outfalls
Outfall #: 001 Outfall Description: Pews-dete4iio" o�erfiffs OP TIezz, ael
Outfall Lattitude: 35.972500 Outfall Longitude:-77.887500 Represented by Outtalk.
5tormwater: 100
Basin
Tar -Pamlico
fl/a Industrial:
Waterbody Name
Stony Creek (Soddies Millpond)
Streams
Index Number
28-68
Waterbody
Classification
C;NSW
2/23/2022