NCG140443_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 Vermit as of 2/23/2022.
Permit Number:
NCG140443 Permit Status; A ive
Permit Type:
Ready Mix Concrete_ Stormwater/Wastewater Discharge COC
Facility Name:
Eagle Rock Concrete, LLC (Old Roberts Road)
Facility Addressi:
624 Old Roberts Rd
Facility Address2:
City, State & Zip,
Benson, NC 27504
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/Ownership" Form)
Owner Name:
Eagle Rock Concrete
Owner Type:
Non -Government Owner Type Group: Organization
*** Legally Responsible for Permit ***
(Responsible corporate offcer/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:
Addressi:
8311 Bandford Way Ste 003
/Address2:
City, State & Zip:
Raleigh NC 27615
Work Phone:
919-819-1100 Fax:
Email Address:
adpmftgag1gMkcgncrgte.rom
*** Permit Annual Fee Billing ***
Billing Month: January
Invoice Number
Invoice Date Invoice Due Date Invoice A,,mggnt Invoice Status
Owner Contact Person(s)
CQDjag, Name I!11& Addre s Phone Fax Email
7 'gtMI-C /��
Facility Contact Person(s)
Contact Name Tit g Address Phg0g F, , Email
8310 Sandford Way, Raleigh, NC 27615
vdm@eaglerockcon
crete.com
Permit Contact Person(s)
Contact Name Iftk Address P o ," Email
S,m: ,es .grclzlry� cvww vem,�
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 t A dr ss h fix m
/ /_ Eail
of AdffM- qn 8310 Bandford Way, Raleigh, NC 27615 � at 1�ba►w@eagIerockcon
a g2 of=Mt-17 4 crete.com
Person(s) with Delegated Signatory Authority
Tvoe Contact Name IMq Address Phone Fax E 'I
MrCA- IVCr— ft� Ae 831 B oFa¢D ul , Siron3 dklt lw— ci �'
Person(s) with Electronic Signature Authority
Tvoe Contact Name jLkLq Address Phone Fax Email
�N'r!
Outfalls
Outfall #: 001
Outfall Description: Qutfall 1
/Outfall
Lattitude:
35.526390 Outfall Longitude:-78,556390
Represented by Outfall;
% Stormwater:
100 % Industrial:
Stream Waterbody
Basin
Waterbody Name
Index Number Classification
Neuse
Beaverdam Branch
27-43-15-13 C;NSW
2/23/2022