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Home My WebLink AboutNCG090020_Owner Affiliation Change_20220125Division 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 tI.VVUVLLr\G.IIJV LL.7L4LG LVL ) Use this form if there has been: FOR AGENCY USE ONLY Date Received Year Month Day kidtIVE® NO CHANGE in facility ownership or facility name, but thePINE 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 N I C I S TT= 2) Facility Information: Facility name: Company/Owner Organization: Facility address: (or) Certificate of Coverage or No Exposure N I C I G 10 19 10 0 12 10 Axalta Coating Systems 1717 W English Road Address High Point NC 27262 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- rop gram and run the Permit Contact Summary Report. 3) OLD OWNER AFFILIATION that should be removed: Previous legally responsible individual: Jeremy S Hall First MI Last 4) NEW OWNER AFFILIATION (legally responsible for the permit): Person legally responsible for this permit: Richard Rejdovjan First MI Last S W U-0 W N ERAF FIL4Nov2019 Page l of 2 NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION Form (if no Facility Name/Ownership Change) Plant Manager Title 1717 W English Road Mailing Address High Point NC 27262 City State Zip (678 ) 314-5714 richard.rejdovjan@axalta.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 Richard Rejdovjan 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 prod. � � 7 h 4 '�/ January 5, 2022 ignature 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 WNERAFFn,-4Nov2019 Tran, Kieu M From: Richard Rejdovjan <Richard.Rejdovjan@axalta.com> Sent: Monday, March 14, 2022 2:46 PM To: Tran, Kieu M Subject: [External] RE: NCG090020 Owner Affiliation Information Attachments: image003.wmz CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to Report Spam. Hi Kieu, I would like to confirm the information below. Please, go ahead and update the permit information in the system. Thank you. Richard Richard Rejdovjan Plant Manager Operations Axalta Coating Systems 1717 English Rd. High Point, NC 27262 Richard. Rejdovjan axalta.com axalta.com Sensitivity: Business Internal From: Tran, Kieu M <kieu.tran@ncdenr.gov> Sent: Monday, March 14, 2022 1:29 PM To: Richard Rejdovjan <richard.rejdovjan@axalta.com> Subject: [EXTERNAL]NCG090020 Owner Affiliation Information Good afternoon Richard, I hope this email finds you well. I'm currently processing the Permit Owner Affiliation Designation Form and I noticed that this Owner entity is attached to two permits. If I update the Owner -Owner affiliation (legally responsible person) from Jeremy Hall to you, Richard, this will affect all these other permits since the same owner is tied to them. That may be perfectly appropriate — I just wanted to confirm that with you first. There is a stormwater permit and a no exposure certification. 1 Owner: alta Coating Systems U SA LLC Permit Version Status Type Facility NCO026077 1.0 Inactive Industrial Process & Commercial Wa... Axalta Coating Systems U.S.A, LLC NCGO90012 1.0 Inactive Paints, Varnishes, Lacquers Stormwa... Axalta Coating Systems U.S.A, LLC NCGO90012 2.0 Inactive Paints, Varnishes, Lacquers Stormwa... Axalta Coating Systems U.S.A, LLC NCGO90012 3.0 Inactive Paints, Varnishes, Lacquers Stormwa... Axalta Coating Systems U.S.A, LLC NCGO90020 1.0 Inactive Paints, Varnishes, Lacquers Stormwa... Axalta Coating Systems U.S.A, LL... NCGO90020 2.0 Inactive Paints, Varnishes, Lacquers Stormwa... Axalta Coating Systems U.S.A, LL... NCGO90020 10 Inactive Paints, Varnishes, Lacquers Stormwa... Axalta Coating Systems U.S.A., LL... NCGO90020 4.0 Inactive Paints, Varnishes, Lacquers Stormwa... Axalta Coating Systems U.S.A, LL... NCGO90020 5.0 Inactive Paints, Varnishes, Lacquers Stormwa... Axalta Coating Systems U.S.A, LL... NCGO90020 6.0 Inactive Paints, Varnishes, Lacquers Stormwa... Axalta Coating Systems U.S.A, LL... NCGO90020 7.0 Inactive Paints, Varnishes, Lacquers Stormwa... Axalta Coating Systems U.S.A, LL... NCGO90020 8.0 Active Paints, Varnishes, Lacquers Stormwa... Axalta Coating Systems U.S.A., LL... NCGNE0758 1.0 JActive 13tormwater discharge, No Exposure ... Axalta Coating Systems U.S.A., LLC Thank you, _ Kieu Tran Stormwater Program Administrative Assistant Office: (919) 707- 3640 Kieu.Tran @ncdenr.gov North Carolina Department of Environmental Quality Division of Energy, Mineral, and Land Resources Stormwater Program 512 N. 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