NCG120096_Name-Owner Change Form_20220224

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/24/2022 11:57:14 AM (Name Change Submission)
Approve by Tran, Kieu M 3/25/2022 10:00:43 AM (Review Assigned to Admin)
* The legally responsible individual has been changed from Franklin Lorick to Joseph Santangelo.
Donald Plessinger has been listed as the permit contact. If you want to give Donald Plessinger the
signatory authority for permit number NCG120096, please fill out the Permit Contact Update Request
Form (https://edocs.deq.nc.gov/Forms/SW-Permit-Contact-Updates) and select Delegation of
Signature Authority (DOSA).
• Georgoulias, Bethany A reassigned the task to Tran, Kieu M 3/23/2022 9:32 AM
Georgoulias, Bethany A reassigned the task to Georgoulias, Bethany A 3/23/2022 9:31 AM
The task was assigned to DEMLR SW Admin 2/24/2022 11:57 AM

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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) #:
NCG120096
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:*
Waste Industries LLC
Company Name
b. Person legally responsible for permit:
First name:* Middle name
Franklin
Title:
Permit holder's mailing address:*
Phone #: *
91987
72235
c. Facility name:*
d. Facility address:*
Fax #:
Last name:*
Lorick
Street Address
3301 Benson Dr
Address Line 2
Ste 601
city
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27609
USA
Red Rock Disposal LLC
Street Address
7130 New Landfill Dr
Address Line 2
city
State / Province / Region
Holly Springs
NC
Postal / Zip Code
Country
27540
USA
e. Facility contact person (prior to change, optional):
First name:
Phone M
Middle name: Last name:

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: * Red Rock Disposal LLC
Company Name
c. Person to be legally responsible for permit:
First name:* Middle name: Last name:
Donald Plessinge
r
Title: General Manager
Permit holder's mailing address:*
Phone #: *
9195579
583
d. Faciltiy name:*
Email address:*
donald.pl
essinger
@gflenv.
com
Street Address
7130 New Landfill Dr
Address Line 2
city
Holly Springs
Postal / Zip Code
27540
Red Rock Disposal LLC
State / Province / Region
NC
Country
USA
Is the FACILITY contact different than the person legally responsible above?*
Yes
+ No

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:*
Joseph
Title:
Mailing Address:*
Phone #: *
Middle Name:
7242449511
Last Name:*
Santange
to
Compliance Manager
Street Address
1192 McClellandtown Road
Address Line 2
City
McClellandtown
Postal / Zip Code
15458
Email Address: * [e-mail]
State / Province / Region
PA
Country
us

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
This completed application is required for both name change and/or ownership change requests.
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.
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
Permit -holder prior to the ownership change, or permit -holder authorizing the name change
Date 3/25/2022

Initial Review
Project ID: *
Staff Member Email for Reminder CC
of Next Step
Reviewer: Revise permit number here if incorrect.
NCG120096
Reviewer may revise if needed.
[e-mail]