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HomeMy WebLinkAboutNCG120097_Name-Owner Change Form_20220224Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 2/24/2022 12:01:35 PM (Name Change Submission) Approve by Tran, Kieu M 3/25/2022 10:13:51 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 NCG120097, 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 3/21/2022 4:39 PM • The task was assigned to DEMLR SW Admin 2/24/2022 12:01 PM I� 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) #: NCG120097 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 #: * 91932 54000 c. Facility name:* d. Facility address:* Fax #: Last name:* Lorick Street Address 3301 Benson Drive Address Line 2 Ste 601 city State / Province / Region Raleigh NC Postal / Zip Code Country 27609 us Wake Recovery LLC Street Address 2600 Brown Field Rd Address Line 2 city State / Province / Region Raleigh NC Postal / Zip Code Country 27610 us 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: * b. Permit to be issued to: * Change in ownership of facility Name Change of the facility or owner Wake Reclamation 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 Drive Address Line 2 City Holly Springs Postal / Zip Code 27540-6921 Wake Reclamation LLC State / Province / Region NC Country us 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: * joseph.santangelo@gflenv.vom State / Province / Region PA Country United States 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. NCG120097 Reviewer may revise if needed. brittany.carson@ncdenr.gov