NCGNE1142_Name-Owner Change Application_20220513

NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF Energy, Mineral, and Land Resources
STORMWATER PROGRAM
NORTi i CAROLINA
Environmental Quality
NPIDES STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
1, CURRENT PERMIT WORMAT11ON:
Permit iNiumber: WIGS or NCG iy i r i i r` i i 4/ i
Amazon.com.dedc, LLC - UNC2
1. Facility Name (prior to change):
H. NF-W OWNFRiNAME iNFOWATiON:
2. This request for a name change is a result of:
X a. Change in ownership of property/company
v
^ b. Name change only (Facility and/or Company)
c. Other (please explain):
(for example, facility address update. Include additional attachments if necessary.)
3. New owner's name (name to be put on permit as Permittee):
Prime IVow LLC
4. New owner's or signing official's name and title: Paul Wilson
(Person legally responsible for permit)
NA Environmental Leader' Last Mile
(TIIIC'11 e)
I
5. Mailing address: NA Environmental Department - Amazon.com City: Seattle, PO Box 80842
State: WA Zip Code: 98108 Phone:( 951 ) 445-7785
E-mail address:
amazon-eau-northamerica(Marnazon.COrrl
6. New facility name (if applicable):
Prime Now LLC - UNC2
7_ Efferiiye rule of transfer or name Change:
05/04/2022
r/ D.E
A North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
,Lj,/'A 512 North Salisbury Street ! 1612 Mail Service Center I Raleigh, North Carolina 27699-1612
9]9.707.9200

NPDES otormwaterr Permit Name/Ownership Change
Page 2 of 2
III. PERMIT AND FACILITY CONTACT INFORMATION
o. New permit contact's name and title: Paul Wilson
(F'er(Tili 4Ur1tdGL)
NA Environmental Leader— Last Mile
(Title)
., a ikn address.- nln In 1 rlepa..+... ent n .-:ty: Seattle, PO Box 8n842
7. MallI auu eJS: �Yr-��.nJiro iuiien�a�vcNdiunc���-r�mazi�n.wi�i L,ILy, a«t., vuvn v
I A I A
State: °°M Zip Code: 98108 Phone: ( 951 ) 445-7785
E-mail address: [e-mail]
10. New facility contact's name and title: Paul Wilson
(Facility Contact)
NA Environmental Leader — Last Mile
(Title)
nn� i rt _4,4 o« NA Environmental Department - Amazon.com rr Seattle, PO Box 80842
1 N, a i.i i � g ouur�o� r;ty:
State: WA Zip Code: 98108
Phone: ( 951 ) 445-7785
E-mail address: [e-mail]
12 New billing con ad's e: Oau la Salomon
IYI.VY N��l��15 \.V��tPVi J .:amp.
(Billing Contact)
13. Mailing address: NA Environmental Department - Amazon.com City: Seattle, PO Box 80842
State: WA Zip Code: 98108 Phone: ( 206 ) 206-1036
E-mail address: [e-mail]
IV. FACILITY ACTIVITIES AND DISCHARGE INFORMATION
1. Will industrial activities at the facility remain the sarne asunder the previous owner?
Yes I2l No ❑
2. Will the stormwater discharge location(s) remain the same? Yes L3 No ❑
1110" E: if either of these questions is answered 'Iyfo,then r -fore lf1jurmativn is needed to review
irre ieUueSi. rreuse r.itiucri uucuirrEniUilur) iu uescriue u exulOirr trre cnuiriies iu ine Icruury
4 activities, stormwater discharges, andlor outfall location. Depending on the information
provided, the Division may require that the new owner file a new permit application.
Last Revised 3/ 13/2022

NPDES-Stermwater permit Name,/Ownership -Change
Page 2 of 2
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS
ALL OF THE ITEMS LISTED BELOW ARE INCLUDED.
REQUIRED ITEMS:
1. This completed application form (with original signature)
2. Legal documentation of transfer of ownership (such as relevant pages of a deed or a bill of sale) is
required for an ownership change request. Articles of incorporation are not sufficient for an
ownership change but can be provided for a game change.
3. Information to document facility, industrial activities, stormwater discharges, or outfall changes
as noted in item IV above (if appropriate)
Why is this information needed?
Regulations in 40 CFR §122.63 allow for minor modifications to NPDES permits for a change of
ownership or operational control of a facility, provided that information supports that no other change
in the permit are necessary.
Why does this form need to be mailed in?
Permittees and applicants must fulfill signatory requirements in the NPDES federal
regulations in 40 CFR §122.22 (please see those regulations for guidance). Until NCDEQ's
electronic submission process meets Cross -Media Electronic Reporting (CROMERR)
requirements, this original signed (not digital signature) form must be mailed to the
address below. The uploaded copy is stored as part of the permit record in the Division's
digital repository.
Applicant's Certification:
I, Paul Wiison , attest that the application for a name and/or ownership
change submitted 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 package will be considered
incomplete and may be returned.
Signature: Date: ! ��
THE COMPLETED APPLICATION AND ALL SUPPORTING INFORMATION SHOULD BE SENT TO:
DErVlLR Stormwater Program
512 =North Safisbury Street, 6tn door (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
I — On-i-4 a P' 3lln )I