NCG200534_DOSA Form_20220615

RECEIVED
NC Department of Environmental Quality
vision of Energy, Mineral and Land Resources
NORTH CAROLINA DEmm-stormwater Progr2rfl
Envlmm mmf Qualffy
Stormwater Permit Delegation of Signature Authority Form
Directions are in red.
This form shall be used to delegate signature authority from the permit Owner (Permittee) to
another party. Only the Responsible Official defined below may submit permit applications and
reports required by the permit (such as Data Monitoring Reports and Annual Reports) until this
form is completed and submitted to the DEMLR Stormwater Program. Please note that delegating
signature authority does not relieve the Permit Owner from the responsibility for permit
compliance.
=> The permit Owner is the legal entity to which/whom a permit has been issued, and may be an individual
or an organization such as a company or government agency. Every Owner is required to have a
Responsible Official who meets the legal signature authority requirements in 40 CFR 122.22, summarized
below:
• For a corporation, the Responsible Official shall be a president, secretary, treasurer, or vice-
president in charge of a principal business function, or another individual who performs similar
functions for the corporation, or the manager of one or more manufacturing, production, or operating
facilities who is authorized to make management decisions about the facility operation.
• For a partnership or sole proprietorship, the Responsible Official shall be a general partner or the
proprietor, respectively; or
For a municipality, State, Federal, or other public agency, the Responsible Official shall be either a
principal executive officer [City/County Manager] or ranking elected official (Mayor].
=> Even if delegated signatory authority has been delegated to another individual, the Responsible Official
retains responsibility for compliance with permit conditions.
Organization Name: ISims Metal - New Bern Facility
Responsible Official Name: Fred Cornell
Responsible Official Title: Regional General Manager
Email Address: [e-mail] Phone: [phone]
Mailing Address: 4300 Buell Street
City: Chesapeake I State: IVA I ziP 23324
Stormwater Delegation of Signature Authority Form
Page 1

A. Persons to Receive Signatory Authority
The signatures of the persons listed below indicates their acceptance of signatory authority.
Delegated Party_Name:
Delegated Party Title:
Permit Number.
Email Address:
Melling Address:
City:
Signature of Delegated Party indicating
ae2
-6 me of Signatory Aulhodty:
Date:
Delegated Party Name:
Delegated Party Title:
Permit Number:
Email Address:
Mailing Address:
City:
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Title:
I Email Address: I
Delegated Party Name:
I Email Address: I
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Scott Scaggs _
EHS Specialist
NCG20053_4
[e-mail] Phone_ 757-793-3807
300 Buell Street _ _�" _
Chesapeake State_IvA I ZIP 123324
5/3112022
Phone
State: I I Zip: I
Phone:
Slate:
Phone_
State: I
Slormwater Permit Delegation of Signatory Authority Form
Page 2

B. Responsible Official Signature
The Responsible Official, as identified in accordance with 40 CFR 122.22, is the appropriate
individual with the authority to sign and submit reports for the organization.
As the Responsible Official, I, Fred Cornell (printed name),
have the authority to enter into this Agreement for
Sims Metal - New Bern Facility (Owner/Organization Name).
I request that the DEMLR Stormwater Program include the persons listed in Part A of this form
signatory authority for the above -named permit.
I acknowledge that I, and the persons listed in Part A of this form work at/for my organization
and have authority to act as a signatory for purposes of the NCDEQ's electronic document
systems.
By submitting this application, I, Fred Cornell (printed name),
have read, understand, and accept the terms and conditions of the stormwater permit(s) for
which I am the Responsible Official.
Responsible Official Signature
Regional General Manager
Title
5/31/2022
Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3