NCS000251_Name-Owner Change Form and Supporting Doc_20220721

NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF Energy, Mineral, and Land Resources
STORMWATER PROGRAM
NORTH CAROLINA
Environmental Quality
NPDES STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Permit Number: or
1. Facility Name (prior to change): Georgia—Pacific Chemicals LLC
IL NEW OWNER/NAME INFORMATION: RECEIVED
2. This request for a name change is a result of: JUL 1 1022
_a. Change in ownership of property/company
DEMLR-Stormwater Program
X 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):
Bakelite Chemicals LLC
4. New owner's or signing official's name and title: Robert Dalton
(Person legally responsible for permit)
Plant Manager
(Title)
S. Mailing address: P.O. Box 368 City: Conwa
State: NC Zip Code: 27820 Phone:( 404 ) 343-7545
E-mail address: [e-mail]
6. New facility name (if applicable): Conway Resin Plant
7. Effective date of transfer or name change: May 27, 2022
DEQJ� North Carolina Department of Environmental Quality I Division of Energy, Mineral and Land Resources
512 North Salisbury Street 1 1612 Mail Service Center I Raleigh, North Carolina 27699-1612
u+� / 919.707.9200

NPDES Stormwater Permit Name/Ownership Change
Page 2 of 2
III. PERMIT AND FACILITY CONTACT INFORMATION
8. New permit contact's name and title:
Tim Riddick
(Permit Contact)
Facility Environmental Manager
(Title)
9. Mailing address: P.O. Box 368 City: Conway
State: NC Zip Code: 27820 Phone: ( 252 ) 585-3819
E-mail address: timothy. riddick@bakelite .com
10. New facility contact's name and title: Tim Riddick
(Facility Contact)
Facility Environmental Manager
(Title)
11. Mailing address: P.O. Box 368 City: Conway
State: NC Zip Code: 27820 Phone:( 252 ) 5 8 5— 3 819
E-mail address: timothy. riddick@bakelite . com
12. New billing contact's name:
13. Mailing address:
P.O. Box 368
Tim Riddick
(Billing Contact)
City: Conway
State: NC Zip Code: 27820 Phone:( 252 ) 585-3819
E-mail address: [e-mail]
IV. FACILITY ACTIVITIES AND DISCHARGE INFORMATION
1. Will industrial activities at the facility remain the same asunder the previous owner?
Yes ® No ❑
2. Will the stormwater discharge location(s) remain the same? Yes ® No ❑
NOTE: If either of these questions is answered "No," then more information is needed to review
the request. Please attach documentation to describe and explain the changes to the facility
activities, stormwater discharges, and/or 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 Stormwater 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 name 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, Robert Dalton , 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:
*� vl:,EQ--
Date: ZZ
THE COMPLETED APPLICATION AND ALL SUPPORTING INFORMATION SHOULD BE SENT TO:
DEMLR Stormwater Program
512 North Salisbury Street, 6`h Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
Last Revised 3/13/2022

rA
Delaware Pagel
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY THE ATTACHED IS A TRUE AND CORRECT
COPY OF THE RESTATED CERTIFICATE OF "GEORGIA—PACIFIC CHEMICALS
LLC", CHANGING ITS NAME FROM "GEORGIA—PACIFIC CHEMICALS LLC" TO
"BAKELITE CHEMICALS LLC", FILED IN THIS OFFICE ON THE TWENTY—
SEVENTH DAY OF MAY, A.D. 2022, AT 9:45 O'CLOCK A.M.
4235646 8100
SR# 20222404388
H n� w. nee wa. a.rwr�r a aw.
Authentication:203539433
Date: 05-27-22
You may verify this certificate online at corp.delaware.gov/authver.shtml

• State of Delaware
Secretary, of State
Dhision of Corporations
Delp erect 09:45 AA105/2712022
FILED 09:45AI4I05/27a022 AMENDED AND RESTATED
SR 20222404388 - FileNumber 4235646
CERTIFICATE OF FORMATION
OF
GEORGIA-PACIFIC CHEMICALS LLC
Pursuant to Section 18-208 of the
Delaware Limited Liability Company Act
Georgia-Pacific Chemicals LLC, a Delaware limited liability company formed on
October 20, 2006, under its current name, does hereby certify, pursuant to Section 18-208 of the
Delaware Limited Liability Company Act, that its Certificate of Formation is hereby amended and
restated to read in its entirety as follows:
FIRST: The name of the limited liability company is Bakelite Chemicals
LLC (the "Com an ).
SECOND: The address of the registered office of the Company in the State of
Delaware is 251 Little Falls Drive, Wilmington, New Castle County, Delaware 19808.
The name of its registered agent at such address is Corporation Service Company.
[SIGNATURE PAGE FOLLOWS]
862323.02A-WRSROIA - MSW

IN WITNESS WHEREOF, the undersigned has executed this Amended
and Restated Certificate of Fornxation this 27th day of May, 2022.
GEORGIA-PACIFIC CHEMICALS LLC
By:
Name: can -Paul Aucoin
[Signature Page to Amended and Restated 'Certificate i f Formaf on of Georgia-PAcif c Chemicals LLC]

b
BAKELITE
ENVIRONMENTAL SIGNATORY AUTHORIZATION
The purpose of this document is to provide, pursuant to the requirements of the United States
Environmental Protection Agency or the appropriate state or local regulatory agencies, environmental
signatory authorization for designated management positions of the following facilities owned and
operated by Bakelite Chemicals LLC:
Albany, OR
Decatur, Ga R&D facility)
Beaver Creek, MI
Eugene, OR
Columbus, OH
Lufkin, TX
Conway, NC
Ta lorsville, MS
Crossett, AR
Management positions that are responsible for the overall operation of their respective facilities are
hereby delegated as having signatory authority for environmental permit applications, registrations,
certifications, compliance reports and other environmental documents or inquiries required or requested
by the regulatory agencies, as allowed by applicable federal, state and/or local regulations. These
designated managerial positions are the VP — Operations, Regional Manufacturing Managers, Complex
Managers, Plant Managers and persons acting in the position of Plant Manager, and the Director of
Research & Development.
This signatory authorization is intended to apply to the fullest extent that such designation of authority is
allowed by the applicable law, regulation and permit.
Bakelite Chemicals LLC
Cu�tit��lieGatt
Curtis Shelast (Jun 14, 30n M:58 COT)
Curtis Shelast, Americas General Manager
Date: Jun 14, 2022