HomeMy WebLinkAboutNCG020913_Permit Contact Update Request_20220816Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/16/2022 2:14:34 PM (Permit Contact Update Request)
Approve by Tran, Kieu M 8/19/2022 8:47:52 AM (Contact Update Review)
• The task was assigned to Tran, Kieu M. The due date is: September 27, 2022 5:00 PM
8/16/2022 2:14 PM
Request Submitted
NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number.
Number* NCG020913
Begins with NCS, NCG, or NCGNE (no exposure)
Facility Name* Sanford Quarry
(Used to verify permit number)
Check permit contact information for your permit by running a Stormwater Permit Summary Report.
Guidance for COC holders: Do not enter the General Permit number with all 0's (for example, NCG030000) but instead
your Certificate of Coverge (COC) number.
Check all that Owner Affiliation (Legally Responsible Individual) Update
apply: * Permit Ownership Transfer or Facility Name Change
Delegation of Signature Authority (DOSA)
Permit Contact Update
Billing Contact Update
Facility Contact Update
Other Contact Update
Stormwater Program's Billing Specialist will be notified about the billing update request by email upon approval.
Billing Contact Update
Provide new billing contact information
Note: This person will REPLACE the current billing contact. We can only designate one billing contact in our
permitting database.
New Contact Name* First and Last Name
Mark Williams
E-mail Address* MarkDWilliams@Luckcompanies.com
Phone No.* 804-784-6300
Mailing Address* PO Box 29682
Richmond VA, 23242
Physical Address If different than mailing address
................................................................................................
Facility Contact Update
Provide new facility contact information
• This person should REPLACE the current facility contact.
This person should just be added as another facility contact.
New Contact Name* First and Last Name
Mark Williams
E-mail Address* MarkDWilliams@luckcompanies.com
Phone No.* 804-784-6300
Mailing Address* PO Box 29682
Richmond VA 23242
Physical Address If different than mailing address
_.....................................................................................................................................................................
Add another facility contact if needed by clicking the 'Add' button below
Other Contact Updates
Only use this section if none of the categories above apply.
Provide details about Please update the Address in the "Owner Contact Person"
another contact Luck Stone Corporation from 1930 North.... to PO Box 29682, Richmond, VA 23242
update: * or Delete this line as the second line with Mark Williams information is accurate.
Submitter's Name* Please enter your FIRST and LAST name
Clint Zimmerman
Phone Number* Please enter your phone number
804-920-5373
Any format is fine.
Email Address* Please enter a valid e-mail address
clint.zimmerman@luckstone.com
A confirmation of submission will be e-mailed to this address.
* By checking the box and signing below, I certify that:
I have given true, accurate, and complete information on this form;
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");
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");
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature (except for any uploaded Owner Affiliation Change or Delegation of Signature of Authority forms, which
also must be mailed in with original signature); AND
I intend to electronically sign and submit this Permit Contact Update Request form.
Signature
Date
�UrJ��Anf
8/16/2022
Questions? Contact bethany.georgoulias@ncdenr.gov.
Review
Verify Permit No.* Revise permit number below if incorrect.
NCG020913