NCG080840_Owner Affiliation Change_20220803

LWA
D_E Q Division of Energy, Mineral, and Land Resources
moo•,\ / Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
FOR AGENCY USE ONLY
Date Received
Year
I Month
I Day
PERMIT OWNER AFFILIATION DESIGNATION FORM ut
(Individual Legally Responsible for Permit)
Use this form if there has been: DEMIR-Stormwater
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual' mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit (or)
N C S
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
Certificate of Coverage or No Exposure
N I C I G 10 18 0 8 4 0
of Charlotte - Sweden Road
City of Charlotte
4600 Sweden Road
Address
Charlotte NC 28273
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https:Hdeg.nc.gov/sw/ Navigate to the "NPDES Industrial Program" section and run the Stormwater Permit
Contact Summary Report for your permit number.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Mike
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit:
Davis
MI
Phil Reiger
First MI Last
Page 1 of 2
Last revised 20 Feb 2022

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
Director of General Services
Title
600 East Fourth Street
Mailing Address
Charlotte NC 28202
City State Zip
(704 ) 336-4896 [e-mail]
Telephone E-mail Address
Fax Number
5) Reason for this change:
A result of: 0 Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
Note: 40 CFR 122.22(c) requires an original signature (not digital)
PERMITTEE CERTIFICATION:
1, Phil Reiger , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of
my knowledge. I understand that if all required parts of this form are not completed, this change may not
be processed.
7100/2o Zz
i e Date
PLEASE SEND THE ORIGINAL SIGNED COPY OF THE COMPLETED
OWNER AFFILIATION CHANGE FORM TO:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website
at: http://deg.nc.gov/sw
Per NC General Statute 143-215.6B (i), 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 ... shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten thousand dollars ($10,000).
Page 2 of 2
Last revised 20 Feb 2022

Facility
COC Number
Previous Owner
New Owner
Previous Responsible Person
New Responsible Person
Permit Contact
City of Charlotte Light Vehicle Maintenance Facility
NCG080879
City of Charlotte Storm Water Services
City of Charlotte General Services
Michael Davis
Phil Rel er
Andrew DeCristofaro
City of Charlotte - Sweden Road Shop
NCG080840
City of Charlotte
MV of Charlotte General Services
Mike Davis
Phil Rei er
Andrew DeCristofaro
City of Charlotte - Central Yard
NCG080822
City of Charlotte
CitV of Charlotte General Services
Mike Davis
Phil Rei er
Andrew DeCristofaro
of Charlotte Fleet Management
NCG080063
Mecklenburg unty Fleet
CitV of Charlotte General Services
Michael Davis
Phil Rei er
Andrew DeCristofaro
.City
Northeast Equipment Maintenance Facility
NOG081006
City of Charlotte
City of Charlotte General Services
David Wolfe
Phil Rei er
Andrew DeCristofaro