NCG030427_SW Permit DOSA_20220916

NC Department of Environmental Quality
Division of Energy, Mineral and Land Resources
E.rl : ip'orm.nfcai f�uuFity
Storm- titer Permit tion of Sig -nature Authority Form
Directions are in red.
=> This farm shall be used to delegate signature authority from than perm t Owner (Fer ittee) to
another pares. 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 mote that delegating
signature authority does not relieve the Permit Omer from the responsibility for permit
compliance.
The permit Owner�is the legal entity to whichfwhom a permit has been issued.. and maybe an individual
oran organization such as a company orgovernment agency. Rvany ©vdrre; is recluire d to nave a
Responsible Official who meets the legal signature authority requirements in 40 1.22 2?, summarized
below.
For a corporation, the Responsible Officiaf shall be a president, secretary, treasurer,, or vrce-
president in charge of a principal business function, or another- individual who perfonrs simiier
functions for the conooration, or the manager of one or more manufacturing, production, or operating
facfl;tles who is authorized o make management decisions about free f,cility operation.
For a partnership, or sole proprietorship, the Responsible Official shall be a general partner or the
proprietor, respectively; or
For a municipalky, State, Federal, or ob; er public agency., the Responsible Official sha=i be either a
principal executive aff°cer [City/County Maragerl or ranking elected official [Mayor].
=> Ever; if delegated signatory authoritl has been delegated to another individual, :he Responsible Official
retains responsibility for compliance with per, iiit ccnditions.
Organization dame:
GKN Drivel Alamance
Responsible Official Name:
Gregory Brinker
Responsible Official Title:
Plant Director
Email Address:
[e-mail]
Phone
919-304-7200
Mailing Address`.
1067 Trollingwood Hawftelds Rd
City:
Mebane
I State:
NC
I 2iP
27302
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:
Lauren Lowe
Delegated Party Title:
Environmental, Health, and Safety
Permit Number:
NCG030427
Email Address:
[e-mail]
I Phone:
919-304.7336
Mailing Address:
1067 Trollingwood Hawfields Rd
City:
Mebane
I State:
NC
I Zip:
27302
Signature of Delegated Party indicating
acceptance of Signatory Authority:
C�Lmm C�4�
Date:
Delegated Party Name:
Jorge Sotoperez
Delegated Party Title:
Healthy & Safety
Permit Number:
NCG030427
Email Address:
[e-mail]
Phone:
919-304-7200
Mailing Address:
1067 Trollingwood Hawfields Rd
City:
Mebane
State:
NC
Zip:
27302
Signature of Delegated Party indicating
acceptance of Signatory Authority:
II
.,.J. S'r'I
Date:
at I kZ (z.t
Delegated Party Name:
Nathaniel Lee
Delegated Party Title:
Quality & Risk Manager
Permit Number:
NCG030427
Email Address:
[e-mail]
Phone:
919-304-7200
Mailing Address:
1067 Trollingwood Hawfields Rd
City:
Mebane
I State:
NC
I ZIP:
27302
Signature of Delegated Party indicating
acceptance of Signatory Authority:
_f
Date:
C1 ,- l - ZZ
Delegated Parry Name:
Delegated Party Title:
Permit Number:
Email Address:
Phone:
Mailing Address:
City:
State:
Zip:
Signature of Delegated Party indicating
acceptance of Signatory Authority:
Date:
Stormwater 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, Gregory Brinker (printed name),
have the authority to enter into this Agreement for
GKN Drivel Alamance
(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 1, 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, 1, Gregory Brinker (printed name),
have read, understand, and accept the terms and conditions of the stormwater permit(s) for
which I am the Responsible Official. .
M
Responside 6fficial Signature yy / j -}
R..4 b,VICAor
Title Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3