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HomeMy WebLinkAboutNCS000253_Permit Contact Update Request_20221026Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 10/26/2022 12:02:18 PM (Permit Contact Update Request) Approve by Tran, Kieu M 10/31/2022 10:58:54 AM (Contact Update Review) • The task was assigned to Tran, Kieu M. The due date is: December 7, 2022 5:00 PM 10/26/2022 12:02 PM Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number. Number* NCS000253 Begins with NCS, NCG, or NCGNE (no exposure) Facility Name* SOUTHEASTERN FOUNDRIES (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 ROBIN GROGAN E-mail Address* RGROGAN@SEFCORP.NET Phone No.* 336-299-7211 Mailing Address* 2706 OAKLAND AVE GREENSBORO NC 27403 Physical Address If different than mailing address ................................................................................................ Submitter's Name* Please enter your FIRST and LAST name TINA KELLY Phone Number* Please enter your phone number 336-299-7211 Any format is fine. Email Address* Please enter a valid e-mail address TKELLY@SEFCORRNET 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 10/26/2022 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCS000253