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Home My WebLink AboutNCS000208_Permit Contact Update Request_20221130Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 11/30/2022 9:33:52 AM (Permit Contact Update Request) Approve by Tran, Kieu M 12/5/2022 10:50:40 AM (Contact Update Review) • The task was assigned to Tran, Kieu M. The due date is: January 11, 2023 5:00 PM 11/30/2022 9:33 AM Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number. Number* NCS000208 Begins with NCS, NCG, or NCGNE (no exposure) Facility Name* Military Ocean Terminal Sunny Point (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 Permit Contact Update Provide new permit contact information This person should REPLACE the current permit contact. This person should just be added as another permit contact. New Contact Name* First and Last Name ADRIENNE'AT ROGERS E-mail Address* ADRIENNE.M.ROGERS.CIV@ARMY.MIL Phone No.* 910-457-8425 Mailing Address* SDAT-MID 6280 SUNNY POINT ROAD SOUTHPORT. NC 28461 Physical Address If different than mailing address Add another permit contact if needed by clicking the'Add' button below 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 ADRIENNE'AT ROGERS E-mail Address* ADRIENNE.M.ROGERS.CIV@ARMYMIL Phone No.* 910-457-8425 Mailing Address* SDAT-MID 6280 SUNNY POINT ROAD SOUTHPORT, NC 28461 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 ADRIENNE'AT' ROGERS E-mail Address* ADRIENNE.M.ROGERS.CIV@ARMYMIL Phone No.* 910-457-8425 Mailing Address* SDAT-MID 6280 SUNNY POINT ROAD SOUTHPORT, NC 28461 Physical Address If different than mailing address Add another facility contact if needed by clicking the 'Add' button below Submitter's Name* Please enter your FIRST and LAST name DAVID VON KOLNITZ Phone Number* Please enter your phone number 910-457-8422 Any format is fine. Email Address* Please enter a valid e-mail address DAVID.M.VONKOLN ITZ.CTR@ARMYMIL 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 G c� eo dal,Y,& Date 11 /30/2022 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCS000208