NCG060089_Permit Contact Update Request_20221203

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/3/2022 10:36:02 AM (Permit Contact Update Request)
Approve by Tran, Kieu M 12/5/2022 11:33:51 AM (Contact Update Review)
• The task was assigned to Tran, Kieu M. The due date is: January 16, 2023 5:00 PM
12/3/2022 10:36 AM

Request Submitted
NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number.
Number* NCG060089
Begins with NCS, NCG, or NCGNE (no exposure)
Facility Name* Moody Dunbar Incorporated
(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
Debra Davis
E-mail Address*
[e-mail]
Phone No.*
9108923175
Mailing Address*
Dunbar Foods Corporation
P.O Box 519
Dunn, NC 28335
Physical Address
If different than mailing address
1000 S. Fayetteville Ave
Dunn, NC 28334
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
Brett Godwin
E-mail Address*
[e-mail]
Phone No.*
9108923175
Mailing Address*
Dunbar Foods Corporation
P.O. Box 519
Dunn, NC 28335
Physical Address
If different than mailing address
1000 S. Fayetteville Ave
Dunn NC, 28334
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 The Owner Contact Person is currently showing as Randy Sweigart on the NPDES
another contact Stormwater Permit Summary. This contact needs to be updated to Sony Yang.
update: *
Sony Yang
Phone: [phone]
Email: [e-mail]
Mailing Address: P.O. Box 519 Dunn, NC 28335
Submitter's Name* Please enter your FIRST and LAST name
Brett Godwin
Phone Number* Please enter your phone number
9108923175
Any format is fine.
Email Address* Please enter a valid e-mail address
[e-mail]
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
NZ6�#Aa

Date 12/3/2022
Questions? Contact [e-mail].

Review
Verify Permit No.* Revise permit number below if incorrect.
NCG060089