NCG050152_Name-Owner Change Application_20221222

NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVIsION OF Energy, Mineral, and land Resources
STORMWATER PROGRAM,
NORTH CAROUNA
Elivironmenta! Qualfly
NPDES STORMWATER PERMIT NAME/OWNERSHIP_CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NCS_/_/_/_/_ /_ or NCG_DJ_B_/___Oj__J/_,5_ /_
1. Facility Name (prior to change): von Drehle Corporation LLC
ll. NEW OWNERMAME INFORMATION:
2. This request for a name change is a result of:
X a. Change in ownership of property/company
b. Name change only (Facility and/or Company)
c. other (please explain):
(for example, facility address update. Include additional attachments if necessary,)
3. New owner's name (name to be put on permit as Permittee):
Marcal Cordova LLC
4. New owner's or signing official's name and title: Michael Menning
(Person legally responsible for permit)
Mill Manager
5. Mailing address:
PO Box 159, 126 First Street
city:
(Title)
Cordova
State: NC Zip Code: 28330 Phone:( 910 ) 410-9131
E-mail address: [e-mail]
6. New facility name (if applicable): Marcal Cordova LLC
7. Effective date of transfer or name change: i Z — 21 — 2—
North Carolina Department or Environmental Quality I Division of Energy,hineralandLand Resources
512 North Salisbury Street 11612 A4all5e"Ice Center I Raleigh, North Carolina 27699-1612
�i�ITH tJ.'i?l Si\ A si
i44_Tm_ �=^d RA 919,7079200

NPDES Stormwater Permit Name/Ownership Change
Page 2 of 2
Ill. PERMIT AND FACILITY CONTACT INFORMATION
5. New permit contact's name and title: Michael M..enning
(Permit Contact)
Mill Manager
9. Mailing address:
State: NC
PO Box 159, 126 First Street
Zip Code.. 28330
(Title)
city: Cordova
Phone:( 910 ) 410-9131
E-mail address: [e-mail]
10. New facility contact's name and title:
11. Mailing address:
State: NC
E-mail address:
Mitchell L.uckie
(Facility Contact)
Process Engineer
(Title)
PO Box 159, 126 First Street City:
Cordova
Zip Code: 28330 Phone: (256 ) 496-6530
[e-mail]
12. New billing contact's name:
13. Mailing address:
State: NC
E-mail address:
Penny Wallace
(Billing Contact)
PO Box 159, 126 First Street city: _
Zip Code: 28330 Phone: ( 910
[e-mail]
IV. FACILITY ACTIVITIES AND DISCHARGE INFORMATION
Cordova
410-9131
1. Will industrial activities at the facility remain the same asunder the previous owner?
Yes IX No ❑
2. Will the stormwater discharge location(s) remain the same? Yes N No ❑
NOTE: If either of these questions is answered "No," then more information is needed to review
the request. Please attach documentation to describe and explain the changes to the facility
activities, stormwater discharges, and/or outfall location. Depending on the information
provided, the Division may require that the new owner file a new permit application.
Last Revised 3/13/2022

NPDES Stormwater Permit Name/Ownership Change
Page 2 of 2
THIS APPLICATION. ,P . CWiE.WILL NOT.B9 ACCEPTED BY,THC DIV.ISI©N .UNLESS
ALL OF THE ITEMS LISTED BELOW ARE INCLUDED.
REQUIRED ITEMS:
1. This completed application form (with original signature)
2. Legal documentation of transfer of ownership (such as relevant pages of a deed or a bill of sale) is
required for an ownership change request. Articles of incorporation are not sufficient for an
ownership change but can be provided for a name change.
3. Information to document facility, industrial activities, stormwater discharges, or outfall changes
as noted in Item IV above (if appropriate)
Why is this information needed?
Regulations in 40 CFR §122.63 allow for minor modifications to NPDES permits for a change of
ownership or operational control of a facility, provided that information supports that no other change
in the permit are necessary.
Why does this form need to he mailed in
Permittees and -applicants roust fulfill signatory requirements in the NPDES federal
re ulMloils in 4.0 CFR §122.22 (please see those rOg0kl t'WIS for guidance). Until iCf ECn s
electronic iubrnission process r eets Cross-Medla Electronic Reporting( ROMERR)
requirements, this original si Led (. d� it l signature) form rmis`r be mailed to the
address below. The uploaded copy is stored as part of the permit record in the Division's
digital repository,
Applicant's Certification:
I' l 44V / Y 1041 4, !i , attest that the application for a name and/or ownership
change submitted has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this application are not completed, or if all
required supporting information is not included, this application package will be considered
incomplete and may be returned.
Signature: Date:
THE COMPLE D APPLI ION AND LL SUPPORTING INFORMATION SHOULD BE SENT TO:
DEMLR Stormwater Program
512 North Salisbury Street, 61h door (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
Last Revised 3/13/2022