NCG050153_SW Permit DOSA_20230503

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
DOUGLAS R. ANSEL
Interim Director
NORTH CAROLINA
Environmental Quality
Stormwater Delegation of Signature Authority Form (DOSA)
This form shall be used to delegate signature authority from the permit Owner (Permittee) to
another party. 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 note that delegating
signature authority does not relieve the Permit Owner from the responsibility and compliance for
permit compliance.
Permit Owner: The legal entity to which/whom a permit has been issued and may be an individual
or an organization such as a company or government agency. Every Owner is required to have a
Responsible Official who meets the legal signature authority requirements in 40 CFR 122.22,
summarized below:
• For a corporation, the Responsible Official shall be a president, secretary, treasurer, or vice president
in charge of a principal business function, or another individual who performs similar functions for
the corporation, or the manager of one or more manufacturing, production, or operating facilities
who is authorized to make management decisions about the facility operation.
• For a partnership or sole proprietorship, the Responsible Official shall be a general partner or the
proprietor, respectively; or
• For a municipality, State, Federal, or other public agency, the Responsible Official shall be either a
principal executive officer [City/County Manager] or ranking elected official [Mayor].
Please mail the DOSA Form with original wet signatures to: NCDEMLRStormwater
Program, 1612 MSC, Raleigh, NC 27699-1612
Name of Organizational Entity
Cascades Tissue Group - Rockingham, a division of Cascades Hold
Responsible Official Name
Jean -David Tardif
Responsible Official Title:
President and Chief Operating Officer
Email Address:
[e-mail]
Phone
1 [phone]
MailingAddress
PO Box 578, 805 Midway Rd.
city
Rockingham
State
NC
Zip code
28380-0578
D North Carolina Department of Environmental Quality 1 Division of Energy, Mineral and Land Resources
512 North Salisbury Street 1 1612 Mail Service Center 1 Raleigh. North Carolina 27699-1612
919.707.9200
Ing US Inc.

A. Persons to Receive Signature Authority
The signatures of the persons listed below indicates their acceptance of signatory authority.
Attach additional pages if you need more space.
Delegated Party Name
John Quick (Primary)
Delegated Party Title
Mill Manager
Permit Number(s)
NCG050153
Email Address:
John Quick Cascades.com
Phone
901-489-6520
MailingAddress
PO Box 578, 805 Midway Rd.
city
Rockingham
State
NC
Zip code
28380-0578
Signature of Delegated Party
indicating acceptance of
Signatory Authority:
Date
i /2 23
Delegated Party Name
Karen Bellamy (Secondary)
Delegated Party Title
Environmental Manager
Permit Number(s)
NCG050153
Email Address:
Karen_Bellamy@Cascades com
Phone
910-995-8292
MailingAddress
PO Box 578, 805 Midway Rd
city
Rockingham
State
NG
Zip code
28380-578
Signature of Delegated Party
indicating acceptance of
Signatory Authority:
` vv✓v
Date
04/24/23
Delegated Party Name
Delegated Party Title
P ermit N umber(s)
Email Address:
Phone
MailingAddress
city
State
Zip code
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, Jean -David Tardif
have the authorityto enter into this Agreement for
(printed name),
Cascades Tissue Group - Rockingham, a division of(Owner/Organization Name).
Cascades Holding US Inc.
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 I, and the persons listed in Part A of this form work at/for my
organization and have authorityto act as a signatory for purposes of the NCDEQ's
electronic document systems.
By submitting this application, I,Jean-David Tardif
(printed name), have read,
understand, and accept the terms and conditions of the stormwater permit(s) for which I
am the Responsible Official.
Responsible Official Signature
President and Chief Operating Officer,
Cascades Tissue Group, a division of
Cascades Canada ULC.
Title
04/24/23
Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy. Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
land Resources
ENVIaONMENTAL QUALITY (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit (or) Certificate of Coverage or No Exposure
N I C I S I I I N IC I G 10 15 10 1 5 3
2) Facility Information:
Facility name: Cascades Tissue Group - Rockingham, a division of Cascades Holding US Inc
Company/Owner Organization: Cascades Tissue Group, a division of Cascades Holding US Inc
Facility address: 805 Midway Rd
Address
Rockingham North Carc 28379
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
littps://deg.iic.,ov/about/divisions/eiier,(y-m ineral-land-resources/eiier�-,_y-mineral-lancl-perm itS/npdeS-industi-ial-
lrogram and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Corey Wyand
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit:
John Quick
First MI Last
Page 1 of 2
S WU-OWNERAFFIL4Nov2019

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
5) Reason for this change:
A result of:
If other please explain:
Mill Manager
Title
PO Box 578 805 Midway Rd.
Mailing Address
Rockingham NC 28380
City State Zip
(910 ) 895-4033 John [e-mail]
Telephone E-mail Address
(910 ) 895-9887
Fax Number
❑✓ Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
1, Jean -David Tardif , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processed. L�/
ZV_
05/02/2023
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website
at: littp://deg.nc.gov/about/divisions/energy-mineral-land-resotu•ces/stormwater
Page 2 of 2
S WU-0WNERAFFIL-4Nov2019

BOOK 1743 PAGE 365(2)]A3665
�IMI�16N�11�l�B
Filed: 02/15/2017 09:55:19 AM
Linda W. Douglas, Register of Deeds
Richmond Countv. NC
4;2� --n/
L!/ Deputy
CERTIFICATE OF ASSUMED NAME FOR CORPORATION
The undersigned corporation, proposing to engage in business in Richmond
Carolina. under an assumed name other than its corporate name, hereby certifies that:
1. The assumed name under which the business is to be conducted is:
Cascades Tissue Group - Rockingham
2. The names and address of the owner(s) of the business is (are):
Cascades Holding US Inc.
4001 Packard•Road, Niagara Falls, NY 14303-2202
County, North
In witness whereof, this certificate is signed in the name of the corporation by its Assistant Secretary
this 27th
day of January
NC010- 04J3012008 C TSyslcm On inc
2017
Cascades Holding US Inc.
(Title)
(Name of Corporation)
(Signature and Title)
Revised 6/8/2007

Notary Acknowledgment for the "Certificate of Assumed dame for Corporation"
State of Province pf Quebec, Canada
County of
1, Luce Ayotte a Notary Public for Province of Quebec County
State of , certify that Louise Paul
personally appeared before me this day and acknowledged that he/she is Assistant Secretary
(Title of Official)
of Cascades Holding US Inc. Corporation; and that he/she as Assistant Secretary
(Name of Corporation) (Title of Official)
be.ing authorized-to-do-so,—e-cecuted-the-fore-goir-instr-ument on-beha-I# e,f-the-said-eorporat-ion.
Witness my hand and official seal, this the 27th day of January 17
fii'lir.:r 500
'guy _55.
Notary Public
My Commission Expires: 11/12/2019
Month/Day/Year
2 Revised 6/8/2007
NCO 10 - 04/30/2008 C T System Online

BOOK 1673 PAGE 427(2) 231863
Filed: 1 11=014 01:1059 PM
Linda W. Douglas, Register of Deeds
Richmond CountV. NC
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