NCGNE0641_Name-Owner Change Application_20230530

4,01
- Cornerstone
ENVIRONMENTAL HEALTH AND SAFETY INC
ISO 4001.2015 REGISTERED QUAE11v 5051EM
May 18, 2023
DEMLR Stormwater Program
512 North Salisbury Street, 6Ih Floor(Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
Re: NPDES Stormwater Permit Name/Ownership Change
Facility Name Change
Stormwater Discharge, No Exposure Certificate Permit No: NCGNE0641
Dear Sir/Madam:
Cornerstone Environmental, Health and Safety Inc. is pleased to submit this NPDES Stormwater Permit
Name/Ownership Change for a name change concerning the Stormwater Discharge, No Exposure Certificate for
the facility known as"Hitachi Astemo Greenfield, LLC." (located at 4047 McNair Road, Tarboro, NC 27886). As of
April 1st, 2023,the company's legal name was changed from"Hitachi Astemo Greenfield, LLC."to"Hitachi Astemo
Indiana, Inc.". The attached form is signed by the Signing Official.
Should you have any questions or concerns regarding this permit application, please do not hesitate to contact me
directly at [phone] or [e-mail].
Best regards,
011 ' I '
fi i ?if 1 4141441
Jonathon Lewis
EHS and Sustainability Associate
880 Lennox Court,Zionsville,IN 46077 [phone] Fax[phone] www.corner-enviro.com

;`` NC DEPARTMENT OF ENVIRONMENTAL QUALITY
' DIVISION OF Energy, Mineral, and Land Resources
STORM WATER PROGRAM
NORTH CAROLINA
Environmental Quality
NPDES STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NCS / / / / / or NCG N/ E / 0 / 6 / 4 / 1
1. Facility Name (prior to change): Hitachi Astemo Greenfield LLC
II. NEW OWNER/NAME INFORMATION:
2. This request for a name change is a result of:
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):
Pi I T at L, p C +t tvI C n c11 a n ik -r,c -
r
4. New owner's or signing official's name and title: David Catt C
(Person legally responsible for permi
Plant Manager
(Title)
5. Mailing address: 4047 McNair Rd City: Tarboro
27886
State: NC Zip Code: Phone: ( 252 ) 641-6750
E-mail address: [e-mail]
6. New facility name(if applicable): Hitachi Astemo Indiana, Inc.
7. Effective date of transfer or name change: April 1st, 2023
D
-y J� 51 No2rthNorth Carolina DepartmentSalisburyStreet of Environmental
Mail Quality I DRivisionaleigh.North of Energy.Mineral and Land Resources
11612 Service Center I 21699 1612
/'/ 9I9.7079200

NPDES Stormwater Permit Name/Ownership Change
Page 2 of 2
III. PERMIT AND FACILITY CONTACT INFORMATION
8. New permit contact's name and title: John Foster
(Permit Contact)
EHS Manager
(Title)
9. Mailingaddress: 4047 McNair Rd City: Tarboro
State: NC Zip Code: 27886 Phone: ( 252 ) 343-5292
E-mail address: [e-mail]
10. New facility contact's name and title: John Foster
(Facility Contact)
EHS Manager
(Title)
11. Mailing address: 4047 McNair Rd City: Tarboro
State: NC Zip Code: 27886 Phone: ( 252 ) 343-5292
E-mail address: [e-mail]
12. New billing contact's name: John Foster
(Billing Contact)
13. Mailing address: 4047 McNair Rd Tarboro
City:
State: NC Zip Code: 27886 Phone: ( 252 ) 343-5292
E-mail address: [e-mail]
IV. FACILITY ACTIVITIES AND DISCHARGE INFORMATION
1. Will industrial activities at the facility remain the same as under the previous owner?
Yes ErNo ❑
2. Will the stormwater discharge location(s) remain the same? Yes E' 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 PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION 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 be mailed in?
Permittees and applicants must fulfill signatory requirements in the NPDES federal
regulations in 40 CFR §122.22 (please see those regulations for guidance). Until NCDEQ's
electronic submission process meets Cross-Media Electronic Reporting (CROMERR)
requirements, this original signed (not digital signature) form must 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,7DA A. A1 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:, � (/\1 . ' 1 Date: Z 3/ 2c 2---
THE COMPLETED APPLICATION AND ALL SUPPORTING INFORMATION SHOULD BE SENT TO:
DEMLR Stormwater Program
512 North Salisbury Street, 6th Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
Last Revised 3/13/2022