NCS000208_Name-Owner Change Application_20230601

D ", FOR AGENCY USE ONLY Division of Energy,Mineral, and Land Resources Date Received
''parts nu Fri rvn Land QualitySection/Stormwater Program Deparhnznt of Environmental Uual� � g Year Month Day
�/ National Pollutant Discharge Elimination System (NPDES)
PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
Use this form if there has been:
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 C S 0 0 0 2 0 8 N C G
2) Facility Information:
Facility name: MILITARY OCEAN TERMINAL SUNNY POINT
Company/Owner Organization: US ARMY
Facility address: 6280 SUNNY POINT ROAD
Address
SOUTHPORT NC 28461
City State Zip
To find the current legally responsible person associated with your permit,go to this website:
https://deq.nc.gov/sw/ Navigate to the "NPDES Industrial Program" section and am the Stormwater Permit
Contact Summary Report for your permit number.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: WILLIAM C ARNOLD
First MI Last
4) NEW OWNER AFFILIATION(legally responsible for the permit):
Person legally responsible for this permit: MALCOLM E CHARLES
First MI Last
Page 1 of 2
Last revised 20 Feb 2022

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
DIRECTOR, PUBLIC WORKS DIVISION
Title
6280 SUNNY POINT ROAD
Mailing Address
SOUTHPORT NC 28461
City State Zip
(910 ) 457-8410 [e-mail]
Telephone E-mail Address
( )
Fax Number
5) Reason for this change:
0 Employee or management change
A result of: 8 Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
Note: 40 CFR 122.22(c) requires an original signature (not digital)
PERMITTEE CERTIFICATION:
I, MALCOLM E.CHARLES ,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 t t if all required parts of this form are not completed,this change may not
be p cessed.
30 May 2023
Signature Date
PLEASE SEND THE ORIGINAL SIGNED COPY OF THE COMPLETED
OWNER AFFILIATION CHANGE 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(919) 707-9220 or visit the website
at: http://deq.nc.gov/sw
Per NC General Statute 143-215.6B(i),any person who knowingly makes any false statement,representation, or
certification in any application,record,report,plan,or other document filed or required to be maintained under this
Article or a rule implementing this Article . . . shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten thousand dollars($10,000).
Page 2 of 2
Last revised 20 Feb 2022

riT o DEPARTMENT OF THE ARMY
.-: .
(4 _� ""�:.���s,� MILITARY SURFACE DEPLOYMENT AND DISTRIBUTION COMMAND
'; /�, 596TH TRANSPORTATION BRIGADE
311 f '� 6280 SUNNY POINT ROAD SE
',III
�;" SOUTHPORT NC 28461-7800
\Low, .
SDAT-MID (25-50a) 05 December 2022
MEMORANDUM FOR Mr. Malcolm Charles
SUBJECT: Delegation of Authority to Sign Industrial National Elimination
Discharge Pollution System Stormwater Permits and Construction Stormwater
Management Permits
1. EFFECTIVE: You have been delegated the authority to sign Industrial National
Elimination Discharge Pollution System (NPDES) Stormwater Permits and Construction
Stormwater Management Permits as the Director of Public Works at Military Ocean
Terminal, Sunny Point.
2. AUTHORITY: AR 200-1, Environmental Protection and Enhancement, 13 Dec 2007;
40 Code of Federal Regulations 122.22.
3. PURPOSE: Delegates authority to sign Industrial NPDES Stormwater Permits and
Construction Stormwater Management Permits issued by the North Carolina
Department of Environmental Quality.
4. Period: Until officially relieved or reassigned.
FOR THE COMMANDER:
BLACKETER.CH BIACKEfER CUAD.J.1050588J
AD.J.1050598388 oats:2022.12.05 14:18:27-05ro0
CHAD J. BLACKETER
COL, LG
Commanding
CF:
PUBLIC WORKS Delegation of Authority File
ADMIN Delegation of Authority File