NCS000021_Permit contact update request_20230714 (2)

DEQNPDES Stormwater Permit Contact Update
Request
NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number.
Number* NCS000021
Begins with NCS,NCG,or NCGNE(no exposure)
The information below is auto-filled after the permit number is entered and you click outside the box:
Permittee* Siemens Energy Inc
Facility Name* Charlotte Turbine Generator Service Center
County* Mecklenburg
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
M Other Contact Update
Permit Contact Update
Provide new permit contact information
* This person should REPLACE the current permit contact.
This person should just be added as another permit contact.
New Contact Name* First and Last Name
Byron Miller
E-mail Address* [e-mail]
Phone No.* 980-228-7540
Mailing Address* 5101 Westinghouse Blvd.
Charlotte, NC 28273
Physical Address If different than mailing address
..........................................................................................
* This person should REPLACE the current permit contact.
This person should just be added as another permit contact.
New Contact Name* First and Last Name
Ken Ball
E-mail Address* [e-mail]
Phone No.* 980-833-3360

Mailing Address* 5101 Westinghouse Blvd.
Charlotte, NC 28273
Physical Address If different than mailing address
Add another permit contact if needed by clicking the'Add'button below
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
Richard Pope
E-mail Address* [e-mail]
Phone No.* 704-530-7150
Mailing Address* 5101 Westinghouse Blvd.
Charlotte, NC 28273
Physical Address If different than mailing address
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 Changes to personnel.
another contact
update:*
Submitter's Name* Please enter your FIRST and LAST name
Damon Crowther
Phone Number* Please enter your phone number
704-737-3028
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*
Date 7/14/2023
Questions? Contact [e-mail].