NCG190047_Name Ownership Change Form_20230901

NPDES Stormwater Permit Name/Owner Chang
Request
Facility Name* Maycraft Boats, LLC
NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number.
Number* NCG190047
Begins with NCS, NCG,or NCGNE(no exposure)
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 current owner and facility information for the permit by running a Stormwater Permit Summary Report.
Name/Owner Change Application Upload
Upload a copy of the completed and signed Permit Name/Owner Change Form below. We can begin making updates
with this submittal, but please note that you must mail in the original signed copy to our office, in accordance
with requirements in 40 CFR 122.22.
Name/Owner Change Please upload the signed"Permit Name/Owner Change Form"
Form Upload* DEMLR Stormwater Program 04.14.2022.pdf 3.05MB
pdf only
Supporting Please upload any supporting documents(if separate from above)
Documents Upload pdf only
Stormwater Industrial Permit holders who must submit discharge monitoring reports (DMRs): Once ownership
transfer for your permit is completed, be sure to complete the Six Step Process for eDMR registration.
Submitter's Name Please enter your FIRST and LAST name
Brenda Hale
Phone Number* Please enter your phone number
919-934-3000
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 the completed Name/Owner Change Form, which also must be mailed in with original signature);
AND
I intend to electronically sign and submit this Name/Ownership Change Request form.
Signature*
tme-a w�l
Date* 4/14/2022
Questions? Contact [e-mail].

March 14, 2022
DEMLR Stormwater Program
512 North Salisbury Street, 6th Floor(Office 640K)
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
RE: May-Craft Fiberglass Products, Inc.—Smithfield, North Carolina Plant
Name/Ownership Change
Dear Sir/Madam,
Maycraft Boats, LLC is purchasing the May-Craft Fiberglass Products, Inc., Smithfield Plant. Enclosed is
the Name/Ownership change application, including:
• Permit Name/Ownership Change Form
No additional changes are required at this time. If you have any questions regarding this submittal or
need additional information, please contact me at(919) 934-3000.
Sincerely,
MAYCRAFT BOATS, LLC
Stanley Palmer
Member

SiATr r
NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF Energy, Mineral, and Land Resources
.a•
•O:Rr+.MP•
STORMWATER PROGRAM
NORTH CAROL114A
Environmental Quality
NPDES STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NCS__J__J__J__j_/_ or NCG_1j_
1. Facility Name:_Iq4y- 09-AF'T' ri 856 (qL4= PG.cDoCTS,
11. 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). New facility name should be listed
above.
c. Other(please explain):
(for example,facility address update)
3. New owner's name(name to be put on permit as Permittee):
i AgC-AA r a•r-s L.L C
4. New owner's or signing official's name and title: Jrew D�:A__LmEJZ.
(Person legal) responsible for permit)
cpk
(Title)/ ®�
5. Mailing address: L'P ('( tLVROE6 )20 City: R O-IKS
State: MC Zip Code: 2�JSZ(� Phone: ( ` (q ) 53 OC4 - 3 0
E-mail address: bCb ® CST l a�►Ce�so$4 . Cary!
6. Effective date of transfer or name change: � �RE2 l Zo2
—E North Carolina Drpar tmcnt of Environmental Quality 1 Divisional Energy,6fineral and Land Resources
512 North Salisbury 51rert 11612 h1ail Sri vice Ccnter I Raleigh.North Carolina 27699 1612
90707.9100

NPDES Stormwater Permit Name/Ownership Change
Page 2 of 2
III. PERMIT AND FACILITY CONTACT INFORMATION ,J
7. New permit contact's name and title:
(Permit Con act)
(�I 41L'LSfDA?-0
(Title)
8. Mailing address: `1P /CD , City: , DUie OARS
State: N C Zip Code: 27S?-q Phone: ( L 1 q ) 173q- 3000
E-mail address: Ffe6AJL> MAt/CeAF- , -S C 49
9. New facility contact's name and title: GNAP /Y!
(Facilit/yC�onta t)
D i-�41JT �✓1.4N.4(��
(Title)
(j
10. Mailing address: -(je 4,"S43d)90 ia City: Q 6445
State:_L, Zip Code: Z7= Phone: ( R ij ) 93r4 - ?c4nn
E-mail address: 096r.1D0t (0-, A4AVCAAFT"R0A7'S Cdyy�
11. New billing contact's name: -eswE,4g A q4LS;
( (Billing Contact)
Q/I
12. Mailing address: 1� t-t 1i.L5f30,2Q )D City: rut 0,6LS
State: AJ C Zip Code: '2 7 524 Phone: ( q q ) lq3�- ?Zoo
E-mail address: b&24-ObA C3, titq I/CRAFTP,,,::,A7-S , CcM
IV. FACILITY ACTIVITIES AND DISCHARGE INFORMATION
1. Will industrial activities at the facility remain the same asunder the previous owner?
Yes PNo ❑
2. Will the stormwater discharge location(s)remain the same? Yes 0'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,storm water 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 3/2/2022

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:
I. 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, STAN3L&q PAL-#* r-2 , 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: 0Date:
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 3/2/2022