NCG030166_SW Permit DOSA_20230815

TIMKEN
Where You Turn
CERTIFIED MAIL
atthew Goins RETURN RECEIPT REQUESTED
Environmental Engineer January 30, 2023
Attn: DEMLR—Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Re: Timken Lincolnton Stormwater Delegation Documents
Certificate of Coverage No. NCG030166
Enclosed are the Stormwater Permit Owner Affiliation Designation Form and
Stormwater Delegation of Signature Authorization Form for the Timken Bearing
Plant Lincolnton NC.
We are submitting these forms below to update the information on the
• Stormwater Permit Owner Affiliation Designation Form
• Stormwater Delegation of Signature Authorization Form
These forms have been revised to reflect that Jonathan Waller is now the Authorized
representative and Matthew Goins is now the Responsible Officer for the Lincolnton
facility.
If you have any question or need any more information, please contact me at your
convenience.
Sincerely,
Matthew Goins
Sr. Environmental Engineer
The Timken Company
Mail Code: LIN-01
1000 Timken Place
Iron Station,N.C.28080
Telephone: [phone]
Facsimile: [phone]
[e-mail]

..DEQ ,,r) Division of Energy, Mineral, and Land Resources FOR AGENCY USE ONLY
N; �°�.. � \ /-" LandQualitySection /StormwaterProgram Date Renewed
�✓ ro 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 N C G 0 3 0 1 6 6
2) Facility Information:
Facility name: Timken Compant-Timken Bearing Plant
Company/Owner Organization: Timken Company
Facility address: 1000 Timken Place
Address
Iron Station NC 28080
City State Zip
To find the current legally responsible person associated with your permit,go to this website:
https:i.'deq.nc.gov sw Navigate to the"NPDES Industrial Program"section and run the Stormwater Permit
Contact Summary Report for your permit number.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Marty A Hallman
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Jonathan A Waller
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)
Plant Manager
Title
1000 Timken Place
Mailing Address
Iron Station NC 28080
City State Zip
(704 )736 2783
Telephone E-mail Address
(704 )736-6537
Fax Number
5) Reason for this change:
❑✓ Employee or management change
A result of: 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, Jonathan A. Waller , 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.
C,L el,Jak./L I - 3 o—2 3
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 [phone] or visit the website
at: http:r'rdeq.nc.gov/sw
Per NC General Statute 143-2I5.6B (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 of2
Last revised 20 Fcb 2022

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, .- -kip (printed name),
have the authority to enter into this Agreement for
rnt kRn C-0^+ *.N-A Z.;A.co 4 (Owner/Organization Name).
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 authority to act as a signatory for purposes of the NCDEQ's
electronic document systems.
By submitting this application,1, n ci n 4\- ck( . (printed name),have read,
understand,and accept the terms and conditions of the stormwaterpermit(s)for which I
am the Responsible Official.
Vicw,cutLA, a '2,,,gsl2,
Responsible Official Signature
I — 30--23
Title Date
Stormwater Permit Delegation of Signatory Authority Form
Page 3

ROY COOPER :- � -
n
Governor '.f 1
ELIZABETH S.BISER
Secretary ' `�'w..00'.
DOUGLAS R.ANSEL NORTH CAROLINA
Interim Director 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
signa tr hority does not relieve the Permit Owner from the responsibility and comp ' e 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
. l.r kA". /�CoN pc:„ - L;i,_o1,4.-far` -- ; fl14,,„-"
Responsible Official Name _
Responsible Official Title:
}p io kt--i- N(0.►1aq.tz r—
EmailAddress: J Phone 7o(I- .�3 b_�53�
..I0.+►v.,.w4[k►-@ r1,9 ktN.(0�
Mailing Address
7,7,„k;.. co,tpa.ty )Uuc 1;-,1ktv, t trice.,
City State Zip code
5 North512North Carolina
Sa1i.hur
Department of Environmental Quality Division of Energy,Mineral and Land Resources
` Str rrt 1612 Mali Service Center Raleigh,North Carolina 27699 16I2
• \ / 919 7079200

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 (YlQ Ga S
Delegated Party Title S r. G-(` L
n L.✓a.ti ,,,,,, c.i &'1,5 "its✓
Permit Numbers) AA. Cr., O30/Uf,
Email Address: Mu-14.kk.� , CTo...s cb Phone "709- 7 _a
Mailing Address J0 Ou
City ar. S �o„ State NC Zip code Z�o S 0
Signature of Delegated Party
indicating acceptance of
Signatory Authority:
Date /— 3o - -ZoZ3
Delegated Party Name
Delegated Party Title
Permit Number(s)
Email Address: Phone
Mailing Address
City State Zip code
Signature of Delegated Party
indicating acceptance of
Signatory Authority:
Date
Delegated Party Name
Delegated Party Title
Permit Number(s)
Email Address: Phone
Mailing Address
City State Zip code
Signature of Delegated Party
indicating acceptance of
Signatory Authority:
Date
Stormwater Permit Delegation of Signatory Authority Form
Page 2