NCC205268_Contact Update Request_20231206

NCG01 Legally Responsible Individual Change Form
Use this form when:
The person who is legally responsible for the permit has changed, but there is NO CHANGE in the project name
or ownership.
**If the project name has changed, or if the ownership of the project has changed, do NOT use this form.**
Instead,you must submit a new NCG01 electronic Notice of Intent(eNOI).
Directions:
Print this form,complete,scan and upload to the Construction Stormwater Permit MODIFICATION Form.
Then, mail the original form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral& Land Resources Stormwater Program
512 N.Salisbury Street, 61h Floor(Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM UNTIL YOUR MODIFICATION HAS BEEN REVIEWED AND ACCEPTED AS COMPLETE.
THE FORM YOU MAIL MUST BE COMPLETER WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.22]
Certificate of Coverage(COC) Number: /yG� p-� 2— 6, 9
Name of Project: tr►t4 t' A06 �,,,e14'. JPLI�-
Legally Responsible Organizational Entity: tL L
PREVIOUS Legally Responsible Individual: Z_
NEW Legally Responsible Individual: D e-
The following section is to be completed and signed by the NEW Legally Responsible Individual.
Per NC General Statute 143-215.6E(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 1 of 2

CG 1 Legally Responsible Individual Change Form
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) [40 CFR 122.221
Under penaltyof law, I certify that(check all boxes to indicate your agreement):
Ld I am the person responsible for the construction activities of this project,for satisfying the
requirements of this permit, and for any civil or criminal penalties incurred due to violations of this
/permit.
Cl' I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and
— Sediment Control Plan.
Lid'/If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan)of the NCG010000 General Permit, I will nonetheless ensure that all conditions of
Part II of the permit are met on the project at all times.
1 understand that coverage under this permit will constitute the permit requirements for the
discharge(s) and is enforceable in the same manner as an individual permit.
C�This form has been reviewed and is accurate and complete to the best of my knowledge.
*Signature: Date: IZ _6 - Z02-3
Print Name of Signed:
Title: } y� 0
Mailing Address: ►2_s aft �r,�4
Street Address: rZ 5- 49
Email Address:
Phone Number:
* IMPORTANT NOTE: This form must be signed by a responsible corporate officer that owns or operates the
construction activity,such as a president,secretary, treasurer, or vice president, or a manager that is
authorized in accordance with Part IV,Section B, Item (6)of the NCG010000 permit.
For more information on signatory requirements,see Part IV,Section B, Item(6)of the NCG010000 permit.
Page 2 of 2

Georgoulias, Bethany
From: Dayne Willis <[e-mail]>
Sent: Wednesday, December 6, 2023 12:48 PM
To: Georgoulias, Bethany; Claude Dube; Holloman, Tevye L
Cc: Amber Wasson; Brian Scott
Subject: [External] RE: Construction SW General Permit - NCC205268 Leg Responsible Update
Attachments: Xerox Scan_12062023124050.pdf
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Bethany,
Here is the scanned copy of this document.
Amber,
Please mail the original to the below address.
Thanks all,
DW
Dayne Willis
General Manager
AMES Copper Group LLC
125 Old Boiling Springs Rd.
Shelby, NC 28152
Email: dayne.willis(abamescoppergroup.com
Mobile: [phone]
Office: 1.980.552.3531
COPPER GROUP
From: Georgoulias, Bethany<[e-mail]>
Sent:Wednesday, December 6, 2023 12:35 PM
To: Claude Dube<[e-mail]>; Holloman,Tevye L<[e-mail]>
Cc: Dayne Willis<[e-mail]>
Subject: RE: Construction SW General Permit- NCC205268 Leg Responsible Update
Importance: High
Good afternoon,
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Thank you for letting us know. Because you are listed as the legally responsible person for this permit, it is very
important that Dayne complete the attached form and return it to us. He can email a scanned copy, but please also
send in the original. Then we will be able to update the legally responsible designation.
Please let us know if you have additional questions.
Thank you,
Bethany Georgoulias (she/her)
Environmental Engineer, Stormwater Program
DEMLR Laserfiche Administrator
Division of Energy, Mineral,and Land Resources
N.C. Department of Environmental Quality
919 707 3641 office
[e-mail]
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
Website: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
From: Claude Dube<[e-mail]>
Sent:Wednesday, December 6, 2023 12:17 PM
To: Holloman,Tevye L<[e-mail]>; Georgoulias, Bethany<[e-mail]>
Cc: Dayne Willis<[e-mail]>
Subject: [External] RE: Construction SW General Permit Annual Fee Received - NCC205268
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
The contact for AMES is Dayne Willis-General Manager.
Please remove my name from the contact list.
Regards,
Claude Dube
Chief Technical Leader
Cell: 843-209-0954
Direct: 704-471-6575
IMC-MetalsAmerica
135 Old Boiling Springs Road
Shelby, NC 28152-0648
Telephone [phone]
Facsimile [phone]
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Part of the PMR !Network
From: [e-mail]<[e-mail]>
Sent:Wednesday, December 6, 2023 10:55 AM
To: Claude Dube<[e-mail]>
Cc:[e-mail]; [e-mail]; ray@ hokenterprises.com
Subject: Construction SW General Permit Annual Fee Received - NCC205268
Dear Construction General Permit Permittee:
Certificate of Coverage (COC) no. NCC205268 has been successfully renewed by payment of the 2023 annual fee, as long
as all other annual fees have been paid. If no fees are owed,this project remains actively covered under North Carolina's
NPDES General Stormwater Permit for Construction Activities.
(Note, if this COC was recently terminated, the payment was successfully applied to invoice period.)
This COC is for AMES Copper Smelting Plant in Cleveland County, issued to MA Shelby, LLC.The payment was applied to
Invoice no. NCC205268-2023.
If you have any questions, please contact the Stormwater Program at(919) 707-3649, or visit https://deg.nc.gov/NCG01.
Be sure to add [e-mail] to your contacts to avoid future a-mails from going into Spam filters.
The INC DEMLR Stormwater Program
512 N. Salisbury Street, Archdale Building 6th Floor(640K), 1612 Mail Service Center, Raleigh, NC 27699-1612
This email was automatically generated by Laserfiche. Please do not respond to this email address, as responses are not
monitored.
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.
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