NCG030238_Permit Contact Update Request_20231228

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 12/28/2023 3:24:44 PM (Permit Contact Update Request)
Approve by Austin Sanderford 2/7/2024 9:28:07 AM (Contact Update Review)
0 Updated
• The task was assigned to DEMLR SW Admin General.The due date is: February 8,2024 5:00 PM
12/28/2023 3:24:49 PM
• The task was assigned to Joyce Sanford by round robin distribution 12/28/2023 3:24:49 PM
• Joyce Sanford reassigned the task to Austin Sanderford 1/24/2024 9:38:36 AM

DEQIwo NPDES Stormwater -Request
Request Submitted
NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number.
Number* NCG030238
Begins with NCS,NCG,or NCGNE(no exposure)
Facility Name* Siemens Energy Inc
(Used to verify permit number)
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
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
Van Sullivan
E-mail Address* [e-mail]
Phone No.* 336-408-3688
Mailing Address* 3050 Westinghouse Rd.
Rural Hall, NC 27045-4699
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
Srikanth Parvathaneni
E-mail Address* [e-mail]
Phone No.* 407-516-6806
Mailing Address* 3050 Westinghouse Rd.
Rural Hall, NC 27045-4699

Physical Address If different than mailing address
................................................................................................................................
Add another permit contact if needed by clicking the'Add'button below
Stormwater Program's Billing Specialist will be notified about the billing update request by email upon approval.
Billing Contact Update
Provide new billing contact information
.................................................... ........................
Note:This person will REPLACE the current billing contact.We can only designate one billing contact in our
permitting database.
New Contact Name* First and Last Name
Tarasingh Rawat
E-mail Address* [e-mail]
Phone No.* 770-298-6315
Mailing Address* 3050 Westinghouse Rd.
Rural Hall, NC 27045-4699
Physical Address If different than mailing address
....................................................... ...
Person(s) with Delegation of Signature Authority (DOSA)
...........................................
Delegation of Please upload the signed"Stormwater Permit Delegation of Signature Authority Form"
Signature Authority Siemens Energy NCG030238-Stormwater DOSA
558.84K6
Form Dated 12-28-23.pdf
pdf only
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
Cory Phillips
E-mail Address* [e-mail]
Phone No.* 704-806-3714
Mailing Address* 3050 Westinghouse Rd.
Rural Hall, NC 27045-4699
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 Please remove James Whiticar from the following Stormwater Contact roles:
another contact
update:* Permit Contact Person(Replaced by Van Sullivan above)
Permit Billing Contact(Replaced by Tarasingh Rawat above)
"Wet Signature"DOSA form will be submitted as required.
Submitter's Name* Please enter your FIRST and LAST name
Van Sullivan
Phone Number* Please enter your phone number
336-408-3688
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
Viet liY&a
Date 12/28/2023
Questions? Contact [e-mail].

Review
Verify Permit No.* Revise permit number below if incorrect.
NCG030238