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HomeMy WebLinkAboutNC0086827_Renewal (Application)_20240202ROY COOPER :a MICHAEL S. RFGAN LINDA CULPEPPER Water Resources ENVIRONMENTAL QUALITY PERMIT NAME/OWNERSHIP CHANGE FORM I. CURRENT PERMIT INFORMATION: Permit Number: NCO086827 or NCG5_/ /_/_/_ 1. Facility Name: Brenntaq/Durham remediation 11. NEW OWNER/NAME INFORMATION: 1. This request for a name change is a result of: a. Change in ownership of property/company b. Name change only _X_ c. Other (please explain): Change in responsible official only. 2. New owner's name (name to be put on permit): 3. New owner's or signing official's name and title: Chris Isaacs (Person legally responsible for permit) Regional SRQ Manager (Title) 4. Mailing address: 2000 East Pettigrew Street City: Durham State: NC Zip Code: 27703 Phone: 3174434104 E-mail address: chris.isaacs(a)brenntag.com THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL. REQUIRED ITEMS: 1. This completed application form 2. Legal documentation of the transfer of ownership (such as a property deed, articles of incorporation, or sales agreement) [see reverse side of this page for signature requirements] State of North Carolina I Environmental Quality I Water Resources 1617 Mail Service Center I Raleigh, NC 27699-1617 919 807 6300 919-807-6389 FAX httpsJ/deq. ne.gov/about/d ivisions/water-resources/water-resources-perm its/wastewater-brancb/npdes-wastewater-perm its NPDES Name & Ownership Change Page 2 of 2 Applicant's Certification: I, Chris Isaacs , attest that this application for a name/ownership change 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 and that if all required supporting information and attachments are not included, this application package will be returned as incomplete. Signature: Date: ;2— THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS: NC DEQ / DWR / NPDES 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Version 1112017