NCG050398_Owner Affiliation Change_20240221

�} Division of Energy, Mineral, and Land Resources FOR AGENCY USE ONLY
t Date Received
Ww d&PA,M,KflW or Land Quality Section/Stormwater Program Year Month I 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 I S N I C I G 10 15 10 13 Iflfl
2) Facility Information:
Facility name: K-Flex USA
Company/Owner Organization:
Facility address: 100 K-Flex Way
Address
Youngsville NC 27596
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https://deg.nc.gov/swl 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: Sheila Murray
First M I Last
4) NEW OWNER AFFILIATION(legally responsible for the permit):
Person legally responsible for this permit: Giuseppe Guarino
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)
President
Title
100 K-Flex Way
Mailing Address
Youngsville NC 27596
City State Zip
(919 ) 435-5533 [e-mail]
Telephone E-mail Address
(919 )
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:
1, Giuseppe Guarino , 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.
-7✓ )71-0
atut Date
PL ASE SEND 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://deg.nc.gov/sw
Per NC General Statute 143-215.613 (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 of 2
Last revised 20 Feb 2022

Georgoulias, Bethany
From: Mike Walker <[e-mail]>
Sent: Wednesday, February 21, 2024 11:03 AM
To: Sanford, Joyce
Cc: Georgoulias, Bethany; Victor Nagy
Subject: [External] RE: Permit Contact Update Request for NCG050398
Attachments: Step 1 - NPDES SW Permit Summary Report.pdf, DEQ Conact Update Submission.pdf,
K-Flex Owner Affiliation Form.pdf
Importance: High
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.
Joyce, Bethany,
I am circling back on this denied request to update the permit contacts for K-Flex USA. It appears that we used the
correct form, although the denial seems to suggest otherwise. I may have attached the incorrect form to the Update
Request, although the correct form was mailed to DEMLR.
The name of the "Legally Responsible Person" needs to be changed (see attached Permit Summary). We submitted the
"NPDES Stormwater Permit Contact Update Request" form,which required that the Owner Affiliation form be
submitted. These two are attached.
How do we proceed in making these changes to the record so that we can continue the eDMR registration process?
Thank you for your help.
Best Regards,
Michael L.Walker, PE I Vice President, Principal Engineer
The El Group, Inc.
Environmental, Health and Safety Solutions.TM
Direct: 919.459.5245
Mobile: [phone]
www.eil.com
From: Mike Walker
Sent:Thursday, December 7, 2023 1:39 PM
To: '[e-mail]' <[e-mail]>
Cc: [e-mail]; '[e-mail]' <[e-mail]>
Subject: RE: Permit Contact Update Request for NCG050398
Joyce,
I just left a message for you at the general stormwater number(919-707-9220).
1

I am circling back on this email exchange to resolve the issue to get my client registered for eDMR. I believe that the
hard copy of the signed form did not make it to your office. Can you confirm that is why this change was accepted and if
we can simply send it to you now? (Note that an electronic copy was attached to the request form.
Thank you and best regards,
Michael L.Walker, PE I Vice President, Principal Engineer
The El Group, Inc.
Environmental, Health and Safety Solutions.TM
Direct: 919.459.5245
Mobile: [phone]
www.eil.com
From: Mike Walker
Sent:Wednesday, October 11, 2023 2:08 PM
To: '[e-mail]' <[e-mail]>
Subject: Permit Contact Update Request for NCG050398
Joyce,
I received this notice:
Unfortunately we cannot process the Permit Contact Update Request for permit no. NCG050398 submitted
on 9/4/2023 any further. A Stormwater Program staff member will be in touch with more information.
Comments during review: Not Owner Affiliation Form
Please Let me know what the problem was and what we need to do. Feel free to call me (on my mobile).
Best Regards,
Michael L.Walker, PE I Vice President, Principal Engineer
The El Group, Inc.
Environmental, Health and Safety Solutions.TM
Direct: 919.459.5245
Mobile: [phone]
www.eil.com
2

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for your permit as of 8/30/2023.
Permit Number: NCG050398 Permit Status: Active
Permit Type: Apparel/Printing/Paper/Leather/Rubber Stormwater Discharge COC
Facility Name: K-Flex USA
Facility Addressl: 100 K-Flex Way
Facility Address2:
City,State&Zip: Youngsville, NC 27596
Owner Information Details:
MUST submit a Change of Name/Ownership form to DEMLR to make any changes to this Owner information.
(Click Here for "Change of Name/Ownershiv"Form)
Owner Name: K-Flex USA
Owner Type: Non-Government Owner Type Group: Organization
*** Legally Responsible for Permit ***
(Responsible corporate officer/principle executive officer or ranking elected official/general partner or proprietor;
or any other person with delegated signatory authority from the legally responsible person.)
Owner Affiliation: Sheila Murray Title:
Addressl: 100 Namaco Dr
Address2:
City,State&Zip: Youngsville, NC 27596
Work Phone: [phone] Fax: [phone]
Email Address: [e-mail]
*** Permit Annual Fee Billing ***
Billing Month: December
Invoice Number Invoice Date Invoice Due Date Invoice Amount Invoice Status
Owner Contact Person(s)
Contact Name Title Address Phone Fax Email
Giuseppe 100 Namaco Dr,Youngsville, NC 27596 919-435-5533
Guarino
Facility Contact Person(s)
Contact Name Title Address Phone Fax Email
Kraus 100 Namaco Dr,Youngsville, NC 27596 919-435-5530 klaus,winterholler@k
Winterholler flexusa.com
Permit Contact Person(s)
Contact Name Title Address Phone Fax Email
8/30/2023 Page 1

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Summary
NC DEMLR has the following information in our Permit Database for your permit as of 8/30/2023.
Permit Billing Contact(s)
Contact Name Title Address Phone Fax Email
Sheila Murray 100 Namaco Dr, Youngsville, NC 27596 919-435-5505 919-882-9869 sheila.murray@kflex
usa.com
Person(s) with Delegated Signatory Authority
Type Contact Name Title Address Phone Fax Email
Person(s) with Electronic Signature Authority
Type Contact Name Title Address Phone Fax Email
Outfalls
Outfall #: 001 Outfall Description: unknown
Outfall Lattitude: 36.006390 Outfall Longitude: -78.480560 Represented by Outfall:
%Stormwater: 100 % Industrial:
Stream Waterbody
Basin Waterbody Name Index Number Classification
Neuse Hattles Branch 27-21-1 C;NSW
8/30/2023 Page 2

9/4/23, 11:57 AM New Submission
DEQ - - . e .
NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number.
Number* NCGO50398
Begins with NCS,NCG,or NCGNE(no exposure)
The information below is auto-filled after the permit number is entered and you click outside the box:
Permittee* K-Flex USA
Facility Name* K-Flex USA
County* Franklin
Check permit contact information for your permit by running a Stormwater Permit Summary Report
(https://reports.ncdenr.org/BOE/OpenDocument/2002150408/CrystaIReports/viewrpt.cwr?
id=585684&apsuser=B1 MS_U&apspassword=b10Ms_cr%28ddnri59%29&apsauthtype=secEnterprise&cmd=EXPORT&EXPO'
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 0 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
Owner Affiliation (Legally Responsible Individual) Change
Upload a copy of the completed and signed Permit Owner Affiliation Designation Form (https://deq.nc.gov/energy-mineral-
and-land-resources/stormwater/npdes-miscellaneous-forms/npdes-stormwater-owner-affiliation-cha nge-
form/download)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.
Staff may contact you to confirm the requested change if this Owner is also associated with other permits in our system.
Changes to Owner Affiliation affect all permits tied to that Owner.
Owner Affiliation Please upload the signed"Permit Owner Affiliation Designation Form"
Change Form Upload
Upload* NPDES SW eDMR Owner Verification.pdf(blob:htt... 41.24KB X
pdf only
Submitter's Name* Please enter your FIRST and LAST name
Michael Walker
https://edocs.deq.nc.gov/Forms/SW-Permit-Contact-Updates 1/2

9/4/23, 11:57 AM New Submission
Phone Number* Please enter your phone number
919-280-9889
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.
* Q 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* x
Date Date will be captured on form submission
Questions? Contact [e-mail](http://mailto:[e-mail]).
https://edocs.deq.nc.gov/Forms/SW-Permit-Contact-Updates 2/2