NC0055212_owner (name change)_20240312

NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NPDES PERMITTING
NORTH CAROLINA
Envfronmental Qnal7ly
PERMIT NAME/OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Permit Number: NC00_5,_5_/_2J_1J_2_ or NCGSJJJJ-
1. Facility Name: Auman Acres MHC
NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
_X_a. Change in ownership of property/company
_b. Name change only
_c. Other (please explain):
2. New owner's name (name to be put on permit):
Auman Acres MHC, LLC
3. New owner's or signing official's name and title: Julio C. Jaramillo
(Person legally responsible for permit)
Managing Member
(Title)
4. Mailing address: 321 North Pass Avenue, Suite 300_City: Burbank
State: CA Zip Code: 91505 Phone:[phone]
E-mail address: [e-mail]
FACILITY AND DISCHARGE INFORMATION
1. Will the waste stream for the facility remain the same as under the previous owner? Yes X No ❑
2. Will the treatment system and discharge location remain the same? Yes X No ❑
"No Responses''
If either or both of these questions are answered "No" then more information will be needed to review the
request. Alcove attach daeumcntation to describe and evplo;n the changes to the facility acHvitfe; wastes
stream, treatment process or outfall location. The Division may not be able to process the Permit
Name/Ownership Change request and may require that the new owner file a new permit application.
Q� North Carolina Department of Environmental Quality I Division of Water Quality
D_E 512 North Salisbury Street 1 1617 Mall service Center I Raleigh, North Carolina 27699-1617
;.�,
919.707.9000

NPDES Name and Ownership Change
Page 2 of 2
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)
3. Information to document facility, waste stream, treatment system or outfall changes as noted in
item III above (if appropriate)
Applicant's Certification:
I, Julio C. Jaramillo 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. 1 understand that Permit Name/Ownership Change can only take place through
action taken by the Division of Water Resources and that no actions on my part or the part of my
company result in the automatic transfer of permit coverage.
Signature: C,) Date:
THE COMPL ION CKAGE, INCLUDING ALL SUPPORTING INFORMATION & MATERIALS,
SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
INC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 07/2021