NCG080760_DMR_20220215

Ira P5
ABF
•
Freight
An ArcBest'Company
P.O.Box 10048(72917-0048)
3801 Old Greenwood Road
Fort Smith,AR 72903
�+
479.785.6000
RECEIVED Tisha Cochran
Senior Manager
815 2022 Real Estate Compliance
[e-mail]
:479.785.6026
OENR.LAND QUALITY p 479.785.6015
February 7, 2022 STORMWAR PERMITTING
Certified Mail
DEMLR—Stormwater Program NC Department c f
Environmental Quality
Dept. of Environmental Quality Received
1612 Mail Service Center MAR 2 2 2022
Raleigh, North Carolina 27699-1612
Vv;
Re: ABF Freight System, Inc. R ri l I is
1165 NC Hwy 66 S
Kernersville, NC 27284
COC#: NCG080760
To Whom It May Con ern:
Enclosed for processing, please find ABF Freight System, Inc. completed Permit Owner Affiliation
Designation Form for the above-mentioned facility. Please contact me should you have any questions.
Thanks, II MM 11-
� n t
Tisha Cochran
Sr. Manager, Real Estate Compliance
Enclosure
cc: ABF Service Center

Division of Energy,Mineral, and Land Resources FOR AGENCY USE ONLY
Land Quality` Section /Stormwater Pro ram Date Rthived
g Year Month Day
NC Lepartm.ilt
National Pollutant Discharge Elimination System (NPDES) nvrronmental Qualify
Received
Energy,Mineral& PERMIT OWNER AFFILIATION DESIGNATION FORM MAR 2 2 2022
Land Resources
EUVIR NMENTALGUALt7Y (Individual Legally Responsible for Permit)
Winston-Salem
Use this form if there has been: Regional Office
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.
RECEIVED
What does "legally responsible individual"mean? EB 1 5 2022
The person is either:
• the responsible corporate officer(for a corporation); NR-LAND QUA 'I,�.
• the principle executive officer or ranking elected official (for a municipality, states atLARt.N `i7`iTld�
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 S N C'-G; 0 8 0 7 6 0
2) Facility Information:
Facility name: ABF Freight System, Inc.
Company/Owner Organization:
Facility address: 1165 NC Hwy 66 S
Address
Kernersville NC 27284
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https://deq.nc.gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/npdes-industrial-
program and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Mark McMinn
First MI Last
4) NEW OWNER AFFILIATION(legally responsible for the permit):
Person legally responsible for this permit: Matthew Godfrey
First MI Last
Page 1 of 2
S WU-OWNERAFFIL4Nov2019

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
Vice President
Title
PO Box 10048
Mailing Address
Fort Smith AR 72917
City State Zip
(479 )785-6000 [e-mail]
Telephone E-mail Address
(479 )785-6015
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.
PERMITTEE CERTIFICATION:
I Matthew Godfrey ,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.
? f9
ei
Signature Date
PLEASE SEND THE COMPLETED 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://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
Page 2 of 2
S WU-O WNERAFFIL-4Nov2019