NCG050400_Owner Affiliation Change_20240513

DEQ ,). Division of Energy, Mineral, and Land Resources FOR AGENCY USE ONLY
ReceLand Quality Section /Stormwater Program Date Month ed
nprrtnrnnf nl CnNrMinmrLM OLLrlt/
g Year Day
National Pollutant Discharge Elimination System (NPDES)
PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
Use this form if there has been:
O 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 S 0 15 014 0 0 N C G
2) Facility Information:
Facility name: TruExterior Plant 1
Company/Owner Organization: Westlake Royal Building Products LLC
Facility address: 500 Correll Street
Address
Salisbury NC 28144
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https://dcq.nc.gov/sw/ 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: Daniel Andaya
First MI Last
4) NEW OWNER AFFILIATION(legally responsible for the permit):
Person legally responsible for this permit: Timothy Herold
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)
Facility Manager
Title
175 Circle M Drive
Mailing Address
Salisbury NC 28147
City State Zip
(812 )675-1029 [e-mail]
Telephone E-mail Address
(704 )633-5754
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:
I, Derrick Cyprian , 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.
,01
Si nature Date,
PLEASE SEND THE 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://deq.nc.gov/sw
Per NC General Statute 143-215.6B (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

D_EC1 ,) Division of Energy, Mineral, and Land Resources FORnGErrcvusEorrt.Y
Date Received
Mn�OODeol nl Fnwommnnl.tl(N ON �� Land Quality Section /Stormwater Program Year Month 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 S 0 5 0 4 2 8 N C G
•
2) Facility Information:
Facility name: TruExterior Plant 2
Company/Owner Organization: Westlake Royal Building Products LLC
Facility address: 175 Circle M Drive
Address
Salisbury NC 28147
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https://dcq.nc.gov/sw/ 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: Daniel Andaya
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Timothy Herold
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)
Facility Manager
Title
175 Circle M Drive
Mailing Address
Salisbury NC 28147
City State Zip
(812 )675-1029 [e-mail]
Telephone E-mail Address
(704 )633-5754
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:
I, Derrick Cyprian , 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.
'Signature Date
PLEASE SEND THE 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: httpp://deq.nc.gov/sw
Per NC General Statute 143-215.6B (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

ta ie Westlake'RCorporationdSuite
195
{}q+ r s ;t Road, a;
Atlanta,CA 3 328
May 10,2024
DEMLR Stormwater Program
512 North Salisbury Street, 6th Floor (Office 640K)
1612 Mail Service Center
Raleigh,NC 27699-1612
RE: Westlake Royal Building Products
TruExterior Plants 1 &2
Stormwater General Permits
Permits No. NCG050400 and NCG050428
Attn Ms. Mayes:
Please find enclosed the Change of Permit Owner Affiliation Designation Form 20240509 for
TruExterior Plant 1 and TruExterior Plant 2. The previous person is no longer employed by Westlake.
If you have any questions or require any additional information, please do not hesitate to contact me by
phone at(713) 430-6551 or by email at [e-mail].
Sincerely,
Kelly R McCormick
Environmental Manager
Enclosures (2)
Permit Owner Affiliation Designation Form 20240509 for TruExterior Plant 1
Permit Owner Affiliation Designation Form 20240509 for TruExterior Plant 2