NC0005177_Owner (Affiliation Change)_20240805

ROY COOPER
•
MICHAEL S. REGAN
LINDA CULPEPPER
Water Resources
ENVIRONMENTAL QUALITY RECEIVED
_LIVED
PERMIT NAME/OWNERSHIP CHANGE FORM AUG 0 5 2024
I. CURRENT PERMIT INFORMATION:
NCDEQ/DWR/NPDES
Permit Number: NC00 0 / 5 / 1 / 7 / 7 or NCG5 / / / /
1. Facility Name: Livent USA Corp
II. 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):New Responsible Official
2. New owner's name(name to be put on permit):
N/A
3. New owner's or signing official's name and title: Jon Kimmel
(Person legally responsible for permit)
Plant Manager
(Title)
4. Mailing address: P.O.Box 795 City: Bessemer City
State:NC Zip Code:28016 Phone: [phone]
E-mail address: ion.kimmel(@arcadiumlithium.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
hops://deg.nc.gov/about/d ivi sions/water-resou rces/water-resources-permits/wastewater-branch/npdes-wastewater-perm its

NPDES Name&Ownership Change
Page 2 of 2
Applicant's Certification:
I, Jon Kimmel , 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: 7
Date: /7 91 9
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 11/2017