The URL can be used to link to this page

Home My WebLink AboutNC0079740_Owner Name Change_20160610 RECEIVEDINCDEQIDWR --= - JUN 092D6 NCDENRwater Quality North Carolina Department of Environment and Natural Resourc@srrnitting Section Division of Water Resources Pat McCrory Donald R.van der Vaart Governor WATER QUALITY PERMITTING SECTION Secretary PERMIT NAME/OWNERSHIP CHANGE REQUEST This form is for ownership changes or name changes of NPUES wastewater permits. • "Permittee"references the existing permit holder • "Applicant" references the entity applying for the ownership/name change. } 1. NPDES Permit No.(for which the change is requested): N C 0 0 7(7 7 9i or Certificate of Coverage#: N C G 5 II. Existing Permittee Information: a. Permit issued to(company name): 0/4//1 '729_s / 2w b. Person legally responsible for permit: 2n//V I we.I/S First MI Last 0.1.1-er Ae_ curet,_ rec- r Title f 6 180,4. ermit l-older Maiilin jAddress /4114 ttz r( / l , 910,(% City 1 State Zip (71* 73St- ca5' (7. )13o- 2J5� Phone Fax r c. Facility name: j. E/11. 0.416lizi� ez'lrJen.t i . 1.11/ d. Facility's physical address: N.3 �reyv ec Address g, t'14/2 l;i AJC City State Zip e. Facility contact person: Nea)7 i //€A <o) C: (70 4 f2-7/3/ First / MI / Last Phone III. Applicant Information: a. Request for change is a result of: ❑ Change in ownership of the facility ❑ Name change of the facility or owner If other please explain: (J(Ln b. Permit issued to(company name) Cs/ 0 P ncy< QctN- "( c. Person legally responsible for permit: n 'fC -,DcaA/ Firs / MI Last C.f ,eby....56,SQI.c roes .1t r� � Title ita Perniit,Holder piling Address C State Zip (70IP 73 - riek ydEGtkoPk.A.et" Phone E-mail Addrodss Page 1 of 2 Revised 7/01/2014 4. r . / d. Facility name: 17;_i: Eli Seamf ei /T�/7/P Si/xy e. Facility's physical address: J4 22• Ca//c rnv� �d / Address s ICOfrithinf WG .Wecg City State Zip f. Facility contact person: Alf / ,Jr First MI Last //_ Title Phone E-mail Address // IV. Wille permitted facility continue to conduct the same commercial/industrial are 4,4kodd 6.4°7°4 s teem ctivities conducted prior to this wnership or name change? Yes ❑ No(please explain) If applicable,the applicant shall submit a major permit modification request to DWR.A major modification shall be defined as one that increases the volume,increases the pollutant load,results in a significant relocation of the discharge point,or results in a change in the characteristics of the waste generated. V. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE INCOMPLETE OR MISSING: 1. This completed application is required for both name change and/or ownership change requests. 2. Legal documentation of the transfer of ownership(such as relevant pages of a contract deed,or a bill of sale)is required for an ownership change request. Articles of incorporation are not sufficient for an ownership change. Applicable regulations:40 CFR 122.41,40 CFR 122.61 and ISA NCAC 02H.0114 The certifications below must be completed and signed by the permit holder prior to the change(Permittee),and the new applicant in the case of an ownership change request. For a name change request,the signed Applicant's Certification is sufficient. PERMITTEE CERTIFICATION(Permit holder prior to ownership change): I, ,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 is not included,this application package will be returned as incomplete. Signature Date APnPLICANNTT CERTIFICATION I,x iC 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 is not included,this application package will be returned as incomplete. r I 6/.272,6 r Signature Date ************************** PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO: Division of Water Resources Water Quality Permitting Section 1617 Mail Service Center Raleigh,North Carolina 27699-1617 NPDES PERMIT NAME/OWNERSHIP CHANGE REQUEST Page 2 of 2 Revised 7/01/2014 r �. ( THE CITY OF KINGS MOUNTAIN 1' s �} PO.BOX 429 • KINGS MOUNTAIN NORI'H CAROLINA 2808(1 • 704-734-033 64. wie June 2, 2016 Wastewater Branch Water Quality Permitting Section Division of Water Resources 1617 Mail Service Center Raleigh,NC 27699-1617 Subject: Delegation of Signature Authority T. J. Ellison Water Treatment Plant NPDES Number NC0079740 To Whom It May Concern: By notice of this letter, I hereby delegate signatory authority to each of the following individuals for all permit applications, discharge monitory reports, and other information relating to the operations at T. J. Ellison Water Treatment Plant as required by all applicable federal, state, and local environmental agencies specifically with the requirements for signatory authority as specified in 15A NCAC 2B.0506. Ricky C. Duncan Water Resources Director If you have any questions regarding this letter, please feel free to contact me at 704-734-0333. Sincerely, hced— Zeddi G. Scott Neisler Mayor, City of Kings Mountain Cc: NCDWR Mooresville Regional Office, Water Quality Permitting Section The Historical City