NC0088226_Responsible Person_20160531

RECEIVEDINCDEQIDWR
ATA
i _ MAY 31 2015
NCDENR Water Quality
Permitting Section
North Carolina Department of Environment and Natural Resources
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 NPDES wastewater permits.
• "Pernuttce" references the exiting permit holder
• "Applicant"references the entity applying for the ownership/name change
I. NPDES Permit No.(for which the change is requested): N C 0 0 8 8 2 2 6
or
Certificate of Coverage#: N C G 5
II. Existing Permittee Information:
a. Permit issued to(company name): Wells Fargo,N.A
h. Person legally responsible for permit: Rhonda Ballard
First MI Last
Sr. Vice President
Title
550 South Tryon Street, 30'h Floor
Permit Holder Mailing Address
Charlotte NC 28202-
City State Zip
[phone] (
Phone Fax
c. Facility name: Wells Fargo Tryon Street GWR
d. Facility's physical address: 500 Block of South Tryon Street
Address
Charlotte NC 28202-
City State Zip
c. Facility contact person: John Cranfill [phone] _
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: New Legally Responsible Person on permit
b. Permit issued to(company name): Wells Fargo, N.A.c. Person legally responsible for permit: Suzanne Fountain
First MI Last
Sr. Vice President
_ _-- Title - -550 South Tryon Street, 30th Floor
Permit Holder Mailing Address
Charlotte NC 28202-
—
City State Zip
[phone]
Phone E-mail Address
Revised 7/0//20/

d. Facility name: Wells Fargo Tryon Street GWR
c. Facility's physical address: 500 Block of South Tryon Street
Address
Charlotte NC 28202-
City State Zip
I Facility contact person: John Cranfill
First MI Last
Sr. Chief Engineer
Title
[phone] [e-mail]
Phone E-mail Address
IV. Will the permitted facility continue to conduct the same commercialfindustrial activities conducted prior to
this ownership 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:
I. 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
renllired for an ownership change request. Articles of incorporation are not sufficient for an ownership change.
Applicable reputations:40 CFR 122.41,40 CFR 122.61 and I 5A NCAC 0214 .0114
The certifications below must he completed and signed by both 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 arc not
completed and that if all required supporting information is not included,this application package will he returned as
incomplete.
Signature Date
APPLICANT CERTIFICATION
I. /sl:Z►7vftyf geol.-Th-4, ,attest that this application for a name/ownership change has heen 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.
s ` lI-. .1
Signature Dale
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Resources
Water Quality Permitting Section
NPDES PERMIT NAME/OWNERSHIP CHANGE REQUEST
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