NC0005088_Owner Name Change_20160812

Pat McCrory
Governor
AUG 12 2016
NC®ENR D6tiR ACTION
North Carolina Department of Environment and Natural 149961rl)g*A�OCSSSIAiGUN1T
Division of Water Resources Donald R. van der vaart
WATER QUALITY PERMITTING SECTION Secretary
This form is for- ownership changes or name changes of NPDES wastewater permits.
'Permiltec' references the existing permit holder
o •'Annlicant" references the entity applying for the ownership/name change.
Permit No. (for which the change is requested): N C 0 0 0 5 0 8 8
L NPAES
or
#:
NCG5 —�
Certificate of Coverage
II. Existing Permittee Information:
Duke Energy Carolinas LLC
a. Permit issued to (company name):
b. Person legally responsible for permit:
Dave Barnhardt
First MI Vast
Station Manager - GM II Regulated Stations
Title
573 Duke Power Road
Permit Holder Mailing Address
Mooresboro NC 28114 -
City State Zip
[phone] ( )
Phone Fax
Cliffside Steam Station
c. Facility name:
d. Facility's physical address:
573 Duke Power Road
Address
Mooresboro NC 28114-
City State Zip
Steve Hod es [phone]
e. Facility contact person:
First / MI / Last Phone
III. Applicant Information:
a. Request for change is a result of:
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
Pate t of 2
❑ Change in ownership of the facility
® Name change of the facility or owner
Duke Energy Carolinas LLC
Dave Barnhardt
First MI Last
Station Manager - GM II Regulated Stations
Title
573 Duke Power Road
Permit -Holder Mailing Address
Mooresboro NC 28114 -
City State Zip
Dave.Barnhardt@Duke-
[phone] Energy.com
Revised 7101/1014

d. sacility name: -
Boge saEnergy-Complex>
e. Facility's physical address:
573 Duke Power Road
Address
Mooresboro
NC
28114 -
City
State
Zip
f. Facility contact person:
Steve
Hodges
First
MI
Last
Lead EHS Professional
Title
Steve.Hodges @Duke
-
[phone] energy.com
Phone
E-mail Address
IV. Will the permitted facility continue to conduct the same commercial/industrial 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 11F 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 15A NCAC 02H.01 14
.....................................................................................................................
The certifications below must be 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.
PERM=E CERTIFICATION (Permit holder prior to ownership change):
I, , attest that this application for a namelownership 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
APPLICANT CERTIFICATION
Date
I, IDPA , 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 informati is not ' clu , this application package will be returned as incomplete.
eallf—
Y) I) ht
Signature Date
PLEASE SEND THE -COMPLETE APPLICATION PACKAGE TO:
Division of Water Resources
Water Quality Permitting Section
NPDES PERMIT NAME/OWNERSHIP CHANGE REQUEST
Pam 2of2
ReWcoa 7mrnn14

If you have any questions regarding these designations, please do not hesitate to contact Mr.
Jeremy Pruett, P.E., Manager of Environmental Services at [phone] or via email at
[e-mail].
Sincerely,
Mr. tarry E. Hatcher
Vice President Environmental Services
Environmental, Health & Safety
cc: Asheville Regional NCDEQ
Fayetteville Regional NCDEQ
Raleigh Regional NCDEQ
Washington Regional NCDEQ
Wilmington Regional NCDEQ