NC0028614_NOV2015LV0239_20150415 (2)

d. Facility name: Coastal Carolina Clean Power LLC
e. Facility's physical address: 1838 NC 11& 903
Address
Kenansville NC 28349-
City State Zip
f. Facility contact person: Michael A Houston
First MI Last
Operator in Responsible Charge
Title
[phone] [e-mail] ,
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: TRIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS ARE ,
INCOMPLETE OR MISSING:
L 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.
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
APPLICANT CERTIFICATION
I,Michael Wood,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
require supporting information is of in luded,this application packs a will be returned as incomplete.
nv
Signature Date
'i
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
Re wised 710112014

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