NC0088773_Signatory Authority_20160919

..ii}* ucnccxrxNr.�r:
DY
September 19, 2016
Wastewater Branch
Water Quality Permitting Section
Division of Water Resources
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Signature Authority
Dow Corning Greensboro Site
NPDES Number NC0088773- Physical/Chemical, Class I
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 monitoring reports, and other information relating to the operations at the subject facility
as required by all applicable federal, state, and local environmental agencies specifically with the requirements
for signatory authority as specified in 15A NCAC 213.0506.
Name #1
Mr. James Strunk, Jr.
310 George Patterson Blvd., Suite 100
Bristol, Pennsylvania 19007
[e-mail]
Office Phone [phone]
Mobile Phone [phone]
Name #2
Mr. Darren Cammin
2914 Patterson Street
Greensboro, North Carolina 27407
[e-mail]
Office Phone [phone]
Mobile Phone [phone]
If you have any questions regarding this letter, please feel free to contact me at [phone].
Sincerely,
Darren Cammin
Greensboro Site Manager
2914 Patterson Street, Greensboro, NC 27406
[e-mail]
Office Phone [phone]; Mobile Phone [phone]
cc: NCDWR Winston-Salem Regional Office, Water Quality Permitting Section

PAT MCCRORY
Governor
DONALD R. VAN DER VAART
N"
Secrelaq
S. JAY ZIMMERMAN
Water Resources
ENVIRONMENTAL QUALITY Direelor
PERMIT NAME/OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Permit Number: NC00 8 / 8 / 7 / 7 / 3 or NCG5 / / / /
1. Facility Name: Dow Corning Corporation
II. NEW OWNER/NAME INFORMATION:
1. This .request for a name change is a result of:
a. Change in ownership of property/company
X_b. Name change only
c. Other (please explain
2. New owner's name (name to be put on permit):
Mr. Darren Cammin
3. New owner's or signing official's name and title: Mr. Darren Cammin
(Person legally responsible for permit)
Greensboro Site Manager
(Title)
4. Mailing address: 2914 Patterson Street City: Greensboro
State: NC Zip Code: 27407 Phone: [phone]
E-mail address: darren.w.cammini )dowcorning.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
https://deq.nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

NPDES Name & Ownership Change
Page 2 of 2
Applicant's Certification:
I, Darren Cammin { , 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 thatjif 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.
I
Signature: L1' Date: 9119 12,014,
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD RE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ / DWR / NPDES
1617 Mail Service Center
gh, North Carolina 27699-1617
Version 7/2016

Page 1 of 1
Dow Corning Corporation Greensboro
[Greensboro Plant] - 2914 Patterson Street Greensboro, NC 27407
Originator: CHELSEA FIELDS [CMFIELDS]
Phone: [phone]
Miscellaneous Shipping Request
MSR # 138947
Date Created : 2016-09-19
Ship to:
NC Division of Water Quality
NC Div Of Water Quality
1617 Mail Service Center
Raleigh, NC
27699-1617
USA
Contact Name: Tom Belnick
Contact Phone: [phone]
Shipping Information:
Weight:
Carrier:
Tracking Number:
Containers:
Transport: i Next Day Air
N D
SEP 24 t6
DENR-LAPID QUALITY
STORMWATER PERMITTIPlG
Payment PRPD
Cost Center:
Shipment Value: 0
Shipped by
e The requisitioner is responsible for attaching Material Safety Data Sheet(s) to the shipping
documents
Special Shipping Instructions:
None specified
Description: Letter of Delegation of Signature Authority
http://intranetapp/returnorder/msr report.asp?From=MSR&RecId=138947 9/19/2016