NC0085979_Signatory Authority_20170210

January 25, 2017
State of North Carolina
Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: ROSMAN MAINTENANCE FACILITY
NPDES PERMIT: NCO085979
HWY 64 WEST
ROSMAN, NC 28722
Water Resources:
: �Oamec
RECEDVED foster
wheeler
JAN 2 6 2017
Information Processing Unit
DWR Section
On behalf of the NCDOT Roadside Environmental Unit, Amec Foster Wheeler Environment &
Infrastructure submits the enclosed Permit Name/Ownership Form, the eDMR Registration Form,
and the Delegation of Authority Form. Because of reorganization within the NCDOT Roadside
Environmental Unit, information on how to access the current eDMR account is not available.
Therefore, Amec Foster Wheeler requests access to a new eDMR account for the Rosman
Maintenance Facility, so we can complete eDMR forms on behalf of NCDOT. Ms. Brianna Young
of the Central Office may be able to provide additional details regarding this issue.
If you have any questions or need additional information, please contact me at [phone].
Sincerely,
Amec Foster Wheeler Environment & Infrastructure, Inc.
Sheri Knox, P.E., PMP®
Senior Remediation Engineer
Enclosures: Permit Name/Ownership Form,
eDMR Registration Form
Delegation of Authority Form
cc: Robin Maycock via email
ArIMe Foe1M WhoMw Envilmnittent & Infrastructure, Ina Tel -[phone]
4021 Stimp Creek Drive, Suite 100 Fax - [phone]
Durham, NC 27703 1 Arrlecfw-�
Licensure: NC Engineering F-1253; NC Geology C-180

ROY COOPER
Gnr. rnw
MICHAEL S. REGAN
Water Resources S. JAY ZIMMERMAN
ENVIRONMENTAL QUALITY
Ov.rrnr
PERMIT NAME/OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Permit Number. NC00_8/5/9/7/9 or NCG5_/_/_/_/_ RECEIVED
1. Facility Name: Rosman Maintenance Facility
II. NEW OWNER/NAME INFORMATION: JAN l G 2017
1. This request for a name change is a result of: Information Processing Unit
OWFt Section
a. Change in ownership of property/company
b. Name change only
X_c. Other (please explain): NCDOT Roadside Environmental Unit is managing the Rosman
Maintenance Facility Permit and has hired Amec Foster Wheeler to Implement. The NCDOT individual once
assigned to implement the permit (Mr. David Hill) will no longer implement the permit.
2. New owner's name (name to be put on permit):
NCDOT Roadside Environmental Unit is the owner of the permit. Sheri Knox of Amec Foster
Wheeler will help manage the permit
3. New owner's or signing official's name and title: On Behalf of NCDOT: Sheri Knox
Please see the attached Delegation of Authority Form.
(Person legally responsible for permit)
Remediation Engineer—Amer Foster Wheeler
(Title)
4. Mailing address: 4421 Stirrup Creek Drive City. Durham
State:NC_ Zip Code: 27703 Phone: [phone]
E-mail address: sheri.knox()g.amecfw.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) There has NOT been a change of ownership. NCDOT
owns the facility, the submitter for the eDMR has changed
[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.goviabout/divisions/water-resoumes/water-resources-permits/ tmata-branciVnpdes-wastewater-permits

NPDES Name & Ownership Change
Page 2 of 2
Applicant's Certification:
I, Sheri L. Knox , 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 and attachments are not included, this application
package will be returned as incomplete.
Signature: Z `-- Date:
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 7/2016
i

Permit No.: NCO085979
Owner/Permittee :
Responsible Official:
Resp. Official Title:
Facility Name:
Facility Address:
Registered for eDMR? :
Facility Classification:
ORC Name
Required, Not
Version: 4.00
NC DOT - Environmental Orwations
David Hill
Rosman Maintenance Facility
NCSR 1388
Rosman, NC 28772
Yes
PCNC
Permt Status: Active
Certification # Cert Status ORC Deslanation
PCNC / 995491 Active ORC
Page # : 4
Date : 1/26/2017