NC0002305_Owner Name Change_20170202 (2)

MINWA
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NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Pat McCrory
Governor WATER QUALITY PERMITTING SECTION
I.
II.
John E. Skvarla, III
Secretary
PERMIT NAME/OWNERSHIP CHANGE REQUEST
This form is for ownership changes or name changes of NPDES wastewater permits.
• "Permittee" references the existing permit holder
• "Applicant" references the entity applying for the ownership/name change.
NPDES Permit No. (for which the change is requested:
or
Certificate of Coverage #:
Existing Permittee Information:
a. Permit issued to (company name):
b. Person legally responsible for permit:
NCOCnIMCD10 OR
0 2 3 0 5
NCGS
Guilford Mills. LLC.
Michael M Mason
First MI Last
Engineering Manager
Title
1754 NC Hwy 903
Permit Holder Mailing Address
Kenansville NC 28349-
PlEGr-iv
City State Zip
2017
FEB 0 2
[phone] [phone]
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c. Fac�jJ��gect10n
Phone Fax
Guilford Mills, LLC.
d. Facility's physical address:
1754 NC Highway 903
Address
Kenansville NC 28349 -
City State Zip
e. Facility contact person:
Edward K Westbrook [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: Name Change of Facility Only
b. Permit issued to (company name):
Lear Corporation
c. Person legally responsible for permit:
Michael M Mason
First MI Last
Engineering Manager
Title
1754 NC Hwy 903
Permit Holder Mailing Address
Kenansville NC 28349 -
City State Zip
[phone] [e-mail]
Phone E-mail Address
Page 1 of 2 Revised 7101/2014

d. Facility name: Lear Corporation
e. Facility's physical address:
1754 NC Hwy 903
Address
Kenansville
NC
28349 -
City
State
Zip
f. Facility contact person: Edward
K
Westbrook
First
MI
Last
Wastewater Manager
Title
[phone]
ewestbrookplear.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 IF 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.
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
APPLICANT CERTIFICATION
Date
I, Michael Mason , 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 re sgpport' g in ation is n t included, this application package will be returned as incomplete.
ell
Signature Date
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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
Page 2 of 2 Revised 7/01/2014