NCG030301_Name Ownership Change_20171030

Alexander, Laura
From:Hammon, Daniel <[e-mail]>
Sent:Monday, October 30, 2017 12:15 PM
To:Alexander, Laura
Subject:\[External\] Name change form
Attachments:DOC103017-10302017090646.pdf
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Laura,

Here is the name change form. Let me know what else is required. Our permit expires on Oct. 31, 2017. If I understand
your letter correctly, we are up to date and our permit will be automatically renewed. If I am wrong, please advise on
what I need to do to get us in compliance.

Thanks,

Danny Hammon
EH&S Mgr.
AP Emissions Technologies, Inc.
919-580-1940

-----Original Message-----
From: [e-mail] \[mailto:[e-mail]\]
Sent: Monday, October 30, 2017 12:07 PM
To: Hammon, Daniel
Subject: Send data from MFP11301997 10/30/2017 09:06

Scanned from MFP11301997
Date:10/30/2017 09:06
Pages:2
Resolution:200x200 DPI
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1

®� Division of Energy, Mineral & Land Resources FOR AGENCY USE ONLY
Date Received
Land Quality Section/Stormwater Permitting Year Month I Day
NCDENRNational Pollutant Discharge Elimination System
PERMIT NAME/OWNERSHIP CHANGE FORM
Ery PaNMF1rt OHo NmWUL RgWPCEs
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C I S 10 1 1 N I C I G, 10 O n O iJ
II. Permit status prior to requested change.
a. Permit issued to (company name): h j d ( No l g 0 .. :17fj c
b. Person legally responsible for permit: d,,A4jti a fl»t n/o�
Firstj
MI
Last
t4 S
Mar -
Title
300 DIX16
Tt2�t'
1 Permit Holder Mailing Address
601WS%orp
IJ k,-
o27S30
City State
c9 (9) 5,80-19No (G
Zip
19) S80-200
Phone
Fax
c. Facility name (discharge): A P �jt 11fiUSj�
�G%No�04lES
=NL
d. Facility address: �jOc� J7l X 1l�
?1ZN 1
& Ic borJ
Address
/J.C-. •
.2753 O
_
CityState
Zip
e. Facility contact person: 0L,
/rlar-1
(919 )Sso 1Fye�
First / NU ast
Phone
I11. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
2-9ame change of the facility or owner
Ifotherplease explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
to
Title
��� 1X1 G I IZW-1
Permit Holder Mailing Address
C7o
1c4 borg A C, 7,5-3 0
City state Zip
tR 19) 5bb- IIND &h AvnmotJIR1400-.ih#W I oO/h
Phone E-mail Addmss
ire m S —1-6L sofa les CLC
300 D 1 X 1 C -TP -�
rnune n -luau a Uwe�b
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan. 27. 2014
cc /V% -

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact:
First Mi Last
Title
Mailing Address
City State Zip
Phone E-mail Address
V Will the permitted facility continue to conduct the same industrial activities conducted prior
to this wnership or name change?
Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
COMPLETE OR MISSING:
Rr This completed application is required for both name change and/or ownership change
requests.
❑ 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.
.......................................................................................................................
The certifications below must be completed and signed by both the permit holder prior to the change, 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.
a)m MOIJ
Signature
APPLICANT CERTIFICATION
/0 /i -T
Date
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.
Revised Jan. 27, 2014
Signature
Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612