NCG160083_Name Ownership Change_20180124

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January 16, 2018
NC DEQ
NPDES Permit Coverage Rescission
1612 Mail Service Center
Raleigh, NC 27699-1612
RE: Lane Construction Matthews Plant
To Whom It May Concern,
RECEIVE®
JAN 24 2010
DENR"LAND QUALITY
STORMWATER PERMITTING
Please find enclosed applications for permit rescission and ownership change form for the above
referenced plant. The Lane Construction Corporation has not operated the Matthews plant for several
years. The plant, situated on property leased from Martin Marietta, was removed in July 2017. The only
industrial activity remaining on the site is a recycled asphalt product (RAP) pile that belongs to a different
tenant of Martin Marietta.
Please transfer permit NCG 160083 from Lane Construction to Martin Marietta.
If you need anything else, please do not hesitate to call.
Greg Davis
Environmental Coordinator
Lane Construction
The Lane Construction Corporation
8205 Wilkinson Blvd
Charlotte, NC 28214
T 704-395-3264 F 704-394-5354
www laneconstruct com
An Equal Opportunity Employer M / F / D / V

I
�� Division of Energy, Mineral &Land Resources FOR AGENCY USE ONLY
• Date Received
Land Quality Section/Stormwater Permitting Year I Month Day
National Pollutant Discharge Elimination System
NCDENR
NO DAROUNA DE -M- OF
ENh NM ANON.vuRALR-R- PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N I C I S 10 1 1 1 1 1 1 1 N I ,C jGj. I 1 16 1 0 1 0 1 8 1 3
II. Permit status prior to requested change.
a. Permit issued to (company name): Lane Construction Corporation
b. Person legally responsible for permit: Timothy C Gaddy
i First MI Last
I i� E Plant Manager
Title
JAS 24 20138205 Wilkinson Blvd
DERR-LARD QUALITY Permit Holder Mailing Address
STQRMWATER PERMITTING Charlotte NC 28214
City State Zip
[phone] [phone]
Phone Fax
c. Facility name (discharge): Matthews Plant
d. Facility address: 1011 Sam Newell Road
Address
Matthews NC 28105
City State Zip
e. Facility contact person: Greg Davis [phone]
First / MI /Last Phone
IIl. Please provide the following for the requested change (revised permit).
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:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
Martin Marietta Materials, Inc.
Larry J Roberts
First MI Last
Division President
Title
413 S. Chimney Rock Road
Permit Holder Mailing Address
Greensboro NC 27409
City State Zip
[phone] [e-mail]
Phone E-mail Address
Matthews Plant
1011 Sam Newell Road
Address
Matthews NC 28105
City State Zip
Tom K Neely
First MI Last
[phone] tom.neelypmartinmarietta.com
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: Richard W Broughton
First MI Last
District Environmental Services Manager
Title
8451 Monticello Road
Mailing Address
Columbia SC 29203
City State Zip
(8_03) 978-6275 richard.broughtonpmartinmarietta.c
Phone E-mail Address
V Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ 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, Timothy Gaddy, 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.
/ Ad -
0S ate
APPLICANT CERTIFICATION
I, Larry Roberts, 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.
/// fLI 2-1 ilo
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
Revised Jan 27, 2014

FOR AGENCY USE ONLY
A®� YDivision of Energy, Mineral & Land Resources Date Received
�d Land Quality Section/Stormw�ater Permitting Program Year Month Day
NC®ENR National Pollutant Discharge Elimination System
NO- C -LINA DEPARTMEM OF
ENVIRONMENT ANO NRURAL RESOURCES
RESCISSION REQUEST FORM
Please fill out and return this form if you no longer need to maintain your NPDES stormwater permit.
1) Enter the permit number to which this request applies:
Individual Permit (or) Certificate of Coverage
nl I c I s 1 1 1 1 1 1 1 1 nl I c I G/( 10 1
2) Owner/Facility Information: * Final correspondence will be mailed to the address noted below
Owner/Facility Name GAA/��ti'Sl/dGli©r✓ 17JATT����Js' ,,JG/,�Jj
Facility Contact ��1> /��yi 5�
Street Address loll JA 114 _e �
City
County �ileG'/ll�r1�4
Telephone No.
State it/(f ZIP Code
E-mail Address G6✓Jr�✓fSL��L/1�/TC°ci�T�L�✓ ���'t
Fax: %,Y
3) Reason for rescission request (This is required information. Attach separate sheet if necessary):
❑ Facility closed or is closing on ' All industrial activities have ceased such that no discharges of
stormwater are contaminated by exposure to industrial activities or materials
❑X Facility sold to4 on If the facility will continue operations under the new owner it
may be more appropriate to request an ownership change to reissue to permit to the new owner
❑ Other
4) Certification:
I, as an authorized representative, hereby request rescission of coverage under the NPDES Stormwater Permit for the
subject facility. I am familiar with the information contained in this request and to the best of my knowledge and belief
such information is true, complete and accurate.
Signature � , , Date A/' A� �
Print or type name of person signing above Title
Please return this completed rescission request form to: NPDES Permit Coverage Rescission
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
1612 Mad Service Center, Raleigh, North Carolina 27699-1612
Phone [phone] FAX [phone]
An Equal Opportunity 1 Affirmative Action Employer