NCG050153_Owner Affiliation Change Info_20180312

—Fa ejz�d & .
Division of Energy, Mineral, and Land Resources FOR AGENCY USE ONLY
Date Received
Land Quality Section / Stormwater Program YearI Month Da„
National Pollutant Discharge Elimination System (NPDES)
Eneu/), ,%hncl a! PERMIT OWNER AFFILIATION DESIGNATION FORM
Lural Resources
:. + • 1..L(Individual Legally Responsible for Permit)
Use this form if there has been:
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual' mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit (oi) Certificate of Coverage
N I C I S I I I I I = I N I C I G 10 15 10 11 15 13
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
Cascades Tissue Group -North Carolina, a division of Cascades Holding US Inc.
Cascades Inc.
PO Box 578 805 Midway Rd.
Address �A.U,41,% c1. 1 a nom,
Rockingham North Cad 28379
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
littp:Hdeg.nc.gov/about/divisions/eiiergy-mi neral-land-resources/eiieray-mineral-land-perm its/stormwater-program
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual:
Eric
Taylor
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: MI y
First ml,,, --Last
Page 1 of 2
S WU-OWNERAFFII,23March20l7
L l

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
Guillaume Bouvier- VP of Operations
Title
77,Marie-Victorin Blvd.
Mailing Address��
Candiac(Quebec, Card' J5R1C2
City State Zip
('+Ou) n4by �unidunre auuviertw�asudc��
Telephone E-mail Address
Fax Number
5� Reason for this change:
A result of:
If other please explain:
0✓ Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I, Mickey Lee , attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
processed.
'1 03/02/2018
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website
at: http://deg.iic.gov/about/divisions/energy-mineral-land-resources/stormwater
Page 2 of 2
S WU-OWNERAFF1Lr23Mar20l7

Alexander, Laura
From:Karen Bellamy <[e-mail]>
Sent:Monday, March 12, 2018 1:05 PM
To:Alexander, Laura
Subject:RE: \[External\] Permit Contact Change Request - General Permit
CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an attachment to
Report Spam.

Laura,
This form is correct . Eric Taylor is removed and Mickey Lee put in his place. Gary Hayden removed and Guilliame put in
his place.
This is the form I just sent to the Stormwater section the other day for changes.

From: Alexander, Laura \[mailto:[e-mail]\]
Sent: Monday, March 12, 2018 9:21 AM
To: Karen Bellamy <[e-mail]>
Subject: RE: \[External\] Permit Contact Change Request - General Permit

Good Morning,

Please edit the first page to Guillaume Bouvier as the owner in place of Mickey Lee and I will get our system
st
updated. You can scan 1 page back to me.

Thanks,
Laura

From: Karen Bellamy \[mailto:[e-mail]\]
Sent: Thursday, March 08, 2018 11:41 AM
To: Alexander, Laura <[e-mail]>
Subject: RE: \[External\] Permit Contact Change Request - General Permit

CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an attachment to
Report Spam.

Once the changes have been completed can you send me a screen shot to make sure it is correct.
Thanks

From: Alexander, Laura \[mailto:[e-mail]\]
Sent: Thursday, March 08, 2018 11:39 AM
To: Karen Bellamy <[e-mail]>
Subject: RE: \[External\] Permit Contact Change Request - General Permit

Good Morning,

Would you mind editing the first page of the owner affiliation form so that we have Guilliame Bouvier listed instead of
Mickey Lee? Thanks for your help. I’ve already had the billing info updated so that you will receive invoices in
Rockingham.
1

Regards,

Laura Alexander

From: Karen Bellamy \[mailto:[e-mail]\]
Sent: Monday, March 05, 2018 11:56 AM
To: Alexander, Laura <[e-mail]>
Subject: RE: \[External\] Permit Contact Change Request - General Permit

CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an attachment to
Report Spam.

Guilliame Bouvier would be the owner. Mickey Lee is the Mill Manger who will sign off on Permits , etc. Mickey Lee and
I need to get the information and Billing at Rockingham.
Guilliame is the VP of Operation for Cascades , He would replace Gary Hayden’s name on your list.
Thanks

From: Alexander, Laura \[mailto:[e-mail]\]
Sent: Monday, March 05, 2018 9:28 AM
To: Karen Bellamy <[e-mail]>
Subject: RE: \[External\] Permit Contact Change Request - General Permit

Good Morning Karen,

We received the form that you uploaded. Thank you. One question. I noticed that you listed Guillaume Bouvier on the
second page. Is this the information that you’d like under Mickey Lee’s name? Let me know and I’ll make sure our
system reflects the correct information.

Thank you,

Laura

From: Karen Bellamy \[mailto:[e-mail]\]
Sent: Wednesday, February 28, 2018 2:42 PM
To: Alexander, Laura <[e-mail]>; Georgoulias, Bethany <[e-mail]>; Karen
Bellamy <[e-mail]>
Subject: \[External\] Permit Contact Change Request - General Permit

CAUTION: External email. Do not click links or open attachments unless verified. Send all suspicious email as an attachment to
Report Spam.

Hi Laura and Bethany,
Cascades Tissue Group-NC Stormwater permit should be coming up for renewal. NCG050153
Eric Taylor is no longer at our facility.
Mickey Lee has taken his place. [e-mail]. 805 Midway rd. Rockingham, NC 28379
Phone [phone] Ext. 74223.

We want our permit renewed. I am still the permit contact and also handle paying the permit.
Cascades Inc is the owner and Mickey_Lee is the Mill Manger and has signatory authority for the mill.

2

If you have any questions please let me know.

Karen V. Bellamy
Karen Bellamy
Environmental Manager
CASCADES Tissue Group North Carolina
805 Midway Rd
Rockingham, North Carolina 28379
Tel: [phone] Ext. 74280

Cell: 910-995-8292 or 0091

3