HomeMy WebLinkAboutNCGNE1142_Owner Affiliation Change Request_20170824v�c6- hit l 4 -->—
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August 8, 2017
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, NC 27699-1612
Re: Change of Responsible Official on No Exposure Certification for Exclusion from Industrial
Stormwater Permitting
To Whom It May Concern:
I am writing to request a change of contact information listed on the No Exposure Certification for the
Amazon.com.dedc, LLC — 1UNC2 facility located at 3200 Bush Street, Raleigh, NC 27609. Please accept
this request to remove Derek Jones from the Responsible Authority contact and add Kevin Winston as
the Responsible Authority for the No Exposure Certification at this facility. Please find attached a NPDES
Owner Affiliation Designation Form as the request for this change. For your reference, Kevin Winston's
information is as follows:
Kevin Winston
Senior Regional Environmental Manager
Cell: (925) 577-5326
Email: winskevi@amazon.com
Mailing Address:
NA Environmental Dept.
Amazon.com
P.O. Box 80842
Seattle, WA 98108
RECEIVED
AUG 2 4 2017
DENR-LAND QUALITY
STORMWATER PERMITTING
AUG 24 2017
Please let me know if you have any questions or require any additional information.
Sincerely,
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Kevin Winston
Senior Regional Environmental Manager
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NCDENR
NoR CAROLINA DERARTMENT OF
ENVIRONMENT ANO NATURAL RESOURCES
M LAI' t _O . H O/.[ �
Division of Energy, Mineral and Land Resources FOR AGENCY USE ONLY
Date Received
Land Quality Section / Stormwater Permitting Program Year Month Day
National Pollutant Discharge Elimination System (NPDES)
PERMIT OWNER AFFILIATION DESIGNATION FORM
(individual Legally Responsible for Permit)
if NO CHANGE in company or facility ownership or name has occurred.
If a Name Change and/or Ownership Transfer at the facility has prompted this change, do
NOT use this form. You must fill out the Dame -Ownership Change Form and provide all
necessary supporting documentation instead.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner
Affiliation") applies:
Individual Permit
N I C I S
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage
N I c I G
I �) JE] I I (JF�j-
Amazon.com.dedc, LLC - UNC2
Amazon.com.dedc, LLC
3200 Bush Street
Address
Raleigh NC 27609
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
http://l)ortal.ncdenr.org/web/lr/sw-permit-contacts and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual:
Derek
First
4) NEW OWNER AFFILIATION (Legally responsible for the permit):
Person legally responsible for this permit:
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SW U-OWNERAFFIL-22May2014
Kevin
Jones
MI Last
Winston
First MI Last
Senior Regional Environmental Manager
Title
P.O. Box 80842, Attn: Amazon com, NA Environmental Dept.
Mailing Address
Seattle WA 98108
City State Zip
( 925 ) 577 - 5326 winskevi(cD_amazon.com
Telephone E-mail Address
Fax Number
Page 1 of 2
NPDESStormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
5) Reason for this change:
A result of: Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
What does "legally responsible person" mean?
That 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 that person above.
The certification below must be completed and signed by the permit
holder.
PERMITTEE CERTIFICATION:
1, Kevin Winston , 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.
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please visit our website:
http://portal.ncdenr. ori_/web/Ir/stonnwater
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SM -OW NE RAFFI L-22May2014