NCG050374 -

Afflo
W FOR �cE>vcwUSE ONLYDivision of Energy, Mineral & Land Resources fA Land Quality Section/Stormwater Permitting Year
�National Pollutant Discharge Elimination System
NCDENR
PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
0 5 0 3 7 4
II. Permit status prior to requested change.
a. Permit issued to (company name):
b. Person legally responsible for permit:
DECEIVED
MAR 0 6 2018
DENR-LAND QUALITY
STORMWATER PERMITTING
c. Facility name (discharge):
d. Facility address:
Piedmont Fiberelass. Inc
Douglas Caudle
First MI Last
President
Trtle
33 Lewittes Road
Permit Holder Mailing Address
Taylorsville NC 28681
City State Zip
[phone] [phone]
Phone Fax
Piedmont Fiberglass, Inc
33 Lewittes Road
IV. Permit contact information (if different from the person legally responsible for the permit)
RovbW An. 27.2014
Address
Taylorsville NC 28681
City State Zip
e.
Facility contact person:
Douglas Caudle [phone]
First / MI /Last Phone
III. 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):
Piedmont Composites and Tooling, LLC
c.
Person legally responsible for permit:
David Himebaugh
First Ml Last
President
Title
33 Lewittes Road
Permit Holder Mailing Address
Taylorsville NC 28681
City State Zip
niaaraacrer.m,,,/
.[phone]
Phone E-mail A dress
d.
Facility name (discharge):
Piedmont Composites and Tooling, LLC
e.
Facility address:
33 Lewittes Road
Address
Taylorsville NC 28681
City State Zip
f.
Facility contact person:
David Himebaugh
First Ml Last
[phone] davJ.Awe/ &jhQ p;edrllo
&SCbM
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
RovbW An. 27.2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: David
Himebaugh
First
Ml
Last
President
✓
Title
33 Lewittes Road
Mailing Address
Taylorsville
NC
28681
City
State
Zip
[phone]
dived. ir�wreb.����ir•�.,+osriL
r.�tr.taa.,
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, Douglas Caudle, President, Piedmont Eilmlass. Inc., attest that this application for a nametownership
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, plica ' package will be returned as incomplete.
Signature Date
APPLICANT CERTIFICATION
I, David Himebaug_L President, Piedmont Composites And Tooling LLC, attest that this application for a
nametownership change has been reviewed and is accurate and complete to the best of my knowledge. I
understand that if all required parts of this app cation are not completed and that if all required supporting
information is not includ this licatio ckage will be returned as incomplete.
r
V Om
Signature Date
......... a ....................... S..
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
Rased Jan. 27.200

February 23, 2018
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
RE: Piedmont Fiberglass - Taylorsville, North Carolina Plant
Name/Ownership Change
Dear Sir/Madam,
Piedmont Composites and Tooling, LLC is purchasing the Piedmont Fiberglass Incorporated, Taylorsville
Plant. Enclosed is the Name/Ownership change application, including:
• Permit Name/Ownership Change Form
No additional changes are required at this time. If you have any questions regarding this submittal or
need additional information, please contact me at [phone].
Sincerely,
PIEDMONT COMPOSITES AND TOOLIr)
<� I ///U, A�
David Himebaugh
President
Rete V
MAR 06 2016
ST RMW LAND QUAL17 y
ATTR pER'f TT1NG