NCG100151_Owner Name Change Request_20170412

Division of Energy, Mineral & Land Resources FOR AGENCY USE ONLY
�• Date Received
r Land Quality Section/Stormwater Permitting Year Month I Day
RCDENR
m
National Pollutant Discharge Elimination Syste
— xx—� ��
PERMIT NAME/OWNERSHIP CHANGE FORM
E.rvvw,.w..t•+r ...p N. .m., Rtcrn.or
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) y Certificate of Coverarye
N C S 10 N I C I G
11. Permit status prior to requested change.
a. Permit issued to (company name): \1_', t,'- tau\ o ",a\v a Cy
b. Person legally responsible for permit: k > l
firs A41 Last
Title 4pf
Perron I ]older Mailing Address
dp 9,/
City State Zip p
( ,Phone Fax
c. Facility name (discharge): e lt;ot- ANDt.) 3c.1\jC,5,f
d. Facility address: ll7 Ir, Ho \f?,5t 5\-:
Address
�1Jrhr M NL %11Cti
City State Zip
e. Facility contact person: �,G�u r,11�bC�- ( `ttd)
First / Ml / Last Phone
111. Please provide the follo»ing for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
©tame change of the facility or owner
If other ph use explain:
b. Permit issued to (company name): L > tk-, r--, YAVAI u-r\S
c. Person legally responsible for permit: /'1' MK J IfVC44 c2,a
First Ml Last
_C,4 -
Title
to S -r
Permit I lolder Mailing Address
u os" NC 2770\-/
City State zip
(3L<fj C11(23 61 410.Cc�s�,
Phone E-mail Address
d. Facility name (discharge): liI C��t•?,= �vq', J, T'S
e. Facility address: lk PvC)T- Sr-
Address
rAddress
VJr�av� i(-- Z%%d Y
City State Zip
f. Facility contact person: k j KIC'"C-AA
l'trst N41 Last
(3%5)53Y -2E0 eyc,6I13e1*e.crr�
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:
First Ml Last
Title
Mailing Address
Citi State Zip
Phone E-mail Address
V Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
E Yes
❑ No (please explain)
V1 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):
1, , 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.
w
re
Signature Date
APPLICANT CERTIFICATION
1. . 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 a lication package will be
returned as ' piece.
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

Book7815 - Page483 Page 1 of 3
FOR REGISTRATION
liallie L. Covington
REGISTER OF DEEDS
Durham County NC
2015 OCT 30 10:11:40 AM
BK:7815 PG:483-485
DEED
FEE:$26.00
INSTRUMENT # 2015036441
SCEARNEL
2015036441
NORTH CAROLINA
NON WARRANTY DEED
Prepared by and Return to: Tonya B. Powell, Esq.
128 E. Hargett Street, Suite 300
Raleigh, NC 27601
PIN: 168365 and 168369
Revenue Stamps: $0.00
THIS DEED made this the � day of October, 2015 by and between
GRANTOR
RAYMOND MARK ELLIOTT3
�>\J orcR&
GRANTEE
1010 HARVEST STREET, LLC
1010 Dresden Meadow Court
Cary, NC 27519
The designation Grantor and Grantee as used herein shall include said parties, their heirs,
successors and -assigns, and shall include singular, plural, masculine, feminine or neuter as
required by context.
WITNESSETH, that Grantor, for a valuable consideration paid by the Grantee, the receipt of
which is hereby acknowledged, has and by these presents does grant, bargain, sell and convey
unto the Grantee in fee simple, all that certain lot or parcel of land situated in Durham County,
North Carolina and more particularly described as follows:
See Exhibit A attached hereto incorporated herein by reference

Book7815 - Page484 Page 2 of 3
The property hereinabove described was acquired by Grantor by instrument recorded in Book
7205, Page 704, Durham County Registry, North Carolina.
TO HAVE AND TO HOLD the aforesaid lot or parcel of land and all privileges and
appurtenances thereto belonging to the Grantee in fee simple.
Title to the property is subject to the following exceptions:
1. Ad valorem taxes for the year 2016 and subsequent years, a lien not yet due and
payable.
2. Restrictions, easements and encumbrances of record.
IN WITNESS WHEREOF, the Grantor has hereunto set his hand and seal, or if corporate, has
caused this instrument to be signed in its corporate name by its duly authorized officers and its
seal to be hereunto affixed by authority of its Board of Directors, the day and year first above
written.
Gr � .�.�/ •0`'Ic.�•.l,G- (Seal)
RAY OND MARK ELLIOTT
STATE OF NORTH CAROLINA, ;,{� horn COUNTY: SS. �jDr���-'��1� Vle-
1, Nce�4ta') i c; U3C' - ��s a Notary Public of the County and State
aforesaid, certify that RAYMOND MARK ELLIOTT, personally came before me this day and
acknowledged the due execution of the foregoing instrument was signed by him in the capacity
shown and sealed with his corporate seal.
Witness my hand and official stamp or seal, this the ��-day of October, 2015.
.L 6&��
_ASTASIA WATKINS
Notary Public
North Carolina
Alamance County
NON -WARRANTY DEED
Notary Public
My Commission Expires:

/ j -!CLOSING -ST TE6[BIVT- .
SELLER: Raymond Mark Elliott
DATE: 10/3012015
PROPERTY: 1010 Harvest Street, Durham, NC
,
Summary of Seller's Transaction Summary of Buyer's Transaction
Gross Amt Due to Seiler Gross Amt Due from Buyer
Contract Sales Price $775,000.00 Total Contract Sales Price $775,000.00
Buyer's closing costs $52.00
(see Closing Costs sheet)
Total 5775,000.00 Total $776,269.43
Deductlons to Amt due to Seller Deductions to Amt due from Buyer
Seller's dosing costs $46,050.00
(see Closing Costs sheet)
2015 Tax Proration $5,949.67
Earnest Money $5,000.00
Total $53,999.67 Total $5,000.00
Net Proceeds Due to Seiler $721,000.33 Net Amt due from Buyer $771,269.43
Sailor. Buyer 1010 Harvest Stree LLG
By.
Raymond I rk Elliott
By'

August 24, 2016
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Lifetime Audi Parts
1010 Harvest St.
Durham, NC 27704
Coverage No.: NCG100151
James Environmental
management, inc.
Certified Mail
On behalf of Lifetime Audi Parts, James Environmental Management, Inc. is submitting the
enclosed Permit Name/Ownership Change Form for transferring the current permit ownership
to Lifetime Audi Parts.
Should you have any questions or require additional information, please feel free to call.
Sincerely,
i
Emily Baca
Enc
cc:
Permit Name/Ownership Change Form
Mark Kuchera
RECEIVE®
APR 12 2017
DENR-LAND QUALITY
STORMWATER PERMITTING
600 Round Rock West Drive, Suite 201 . Round Rock. Texas 78681 • [phone] 9 Fax: [phone]