NCS000077_Owner Name Change_20180305

I. Please enter the permit number for which the change is requested.
Division of Energy, Mineral & Land Resources
FOR AGENCY USE ONLY
•
Land Quality Section/Stormwater Permitting
Date Received
Year I Month Day
NCDENR
National Pollutant Discharge Elimination System
Dow Corning Corporation
NW C-1— D--- or
E_N ME1T DNRiURALRE RG
PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit
(or) Certificate of Coverage
N C S 0 0 0 0 7 7
N I C I G
11. Permit status prior to requested change.
a. Permit issued to (company name):
Dow Corning Corporation
b. Person legally responsible for permit:
Darren W Cammin
First MI Last
Greensboro Site Manager
1
ReCCC�•i�D
Title
MAR 0 51018
2914 Patterson Street
Permit Holder Mailing Address
DENR-LAND QUALITY
Greensboro NC 27407
STORMWAgTER PERMITTING
City State Zip
[phone] [phone]
Phone Fax
c. Facility name (discharge):
Dow Corning Corporation
d. Facility address:
2914 Patterson Street
Address
Greensboro NC 27407
City State Zip
e. Facility contact person:
Allen R. Hetzer [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):
c. Person legally responsible for permit:
d. Facility name (discharge):
e. Facility address:
The Dow Chemical Company
Darren W Cammin
First MI Last
Greensboro Site
Title
2914 Patterson Street
Permit Holder Mailing Address
Greensboro NC 27407
City State Zip
[phone] darren.w.camminnadowcorning.com
Phone E-mail Address
Dow Silicones Corporation
2914 Patterson Street
Address
Greensboro NC 27407
City State Zip
f. Facility contact person: Allen R Hetzer
First MI Last
[phone] [e-mail]
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan. 27, 2014
V

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: Allen R Hetzer
First MI Last
Ehss Team Lead
Title
2914 Patterson Street
Mailing Address
Greensboro NC 27404
City State Zip
[phone] [e-mail]
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, Darren Cammin, 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.
�oGd-.11-- March 1, 2018
Signature Date
APPLICANT CERTIFICATION
I, Darren Cammin, 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.
-bo,— i.j d.—_ March 1, 2018
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

L�Do
Dow Silicones Corporation
MAR .+h 2018 2914 Patterson Street
Greensboro, NC 27407
March 1, 2018
Ms. Laura Alexander
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
512 N. Salisbury Street
Raleigh, NC 27603
RE: Dow Corning Corporation Name Change
Dear Ms. Alexander:
In 2016, The Dow Chemical Company acquired 100% ownership of Dow Corning Corporation.
Since then, some of the sites have continued to operate as Dow Corning Corporation, a wholly-
owned subsidiary of The Dow Chemical Company. The Greensboro site is one of these sites.
This letter serves as notice that Dow Corning Corporation changed its name to Dow Silicones
Corporation, effective February 1, 2018. Please update your systems with the new legal entity
name Dow Silicones Corporation.
Please note that aside from the name change, the legal entity:
1) remains a corporation organized under the laws of the State of Michigan, United States
of America
2) remains a 100% wholly-owned subsidiary of The Dow Chemical Company
3) retains its historic Employer Identification Number (EIN) 38-0495575
Enclosed you will find our completed NPDES Permit Name Change Form to formally initiate this
name change with your agency.
Should you have any questions, please feel free to contact Richard Kelley at [phone] or
[e-mail].
Sincerely,
'D., 0 CO�
Darren Cammin
Dow Silicones Corporation