NCG060168_Name Change to Sara Lee Request_20180924

September 17, 2018
Via Federal Express
Laura Alexander
Stormwater Permitting Program
North Carolina Department of Environmental Quality
217 West Jones Street
Raleigh, NC 27603
RE: NOTIFICATION OF NAME CHANGE
KSLB HOLDINGS, LLC
110 SARA LEE ROAD
TARBORO, NORTH CAROLINA
STORMWATER PERMIT NO. NCG060168
Dear Ms. Alexander:
ENVIRONMENT
& HEALTH
V._
SFP
DENR-LAID 1'GI iT„
STO; fdIV,'ATER PERIM1'11"DING
Ramboll US Corporation has prepared this letter to notify the Department of
Environmental Quality of a name change for the above -referenced facility. The new
name for the facility is Sara Lee Frozen Bakery, LLC. There is no change in ownership
related to this name change. Attached please a signed and notarized State Stormwater:
Permit Information Update Application Form, as well as documentation of the name
change. Ramboll understands that there is no fee associated with the name change.
If you have any questions or need further information, please feel free to call me at 609-
243-9816 or email me at [e-mail].
Sincerely,
Thomas V. Fusillo
Principal
Attachment
Ramboll
101 Carnegie Center
Suite 200
Princeton, NJ 08540
USA
T [phone]
F [phone]
www.ramboll.com

ATTACHMENT A
State Stormwater: Permit Information Update Application Form

STATE STORMWATER:
PERMIT INFORMATION UPDATE APPLICATION FORM
There is NO FEE for updating project name or permittee information.
XECEIV ti
3FPh
2 -� j it I v
Dc�\iR_L A;� D ULIALITy
This form is to only to be used by the current permittee to notify the Division ofSTC7;�1 VVV,,41-EP P -E',"017 TING
1) changes to the Point of Contact (signing official) for the current permittee (LLC, Corporation, HOA or POA);
2) changes to the mailing address, phone number or email address of the current permittee;
3) changes to the name of the project; and
4) changes to the legal corporate name as documented by a Name Change or Merger filed with the NCSOS.
A. NEW PERMIT INFORMATION
State Stormwater Permit Number: NCG060168
Are you updating
(check all that apply):
If so, please provide the updated information:
❑ Project name
® Corporation Name'
Corporation name has been changed to Sara Lee Frozen Bakery, LLC from
KSLB Holdings, LLC. There is no ownership change associated with this name
change.
❑ Permit Contact Name 2,3
❑ Permit Contact Title
❑ Mailing Address3
❑ Phone number
❑ Email address
Provide documentation such as a Name Change / Merger filed with the NCSOS.
Provide supporting documentation such as NCSOS filing. The permit contact's position must be in accordance
with 15A NCAC 02H .1040(1).
If more than one point of contact or mailing address is being changed, please attach a separate sheet.
B. CERTIFICATION OF PERMITTEE
I, Bartlett Harwood IV , the current permittee, hereby notify DEMLR that I am making the
changes as listed in Section A above. I further attest that this application for an update to the permit information currently
on file is accurate and complete to the best of my knowledge.
Signature: A%�2%I L Date:
I, VIAP`i--ACN N f UfVt5P�T , a Notary Public for the State of N�I�i,',YOP-�
W�I C4�tS��
County of - , do hereby certify that .TLUT I
F Aeyuw D
personally appeared before me this the S' day of 5t h_ , 20 1,8-, and acknowledge the due
execution of the forgoing instrument. Witness my hand and official seal,
(Notary Seal)
Notary Signatu vL
My commission expires
Mary -Ann Sievert
Notary Public, State of New York
No. 01 S16045090
Qualified in Putnam County
Certified in Westchester County
Commission Expires July 24, 20o2A2
Stormwater Permit Information Update Form Page 1 of 1 May 11; 2017

ATTACHMENT B
Documentation of Name Change

Delaware Page
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY THE ATTACHED IS A TRUE AND CORRECT
COPY OF THE CERTIFICATE OF AMENDMENT OF "KSLB HOLDINGS, LLC",
CHANGING ITS NAME FROM "KSLB HOLDINGS, LLC" TO "SARA LEE FROZEN
BAKERY, LLC", FILED IN THIS OFFICE ON THE TWENTY-THIRD DAY OF
AUGUST, A.D. 2018, AT 12:38 O'CLOCK P.M.
6896468 8100 "''; ;S�y SR# 20186321016
You may verify this certificate online at corp.delaware.gov/authver.shtml
JanvaY w 9�xnasr_ Yrx�c2ary d 3uta
Authentication: 203300933
Date: 08-23-18

STATE ofDELAWARE
DELAWARE
CERTIFICATE OF AMENDMENT
OF
CERTIFICATE OF FORMATION
OF
KSLB HOLDINGS, LLC
August 23, 2018
State of Delaware
Secretary of State
Division of Corporations
Delivered 12:38 PNI 0812312018
FILED 1238 Pili 08/23/2018
SR 20186321016 - File Number 6896468
s
r",'FR- AAJ
1E1a PSiMf 1-11,J -
The undersigned, desiring to amend the Certificate of Formation of KSLB Holdings, LLC
(the "Company") pursuant to the provisions of Section 18-202 of the Limited Liability Company
Act of the State of Delaware (6 Del.C. § 18-101, et sem.), as amended from time to time, does
hereby certify as follows:
(1) The name of the limited liability company is KSLB Holdings, LLC.
(2) The Company was formed upon the filing of its Certificate of Formation with the
Delaware Secretary of State on May 22, 2018.
(3) The Certificate of Formation of the Company is hereby amended as follows:
"(1) The name of the limited liability company formed hereby is: Sara Lee
Frozen Bakery, LLC."
IN WITNESS WHEREOF, the undersigned has executed this Certificate of Amendment
of the Certificate of Formation as of the date first written above.
By:
Name:
Title:
/s/ Bartlett Harwood IV
Bartlett Harwood IV
Vice President and Treasurer