NCG030284_Name-Owner Change Form_12/18/2018

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/10/2018 6:18:37 PM (Name Change Submission)
Approve by Georgoulias, Bethany 12/19/2018 12:53:45 PM (Initial Review)
* Verified company on Secretary of State website; updated BIMS on 1211912018.
• The task was assigned to Georgoulias, Bethany 12/10/2018 6:18 PM

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I. Permit Information
I. Please enter the permit number for which the change is requested.
NPDES Stormwater Individual Permit #:
NC
SX
XX
XX
X
-OR-
General Permit Certificate of Coverage (COC) #:
NCG030284
NC
GC
XX
XX
X
Use this link to check the permit contact information that is currently in our database.

II. Permit Status
11. Permit status prior to requested change.
a. Permit issued to: Gerdau Ameristeel US Inc
Company Nlarre
b. Person legally responsible for permit:
First name:* Middle name
Rodrigo
Title:
Permit holder's mailing address:*
Phone #:*
704-
596-
0361
c. Facility name:*
d. Facility address:*
Fax #:
Last name:*
Canova
Street Address
PO Box 481980
Address Line 2
oty
State / Ftovince / Fbgion
Charlotte
NC
Fbstal / Zip Code
Country
28269
USA
Charlotte Rebar Division
Street Address
301 Black Sachel Dr.
Address Line 2
oty
State / Ftovince / Fbgion
Charlotte
NC
Fbstal / Zip Code
Country
28216
USA
e. Facility contact person (prior to change, optional):
First name: Middle name: Last name:
LUIS A NIEVES
Phone #: [phone]

III. Requested Change Information
111. Please provide the following for the requested change (revised permit).
a. Request for changes is a result r Change in ownership of facility
of: * r Name Change of the facility or owner
b. Permit to be issued to: CIVIC Steel US, LLC
Corrpany Nacre
c. Person to be legally responsible for permit:
First name:* Middle name: Last name:*
Greg Brandon
Title:
Permit holder's mailing address:*
Street Address
6565 N. MacArthur Blvd.
Address Line 2
Suite 800
City
State / Province / Pegion
Irving
TX
Wstal / Zip Code
Country
75039
United States
Phone #:*
Email address:*
803-
greg.bra
567-
ndon@c
4515
mc.com
d. Faciltiy name:*
CIVIC Rebar
e. Facility address:*
Street Address
301 Black Satchel Dr.
Address Line 2
City
State / Province / Fbgion
Charlotte
NC
Wstal / Zip Code
Country
28216
USA
Is the FACILITY contact different than the person legally responsible
above?*
r Yes
r No
f. Facility contact person:
First name:* Middle name: Last name:*
Tom McDowell
Phone #:* 813-478-1678
Email address:* Thomas. [e-mail]

IV. Permit Contact Information
Is the PERMIT contact different than the person legally responsible
above?
r Yes
r No
IV. Permit contact information
(if different form the person legally responsible for the permt)
.................................................................................................................................................................................
First Name:* Middle Last Name:*
Peter Name: Poao
Title:
Mailing Address:* Street Address
2600 Park Road Ext.
Address Line 2
City
State / Rovince / Fbgion
Burlington
North Carolina
Fbstal / Zip Code
Country
27215
United States
Phone #:* 336-506-1894
Email Address:* [e-mail]

V. Permit Facility Activities
V. Will the permitted facility continue to conduct the SAME industrial activities conducted prior to this
ownership or name change:*
r Yes
r No

VI. Signature
In the case of an ownership change request, certifications must be signed by both the permit holder
prior to the change and the new applicant. For a name change request, the signed Permittee's
Certification is sufficient.
This completed application is required for both name change and/or ownership change requests.
Legal documentation of 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.
File Upload:* Upload supporting docurrentationfor ownership change
NC Mecklenburg Cty_Deed_Gerdau.pdf 168KB
pdr only
North Carolina General Statute 143 - 215.6 b (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan, or
other document filed or required to be maintained under this Article or a rule implementing this Article; or who knowingly makes a
false statement of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or
knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Article
or rules of the [Environmental Management] Commission implementing this Article shall be guilty of a Class 2 misdemeanor which
may include a fine not to exceed ten thousand dollars ($10,000).
Permittee Certification: I attest that this application for a name and/or 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, or if all required supporting information is not included, this application will be considered incomplete.
Permittee Signature
F2rrrit-holder prior to the ownership change, or pernit-holder authorizing the narre change
Applicant Certification: I attest that this application for a name and/or 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, or if all required supporting information is not included, this application will be considered incomplete.
Applicant Signature
To w horn the pernit is to be transferred
Will another person need to complete or sign this form before it can be submitted? No problem! Simply CLICK
the "Save as Draft" button below and send the URL link to the other party to access the form. Questions? Call The
Stormwater Program at [phone] or e-mail Annette Lucas at annette.lucasancdenr.gov.

Initial Review
Project ID: * Fbviewer may revise perrrit number here if incorrect.
NCG030284