NCG100045_Name-Ownership Change_20181205

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I. Permit Information
I. Please enter the permit number for which the change is requested.
NPDES Stormwater Individual Permit #:
Begins with NCS
-OR-
General Permit Certificate of Coverage (COC) #:
NCGl00045
Begins with NOG or NOGNE
(no exposure)
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: WAYNE MCGHEE AUTOMOTIVE
Company Nlarre
b. Person legally responsible for permit:
First name:* Middle name
WAYNE
Title:
Permit holder's mailing address:*
Phone #:*
919-
417-
0151
c. Facility name:*
d. Facility address:*
Fax #:
Last name:*
MCGHEE
OWNER
Street Address
1400 Phelps Rd
Address Line 2
City
State / Province / Fbgion
Hillsborough
NC
Fbstal / Zip Code
Country
27278-8243
us
WAYNE MCGHEE AUTOMOTIVE
Street Address
1400 Phelps Rd
Address Line 2
City
State / Province / Fbgion
Hillsborough
NC
Fbstal / Zip Code
Country
27278-8243
us
e. Facility contact person (prior to change, optional):
First name: Middle name: Last name:
WAYNE MCGHEE
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: ANDREWS AUTOMOTIVE & SALVAGE
Corrpany Nbrre
c. Person to be legally responsible for permit:
First name:* Middle name: Last name:*
ANDREW EDWAR OYAN
D
Title: OWNER
Permit holder's mailing address:*
Street Address
1400 Phelps Rd
Address Line 2
aty
Hillsborough
Wstal / Zip Code
27278-8243
Phone #:* Email address:*
91924 OYANAU
14211 TO@YA
HOO.CO
M
State / Rovince / Plegion
NC
Country
US
d. Faciltiy name:* ANDREWS AUTOMOTIVE & SALVAGE
Is the FACILITY contact different than the person legally responsible
above?*
r Yes
r No

IV. Permit Contact Information
Is the PERMIT contact different than the person legally responsible
above?
f Yes
r No

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.
North Carolina General Statute 143 - 215.6 b (1) 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*
K44 Nf��G1C
FLrrrit-holder prior to the ownership change, or permt-hdder authorizing the narre change
Will another person need to complete or sign this form before it can be submitted? 11/o 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 [e-mail].