NCG060031_Name Ownership Change_20190620

ROY COOPER
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Water Resources
ENVIRONMENTAL QUALfTY
MICHAEL S. REGAN
LINDA CULPEPPER
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PERMIT NAME/OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Permit Number: NCG060031
1. Facility Name: ADM Southport
NEW OWNER/NAME INFORMATION:
1. This request for a name change is a result of:
a. Change in ownership of property/company
_X_b. Name change only
c. Other (please explain):
2. New owner's name (name to be put on permit):
Ryan Howard
3. New owner's or signing official's name and title: Ryan Howard
(Person legally responsible for permit)
Plant Manager
(Title)
4. Mailing address: 1730 East Moore Street SE City: Southport
State: NC Zip Code: 28461 Phone: [phone]
E-mail address: Ryan. Howard (c)ADM.com
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS ALL OF THE
APPLICABLE ITEMS LISTED BELOW ARE INCLUDED WITH THE SUBMITTAL.
REQUIRED ITEMS:
1. This completed application form
2. Legal documentation of the transfer of ownership (such as a property deed, articles of
incorporation, or sales agreement)
[see reverse side of this page for signature requirements]
State of North Carolina I Environmental Quality I Water Resources
1617 Mail Service Center I Raleigh, NC 27699-1617
919 807 6300 919-807-6389 FAX
https://deq. nc.gov/about/divisions/water-resources/water-resources-permits/wastewater-branch/npdes-wastewater-permits

NPDES Name & Ownership Change
Page 2 of 2
Applicant's Certification:
I, Ryan Howard , 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 and attachments are not included, this application
package will be returned as incomplete.
Signature. Date: June 12, 2019
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
INFORMATION & MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDDRESS:
NC DEQ / DWR / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Version 1112017