NCS000088_Owner Affiliation Change_20190724

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stormwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
ENVIRONMENTAL QUAUTV (Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, state, federal or other public
agency);
• the general partner or proprietor (for a partnership or sole proprietorship);
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit (or) Certificate of Coverage
N I C I S 0 0 0 10 18 18 1 N C G
2) Facility Information:
Facility name: Hexion INC
Company/Owner Organization: Hexion INC
Facility address: 1411 Industrial Drive
Address
Fayetteville NC 28301
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
http://deq.nc. gov/about/divisions/energy-m ineral-land-resources/energy-mineral-land-permits/stormwater-program
and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Craig O Morrison
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit:
Ben Tyler
First MI Last
Page 1 of 2
S WU-OWNERAFFILr23March2017

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
5) Reason for this change:
A result of:
If other please explain:
Site Leader
Title
1411 Industrial Drive
Mailing Address
Fayetteville NC 28301
City State Zip
( 910 ) 485-9249 [e-mail]
Telephone E-mail Address
(910 ) 483-6066
Fax Number
❑✓ Employee or management change
® Inappropriate or incorrect designation before
❑ Other
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I,42
n TN/ � e ( attest that this application for this change in Owner Affiliation
(person legally responsible for the permit) has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this form are not completed, this change may not be
7?,/-j
Date
PLEASE SEIN1) '1'HE UUNIFLE1'ED YUH1V1 l U:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call [phone] or visit the website
at: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
Page 2 of 2
S WU-OWNERAFFILr23Mar2017

HEXION'
Date: March 20, 2017
To: Hexion Manufacturing Site Leaders and Regional Manufacturing Directors
From: Jody Bevilaqua — Chief Operating Officer
to, 6,j�-
CC: Frank Hunold, VP EHS EU/IMEA
Lynn Rives, VP EHS Americas, OTG & ANZ
Subject: Delegation of Environmental, Health and Safety Authority
MEMO
As Chief Operating Officer of Hexion Inc. ("Hexion"), I confirm that I have authorized you to interface
with appropriate governmental authorities, media representatives and the public (in a manner consistent
with applicable Hexion policies and standards) on environmental, health, and safety related matters
relating to the Hexion Site or Sites for which you are responsible, as a responsible official of Hexion.
You are further authorized to sign on behalf of Hexion, as a responsible corporate official, all
environmental, health, and safety related:
- applications (including, but not limited to, permit applications);
- transportation documents (including, but not limited to, manifests and shipping papers);
- periodic reports; and
- correspondence
relating to the Hexion Site or Sites for which you are responsible. This delegation of authority is effective
immediately, is consistent with Hexion policies and standards, supersedes all prior delegations of
authority which may have been in place, and shall continue to be effective until explicitly revoked or
otherwise superseded.
Note that this delegation is not effective when otherwise prohibited or superseded by applicable law or
regulation, and does not eliminate the need to submit any legally -mandated delegation of authority form
that locally applicable laws or regulations may require to effectuate delegation of authority. Note also
that this delegation of authority authorizes you to further delegate the authority granted hereunder —
except wAotherwiseprohibi ion policies or standards, or by applicable laws or regulations.
SignaturName: 21r
Title:
Date: 119 -af % f
Site(s): F t/e- -k—v" I i e- , tiL