Loading...
HomeMy WebLinkAboutNCG030321_Name-Owner Change Form_9/25/2019Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 9/25/2019 1:37:35 PM (Name Change Submission) Approve by McCoy, Suzanne 9/25/2019 3:33:15 PM (Notification to Admin) • The task was assigned to McCoy, Suzanne 9/25/2019 1:37 PM � ST1V{ NORTH C:Ft iO�INA ErtYfranminlQf QYQiff}� 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) #: NCG030321 NC GX 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: Carolina Steel Group, LLC Conpany�bne b. Person legally responsible for permit: First name:* Middle name: Last name:* Richard Cooper Title: President and CEO Permit holder's mailing address:* Phone #:* 405- 235- 3621 c. Facility name:* d. Facility address:* Fax #: Street Address PO Box 25369 Address Line 2 aty State / Frovince / Fbgion Oklahoma City Oklahoma Fbstal / Zip Code Country 73125 USA Carolina Steel Group LLC Street Address 9035 West Market Street Address Line 2 aty State / Rovince / Fbgion Colfax NC Fbstal / Zip Code Country 27235 US e. Facility contact person (prior to change, optional): First name: Middle name: Last name: Clyde Martin Phone #: 336-993-2680 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: W&W-AFCO Steel LLC Corrpany Nacre c. Person to be legally responsible for permit: First name:* Middle name: Last name:* Kim Rolston Title: General Counsel Permit holder's mailing address:* Street Address PO Box 25369 Address Line 2 aty State / Province / Fbgion Oklahoma City Oklahoma Wstal / Zip Code Country 73125 USA Phone #:* Email address:* 405- krolston 235- @wwafco 3621 steel.com d. Faciltiy name:* W&W-AFCO Steel LLC e. Facility address:* Street Address 9035 West Market Street Address Line 2 aty State / Province / Pegion Colfax NC FUstal / Zip Code Country 27235 US 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:* Clyde Martin Phone #:* 336-993-2680 Email address:* cmartin@wwafcosteel.com 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:* Clyde Name: Martin Title: Plant Manager Mailing Address:* Street Address 9035 West Market Street Address Line 2 aty Colfax Fbstal / Zip Code 27235 Phone #:* 336-993-2680 Email Address:* cmartin@wvrafcosteel.com State / Rovince / Fbgion NC Country US 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 docurrentation for ownership change 2G3. North Carolina Articles of 76.32KB Merger.pdf pdf only 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 FL-rnit-holder prior to the ow nership change, or perrrit-holder authorizing the nave 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 (919) 707-3639 or e-mail Annette Lucas at annette.lucas(a)ncdenr.gov. Initial Review Project ID: * Fbviewer may revise perrrit number here if incorrect. NCG030321