NCS000373_Email re Contact Updates_20201124

McCoy, Suzanne
From:
Chris Crisler <[e-mail]>
Sent:
Tuesday, November 24, 2020 2:48 PM
To:
McCoy, Suzanne
Subject:
RE: [External] Corrections for Permit
Attachments:
SWPPP legally responsible change form.pdf
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Follow up
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Thank you.
I have sent over the Owner form on another email as I found that form not long after sending you this request.
Chris Crisler:
chris.crisler(@michelin.com
40589 S. Stanly School Rd
Norwood, NC 28128
704-474-7777
Heather Ashby:
heather.ashbv(@michelin.com
40589 S. Stanly School Rd
Norwood, NC 28128
704-474-8136
Thank you!
Chris CRISLER
Environmental Site Specialist
40589 S Stanly School Rd
Norwood, NC 28128
Michelin
North America
Tel: [phone]
Internal: 784-7777
@: chris.crisler(o)-michelin.com
Classification D3
Retention <90 days
1

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From: McCoy, Suzanne <[e-mail]>
Sent: Tuesday, November 24, 2020 2:43 PM
To: Chris Crisler <[e-mail]>
Subject: [EXT] RE: [External] Corrections for Permit
Good afternoon Chris.
Please complete the electronic form for the Legally responsible person, complete the Owner
Designation/Affiliation Form.
I will need the email address, phone number and mailing address for each of the others you indicated below.
Suzanne McCoy
Stormwater Program Administrative Specialist
Division of Energy, Mineral and Land Resources
North Carolina Department of Environmental Quality
Physical: 512 N. Salisbury Street, Office 640K, Raleigh, NC 27604
Mailing: 1612 Mail Service Center, Raleigh, NC 27699-1612
Email: Suzanne. mccoyCa�ncdenr.gov
Phone: [phone]
Website: http://deg.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
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From: Chris Crisler [mailto:[e-mail]]
Sent: Tuesday, November 24, 2020 1:04 PM
To: McCoy, Suzanne <[e-mail]>
Subject: [External] Corrections for Permit
External email. Do not click li
[e-mail] 0
Good afternoon Suzanne,

I need to make an update to our responsible official for our site, also for facility contacts:
Responsible Officer: Shannon Bernhardt
Facility contact persons: Replace Brad Hinchman with Heather Ashby keep Chris Crisler
Permit Contact Person: Replace Brad Hinchman with Chris Crisler keep Heather Ashby
Let me know if you need anything from me, Thanks
Chris CRISLER
Environmental Site Specialist
40589 S Stanly School Rd
Norwood, NC 28128
Michelin
North America
Tel: [phone]
Internal: 784-7777
@: chris.crisler(o)-michelin.com
Classification D3
Retention <90 days
This e-mail may contain confidential information and is intended solely for the use of the addressee. Any disclosure of this information is
strictly prohibited and may be unlawful. If you have received this e-mail by mistake, please notify us immediately and delete this e-mail.
This email was screened for spam and malicious content but exercise caution anyway.

Division of Energy, Mineral, and Land Resources
Land Quality Section / Stm•mwater Program
National Pollutant Discharge Elimination System (NPDES)
Energy, Po1Droral & PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
I;t,,H�,QM!I;M I rn,;,IIIY (Individual Legally Responsible for Permit)
Use this form if there has been:
POR AGENCY USE ONLY
Dale Received
Ycar
I Month
Day
if fhe 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 respmrsible indivichral" 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 duty authorized representative of one of the above.
I) 1lnter the permit number for which this change in Legally Responsible Individual ("Owner Affiliatimr")
applies:
Individual Permit
mmom
2) Facility Htformation:
Facility name:
Company/Owner Organizatimr:
Facility address:
(or) Certificate of Coverage or No ExposureWOMMEMEME
Michelin Aircraft Tire Company
Michelin N America Inc.
40509 S Stanty School Rd
Address
Norwood NC 28128
City State Zip
To find the current legally responsible persmr associated with your perurit, go to this website:
https:/ldeq.nagovlaboutld iv isi onslenergy-m inert]-land-resourceslenergy-mineral-land-perm i tshrpdes-i ndustri program and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Preston
4) NSW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit:
Gray
MI
Last
Shannon Bernhardt
First MI Last
Page I oft
S WU-OWNERAFPRANov2019

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
5) Reason fm• this change:
A result of:
If other please erpla6�:
an Manager
Title
40589 S. Slanly School Rd
Mailing Address
Norwood NC 28128
City State Zip
( 704 ) 474-7757 [e-mail]
Telephone E-mail Address
Pax 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 Shannon Bernhardt
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
processed.
nature
PLEASE SEND THE COMPLETED FORM TO:
DEMLR - Stormwater Program
Dept. of Environmental Quality
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts,
at: httpaldeq.nc.t;ovlaboutldivisions,
Date
call [phone] or visit the website
5 WU-O WNERN� F'IL-4Nov2019
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