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HomeMy WebLinkAboutNCG020795_Delegation_of_Signature_Authority_20210716NC Department of Environmental Quality Division of Energy, Mineral and Land Resources %ORTH CAROLINA Enrlronrrrenfaf QuaNty Stormwater Permit Delegation of Signature Authority Form Directions are in red. => This form shall be used to delegate signature authority from the permit Owner (Permittee) to another party. Only the Responsible Official defined below may submit permit applications and reports required by the permit (such as Data Monitoring Reports and Annual Reports) until this form is completed and submitted to the DEMLR Stormwater Program. Please note that delegating signature authority does not relieve the Permit Owner from the responsibility for permit compliance. => The permit Owner is the legal entity to which/whom a permit has been issued, and may be an individual or an organization such as a company or government agency. Every Owner is required to have a Responsible Official who meets the legal signature authority requirements in 40 CFR 122.22, summarized below. - For a corporation, the Responsible Official shall be a president, secretary, treasurer, or vice- president in charge of a principal business function, or another individual who performs similar functions for the corporation, or the manager of one or more manufacturing, production, or operating facilities who is authorized to make management decisions about the facility operation. • For a partnership or sole proprietorship, the Responsible Official shall be a general partner or the proprietor, respectively; or • For a municipality, State, Federal, or other public agency, the Responsible Official shall be either a principal executive officer [City/County Manager] or ranking elected official [Mayor]. => Even if delegated signatory authority has been delegated to another individual, the Responsible Official retains responsibility for compliance with permit conditions. Permittee: Sibelco North America, Inc. -Schoolhouse Quartz Facility Permit Number: NCG020795 Responsible Official Title: Director HPQ Operations Email Address: Doug.Myers@sibelco.com Phone: �(828) 765-4283 Mailing Address: Post Office Box 588 City: Spruce Pine State: �Nc Zip: 28777 Stormwater Delegation of Signature Authority Form Page 1 A. Persons to Receive Signatory Authority > The signatures of the persons listed below indicates their acceptance of signatory authority. D_el_egated Party Name: Rick Singleton Delegated Party Title: Production Manager - Minerals Separation Delegated Party Organization: Sibelco North America, Inc. Rick.Singleton@sibelco.com Phone: (828) 765-4251 Email Address: Mailing Address: Post Office Box 588 City: T Spruce Pine State: NC Zip: 28777 Signature of Delegated Party indicating acceptance of Signatory Authority: ik� Date: -7114 72 $ Delegated Party Name: James Byrd Delegated Party Title: _ Mining Manager Delegated Parley Organization: Sibelco North America, Inc. Email Address: James.Byrd@sibelco.com Phone: (828) 7s5-4251 Mailing Address: Post Office Box 588 City: Spruce Pine I State: NC Zip: 28777 Signature of Delegated Party indicating acceptance of Signatory Authority: /_ Date: 7/15/2021 Delegated Party Name: iJody McKinney Delegated Party Title: Environmental Affairs Supervisor Delegated Party Organization: Sibelco North America, Inc. Email Address: Jody.McKinney@sibelco.com Phone: (828) 765 4251 Mailing Address: Post Office Box 588 City: Spruce Pine I State: INC; Zp: 28777 Signature of Delegated Party indicating acceptance of Signatory Authority: Date: % - Delegated Party Name: Delegated Party Title: Delegated Party Organization: Email Address: Phone: Mailing Address: City: State: zip: Signature of Delegated Party indicating acceptance of Signatory Authority: Date: Stormwater Permit Delegation of Signatory Authority Form Page 2 B. Responsible Official Signature The Responsible Official, as identified in accordance with 40 CFR 122.22, is the appropriate individual with the authority to sign and submit reports for the organization. As the Responsible Official, I, Douglas E. Myers have the authority to enter into this Agreement for Sibelco North America, Inc. (Owner/Organization Name). (printed name), I request that the DEMLR Stormwater Program include the persons listed in Part A of this form signatory authority for the above -named permit. I acknowledge that I, and the persons listed in Part A of this form work at/for my organization and have authority to act as a signatory for purposes of the NCDEQ's electronic document systems. By submitting this application, I, Douglas E. Myers (printed name), have read, understand, and accept the terms and conditions of the stormwater permit(s) for which I am the Responsible Official. Respohsibl6'Official Signature Director HPQ Operations 7/14/2021 Title Date Stormwater Permit Delegation of Signatory Authority Form Page 3