NCG030466_Owner Affiliation Change_20220126

Division of Energy, Mineral, and Land Resources 1 FOR AGENCY USE ONLY
Land Quality Section / Stormwater Program Dare Received
Q `J g Year I Month Day
National Pollutant Discharge Elimination System (NPDES)
Energy, Mineral& PERMIT OWNER AFFILIATION DESIGNATION FORM
Land Resources
emnaaHMs,u, AL ou>ury (Individual Legally Responsible for Permit)
Use this form if there has been:
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)
NC S'
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
Eaton, Asheville
Eaton Corporation
Certificate of Coverage or No Exposure
NI CIG'0 13 0 4 6 6
221 Heywood Road
Address
Arden NC 28704
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
https://deq. nc. gov/about/divisions/energy-mineral-land-resources/energy-mineral-land-permits/npdes-industrial-
rp ogram and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual: Dave A Mannebach
First MI Last
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: John A RUSSIer
Page 1 of 2
S WU-OWNERAFFIIANov2019

NPDES Stormwater Permit OWNER AFFILIATION DESIGNATION
Form (if no Facility Name/Ownership Change)
5) Reason for this change:
A result of:
If other please explain:
Plant Manager
Title
221 Heywood Road
Mailing Address
Arden NC 28704
CiTy State Zip
( 828 ) 687-3001 [e-mail]
Telephone E-mail Address
( )
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 John Russler ,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.
1 /12/2022
Signature
L
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, please call [phone] or visit the website
at: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
Page 2 of 2
S WU-OwNERAFFIL-4Nov20(9

Georgoulias, Bethany
From: Slack, Todd <[e-mail]>
Sent: Wednesday, January 26, 2022 4:28 PM
To: Georgoulias, Bethany
Cc: Smathers, Kevin M; Brittain, Shelly R; Overly, David A; Jennifer Verde
Subject: [External] eDMR Registration for NCG030466
Attachments: 2021.01.26_Eaton Affiliation Designation.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Good Afternoon Bethany.
Attached is the updated permit owner affiliation designation form for our stormwater program.
R/s,
Todd Slack
Respectfully,
TODD SLACK
Environment, Health, Safety Supervisor
Asheville Facility, Eaton Corporation
Cell: +1 828.767.4068
Desk: +1 828.687.3384
toddslack(a)-eaton.com
IFM,To
ibWVrirrg Business worldw"de
Connect with Eaton:
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