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HomeMy WebLinkAboutNCS000370_Permit Contact Update Request_20220324 (2)Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 3/24/2022 2:51:11 PM (Permit Contact Update Request) Approve by EADS\kmtran 3/28/2022 10:53:33 AM (Contact Update Review) • Georgoulias, Bethany A reassigned the task to Tran, Kieu M 3/25/2022 11:36 AM IN I think this person submitted two requests - this one has additional updates. The task was assigned to Georgoulias, Bethany A. The due date is: May 5, 2022 5:00 PM 3/24/2022 2:51 PM Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number. Number* NCS000370 Begins with NCS, NCG, or NCGNE (no exposure) Facility Name* Bridgestone America's Tire Operations, LLC (Used to verify permit number) Check permit contact information for your permit by running a Stormwater Permit Summary Report. Guidance for COC holders: Do not enter the General Permit number with all 0's (for example, NCG030000) but instead your Certificate of Coverge (COC) number. Check all that Owner Affiliation (Legally Responsible Individual) Update apply: * Permit Ownership Transfer or Facility Name Change Delegation of Signature Authority (DOSA) Permit Contact Update Billing Contact Update Facility Contact Update Other Contact Update Permit Contact Update Provide new permit contact information This person should REPLACE the current permit contact. This person should just be added as another permit contact. New Contact Name * First and Last Name Jerray Battle E-mail Address* battlejerray@bfusa.com Phone No.* 252-2467485 Mailing Address* P.O. Box 1139, Firestone Parkway NE Wilson, NC 27894-1139 Physical Address If different than mailing address 3001 Firestone Parkway Wilson, NC 27893 Add another permit contact if needed by clicking the'Add' button below Stormwater Program's Billing Specialist will be notified about the billing update request by email upon approval. Billing Contact Update Provide new billing contact information This person should REPLACE the current billing contact. This person should just be added as another billing contact. New Contact Name* First and Last Name Jerray Battle E-mail Address* battlejerray@bfusa.com Phone No.* 252-246-7485 Mailing Address* P.O. Box 1139, Firestone Parkway NE Wilson, NC 27894-1139 Physical Address If different than mailing address 3001 Firestone Parkway Wilson, NC 27893 Submitter's Name* Please enter your FIRST and LAST name Jerray Battle Phone Number* Please enter your phone number 252-246-7485 Any format is fine. Email Address* Please enter a valid e-mail address Battlejerray@bfusa.com A confirmation of submission will be e-mailed to this address. * By checking the box and signing below, I certify that: I have given true, accurate, and complete information on this form; I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act'); I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act'); I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature (except for any uploaded Owner Affiliation Change or Delegation of Signature of Authority forms, which also must be mailed in with original signature); AND I intend to electronically sign and submit this Permit Contact Update Request form. Signature '-av�w Date 3/24/2022 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCS000370