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Home My WebLink AboutNCG020353_Permit Contact Update Request_20230510 Action History (UTC-05:00)Eastern Time(US&Canada) Submit by Anonymous User 5/10/2023 11:39:32 AM (Permit Contact Update Request) Approve by Joyce Sanford 5/25/2023 2:37:19 PM (Contact Update Review) • The task was assigned to DEMLR SW Admin General.The due date is:June 21,2023 5:00 PM 5/10/2023 11:39:36 AM • The task was assigned to Joyce Sanford by round robin distribution 5/10/2023 11:39:36 AM DEQIwo NPDES Stormwater -Request Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number. Number* NCG020353 Begins with NCS,NCG,or NCGNE(no exposure) Facility Name* Hall-Rackley Pit (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 Ronald G Kirkpatrick Jr E-mail Address* knewport@tgandp.com Phone No.* 9194999322 Mailing Address* PO Box 1335 Burlington NC 27216 Physical Address If different than mailing address 696 Claude White Road Cameron, NC 28326 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 Note:This person will REPLACE the current billing contact.We can only designate one billing contact in our permitting database. New Contact Name* First and Last Name Ronald G Kirkpatrick Jr E-mail Address* knewport@tgandp.com Phone No.* 9194999322 Mailing Address* PO Box 1335 Burlington NC 27216 Physical Address If different than mailing address 696 Claude White Road Cameron NC 28326 Submitter's Name* Please enter your FIRST and LAST name Karen Newport Phone Number* Please enter your phone number 9194999322 Any format is fine. Email Address* Please enter a valid e-mail address knewport@tgandp.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 rtt�.r�yjrp�tt Date 5/10/2023 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. NCG020353