NCC233392_MODIFICATION Supporting Doc (LEG RESP CHANGE)_20240410

NCG01 Legally Responsible Individual Change Form
Use this form when:
The person who is legally responsible forth e permit has changed, but there is NO CHANGE in the project name
or ownership.
**If the project name has changed, or if the ownership of the project has changed, do NOT use this form.**
Instead,you must submit a new NCGO1 electronic Notice of Intent (eNOI).
Directions:
Print this form, complete,scan and upload to the Construction Stormwater Permit MODIFICATION Form.
Then, mail the original form to the NC DEMLR Stormwater Program at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 6t" Floor(Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAILTHIS FORM UNTIL YOUR MODIFICATION HAS BEEN REVIEWED AND ACCEPTED AS COMPLETE.
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) (40 CFR 122.22)
Certificate of Coverage (COC) Number: NCC233392
Name of Project: Duke Energy-Unit 5 Inactive Ash Basin Impoundment Closure-Phase 6 ECP
Legally Responsible Organizational Entity: Duke Energy Carolinas, LLC
PREVIOUS Legally Responsible Individual: David Del lario Mehdi Maibodi is the Previous LRL Please let me know if another
Change Form is required,or if you can update and accept when
NEW Legally Responsible Individual: Eric Szkolnyj you receive the original.
The following section is to be completed and signed by the NEW Legally Responsible Individual.
Per NC General Statute 143-215.6E(i), any person who knowingly makes any false statement, representation,
or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule implementing this Article. . .shall be guilty of a Class 2 misdemeanor which may
include a fine not to exceed ten thousand dollars($10,000).
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