NCG020910_Permit Contact Update Request_20260204

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 2/4/2026 10:30:39 AM (Permit Contact Update Request)
Approve by bradley.bennett 2/25/2026 11:41:58 AM (Contact Update Review)
0 Changes made in the permitting system.
• The task was assigned to DEMLR SW Admin General.The due date is: March 18,2026 5:00 PM
2/4/2026 10:30:45 AM
• The task was assigned to Mike.Lawyer by round robin distribution 2/4/2026 10:30:45 AM
• brad ley.ben nett reassigned the task to bradley.ben nett 2/25/2026 10:18:37 AM

DEQNPDES Stormwater
e
Request Submitted
NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage(COC)number.
Number* NCG020910
Begins with NCS,NCG,or NCGNE(no exposure)
Facility Name* 421 Quarry
(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.
This is just an update to the SAME contact person's details.
New Contact Name* First and Last Name
Tony Johnson
E-mail Address* [e-mail]
Phone No.* 704-547-7076
Mailing Address* 11020 David Taylor Dr,Suite 400
Physical Address If different than mailing address
This person should REPLACE the current permit contact.
This person should just be added as another permit contact.
This is just an update to the SAME contact person's details.
New Contact Name* First and Last Name
Sarah Harris
E-mail Address* [e-mail]
Phone No.* 8649604967

Mailing Address* 11020 David Taylor Dr,Suite 400
Physical Address If different than mailing address
Add another permit contact if needed by clicking the'Add'button below
Facility Contact Update
Provide new facility contact information
This person should REPLACE the current facility contact.
This person should just be added as another facility contact.
This is just an update to the SAME contact person's details.
New Contact Name* First and Last Name
Joe Hall
E-mail Address* [e-mail]
Phone No.* 336.661.3157
Mailing Address* 4401 N Patterson Ave Winston-Salem, NC 27105
Physical Address If different than mailing address
Add another facility contact if needed by clicking the'Add'button below
Submitter's Name* Please enter your FIRST and LAST name
Sarah Harris
Phone Number* Please enter your phone number
8649604967
Any format is fine.
Email Address* Please enter a valid e-mail address
[e-mail]
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
t Srt tlt/
Date 2/4/2026
Questions? Contact [e-mail].

Review
Verify Permit No.* Revise permit number below if incorrect.
NCG020910