NCG140014_Ownership Change_20260513

NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF Energy, Mineral, and Land IV Resourc�
STORMWATER PROGRAM mow`
NORTH CAROLINA �(
Environmental Quality PybUSSed
NPDES STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
1. CURRENT PERMIT INFORMATION:
Permit Number: NCS����_/_ or NCG140014
1. Facility Name(prior to change): Foltz Concrete Pipe Co LLC
II. NEW OWNER/NAME INFORMATION:
2. This request for a name change is a result of:
X a. Change in ownership of property/company
b. Name change only(Facility and/or Company)
c. Other(please explain):
(for example,facility address update.Include additional attachments if necessary.)
3. New owner's name(name to be put on permit as Permittee):
Foley Products Company,LLC DBA Foley Products A CIVIC Precast Business
4. New owner's or signing official's name and title: Joe Sikes
(Person legally responsible for permit)
Regional Operations Manager
(Title)
5. Mailing address: 1291 Hardigree Road City: Winder
State: GA Zip Code: 30680 Phone: ( 762 822-2857 - -
E-mail address: [e-mail]
6. New facility name(if applicable): Foley Products-Winston Salem
7. Effective date of transfer or name change: 4/9/2026
North Carolina Department of Environmental Quality I Division or Energy,Mineral and Land Resources
Crj--V 512 North Salisbury Street 11612 Mail 5ervlce Center I Raleigh.North Carolina 27699-1612
M z"'sati�--— 1*30 919.7079200

NPDES Stormwater Permit Name/Ownership Change
Page 2 of 2
III. PERMIT AND FACILITY CONTACT INFORMATION
8. New permit contact's name and title: Charles Piwowarski
(Permit Contact)
Environmental Compliance Manager
(Title)
9. Mailing address: 208 Jefferson Street City: Newnan
State: GA Zip Code: 30264 Phone:( 407 ) 408-5917
E-mail address: [e-mail]
10. New facility contact's name and title: Keith Brocar
_ (Facility Contact)
Plant Manager
(Title)
11. Mailing address: 11875 NC-150 City: Winston-Salem
State: NC Zip Code: 27127 Phone:( 336 ) 764-0341
E-mail address: [e-mail]
12. New billing contact's name: Charles Piwowarski
(Billing Contact)
13. Mailing address: 208 Jefferson Street City: Newnan
State: GA Zip Code: 30264 Phone:(407 )408-5917
E-mail address: [e-mail]
IV. FACILITY ACTIVITIES AND DISCHARGE INFORMATION
1. Will industrial activities at the facility remain the same as under the previous owner?
Yes IN No❑
2. Will the stormwater discharge location(s) remain the same? Yes® No ❑
NOTE: if either of these questions is answered"No,"then more information is needed to review
the request.Please attach documentation to describe and explain the changes to the facility
activities,stormwater discharges, and/or outfall location. Depending on the information
provided, the Division may require that the new owner file a new permit application.
Last Revised 3/13/2022

NPDES Stormwater Permit Name/Ownership Change
Page 2 of 2
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS
ALL OF THE ITEMS LISTED BELOW ARE INCLUDED.
REQUIRED ITEMS:
1. This completed application form (with original signature)
2. Legal documentation of transfer of ownership (such as relevant pages of a deed or a bill of sale) is
required for an ownership change request.Articles of incorporation are not sufficient for an
ownership change but can be provided for a name change.
3. Information to document facility,industrial activities,stormwater discharges,or outfall changes
as noted in item IV above(if appropriate)
Why is this information needed?
Regulations in 40 CFR§122.63 allow for minor modifications to NPDES permits for a change of
-ownership-0roperational control of a facility, provided that information supports that no other change in the permit are necessary.
Why does this form need to be mailed in?
Permittees and applicants must fulfill signatory requirements in the NPDES federal
regulations in 40 CFR §122.22 (please see those regulations for guidance). Until NCDEQ's
electronic submission process meets Cross-Media Electronic Reporting (CROMERR)
requirements, this original signed (not digital signature) form must be mailed to the
address below. The uploaded copy is stored as part of the permit record in the Division's
digital repository.
Applicant's Certification:
1 Joe Sikes , attest that the application for a name and/or ownership
change submitted has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this application are not completed,or if all
required supporting informati n is not included,this application package will be considered
incomplete and may retur ed.
Signature: Date:
THE CO LETED APPLICATION AND ALL SUPPORTING INFORMATION SHOULD BE SENT TO:
DEMLR Stormwater Program
512 North Salisbury Street, 61h Floor (Office 640K)
1612 Mail Service Center
Raleigh, NIC 27699-1612
Last Revised 3/13/2022

C202310903927
SOSID:2617498
Date Filed:4/19/2023 2:36:00 PM
Elaine F.Marshall
State of North Carolina North Carolina Secretary of State
Department of the Secretary of State C2023 109 03927
APPLICATION FOR CERTIFICATE OF AUTHORITY
FOR LIMITED LIABILITY COMPANY
Pursuant to §5713-7-03 of the General Statutes of North Carolina,the undersigned limited liability company hereby applies for a
Certificate of Authority to transact business in the State of North Carolina,and for that purpose submits the following:
1. The name of the limited liability company is Spartan Concrete,LLC .
and if the limited liability company name is unavailable for use in the State of North Carolina,the name the limited
liability company wishes to use is
2. The state or country under whose laws the Iimited liability company was formed is Delaware
3. Principal office information:'(Select either a or h)
a. ❑X The limited liability company has a principal office.
s ,
The principal office.telephone number: 706-563-7882
The street address and county of the principal office of the limited liability company is:
Number and Street:
c/o Foley Products Company,1030 1 st Ave,
City: Columbus State:GA Zip Code:31901 County: Muscogee
The mailing address,if different from the street address,of the principal office of the corporation is:
Number and Street:
City: State: Zip Code: County:
b. ❑The limited Iiability company does not have a principal office.
4. The name of the registered agent in the State of North Carolina is: C T Corporation System
5. The street address and county of the registered agent's office in the State of North Carolina is:
Number and Street:160 Mine Lake Ct.,Ste.200
Raleigh, 27615-6417 Wake
City: State: NC Zip Code: County:
6. The North Carolina mailing address,if different from the street address,of the registered agent's office in the State of North
Carolina is:
Number and Street:
City: State: NC. Zip Code: County:
BUSINESS REGISTRATION DIVISION P.O.BOX 29622 RALEIGH,NC 27626-0622
(Revised July 2017) (Form L-09)
NCO57-11 19rz017 Woltem Kluwa online

DocuSign Envelope ID:45664D82-689A.486A-B698-5F5EC460DAC8
APPLICATION FOR CERTIFICATE OF AUTHORITY
Page 2
7. The names,titles,and usual business addresses I f the current company officials of the limited liability company are:
(use attachment if necessary)(This document must be signed by a person listed in item 7.)
Name and Title Business Address
Keith Haas,CEO 10301st Ave.,Columbus,GA 31901
Yijie("Stclla'l Liang,CFO I 1030 1st Ave.,Columbus,GA 3I901
Jack Foley,Vice President 1030 1st Ave.,Columbus,GA 31901
I
S. Attached is a certificate of existence(or document of similar import),duly authenticated by the secretary of state or other official
having custody of limited liability company records in the state or country of formation. The Certificate of Existence must be
less than six months old. A nhotoconv of the certifcation cannot be accepted.
9. If the limited liabilitycompany is required to use a fictitious name in order to transact business in this State,a copy of the
p Y 9
resolution of its managers adopting the fictitious name is attached.
10.(Optional):Please provide a business e-mail add
Privacy Redaction
The Secretary of State's Office will e-mail the business automatically at the address provided above at no cost when a document
is filed. The e-mail provided will not be viewable on the website. For more information on why this service is offered,please see
the instructions for this document.
11.This application will be effective upon filing,unless a delayed date and/or time is specified:
This the 18 day of April 120 23
Spartan Concrete,LLC
Name of Limited Liability Company
Signature of Company Official
Keith Haas,CEO
Type or Print Name and Title
Notes:
1. FiIing fee is$250. This document must be filed with the Secretary of State.
BUSINESS REGISTRATION DIVISION P.O.BOX 29622 RALEIGH,NC 27626-0622
(Revised July 2017) (Form L-09)
NC057-1 I19/2017 Wolters Kluwer Online

Delaware Page 1
The First State
I, JWMMZY W. BULLOCK, SECRETARY OF STATE OF TEE STATE OF
DELAWARE, DO HMUWY CERTIFY "SPARTAN CONCRETE, LLC" IS DULY FORNWD
UNDER TEE LAWS OF TEE STATE OF DELAWARE AND IS IN GOOD STANDING AND
EAS A LEGAL EXISTENCE SO PAR AS TEE RECORDS OF THIS OFFICE SHOW, AS
OF THE NINETEENTH DAY OF APRIL, A.D. 2023.
AND I DO JEURMY FURTHER CETRTIFY THAT THE ANNUAL TAXES HAVE BEEN
PAID TO DATE.
�aatrs�
y4',p� � .t:•�t0 •daltvy Itl.sttilaGly StctetiY O!Stita
4795231 8300 Authentication:203168916
SR#20231514042 `""' Date:04-19-23
You may verify this certificate online at corp.delaware.gov/authver.shtml