NCG030526_Owner Affiliation Change_20260518

RECEIVEDNC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF Energy, Mineral, and Land Resources
MAY 18 2026
STORMWATER PROGRAM
NORTH CAROLINA DEMI.R-STORMWATERPROGRAM
Environmental Quality
NPDES STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
I. CURRENT PERMIT INFORMATION:
Permit Number: NCS or NCG i '
1. Facility Name
II. NEW OWNER/NAME INFORMATION:
2. This request for a name change is a result of:
a. Change in ownership of property/company
b. Name change only (Facility and/or Company). New facility name should be listed
above.
c. Other(please explain):
(for example,facility address update)
3. New owner's name(name to be put on permit as Permittee):
Ii�llliiliicl_
4. New owner's or signing official's name and title:
(Person legally responsible for permit)
(Title)
5. Mailing address: City
State: i Zip Code: Phone:
E-mail address:
6. Effective date of transfer or name change: 0 5'0112026
D_E QJ� North Carolina Department of Environmental Quality I Division of Energy.Mineral and Land Resources
512 North Salisbury Street 1612 Mail Service Center I Raleigh,North Carolina 27699-lbl2

NPDES Stormwater Permit Name/Ownership Change
Page 2 of 3
III. PERMIT AND FACILITY CONTACT INFORMATION
MurpP, i1r1i'uuh-n
7. New permit contacts name and title:
(Permit Contact)
Purchasing
(Title)
PO Box 688 Siler City
8. Mailing address: City:
State: N" Zip Code: 2731, Phone: ( ) 919-663-2244
E-mail address: I;]I rp [e-mail]
9. New facility contacts name and title: I'AUrPhy Milholen
(Facility Contact)
(Title)
10. Mailing address: City: Siler City
State:_ Zip Code: Phone: ( )
919-663-2244
E-mail address: A = i-,i Ir y ,
11. New billing contact's name:
(Billing Contact)
12. Mailing address: City:
State:_ Zip Code: Phone: ( )
E-mail address:
IV. FACILITY ACTIVITIES AND DISCHARGE INFORMATION
1. Will industrial activities at the facility remain the same as under the previous owner?
Yes 0 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 11/24/2025

NPDES Stormwater Permit Name/Ownership Change
Page 3 of 3
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 or operational 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:
I, �A , NU�IZ9 , 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 information is not included,this application package will be considered
incomplete and may be returned.
` '/ /Signature: Date:
THE COMPLETED APPLICATION AND ALL SUPPORTING INFORMATION SHOULD BE SENTTO:
Via USPS: Via Courrier (UPS, Fed Ex, etc.):
DEMLR Stormwater Program DEMLR Stormwater Program
1612 Mail Service Center - OR - 512 North Salisbury Street
Raleigh, NC 27699-1612 Raleigh, NC 27604
Last Revised 11/24/2025