NCS000009_Owner Affiliation Change_20161219

NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Division of Energy, Mineral and Land Resources
Land Quality Section / Stormwater Permitting Program
National Pollutant Discharge Elimination System (NPDES)
PERMIT OWNER AFFILIATION DESIGNATION FORM
(Individual Legally Responsible for Permit)
Use this form if there has been:
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
NO CHANGE in facility ownership or facility name, but the individual
who is legally responsible for the permit has changed.
If the name of the facility has changed, or if the ownership of the facility has changed,
do NOT use this form. Instead, you must fill out a Name -Ownership Change Form
and submit the completed form with all required documentation.
What does "legally responsible individual" mean?
The person is either:
• the responsible corporate officer (for a corporation);
• the principle executive officer or ranking elected official (for a municipality, s@][eCfe,dq'ra2Vj''other public
agency);
• the general partner or proprietor fora artnersbi or soleproprietorship);,'- g P p p ( p p
• or, the duly authorized representative of one of the above.
1) Enter the permit number for which this change in Legally Responsible Individual ("Owner Affiliation")
applies:
Individual Permit
N I C I S 70 0 1 0 1 0 1 0 9
2) Facility Information:
Facility name:
Company/Owner Organization:
Facility address:
(or) Certificate of Coverage
N I C G
SGL Carbon, LLC
SGL Carbon, LLC
307 Jamestown Road
Address
Morganton NC 28655
City State Zip
To find the current legally responsible person associated with your permit, go to this website:
http://portal.nedenr.org/web/lr/sw-permit-contacts and run the Permit Contact Summary Report.
3) OLD OWNER AFFILIATION that should be removed:
Previous legally responsible individual
Charles
First
4) NEW OWNER AFFILIATION (legally responsible for the permit):
Person legally responsible for this permit: Mark
First
Conner
MI Last
Lundblad
MI Last
Page 1 of 2
SM-OW NERAFFI L-25July2014

NPDES Stormwater Permit OWNER AFFILATION DESIGNATION Form
(if no Facility Name/Ownership Change)
Plant Manager
Title
307 Jamestown
Rd
Mailing Address
Morganton NC 28655
City State Zip
[phone] Mark. lundblad(a_�sglcarbon.corn
Telephone E-mail Address
Fax Number
5) Reason for this change:
A result of: Employee or management change
❑ Inappropriate or incorrect designation before
❑ Other
If other please explain:
The certification below must be completed and signed by the permit holder.
PERMITTEE CERTIFICATION:
I, Mark Lundblad, attest that this application for this change in Owner Affiliation (person legally
responsible for the permit) has been reviewed and is accurate and complete to the best of my knowledge.
understand that if all requir d parts of this form are not completed, this change may not be processed.
Signature Date
PLEASE SEND THE COMPLETED FORM TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
For more information or staff contacts, please call 919-707-9220 or visit the website at:
http: //portal.ncdenr. ory/web/lr/stonnwater
Page 2 of 2
SWU-OWNERAFFI L-25July2014

• SGL GROUP
THE CARBON COMPANY
December 12, 2016
NC DEQ
Division of Energy, Mineral & Land Resources
Storm Water Permitting Program
1612 Mail Service Center
Raleigh, NC 27699-1612
Permit Name/Ownership Change NCS000009
Sir/Madam:
Attached with this letter is the signed Permit Owner Affiliation Designation Form to change the
authorizing official for our Storm Water permit and reporting. Effective December 31, 2016
Charlie Conner, our current responsible official will be retiring from the company. He will be
replaced by Mark Lundblad as Plant Manager on January 1, 2017. Mark will assume the role of
responsible authorizing official for future reports and permitting issues.
If you have any questions regarding this change please call me at 828 432-5773 or send email to
bill .t�psongsglcarbon.com .
Mark Lundblad has signed the attached form attesting to this change.
Sincerely;
;�;�4 /)/�' /--
Billy M. Thompson, Jr.
Environmental Manager
SGL Carbon, LLC
307 Jamestown Road
Morganton, NC 28655
cc: Mark Lundblad
r'-G 19 2016
I r Esi�'s4 i i ('r'J n7
SGL Carbon, LLC
307 Jamestown Road
Morganton, NC 28655
Sglcarbon.com
Phone: [phone]
Fax: [phone]