HomeMy WebLinkAboutWPO200700099 Other 2021-10-07VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY
GENERAL VPOES PERMIT FOR DISCHARGES OF STORMWATER FROM CONSTRUCTION ACTIVITIES (VAR101
TRANSFER OF OWNERSHIP AGREEMENT 2019
Permit Coverage Number(VAR1OERag): VAR107218
Construction Activity Name: NGIC EXPANSION - PHASE51 & II
Section 1. Current Construction Activity Operator/Permiftee Information. Operator information as R appears on the
current, active permit coverage.
Construction Activity
Operator Name: UNITED LAND CORPORATION
Contact Person: WENDALL WOOD
Address: PO BOX 5548
City, State and Zip Code: CHARLOTTESVILLE, VA 22905
Phan. Number: 434-975-3334
Primary Email: uIc @embafgmaLl.com
CC Email: hw 918®gmall.com
"I (We) hereby agree to the transfer of ownership modification to the referenced General VPOES Permit for Discharges
.f Stormwater fromConstructionActivities IVARS
WO�" \
Printed Name: We
Signature: �J✓ rill^ a. !/��
Date:
Section II. New Construction Activity Operator/Permhates Information. Permit coverage will be transferred to this
person or entity.
Construction Activity
Operator Name (NEW):
Contact Persom
Address:
City, State and Zip Code:
Phone Number.
Primary Email:
CC Email:
"t (We) hereby agree to the transfer of ownership modification to the referenced General VPDES Permit for Discharges
of Stomlwater from Corntmetl n ctivities IVAR10).'
Printed Name: {'.� �' k l
Signature:
Date: 1
Rev 04/2019 Page 1 of 2
VIRGINIA DEPARTMENT OF ENVIRONMENTAL QUALITY
GENERAL VPOES PERMIT FOR DISCHARGES OF STOBMWATER FROM CONSTRUCTION ACTIVITIES (VAR10)
TRANSFER OF OWNERSHIP AGREEMENT 2019
Section Ill. New Construction Activity Operatar/Permittee Billing Information. This entity will receive Annual Permit
M alntenance and Permit Modification Fee invoices (if applicable). Leave this sedlon blank if same as the New Operator
as identified In Sedlon II. A. above.
Billing Entity Name:
Contact Person:
City, State and Zip Code.
Phone Number:
Primary Email:
CC Email:
May we transmit correspondence electronically? You must choose Wand Include a valid email In orderto Davin
credit card and to receive your transfer approval letter via email: YES E3 NOD
Section IV. Instructions.
A properly authorized individual as specified in the General VPDES Permit for Stormwater Discharges from Construction
Activities (VAR30), Pan Ill K (Signatory Requirements) must physically sign this Transfer of Ownership Agreement.
Please retain a copy of this agreement form for your records and include a copy In your Starmwater Pollution Prevention
Plan (SW PPP).
Submit this form to the VSMP Authority. If the locality is the VSMP Authority, please submit your Transfer of Ownership
Agreement directly to the locality; do NOT send this form to DEQ A list of local VSMP Authorities is ava liable here:
VS NIP Aw h_uw L,
II DEQ is the VSMP Authority please send to: If the locality Is the VSMPA Iholw please send to:
Department of Environmental Quail ty The Local VSMP Authority Insert address below
office of Stormwater Management Suite 1a00
PO Box 1105
Richmond VA Z3218
constru,tlo9XplM4eq.viriiniii.Xov
Rev 04/2019 Page 2 of 2