Please select one of the following options: PERMIT TRANSFER FORM A. Permittee (legal name) change B. Facility name change DB De [2JA&B OA&C R ECEIVED NOV 6 2015 '. 3\II..J~ -rvj C. Responsible official name change OB&C OA&B&C PERMIT NUMBER: I. CURRENT PERMITTEE INFORMATION Permittee (legal name): facility Name: Responsible Official Name (see Section IV below): ARROOA499 ~~~~~-------------------------- Mondi Bags USA, LLC Mondi Bags USA, LLC Johnny Thein Is the permittee identified above, the owner of the facility? 0 Yes [21 No If you mark No, please list the name of the owner: Mondi Romeoville, Inc. II. NEW PERMITTEE INFORMATION Permittee (legal name): Facility Name (if different from Permittee Name): Is the permittee identified above, the owner of the facility? 0 Yes 0 No If you mark No, please list the name of the owner: Responsible Official Name (see Section IV below): Official Title of Responsible Officer: E-mail: Permittee Address: Permittee City: Operations Manazer Mondi Pine Bluff, LLC and Mondi Bags USA, LLC Mondi Pine Bluff, LLC and Mondi Bags USA, LLC Mondi Romeoville, Inc. --------------~------------------------------- Johnny Thein johnny.thein@mondigroup.com 1701 Jefferson Parkway Pine Bluff ------ Permittee State: AR Zip: 71602 Permittee Telephone No.: (870) 341-2483 Owner Type: 0 STATE 0 PARTNERSHIP 0FEDERAL 0 SOLE PROPRIETORSHIP 0 CORPORATION* Is the new permittee registered with the Arkansas Secretary of State? If yes, please provide the full name of corporation if different than the legal permittee name listed above. Facility Mailing Address: P.O. Box 20700 Facility City: ------------------------------- Facility State: 0 Yes 0 No Pine Bluff AR Zip: 71612 Facility Contact Person Name: Ronnie Wallace ----------------------- ------------- Telephone Number: 870-541-5010 fax Number: 870-541-5063 Contact Person Title: E-mail: Invoice Contact Person: Ronnie Wallace City: Pine Bluff EHS Manager -=~~~~~~--~-- ronnie. wallace@mondigrou -"'-P :..:cc""om;.;. Invoice Mailing Address: P.O. Box 20700 State: AR Zip: 71612 ----- Invoice Mailing Address: Telephone: 870-541-5010 Cognizant Official Name: Ronnie Wallace Cognizant Official Title: _E_H_S_M--,-a_na_.g<-:e::-r---=-----:-:- --~----------------------- ronnie. wallace@mond igro Telephone Number: 870-541-5010 Fax Number: 870-541-5063 E-mail: _up._._c_om --------- ARKANSAS DEPARTMENT OF ENVIRONMENTAL QUALITY 5301 NORTHSHORE DRIVE I NORTH UTILE ROCK I ARKANSAS 72118-531 7 I TELEPHONE 501-682-07 44 I FAX 501-682-0880 www.adeq.state.ar.us
PERMIT TRANSFER FORM III. OWNERSHIP CHANGE AGREEMENT Please note you must complete this Section (Ill.) only if the permit has a new owner or a new ownership. Please specify the closing date for this transaction: Current Permittee (Seller): Signature of Responsible Corporate Officer: Title of Responsible Corporate Officer: Printed Name of Responsible Corporate Officer: Date: New Permittee (Buyer): Signature of Responsible Corporate Officer: Title of Responsible Corporate Officer: Printed Name of Responsible Corporate Officer: Date: Disclosure Statement: Disclosure Statement must be submitted for new permittee. Disclosure Statement is not required for Stormwater Permits. Is Disclosure Statement enclosed: DYes [8] No Financial Assurance: Please note that if Financial Assurance is required for the current permittee then the new permittee may have to provide new Financial Assurance before the permit maybe transferred.. Land Use Contract: For land application permits you must submit a new land use contracts for all the sites permitted under the current permit for land application. The new land use contract must be signed by the new permittee and land owner. IV. CERTIFICATION OF NEW PERMITTEE "I certify that the cognizant official designated in this Permit Transfer Form (Section II) is qualified to act as a duly authorized representative under the provisions of 40 CFR Part 122.22(b ). If no cognizant official has been designated, I understand that the Department will accept reports signed by the applicant. I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations." In addition, I certify that there will be no operational changes that warrant a permit modification. (Please note that if there are changes that warrant a permit modification, then you must submit a complete application, updated plans, design calculations and specifications, and the permit modification fee along with this Ownership Change Form. The transfer may be made effective prior to permit modification.) Title: Operations Manager /t)z~tzt: ARKANSAS DEPARTMENT OF ENVIRONMENTAL QUALITY 530 I NORTHSHORE DRIVE I NORTH UTILE ROCK I ARKANSAS 72118-5317 I TELEPHONE 50 1-68'2-0744 I FAX 501-68'2-0880 www.odeq.stote.or.us
Reiber, Loretta From: Sent: To: Subject: Wallace Ronnie (US, Pine Bluff) <Ronnie.Wallace@mondigroup.com> Friday, March 18, 2016 11:42 AM Reiber, Loretta Re: AR0001601 permit transfer I apologize for the no response. Mr. Thein has been traveling a lot lately. Please proceed as you stated above. Sent from my iphone On Mar 18, 2016, at 11:38 AM, Reiber, Loretta <REIBER@adeq.state.ar.us> wrote: https://www.adeq.state.ar.us/downloads/webdatabases/permitsonline/npdes/permitlnformation/ar 0001601 Response%20to%20Permit%20Transfer 20160218.pdf Ronnie, We haven't heard back regarding the letter above. We're going ahead with the permit transfer with the permittee name listed as "Mondi Bags USA LLC and Mondi Pine Bluff, LLC." If you have any questions, please e-mail or call me at (501) 682-0612. Loretta Reiber, P.E. Engineer, NPDES Permits This e-mail as well as any files transmitted with it is confidential and may well contain information which is legally privileged. It is intended solely for the use of the individual or the entity to whom it is addressed. If you are not the intended recipient ofthis e-mail, you are hereby on notice of this status. Any disclosure, copying, distribution, dissemination or publication of the information contained therein is strictly prohibited, unless you have been permitted thereto by the sender, and might be a breach of confidence. If you are not the intended recipient, please return this e-mail immediately to the sender and then delete this message from your system. The sender is not liable for the proper transmission of this information nor for any delay in its receipt. 1
ECEIVED RNOV 6 2015 November 5, 2015 Mr. Thomas Rheaume Permits Branch Manager, Air Division Arkansas Department ofenvironmental Quality 5301 Northshore Drive North Little Rock, AR 72118 AirPermits@adeg.state.ar.us Mr. John Bailey Permits Branch Manager, Water Division 5301 Northshore Drive North Little Rock, AR 72118 water.permit.application@adeg.state.ar.us Mr. Bryan Leamons Attention: Solid Waste Management Division 5301 Northshore Drive North Little Rock, AR 72118 leamons@adeq.state.ar. us Mr. Jay Rich Attention: Hazardous Waste Division 5301 Northshore Drive North Little Rock, AR 72118 ricb@adeg.state.ar.us 501.653.0000 13011 Corporate i Hryar1t, AH 72022
Yates, Adam From: Sent: To: Subject: Porter, Gina Friday, November 13, 2015 11:51 AM Yates, Adam RE: Permittee/Facility Name Change_AR0001601 Adam, I'm not sure if I replied to this one. There are no enforcement issues that would prevent a name change for Mondi bags Permit# AR0001601. Gina From: Yates, Adam Sent: Monday, November 09, 2015 3:11PM To: Porter, Gina Cc: Johnson, Miles; McDonald, Scott Subject: Permittee/Facility Name Change_AR0001601 Gina, Are there any Enforcement issues with Mondi Bags USA, LLC, AR0001601 that would preclude this permittee/facility name change? Thank you, Adam Yates Engineer - Water Division NPDES Permit Section Phone: (501) 682-0617 Fax: (501) 682-0880 1
Yates, Adam From: Sent: To: Cc: Subject: Barber, Kyle Monday, November 09, 2015 3:40 PM Yates, Adam Johnson, Miles; McDonald, Scott; Healey, Richard RE: Permittee/Facility Name Change_ARG160040 Adam There are no enforcement issues with Mondi Bags USA, LLC (NPDES Permit Tracking Number ARG160040) that would preclude a name change. Kyle Barber Enforcement Analyst Water Division (501) 682-0823 From: Yates, Adam Sent: Monday, November 09, 2015 3:11PM To: Barber, Kyle Cc: Johnson, Miles; McDonald, Scott Subject: Permittee/Facility Name Change_ARG160040 Kyle, Are there any Enforcement issues with Mondi Bags USA, LLC, ARG 160040 that would preclude this permittee/facility name change? Thank you, Adam Yates Engineer - Water Division NPDES Permit Section Phone: (501) 682-0617 Fax: (501) 682-0880 1
Yates, Adam From: Sent: To: Cc: Subject: Pemberton, Layne Tuesday, November 10, 2015 12:09 PM Yates, Adam Shafii, Mo; Healey, Richard; McDonald, Scott RE: Permittee/Facility Name Change_ARROOA499 There are no apparent enforcement issues at this time. Layne Pemberton Enforcement Analyst ADEQ Water Division Enforcement Branch Phone: 501-682-0664 Fax: 501-682-0880 pemberton@adeq.state.ar.us D Q ' A R ''~"""" K e4-<wf>=~ A 7nm~ ~ N s A s From: Yates, Adam Sent: Monday, November 09, 2015 3:12PM To: Pemberton, Layne Cc: Johnson, Miles; McDonald, Scott Subject: Permittee/Facility Name Change_ARROOA499 Layne, Are there any Enforcement issues with Mondi Bags USA, LLC, ARROOA499 that would preclude this permittee/facility name change? Thank you, Adam Yates Engineer- Water Division NPDES Permit Section Phone: (50 I) 682-0617 Fax: (501) 682-0880 1
Arkansas Secretary of State Page 1 of 1 ARKANSAS SECRETARY OF STATE ~~ 8eGrch Incorpomtions, Coopemtives, Banks cmd Insu)'(mee Companies Printer Friendly Version LLC Member information is now confidential per Act 865 of 2007 Use your browser's back button to return to the Search Results For service of process contact the Secretary of State'spffice. Corporation Name MONDI BAGS USA, LLC Fictitious Names Filing# Filing Type Filed under Act Status 811013812 Foreign Limited Liability Company Foreign LLC; 1003 of 1993 Good Standing Principal Address Reg. Agent Agent Address Date Filed Officers Foreign Name Foreign Address State of Origin Purchase a Certificate of Good Stl!nding for this Entity CORPORATION SERVICE COMPANY 300 SPRING BUILDING, SUITE 900 300 S. SPRING ST LITTLE ROCK, AR 72201 04/05/2012 WALTER MCMANN, Manager STEPHEN A HELLRUNG, Incorporator/Organizer WALTER MCMANN, Tax Preparer N/A 814 LIVINGSTON COURT MARIETTA, GA 30066 DE Pay Franchise Tax for this corporation / http://www.sos.arkansas.gov/corps/search_corps.php?detail=384938&corp_type_id=&... 11/9/2015
State Of Delaware Entity Details 1/14/2016 4:18:58PM File Number: 5705334 Incorporation Date/ Formation Date: 3/6/2015 Entity Name: MONDI PINE BLUFF, LLC Entity Kind: Limited Liability Company Residency: Domestic Status: Good Standing Entity Type: General State: DELAWARE Status Date: 3/6/2015 Registered Agent Information Name: CORPORATION SERVICE COMPANY Address: 2711 CENTERVILLE RD City: WILMINGTON State: DE Country: Postal Code: 19808 Phone: 302-636-5401
-~ Project/Facility Name ownership change Facility Name change Responsible Official Change ~~ l.lsfi uc.. Permit Number AU&AYqq AFIN NO. Assigned Activity Initials ASII (1 day) Application Logged/ Assign to Engineer -rw Completeness and Technical Review Enter Update Info to Database J Disclosure Statement for A' fj7li Engineer (3 days) Check With Enforcement ~ Check with SOS./ Check Fee Payments / AA III (15 days) Enter Into PDS ~ P3 I Merge Change OwneJ Form (if applicable) 3.J) Email C/0 Form to Committee (if applicable) ~j Wait 10-days fo$nse (if applicable) <../ Merger Letter for Permittee :JjJJ <Cw Engineer (1 day) Review transfer letter and documents UL Engineer Supervisor Review all the documents and letter (1 d(ly) Permits Section Chief (1 day) Review the documents and sign Mail original to applicant. Scan complete folder and place in AS II appropriate E-drive folders. Update (1 day) Zylab. Be sure to include this change 'L\; in weekly report, due every Tuesday by 2:00P.M. '3 ':l -ODCl/7 Date Complete/Entered t 'lw ~ '3 \\Cb\'\j t1lu\\u LJl~/(~ 1\'~'l f_t- Remarks: Revised 1/511 I