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Atkansas. THE NATURAL STATE DEPARTMENT OF PARKS It TOURISM 1 COplloiMoll UHI& Ruci\, AR 72201 501-682-7777 January 8, 2016 Great River Road Division 501-682-1120 Arkansas.com Alex Krebs History Commission ADEQWater Division 501-682-6900 (TDD) Ark-lves.com Human Resotxces Section Re: Change of Authorization for ADEQ permits 501-682-77 42 (TDD) Keep Arkansas Beautiful Division Dear Mr. Krebs, 501-682-3507 (TDD) KeepArkonsasBeoutilul.com Per your conversation with Alex Franks, Maintenance Manager at Arkansas stole Parks Division 501-682-1191 (TDD) State Parks, on Thursday, January 7, 2016 about ADEQ permits. We have attached Ari<CJ'lSOsStateParks.com one (1) request for Change of Authorization and a complete list of our permits and Tourism Division 501-682-7777 (TOO) corresponding locations. Arkansas.com NPDES Permit Number Facility Name ASO Hutchinson --7\R0045888 Cane Creek State Park GOVERNOR -AR0035947 Crowley's Ridge State Park ~R0038113 Daisy State Park -AR0037061 DeGray Lake State Park #2 Main Plant Kane Webb EXECUTIVE DIRECTOR .AR0037061 DeGray Lake State Park #3 DeRouche PI -AR0037940 Devil' s Den State Park __:_'"7\R0038j2.L Lake Catherine State Park ~ li..tc.t. \lft1/lf" DIVISION DIRECTORS ~199 Lake Charles State Park ""!'\R0036811 Lake Ouachita State Park 'f't.J...- k \2..( \1/r'S" Cynthia Dunlap ADMINISTRATION ~0037079 Millwood State Park ..,trR0051845 Mississippi River State Park GmdySJX!nn STATE PARKS "7\R004 8 85 2 Mount Magazine State Park ~ Joe David Rice ...AR003 7966 Mount Nebo State Park ~1\A~ TOURISM -+.R0049972 Petit Jean State Park Ron Maxwell ~R0037605 Queen Wilhelmina State Park ~'YoJks GREAT RIVER ROAD -A-R0040380 Toltec Mounds State Park Dr. Lisa Speer ~~~ HISTORY COMMISSION ""*R003 8202 Village Creek State Park '1\R.0051241 White Oak Lake State Park . Robert Phelps KEEP ARKANSAS Wooly Hollow State Park '(a_ ~ \Z. I' 7/IS' BEAUTIFUL ~ ~ State Parks AN EQUAL Enclosures OPPORTUNITY/ AffiRMATIVE ACTION/ Cc: Alex Franks AMERICANS WITH DISABILITIES ACT EMPLOYER GS/lc REQUEST FOR CHANGE OF AUTHORIZATION (CERTIFICATION AND SIGNATORY REQUIREMENTS) NPDES Permit Number: ------- Facility Name: ------------- Type of Change: D New Cognizant Official (or duly authorized representative) (sections 1 and 2) (check one) D New Ranking Official (complete section 2 only) JSl Both (sections 1 and 2) 1. NEW COGNIZANT OFFICIAL (or duly authorized representative) (See 122.22(b); the individual, authorized by the ranking official in writing, as having responsibility for the .Qlleiilll operation of the regulated facility or activity responsibility, or having overall responsibility for environmental matters for the company.) The ranking official hereby designates the following individual as the cognizant official, {duly authorized representative), for signing the permit required reports, etc., including Discharge Monitoring Reports (DMR) required by the permit, and other information requested by the Director: ~ Signature a he Cognizant Offi ial (Duly Authorized Representative) 3a.t-~~ Ale:-)<., t:=r-~"\~s. Name (First Name, Ml, Last Name) Typed or Printed On'L ~;j_o J rf\~!( .LI+H~ Q.,ck , AJ< 7.22.~\ Mailing Aeress City, State, and Zip Oger~~ ~~ec+- M()..('\_(ft.~(' (SCI > (e3.2- 7&3>9 ~Itt) ~.£2.- t:JC-4 Title ~ A!C Phone Fax Email Address: GJcl(. t="'<OlL.,.....,k"> e_, 00...\ ka.'f\.$4-..S.~S<l\,} By signature below, the ranking official certifies that the above named jndjvjdua! is qualified to act as the duly authorized representative under the provisions of 40 CFR 122.22(b). 2. RANKING OFFICIAL (Note: The ranking official is the person authorized to sign the permit application ilalw 40 CFR 122.22(a). For a Corporation: it is the responsible corporate officer. Partnership or Sole Proprietorship: the general partner or proprietor. Municipality, State, Federal or other Public Agency: the principal executive officer ranking electe ficial.) !- 1-- Ze>lb Date Name (First , Last arne) Typed or Printed o,tZ Colle bl /lze/1 L,lf!-e. ['Zoci< fkC.. 7-ZZ.O( 7 Mailing Address City, State, and Zip Jdrec!r&.r A(?... s~ ?A:IY<"S (!:o t ) 68 2.,;- 1-7-Lf 3 ()c () 411 z. ~ I 3' tt Title ' AIC Phone Fax Email Address: j' D:a:..,.~. :=.pq v1 ......._ re:..a. r&c4~ s • (j ov Certlflcauon: 1 certify under penalty of law that this document and all attachments were prepared under my direct supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate lhe Information submitted. Based on my inquiry of !he person or persons who manage the system, or those persons directly responsible for gathering the information, 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. Will Ranking Official also be the person signing submittals? (Check one) DYes 00 No ARKANSAS DEPARTMENT OF ENVIRONMENTAL QUALITY 5301 NORTHSHORE DRIVE I NORTH LITTLE ROCK I ARKANSAS 72118-5317 I TELEPHONE 501-682-0744 I FAX 501-682-0880 www.adeq .state.or.us REQUEST FOR CHANGE OF AUTHORIZATION (CERTIFICATION AND SIGNATORY REQUIREMENTS) NPDES Permit Number: Facility Name: ______________ Type of Change: fJ! New Cognizant Official (or duly authorized representative) (sections 1 and 2) (check one) 0 New Responsible Official (complete section 2 only) 0 Both (sections 1 and 2) 1. NEW COGNIZANT OFFICIAL (or duly authorized representative) (See 122.22(b); the individual, authorized by the ranking official in writing, as having responsibility for the overall operation of the regulated facility or activity responsibility, or having overall responsibility for environmental matters for the company.) The ranking official hereby designates the following individual as the cognizant official, (duly authorized representative), for signing the permit required reports, etc., including Discharge Monitoring Reports (DMR) required by the permit, and other information requested by the Director: . ~· ·- {¥1- !Jl · ~;:J,__ ~~,~· ·· .. ----=:--:----:----:--:-:--T'==¥-o-g-=m.,..,·z:_an-t,....O=-ffi~i=-cl:-.a::--1(..:::D:.:::u--:-1 +-A--=-u-t:-:-'h=ofi=:-iz_e_d.,..,R=e-p-r.-es_e_n...,.ta-t,.,...i~J-e)-,------------1H----+.-t+.+.. · 4 ?01 ~ ' · 3 ~i"~.._c~ 4. l=;C,oJ"'-\<'_S ~~ ~?} tvY' -N~am-e-(F=I-rs_t...,.N~a-m_e_,...,.M--=-I~,~La-s~t~N~a~m~e...,.)~T~y,-p~ed...,.-o=r=P,rin=t~e~d--------------- 1 Cc-4?'· \-d r<k:..J I _:::,"'·.k ~l3.~ \S LJtt-i c q2 o:Jc.. ().Q. '7 ..2.::2.0 I Mailing Address ' City, State, and Zip Ot~·:-<.:. \:c,,<.> ~~t::,~cd- C(~·l'i-~\.--c:\:r'( 5ol ) {;8._~- 7&3<j (!;:.cl){g".?:J._ -L-:2,&</ Tie ....... A/C Phone Fax Email Address: C.;..\ 1;:" , 1-~-1:1'-"'\ ..._s. @ O,J""\.-...r.z.t'-7/'A. -s . J o\J By signature below, the responsible official certifies that the above named individual is qualified to act as the duly authorized representative under the provisions of 40 CFR 122.22(b). 2. RESPONSIBLE OFFICIAL (Note: The responsible official is the person authorized to sign the permit application ilalw 40 CFR 122.22(a). For a Corporation: it is the responsible corporate officer. Partnership or Sole Proprietorship: the general partner or proprietor. Municipality, State, Federal or other Public Agency: the principal executiv officer ranking elected official.) ~ Sign~re of th esponsiblg_,Official Date (.J - G re..so""1 1..) "'1Ts Name (First Name, Ml, Last Name) Typed or Printed L( 2-2() I 1 ~~ ~. \ ll\lr ~ l;, ~ /4Jc_1 At2.. 1 Mailing Ad ress C1ty, State, and Z1p 1;>;,eulo., A:0,. s,Qt-t (Jq~"-s (S"ot) tt2-77V3 5ol-~12. -/)G~ Title I A/C hone Fax Email Address: e;ve.~. be&.Ji[S {! a.v~u. s.o v Certification: I certify under penalty of law that this document and all attachments were prepared under my direct 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, 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. _ / Will the Responsible Official also be the person signing submittals? D Yes ~ No ARKANSAS DEPARTMENT OF ENVIRONMENTAL QUALITY 5301 NORTHSHORE DRIVE I NORTH UTILE ROCK I ARKANSAS 72118-5317 I TELEPHONE 501-682-0744 I FAX 501-682-0880 www.adeq .state.ar.us Kreps, Alexander From: Kreps, Alexander Sent: Wednesday, January 13, 2016 1:11 PM To: Trotta, Jacqueline Cc: Healey, Richard; Johnson, Miles Subject: RE: Enforcement Check Thank you Jackie. From: Trotta, Jacqueline Sent: Wednesday, January 13, 2016 1:03 PM To: Kreps, Alexander Cc: Healey, Richard; Johnson, Miles Subject: RE: Enforcement Check Alex, Some of the permits that are held by Parks and Tourism have issues, ones that enforcement are aware of. But, they have new Responsible and Cognizant Officials, so we informed them to submit a change in authorization form, so they are doing like we asked. Thanks, Jacqueline Trotta Enforcement Analyst Water Division Arkansas Department of Environmental Quality 5301 Northshore Drive North Little Rock, AR 72118 501-682-0632 From: Johnson, Miles Sent: Wednesday, January 13, 2016 12:59 PM To: Trotta, Jacqueline Cc: McDonald, Scott; Healey, Richard; Kreps, Alexander Subject: RE: Enforcement Check Jackie, Can you please assist Alex with his request? Thanks! Miles Johnson Enforcement Coordinator Water Division Arkansas Department of Environmental Quality Phone: (501) 682-0631 1 Email: [email protected] From: Kreps, Alexander Sent: Wednesday, January 13, 2016 12:50 PM To: Healey, Richard Cc: Johnson, Miles; McDonald, Scott Subject: Enforcement Check Richard, Could you please have your staff check for any issues that Enforcement may have with the Arkansas Department of Parks and Tourism that would prevent them from changing Cognizant and Responsible Officials for the attached permits? Please contact me with any questions.
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