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NAME CHANGE <br /> <br /> OR <br /> <br /> TRANSFER OF OWNER,q~P <br /> <br /> FOR NPDES* OR WPCF** PERMIT <br /> <br />STATE OF OREGON <br />*NATIONAL POLLUTANT DISCHARGE ~ATION SYSTEM <br />**WATER POLL!2TION CONTROL FACILI'tlg~ <br /> <br /> [] Name Change ~ Transfer of Ownership <br /> <br /> Previous Leg~ N;mte Site Address <br />DEQ Site ~ No. P~it No. Ci~ Sute Zip Code <br /> . <br /> <br />New Legal Name <br /> <br />New Common Name <br /> <br />Ci~y <br /> <br />City Stato Zip Codc State Zip Codc <br /> <br />HEREBY AUTHORIZE THE ABOVE REFERENCED NAME CHANGE. <br /> <br />Legally Authorized Representative Title Date <br /> PR.B~IOU$ OW2V~R: <br /> <br />I HEREBY ACKNOWLEDGE THE pENDING TRANSFER OF THE ABOVE REFERENCED PERN~T. <br /> <br />I HF-.REBy APPLY FOR PI/iR.MISSION TO TRANSFER THE ABOVE RIiFF_,RI~CED PER.,MTi" ISSUED IN' THE STATE OF OREGON. <br /> <br /> Title Date <br /> <br />D EQ-WQ-IW~WH5499.5 (10193) <br /> <br /> <br />