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FORM A
GENERAL FACILITY INFORMATION
REVISED 09/22/16 NCDEQ/Division of Air Quality-Application for Air Permit to Construct/Operate A
NOTE-APPLICATION WILL NOT BE PROCESSED WITHOUT THE FOLLOWING:
Local Zoning Consistency Determination
❑ (new or modification only) ❑ Appropriate Number of Copies of Application Application Fee(please check one option below)
Responsible Official/Authorized Contact Signature ❑ P.E.Seal(if required) ❑ Not Required ❑ePayment ❑ Check Enclosed
GENERAL INFORMATION
Legal Corporate/Owner Name: Perdue AgriBusiness LLC
Site Name: Pantego Grain
Site Address(911 Address)Line 1: 1461 Swindell Road
Site Address Line 2:
City: Pantego State: North Carolina
Zip Code: 28760 County: Beaufort
CONTACT INFORMATION
Responsible Official/Authorized Contact: Invoice Contact:
NamefTitle: Sharon Clark, SVP Regulatory Affairs&Compliance Name/Title: Joey Baggett Regional Environmental Manager
Mailing Address Line 1: 6906 Zion Church Road Mailing Address Line 1: 242 Perdue Road
Mailing Address Line 2: PO Box 1537 Mailing Address Line 2:
City: Salisbury State: Maryland Zip Code: 21802-1537 City: Cofield State: NC Zip Code: 27922
Primary Phone No.: —dTT74'2609 Fax No.: Primary Phone No.: 252-348-4383 Fax No.:
Secondary Phone No, • - a 1.1> Secondary Phone No.: 252-287-5196
Email Address: sharon.clark(rDperdue.com Email Address: joey.baggettOperdue.com
Facility/Inspection Contact: Permit/Technical Contact:
Name/Title: Austin Hodges,Grain Manager Name/Title: Joey Baggett Regional Environmental Manager
Mailing Address Line 1: 1461 Swindell Road Mailing Address Line 1: 242 Perdue Road
Mailing Address Line 2: Mailing Address Line 2:
City: Pantego State: NC Zip Code: 28760 City: Cofield State: NC Zip Code: 27922
Primary Phone No.: 252-945-8472 Fax No.: Primary Phone No.: 252-348-4383 Fax No.:
Secondary Phone No.: 252-287-5196 Secondary Phone No.: 252-287-5196
Email Address: austin.hodgesOperdue.com Email Address: ioey.baggettoperdue.com
APPLICATION IS BEING MADE FOR
❑ New Non-permitted Facility/Greenfield ❑ Modification of Facility(permitted) ❑ Renewal Title V ❑ Renewal Non-Title V
❑v Name Change ❑ Ownership Change ❑ Administrative Amendment ❑ Renewal with Modification
FACILITY CLASSIFICATION AFTER APPLICATION(Check Only One)
❑ General El Small ❑ Prohibitory Small ❑ Synthetic Minor ❑ Title V
FACILITY(Plant Site)INFORMATION
Describe nature of(plant site)operation(s): Grain receiving,drying,storage and shippment-
Facility ID No. 0700070
Primary SICINAICS Code: 5153 Current/Previous Air Permit No.03107R17 Expiration Date:5/31/22
Facility Coordinates: Latitude: 35'61023 N Longitude: 76'67713 W
Does this application contain "'If yes,please contact the DAQ Regional Office prior to submitting this
confidential data? ❑ YES El NO application.— (See Instructions)
PERSON OR FIRM THAT PREPARED APPLICATION
Person Name: Joey Baggett Firm Name:
Mailing Address Line 1:242 Perdue Road Mailing Address Line 2:
City: Cofield State: NC Zip Code: County:
Phone No.: 252-348-4383 Fax No.: Email Address.
SIGNATURE OF RESPONSIBLE OFFICIALIAUTHORIZED CONTACT
Name(typed):Sharon Clark Title:SVP Regulatory Affairs&Complian a p
X Signature(Blue Ink): /hi �� Date: Q 061
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Attach Additional Sheets As Necessary i Page f
AUG 1 9 2021
DAQ \A0ARO
FORM A (continued, page 2 of 2)
GENERAL FACILITY INFORMATION
REVISED 09/22/16 NCDEQ/Division of Air Quality-Application for Air Permit to Construct/Operate A
SECTION AA1 -APPLICATION FOR NON-TITLE V PERMIT RENEWAL
(Company Name)hereby formally requests renewal of Air Permit No.
There have been no modifications to the originally permitted facility or the operations therein that would require an air permit since the last permit was issued.
Is your facility subject to 40 CFR Part 68"Prevnetion of Accidental Releases"-Section 112(r)of the Clean Air Act? ❑ YES ❑ NO
If yes,have you already submitted a Risk Manage Plan(RMP)to EPA? ❑ YES ❑ NO Date Submitted:
Did you attach a current emissions inventory? ❑ YES ❑ NO
If no,did you submit the inventory via AFRO or by mail? ❑ Via AFRO ❑ Mailed Date Mailed:
SECTION AA2-APPLICATION FOR TITLE V PERMIT RENEWAL
In accordance with the provisions of Title 15A 2Q.0513,the responsible official of (Company Name)
hereby formally requests renewal of Air Permit No. (Air Permit No.)and further certifies that:
(1) The current air quality permit identifies and describes all emissions units at the above subject facility,except where such units are exempted under the
North Carolina Title V regulations at 15A NCAC 2Q.0500;
(2) The current air quality permit tits all applicable requirements and provides the method or methods for determing compliance with the applicable
requirements;
(3) The facility is currently in compliance,and shall continue to comply,with all applicable requiremetns. (Note: As provided under 15A NCAC 2Q.0512
compliance with the conditions of the permit shall be deemed compliance with the applicable requirements specifically identified in the permit);
(4) For applicable requirements that become effective during the term of the renewed permit that the facility shall comply on a timely basis;
(5) The facility shall fulfill applicable enhanced monitoring requirements and submit a compliance certification as required by 40 CFR Part 64.
The responsible official(signature on page 1)certifies under the penalty of law that all information and statements provided above,based on information and belief
formed after reasonable inquiry,are true,accurate,and complete
SECTION AA3-APPLICATION FOR NAME CHANGE
New Facility Name. Perdue AgriBusiness LLC
Former Facility Name: Perdue Grain and Oilseed,LLC Pantego
An official facility name change is requested as described above for the air permit mentioned on page 1 of this form. Complete the other sections if there have been
modifications to the originally premitted facility that would requie an air quality permit since the last permit was issued and if ther has been an ownership change
associated with this name change.
SECTION AA4-APPLICATION FOR AN OWNERSHIP CHANGE
By this application we hereby request transfer of Air Quality Permit No. _from the former owner to the new owner as described below.
The transfer of permit responsibility,coverage and liability shall be effective (immediately or insert date.) The legal ownership of the
facility described on page 1 of this form has been or will be transferred on (date). There have been no modifications to the originally
permitted facility that would require an air quality permit since the last permit was issued.
Signature of New(Buyer)Responsible Official/Authorized Contact(as typed on page 1):
X Signature(Blue Ink):
Date:
New Facility Name:
Former Facility Name:
Signature of Former(Seller)Responsible Official/Authorized Contact:
Name(typed or print):
Title:
X Signature(Blue Ink):
Date:
Former Legal Corporate/Owner Name
In lieu of the seller's signature on this form,a letter may be submitted with the seller's signature indicating the ownership change
SECTION AA5-APPLICATION FOR ADMINISTRATIVE AMENDMENT
Describe the requested administrative amendment here(attach additional documents as necessary): Contact information changed.Name change.
Attach Additional Sheets As Necessary Page 2 of 2