NCC220284_NOI Signed Certification_20220114

Print this form, complete, scar) ano upload to the eiecircJ 1114VI.
Then, mail the original form to the NC DEMLR 5tgr[pw9ter Program (with $100 check if paying by check) at:
Division of Energy, Mineral & "po �pspurces 5tormwater Program
512 N. Salisbury Stf pet, 61" Floor (Office 640K)
1612 Mg!l Service Center
Raleigh, �� �7699-1612
DO NOT MAILTHISMAIL MUS BE COMPLETED WITH AN ORIGINAL SIGNATURE (NOT DIGITAL) (40RM OR PAYMENT UNTIL YOUR APPLICATION HAS BEEN ACCEPTED AS 0C RP
THE FORM YOU MAIL
Per NC General Statute 143-215.66 (i), any person who kpp. wingly makes any false statement, representation, or
application, record, report, plan, or o fhh f rpcu{nent filed or required to be maintained under this
certification in any app 1,
Article or a rule implementing this Article ... shall be gu oy of q �jpss 2 misdemeanor which may include a fine not to
exceed ten thousand dollars ($10,000).
Under penalty of law, I certify that (check all boxes to indicate your agreement):
�]✓ I am the person responsible for the construction activities of this project, for satisfying the requirements of this
permit, and for any civil or criminal penalties incurred due to violations of this permit.
0 The information submitted in this N01 is, to the best of my knowledge and belief, true, accurate, and complete
based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information.
Q I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control
Plan.
M If the approved Erosion and Sediment Control Plan is not compliant with Part II (5tormwater Pollution
Prevention Plan) of the NCGO10000 General Permit, I will nonetheless ensure that all conditions of Part II of the
permit are met on the project at all times.
0 1 hereby request coverage under the NCGO10000 General Permit and understand that coverage under this
permit will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
Project Name (must match Ala): Woodfin Solar Fpcility
Specific Lot Numbers (must match Alb): 9721959 942726
Permittee (must match B1): Duke Energy Caronl'nas
Legally Responsible Person (must match B2 & B3): iClyp Whiteman
Title of Legally Responsible Person (must match B3b : PIrector, CD Project Manager
Name & Title of Signed if Authorized Individual
Differs from Legally Responsible Person:
Phony Number: 321-544-9435
1 /7/02