NCC230612_FRO Submitted_20230308

CHARLOTTE MOTOR SPEEDWAY LLC BANK OF AMERICA, N.A.
OPERATING ACCOUNT 32-1-1110
P.O. BOX 600 704455-3206
CONCORD, NC 280264"
DATE
11/30/2022
PAY SEVEN THOUSAND SEVEN HUNDRED AND 00/100 DOLLARS
TO THE
ORDER
OF NCDEQ
1606 MAIL SERVICE CENTER
RALEIGH, NC 27699-1606

73614i
AMOUNT
$ 7,700.00
73614
Check No 73614
DISCOUNT TAKEN NET AMOUNT DUE
0,00 7,700.00
11/30/2022 TOTAL
7.700.00
n rn _ _-

FINANCIAL RESPONSIBILITYIOWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place NIA in the blank.)
Part A.
1. Project NameCharlotte Motor Speedway Road Course
2. Location of land -disturbing activity: CountyCabarruS City or Township Concord/Harrisburg
Highway/Street Morehead Road Latitude(decimal degrees) 35,346504 Longitude(deamal degrees)-80.687487
3. Approximate date land -disturbing activity will commence: 1'1 /2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 57 AC
6. Amount of fee enclosed $7,700 . The Express Permitting application fee is a dual charge.
The normal fee of $100.00 per acre (rounded up to the next acre) is assessed without a ceiling amount.
In addition, the Express Permitting supplement is $250 per acre up to eight acres, after which the Express
Permitting supplemental fee is a fixed $2,000.00 (Example: 8.10-acre application fee is $2,900). Checks
should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed @ No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Stephen Swift E-mail Address [e-mail]
Phone: Office # 704.455.3207 Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Charlotte Motor Speedway, LLC 704.455.3207 704.455.4322
Name Phone: Office # Mobile #
P.O Box 600 Concord, NC 28026 5555 Concord Parkway South
Current Mailing Address Current Street Address
Concord NC 28026 Concord NC 28207
City State Zip City State Zip
10. Deed Book No. 9244 Page No. 0047 Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Charlotte Motor Speedway, LLC
Company Name
P.O Box 600 Concord, NC 28026
Current Mailing Address
[e-mail]
E-mail Address
5555 Concord Parkway South
Current Street Address
Concord NC 28026 Concord NC 28207
City
State Zip City
Phone: Office # 704.455.3207
State
Mobile # [phone]
Uri
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
CT Corporation System [e-mail]
Name of Registered Agent E-mail Address
160 Mine Lake Ct Ste 200 160 Mine Lake Ct Ste 200
Current Mailing Address Current Street Address
Raleigh NC 27615 Raleigh NC 27615
City State Zip City State Zip
Phone: office # [phone] Mobile # NIA
Jayna Nickell
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)
(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General

Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
(d) If order to facilitate Express Permitting, it is necessary to be able to contact the engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
LandDesign [e-mail]
Engineering firm or other consultant E-mail Address
Robby Bell 704.333.0325
Individual contact person (type or print)
Phone: Office # Mobile #
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.
Stephen D. Swift
SVP Operation/Development
nne Title or Authority
Date
I, OW ell a Notary Public of the County of
.I? In r-V
State of North Gerelina, hereby certify that appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this "V day of �Dyombelrr , 20 Z2
Sayre e/)Pd <n
Notary
Seal My commission expires
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STATE Ly
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