NCC231095_FRO Submitted (2)_20230419

Part a.
1. Company(ies) who are financially responsible for the land-disturbing activity (Provide a comprehensive list
of all respons.ible parties on accompan.led page) If the company is a sole proprietorship or jf the landowner(s) is
an .Individual(s). the name(s) Of the owner(s) may be listed as the financially responsible party(ies).
C&D Landfill, lnc.
Company Name
802 Recycling Lane
Current Mailing Address
Greenville NC 27834
Ci ty State Z i p
Phone: office # 252-752-8274
n/a
E-mail Address
same as mailing
Current Street Address
City
Mobile# N/A
State
Note: lf 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 actMty.
2. (a) lf 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:
Name of Registered Agent
Current Mailing Address
City
Phone: Office #
State
E-mail Address
Current Street Address
Zip City
Mobile #
State Zip
Name of Individual to Contact (if Registered Agent is a company)
(b) lf 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
Current Mailing Address
City
Phone: Office #
E-mail Address
Current Street Address
State Zi p C ity
Mobile #
State Zi p
Name of Individual to Contact (if Registered Agent is a company)