NCC242656_NOI Signed Certification_20240828

NCGO1 Notice of Int: nt (NOI) Certification Form
irections:
Print this form, complete, s an and upload to the electronic NOI.
Then, mail the original form to the NC DEMLR 'tormwater Program (with $120 check if paying by check)
at:
Division of Energy, Mineral Land Resources Stormwater Program
512 N. Salisbury S reet, 6th Floor(Office 640K)
1612 Mail Service Center
Raleig , NC 27699-1612
THE FORM YOU MAIL MUST BE COMPLETED WIT AN ORIGINAL SIGNATURE(NOT DIGITAL) [40 CFR 122.22]
Per NC General Statute 143-215.6B(i), any person who nowingly makes any false statement, representation, or
certification in any application, record, report, plan, or t ther document filed or required to be maintained under this
Article or a rule implementing this Article. . . shall be g ilty of a Class 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 constructioi 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.
E The information submitted in this NOI 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.
ElI will abide by all conditions of the NCG010000 eneral Permit and the approved Erosion and Sediment Control
Plan.
E If the approved Erosion and Sediment Control Ian is not compliant with Part II (Stormwater Pollution
Prevention Plan)of the NCG010000 General Pe mit I will nonetheless ensure that all conditions of Part II of the
permit are met on the project at all times.
E I hereby request coverage under the NCG0100 0 General Permit and understand that coverage under this
permit will constitute the permit requirements or the discharge(s) and is enforceable in the same manner as an
individual permit.
Project Name (must match Ala): Newton Mini Storage
Specific Lot Numbers(must match Alb):
Permittee (must match B1): Turnrows Storage Center LLC.
Legally Responsible Person (must match B2& B3): Marshall Newton
Title of Legally Responsible Person (must match B3b : Managing Member
Print Name &Title of Signed if Authorized
Individual Differs from Legally Responsible Person:
Phone Number: 9106240149
8/27/24
Signat r of Legally Responsible Person or Authorized Individual Date
i.
* IMPORTANT NOTE: This form must be signed by a responsible corporate officer that owns or operates the construction activity,
such as a president,secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV,Section B,
Item(6)of the NCG010000 permit.