NCG140298 Ownership Change Form

Division of Energy, Mineral & Land Resources
AW
FOR AGENCY USE ONLY
Land uality SectionlStormwater Permittin
+��� Q LJ
Date Received
Year Month Da
AmhmddwNCDENR National Pollutant Discharge Elimination System
President
Ca-Ou- PEti+'OF
N ' t
'­ 0NME—N�URALR�oU�ES PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N IC I S1 0 N C G 1
14 10 12 9 8
Il. Permit status prior to requested change.
a. Permit issued to (company name): Southern Equipment
Company
b. Person legally responsible for permit: Steve
Simonsen
First MI
Last
RECEIVED
JAN 2 9 2018
DENR-I-AND QUALITY
STGRMWATER PERMITTING
c. Facility name (discharge):
d. Facility address:
Environmental Manager
Title
3015 Windward Plaza Suite 300
Permit Holder Mailing Address
Alpharetta GA 30005
City State Zip
[phone] ( _)
Phone Fax
Ready Mixed Concrete Company - Clinton, Plant 120
3095 Turkey Hwy
Address
Clinton NC 28328
City State Zip
e. Facility contact person: [phone] Ext.Andy Stankwytch 10290
First / MI /Last Phone
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of- ® Change in ownership of the facility
❑ Name change of the facility or owner
Revised Jan. 27, 2014
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
Concrete Service Co, Inc.
Richard R Allen
First
MI Last
President
Title
PO Box 1867
Permit Holder Mailing Address
Fayetteville
NC 28302
City
_
State Zip
[phone]
[e-mail]
Phone
E-mail Address
d. Facility name (discharge):
Concrete Service- Clinton
e. Facility address:
3095 Turkey Hwy
Address
Clinton
NC 28328
City
State zip
f. Facility contact person:
Winnie
D Jenkins
First
MI Last
[phone]
313
Phone
E-mail Address

NPDES PERMIT NAME/OWNERSHIIL CHANGE FORhl
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact:
First MI Last
Title
Mailing Address
City State Zip
Phone E-mail Address
V Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
Vl Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ LegaI documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by loth the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change);
I, 'i , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
IZ/j' j
Signature G t c_c.- 1 Date
APPLICANT CERTIFICATION
I, Richard R. Allen, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
/zW Ad_ 1 IST
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014

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BK 1992 PG 0623
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FILED EI4ECTRONICALLY
SANPSON COUNTY NC
ELEANOR N. BRAD -SHAW
FILED Dec 18, 2017
AT •04:.19:33 PM
HOOK 01992
START PACE 0623
END PAGE 0631
INSTRUMENT # 065.02
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�z�Oltat4� 61OSEM4 DULY DbTEO. ONTH9
USMS TA9 MGOkM
submitted electronically by "Wyatt Early Harris Wheeler LLP"
in. compliance with North Carolina statutes governing recordable documents
and the.terms. of the submitter agreement with the Sampson County Register of Qeeds.

MEMORANDUM OF LEASE
THIS MEMORANDUM OF LEASE ("Memorandum") is signed as of December 15,
2017, by ALLEN OF FAYETTEVILLE II, LLC, a North Carolina limited liability company,
with its principal offices in Cumberland County, North Carolina ("Landlord"), and
CONCRETE SERVICE CO., INC., a North Carolina corporation, with its principal offices in
Cumberland County, North Carolina ("Tenant").
Landlord and Tenant have entered into a lease ("Lease") dated as of the date of this
Memorandum for valuable consideration with respect to certain "Premises" in Sampson County,
North Carolina, more fully described and/or depicted on attached Exhibit A.
The term of the Lease is scheduled to commence on December 15, 2017, and expire on
December 14, 2022, unless sooner terminated as provided in the Lease. Tenant shall have the
five (5) options to extend the term of the Lease for periods of five (5) years each as specified in
the Lease.
This Memorandum is executed for the purpose of giving record notice of the existence of
the Lease for the term provided above. All terms and conditions of the Lease are incorporated
into this Memorandum by reference.
72147753
[SIGNATURES APPEAR ON THE FOLLOWING PAGES.]

Landlord and Tenant have executed this Memorandum as of the date set forth above.
Landl O TEVILLE II, LLC
Name: Richard R. Allen., Jr.
Title: Manager
Tena t: CONC `E SERVICE CO., INC.
Name. �(Y1
Title: evr
STATE OF NOR7fl CAS RQLTNI�
COUNTY OF /n,��(�I
I, the undersigned, a Notary Public of the County and State aforesaid, certify that the following person(s)
personallppeared before me this day, and
I have personal knowledge of the identity of the principal(s)
❑ I have seen satisfactory evidence of the principal's identity, by a current state or federal
identification with the principal's photograph in the form of a
❑ A credible witness has sworn to the identity of the principaI(s);
each acknowledging to me that he or she voluntarily signed the foregoing document for the purpose stated
therein and in the capacity indicated:
Date;
1`,Il3aaspao
o0
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STE OFNORI
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a Notary Public of the County and State aforesaid, certify that the following persons)
wed before me this day, and
I have personal knowledge of the identity of the principal(s)
I have seen satisfactory evidence of the principal's identity, by a current state or federal
identification with the principaI's photograph in the form of a
1prulL named
My commission expires: J
❑ A credible witness has sworn to the identity of the principal(s);
each acknowledging to me that he or she voluntarily signed the foregoing document for the purpose
stated therein and in the capacity indicated:: JS,u % (V\476d (fin _ (name)._as
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72147753 Rrahil%�i®��®
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@rant name)
My commission expires:
2

EXHIBIT A
STATE OF NORTH CAROLINA
COUNTY OF SAMPSON
BEGINNING at an iron in the Northern edge of the right-of-way of N.C. Highway No. 24, the
Southeast corner of the Ricky William Autry 1.25 acre tract (Book 1249, page 777, Sampson
County Registry), said beginning iron located South 82 degrees 53 minutes 57 seconds East
4550.27 feet from N.C.G.S. Station "Sampson" N.C. Grid Coordinates X=2,215,348.246,
Y=453,576.747 (1983 N.A. Datum); and runs thence from said BEGINNING North 22 degrees
09 minutes 13 seconds East 564.38 feet to and with the Pope Brothers Farm, Inc. line to an iron;
thence South 82 degrees 10 minutes 28 seconds East 350.00 feet with the Pope line to an iron;
thence South 22 degrees 09 minutes 13 seconds West 539.88 feet with the Pope line to a PK nail
in the center of N.C. Highway No. 24; thence North 82 degrees 10 minutes 28 seconds West
350.00 feet with the center of said highway to a PK nail; thence North 22 degrees 09 minutes 13
seconds.East 29.50 feet to the BEGINNING, containing 4.38 acres, excluding right-of-way of
N.C. Highway No. 24, and BEING ALL OF LOT NO. 2 of the Pope Division as shown on a map
prepared by Lewis G. Paschal, Professional Land Surveyor, under date of November 2, 2001,
and recorded in Plat Book 41, at page 19, of the Sampson County Registry, reference to which
map or plat and the record thereof is hereby made for a more complete description by metes and
bounds, TOGETHER with easement for drainage purposes 30 feet in width, the centerline of
which shall extend from any point in the easterly boundary of the 4.38 acre tract of land
conveyed selected by party o'fthe second part, its successors or assigns, and extending in an
easterly direction to any point in the dragline ditch on the property of the parties of the first part
which is located easterly of the 4.38 acre tract of land herein conveyed provided that the point
shall not be northerly of a point in the dragline ditch which is located South 82 degrees 10
minutes 28 seconds East from the Northeasterly corner of the 4.38 tract of land herein conveyed.
And also being all of the property conveyed to Allen of Fayetteville 11, LLC by deeds recorded in
Book 1992, Page 623; and Book 1992, Page 632, Sampson County Registry.
u:laevanslargosllease documentslsampson countylsampson county memorandum of lease.docx
3
72147753