3405_Forsyth_RJReynolds_RuralHall_Indus_2023LURCert_FID1756739_20230104

NORTH LINA .r
f gwmnent of Emnroamentai & jw*
Inactive Hazardous Sites Branch
Annual Report Form for Perpetual Land -Use Restrictions
Site Name: Rural Hall Edwards Road Landfill
Site In No.: 3405-INDUS-1986
County in NC: Forsyth
YES NA (not applicable). Check all that apply:
All restrictions in the recorded Declaration of Perpetual Land Use Restrictions (DPLUR) document
are still in compliance.
❑All posted signs and demarcations required by the DPLUR that identify the restricted area(s) are
visible and readable.
The contact information on the signs required by the DPLUR is current.
❑All physical markers and barriers (e.g., berms, fences, paved areas, etc.) required by the DPLUR are
in place and intact.
The landfill cover system has been maintained according to the requirements outlined in the DPLUR.
The DPLUR and Notice are still recorded at the county register of deeds office.
The property has not been subdivided since the last certified annual report.
Comments:
Property Owner Certification Statement
I� Shahzeb F Malik , hereby state that: I am over the age of eighteen, I am
competent to make this certification based upon my own personal knowledge and belief and, to the best of my
knowledge and belief, after thorough investigation, the information contained herein is accurate and complete. I
am aware that there are significant penalties for willfully submitting false, inaccurate or incomplete information.
i e011roperty Owner)
Shahzeb F Malik - Senior VP Operations
(Printed Name and Title of Property Owner)
R. J. Reynolds Tobacco Co.
(Printed Name of Company)
01/04/2023
(Date)