NCC192585_NOI Signed Certification_20191031

NCG01 Notice of Intent (NOI) Certification Form
Directions:
Print this form, complete, scan and upload to the electronic NOI.
Then, mail the original form to the NC DEMLR Stormwater Program (with $100 check if paying by check) at:
Division of Energy, Mineral & Land Resources Stormwater Program
512 N. Salisbury Street, 61h Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
DO NOT MAIL THIS FORM OR PAYMENT UNTIL YOUR APPLICATION HAS BEEN
REVIEWED AND ACCEPTED AS COMPLETE
Per NC General Statute 143-215.6E (i), any person who knowingly makes any false statement, representation,
or certification in any application, record, report, plan, or other document filed or required to be maintained
under this Article or a rule implementing this Article ... shall be guilty of a Class 2 misdemeanor which may
include a fine not to exceed ten thousand dollars ($I0,000).
Under penalty of law, I certify that (check all boxes to indicate your agreement):
I am the person responsible for the construction 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.
L 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.
XJ I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and
Sediment Control Plan,
X1 If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan) of the NCGO10000 General Permit, I will nonetheless ensure that all conditions of
Part II of the permit are met on the project at all times.
K I hereby request coverage under the NCGO10000 General Permit and understand that coverage under
this permit will constitute the permit requirements for the discharge(s) and is enforceable in the
same manner as an individual permit.
Name of Proiect: United Parcel Service
Legally Responsible Organizational Entity: United Parcel Service, Inc.
Legally Responsible Person: Kenneth Haynes
Title of Legally Responsi le Person; Project Coordinator
*Signature: I Date:
*Print Name an4 Title of Sig ed if Authorized
Individual Differs from Permittee:
Phone Number: 404-828-3942
* 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.
For more information on signatory requirements, see Part IV, Section B, Item (6) of the NCG010000 permit.

UNITED PARCEL, SERVICE, INC.
(OHIO)
Assistant Secretary's Certificate
1, Ryan C. Swift, do hereby certify that:
I am a duly elected and qualified Assistant Secretary and the keeper of
the records and corporate seal of United Parcel Service, Inc., a corporation
organized, existing and in good standing under the laws of the State of Ohio
(the "Company"); and
I further certify that Rhonda Clark is a duly elected vice President of
the Company and as such, she is authorized to execute agreements on behalf of
United Parcel Service, Inc., (Ohio).
IN WITNESS WHEREOF, I have signed this certificate of the Company as of
the date hereof.
Date: May 23, 2019
R n C. Swift
ssistant Secretary
STATE OF GEORGIA )
)
COUNTY OF FULTON )
This instrument acknowledged before me by Ryan C. Swift, who personally
appeared and is known to me or proved to me on the basis of satisfactory
evidence, did sign the foregoing instrument, and that the same was his
voluntary act and deed.
IN TESTIMONY WHEREOF, I have hereunto subscribed my name and affixed my
official seal this 23`" day of May, 2019
Antonio
Notary Public
My commission expires: April 9,

UNITED PARCEL SERVICE GENERAL SERVICES CO.
POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS:
UNITED PARCEL SERVICE, INC., a corporation duly organized and existing under the laws
of the State of Ohio, United States of America and having its principal office at 55 Glenlake
Parkway, Atlanta, GA 30328, United States of America (the "Company"), does hereby appoint
KENNETH L. HAYNES in his capacity as Project Coordinator of the Company, the power to
execute any petitions or other documents necessary to affect the application approval requested
for building pen -nits. licensing related to property improvements, and to appear on behalf of the
company before any administrative or legislative body in the states of Alabama, Delaware,
Florida, Georgia, Louisiana, Maryland, Mississippi, North Carolina, Pennsylvania, South
Carolina and Tennessee, and to act in all respects as our agent in matters pertaining to what is set
forth in this authorization.
This Power of Attorney is effective as of May 26, 2019 and will expire May 25, 2020. This
authorization is expressly limited to the purposes set forth above.
This Power of Attorney shall remain in effect until specifically revoked in writing, provided that
the provisions of this sentence shall not affect the validity or enforceability of any documents
executed prior to such revocation.
IN WITNESS WHEREOF, the Company has caused its name to be subscribed hereto by its duly
authorized officer this 23,d day of Nlay. 2019.
UNITED PARCEL SERVICE, INC.
By: Yk U (Iowy-
Name: Rhonda Clark
Title: Vice President
STATE OF GEORGIA
COUNTY OF FULTON
This instrument acknowledged before me by Rhonda Clark, who personally appeared and is known to me
or proved to me on the basis of satisfactory evidence, did sign the foregoing instrument, and that the same
was his/her voluntary act and deed.
I TE TIMONY WtiE EOF, I have hereunto subscribed my name affixed my official seal this
day of , 2019. 1 Q �� ///��
j���gS10No'*.�(P i
Notary i Q APRIL
My commission expires: '" �l SAC. yy:•• C.?
r ti <T .