20200598 Ver 1_03a_Agent Authorization_20200616

AGENT AUTHORIZATION FORM
Name: Medline Industries, Inc.
Address: One Medline Place Mundelein, IL 60060
Phone: [phone]
Project Name/Description:Mebane Site
Date: September 9, 2019
The Department of the Army
U.S. Army Corps of Engineers, Wilmington District
Attention: Samantha Dailey
Re: Wetland Related Consulting and Permitting
hereby designates and authorizes Kimley-Horn and
Associates, Inc. to act in their behalf as their agent solely for the purpose of processing
Jurisdictional Determinations, Section 404 permits/Section 401 Water Quality Certifications
applications, and to furnish upon request supplemental information in support of applications, etc.
from this day forward until successful completion of the permitting process or revocation by
.
Authorized this the day of , .
Authorized Representative Authorized Representative
(Print Name) (Signature)
Cc: Karen Higgins
NC Division of Water Resources
401 & Buffer Permitting Unit
1650 Mail Service Center
Raleigh, NC 27699-1650