NCG140497_Application_20210625

AA'ri Division of Energy, Mineral and Land Resources
Land Quality Section
NCDENRNational Pollutant Discharge Elimination System
»;szrry r_.wo�iHn L'EvaRrr.�ewr of
�!IVIR{W M!!1T aH^ yATIJ-i6'� RESCLR. E'
NCG140000
NOTICE OF INTENT
FOR AGENCY USE ONLY
Date Received
Year
Month Dav
Certificate of Covera Te
N C G 1 4
Check it Amount
Permit Assi gned to
� � O
RECE ED
I l 2921
National Pollutant Discharge Elimination System application for coverage under General 0rhif
NCG140000: DENR-LAND QUALITY
STORMWATER AND PROCESS WASTEWATER DISCHARGES associated with activitiej%ssi fRS6jh1ITTING
SIC (Standard Industrial Classification) Code: 3273 and like activities - Ready Mixed Concrete
This NOI may be an application to discharge process wastewater. NCG140000 contains effluent limitations
for process wastewater discharges. Wastewater discharges must meet the requirements of these
effluent limitations. An exceedance of any of these limitations will result in a violation of the permit
conditions.
For questions, please contact the DEMLR Central Office or Regional Office in your area. (See page 6)
(Please print or type)
1) Mailing address of ownerloperator (official address to which all permit correspondence will be
mailed): (Please print or type all entries in this application form.)
Legal Owner Name Chandler Concrete Co., Inc.
(Please attach the most recent Annual Report to the NC Secretary of State showing the current legal name. Alternatively this
permit can be given to an individual.)
Signee's Name (as signed for in question 29 below)
Street Address 1006 S. Church St.
City Burlinfgon
Telephone No. 336.226.1181
Alternate Contact Name Jamie Nelms
Alternate Contact Telephone (if different)
Kenneth E. Waegerle
State NC ZIP Code 27216
Email ke—n.waegerleCcDchandlerconcrete.com
Email "amie.nelms chandlerconcrete.com
2) Location of facility producing discharge:
Facility Name Spruce Pine „Plant #508
Street Address 6945 US 19E
City Spruce Pine State NC ZIP Code 28777
County Mitchell County
Facility Contact Sam Thompson
Telephone No. 828-963-0583 Fax: [phone]
3) Physical location information:
Please provide narrative directions to the facility (use street names, state road numbers, and distance and
direction from a roadway intersection). From 1-40 Exit 86 Marion, take US 221/226-heading North.
Stay on 226 to Spruce Pine. Turn right on 19E and go 2.4 miles, turn left on Berry Hill and vere
left at top of hill you have arrived.
✓ (A copy of a county map or USGS quad sheet with faciiity clearly located on the map is a required part of this application.
SEE SUPPLEMENTAL INFORMATION ATTACHED
4) Latitude 35.9268 Longitude-82.0379
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NCG140000 N.O.I.
5) This NPDES Permit Application applies to the following (check all that apply):
X New or Proposed Facility
❑ Existing Facility Permit #
Date operation is to begin 7/1/2021
6) Consultant's application information:
Consultant: N/A
Consulting Firm. -
Mailing Address:
City:
State:
Phone:( )
Email:
Zip Code:
Fax: ( ) _
(Optional)
Staple Business Card Here:
7) Provide the 4 digit Standard Industrial Classification Code (SIC Code) that describes the primary
industrial activity at this facility:
SIC Code: 3 2 7 3
8) Provide a brief description of the types of industrial activities and products produced at this facility:
(Attach a site diagram showing the process areas present at this facility.)
This new ready mix concrete plant will support and supply our ready mix concrete to area customers.
Production of ready mix concrete, processes include: Material handling — aggregates, cement, flyash, and
admixtures will be delivered by truck to site. End -loader operations for charging plant material bins/hoppers.
Plant Operations — weigh and dispense dry -batch components and water into ready mix truck. Truck wash -
down of residual material on vehicle_ Wash -down and Wash -out of truck and drum.
Stormwater Discharge, Wastewater Treatment & Discharge and Permitting Information
S) Discharge points t Receiving waters:
Number of discharge points (ditches, pipes, channels, etc.) that convey stormwater and/or wastewater from
the property:
Stormwater-only: _2 Wastewater -only: _0 Wastewater Commingled with Stormwater. 1
For new facilities: Expected date of commencement of discharge: 7/1/2021
What is the name of the body or bodies of water (creek, stream, river, lake, etc.) that the facility stormwater
and/or wastewater discharges end up in? 5_ PW discharged from site may enter into Jakes Creek.
This creek feeds into the North Toe River. The Toe River continues to the Nolichucky River, then
to the Tennessee River, to the Ohio River, leading to the Mississippi River to the Gulf of Mexico.
Receiving water classification(s), if known: Class C; Tr
If the site stormwater discharges to a separate storm sewer system, name the operator of the separate storm
sewer system (e.g. City of Raleigh municipal storm sewer). NIA
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>• C�Z�`7i C ��AI�I�I ► pia �
List discharge points (out€ails) that convey discharge from the site (both on -site and off -site) and location
coordinates. Attach additional sheets if necessary, or note that this information is specified on the site plan.
Be sure to indicate a type for each outfall listed below as Stormwater only, Wastewater only or Wastewater
Commingled with Stormwater
Outfall No. 1 Stormwater only _ Wastewater only _ Wastewater Commingled with Stormwater X
Latitude (degrees/minutes/seconds): 35.9271 N
Longitude (degrees/minutes/seconds)-. -82.0385 W
Outfall No. 2 Stormwater only X Wastewater only _ Wastewater Commingled with Stormwater
Latitude (degrees/minutes/seconds): 35.9258 N
Longitude (deg reeslminutes/seconds):-82.0379 W
Outfall No. 3 Stormwater only X Wastewater only _ Wastewater Commingled with Stormwater
Latitude (degrees/minutes/seconds): 35.9264 N
Longitude (degrees/minutes/seconds):-82.0386 W
Outfall No. _ Stormwater only _ Wastewater only ^ Wastewater Commingled with Stormwater _
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Outfall No. _ Stormwater only _ Wastewater only _ Wastewater Commingled with Stormwater
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Outfall No. _ Stormwater only _ Wastewater only _ Wastewater Commingled with Stormwater
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Outfall No. _ Stormwater only Wastewater only — Wastewater Commingled with Stormwater
Latitude (degrees/minutes/seconds): N
Longitude (degrees/minutes/seconds): W
Will this facility discharge wastewater to SA (Shell fishing) waters? ❑ Yes X No
Note: Discharge of process wastewater to receiving waters classified as WS-II to WS-V or SA must be
approved by the N.C. Division of Water Resources, Public Water Supply Section. If DWR does not
approve, coverage under NCG140000 cannot be granted. No new discharges of process wastewater
are permitted in receiving waters classified as WS-1 or freshwater ORW.
You must show all discharge points clearly on the submitted site plan. Be advised that NCDEQ may require you
to apply for an individual permit, based on proposed discharge rates and receiving stream conditions (low flows,
impairments, etc.)
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10) Each applicant shall provide the following information (attach additional sheets as necessary):
• Two (2) site plans depicting the facility or site with numbered outfalls which indicate stormwater and
wastewater outfalls. The plans shall legibly show. at a minimum, (existing or proposed):
Description
1. Outline of drainage areas with topographical lines and features
2. Stormwater/wastewater treatment structures
3. Location of numbered stormwater/wastewater outfalls (corresponding to which drainage areas)
4. Runoff conveyance structures
5. Areas and acreage where materials are stored
6. Impervious area acreages
7. Location(s) of streams and/or wetlands the site is draining to, and any applicable buffers
8. Site property lines, North Arrow, and bar scale
9. If applicable, the 100-year floodplain line
10. Acreage of each stormwater and wastewater topographical area
Note. Impervious area will commingle SW & PWW. Pervious area is primarily SW.
11. Each of the facilities' wastewater or stormwater source and discharge structures and each of its
hazardous waste treatment, storage, or disposal facilities.
12. Site location (insert)
Basin Design & Site Photos
Site plans shall be 24" x 36" in size.
• Line drawing and description: Aline drawing of the water flow through the facility. A pictorial
description of the nature and amount of any sources of water and any collection and treatment measures.
• A narrative description and identification of each type of process, operation, or production area which
contributes wastewater to the effluent for each outfall, and a description of the treatment the wastewater
receives (or will receive), including the ultimate disposal of any solid or fluid wastes other than by
discharge. Processes, operations, or production areas may be described in general terms (e.g. "ash
silo").
11) Does the applicant have any unresolved Notice of Violations (NOVs)?
❑ No X Yes — Chandler is actively engaged in resolving a NOV-2021-PC-0312 received on 6/15/2021 at
our recently acquired facility in Marion, NC. We are working with Amy Annino and Clearwater Environmental
to clean up issues that came to our attention. Most of the impacts are from pre -acquisition operations.
Wastewater.
12) What types of wastewater does your facility generate or discharge?
Type of Authorized Wastewater
Generate
Discharge
Sent to WW
Treatment
System
Vehicle and equipment cleaning VE
X
X*
❑
Wetting of raw material stockpiles RM
X
X*
❑
Mixing drum cleaning MD
X
X*
❑
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Continued...
Further explanation, if necessary: *All process waste _water will be collected in a series of 2 sediment
basins, a primary pond, _a secondary pond and a third earthen holding basin. These have been
installed to reduce the potential discharge of pollutants including solids and high pH process water.
A CO2 pH control system will be installed in the 211 basin. The system is designed to provide for the
recycling of truck wash water and harvesting of process and storm water for that purpose. Wash
water will be recycled water from basin 2 and/or the collection pond. Fresh water will be limited to
makeup water for the collection system
Further motes.
Wash -down is an exterior wash of the truck hopper, chute —50 gallons of recycled water).
Wash -out is a washing of the interior of the drum requiring a larger volume of water (-150 gallons
of recycled water.) and removal of solids that is typically accomplished at the end of the vehicle
work day.
13) Will your facility spray -down or actively wet aggregate piles?
❑ No X Yes Notes. Water from aggregate wetting is returned to the collection pond. Also, recycled water may be
used to supplement the wetting of aggregates.
14) Does the facility use any of the following on site?
❑ Phosphorus -containing Detergents
❑ Brighteners X Other Cleaning Agents
X Non -Phosphorus -containing Detergents
❑ Other:
15) Are wastewater treatment facilities planned in the 100-year flood plain?
X No ❑ Yes
16) Will your facility build a closed -loop recycle system (CLRSs) that meets design requirements in 15A
NCAC 02T .1000 and hold your facilities' working volume'?
❑ Yes X No
If Yes, STOP COMPLETION of this permit. Contact DWR Non -Discharge Permitting Program for
permitting requirements.
17) A wastewater treatment alternatives review is required by 15A NCAC 2H.0105 (c)(2) for any new or
expanding water pollution control facility's discharge in North Carolina. You may attach additional sheets.
a) What wastewaters were considered for this alternatives review? X VE X RM X* MD
b) Connection to a Municipal or Regional Sewer Collection System:
i) Are there existing sewer lines within a one -mile radius? ..................................... X Yes ❑ No
(1) If Yes, will the wastewater treatment plant (WWTP) accept the wastewater? .... ❑ Yes ❑ No
(a) If No, please attach a letter documenting that the WWTP will not accept the wastewater.
(b) If Yes, is it feasible to connect to the WWTP? Why or why not?* Installation and
connection of WW connections is not practicable for this application. The design is
intended for zero discharge however it does not have the engineering certifications
to qualify for that designation. Anticipated potential discharges should be readily
maintained within ordinary permit discharge parameters.
c) Surface or Subsurface Disposal System (e.g., spray irrigation):
1 See DWQ's Aquifer Protection Section Land Application Unit's Water Balance Calculation Policy for more information, on DWQ LAU's
website http:llportal.ncdenr.orglweb/wglaps/iau/policies for more information.
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NCG140000 N.O.I.
Is a surface or subsurface disposal technologically feasible (possible)? .................... X Yes ❑ No
WhyorWhynot? It is technologically feasible however installation, connection and
operation of a Surface/Sub-surface system is not practicable for this application.
ii) Is a surface or subsurface disposal syslern feasible to impletnent?*...........................❑ Yes X No
Why or Why not? See above.
iii) What is the feasibility of employing a subsurface or surface discharge as compared to a direct
discharge to surface waters?* See above.
d) Direct Discharge to Surface Waters: Is discharge to surface waters the most environmentally sound
alternative of all reasonably cost-effective options of the wastewaters being considered?*... X Yes ❑ No
i) If No, contact DEMLR's Land Application Unit to determine permitting requirements.
e) If this review included all wastewater discharge types, would excluding some types (e.g. raw
stockpile wetting) make any of the above non -discharge options feasible? .............. ❑ Yes X No
* You may be asked to provide further information to support your answers to these questions after the initial review.
Feasibility should take into account initial and recurring costs.
Stormwater:
'18) Does this facility employ any best management practices for Stormwater control? ❑ No X Yes
If yes, please briefly describe:
o Stormwater for the operation will pass through a series of silt fences and a rip -rap berm.
Reducing risk of stormwater contamination and commingling:
o All chemical admixtures and tanks will be maintained in secondary containment systems.
o Aggregate wetting runoff will be directed to either the pond or sediment basins.
o The truck washdown and washout will be performed on a concrete pad that drains to the
sediment basins for the collection of solids and pH treatment.
o The 2 sediment basins allow for the reduction of solids in the process water which when at
full capacity will discharge to a pond. The process water entering the basin and pond will be
treated with a CO2 absorption/diffusion system to maintain pH within discharge limits (6.0-
9.0 SU).
19) Does this facility have a Stormwater Pollution Prevention Plan? X* No ❑ Yes
If yes, when was it implemented? *A SWPPP will be finalized based upon any additional approval stipulations
and/or criteria outlined in this permit application as will be required when the permit is received.
20) Are vehicle maintenance activities (VMA) occurring or planned at this facility? X No ❑Yes
If yes, does your VMA area discharge into your wastewater treatment device? ❑ No ❑ Yes
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NCG140000 N.O.I.
Other/Permitting:
21) Does this facility have a Division of Land Resources Erosion & Sedimentation Control (E&SC) Permit?
X No ❑ Yes
If yes, list the permit numbers for all current E&SC permits for this facility:
22) Is your facility subject to Phase II Post -Construction Area?
If yes, who is the permitting authority?
X No ❑ Yes
23) Is your facility located in one of the 20 Coastal Counties? ❑ Yes X No
Is your facility adding more than 10,000 ftz of built -upon area or CAMA Major Permit? ❑ Yes X No
24) Is your facility discharging wastewater (treated or untreated) such as water from wetting of aggregate
piles, drum rinse -out, or vehicle and equipment cleaning to a stormwater BMP? X No ❑ Yes
If yes, please attach your approval from the permitting authority to do so.
25) Does this facility have any other NPDES permits? X_ No ❑ Yes
If yes, list the permit numbers for all current NPDES permits for this facility:
Note. An NCDEQ Air Permit/Registration are to be filed when equipment is received (Serial Numbers and as
built Specs required). This plant will be conditionally exempted from the air permit when registered.
26) Does this facility have any Non -Discharge permits (ex: recycle permits)? X No
If yes, list the permit numbers for all current Non -Discharge permits for this facility: _
27) Hazardous Waste:
a) Is this facility a Hazardous Waste Treatment, Storage, or Disposal Facility?
❑ Yes
X No ❑ Yes
b) Is this facility a Small Quantity Generator (less than 1000 kg. of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
Note. This facility will very little or no hazardous waste. Most oils for equipment are collected and recycled
by our plant maintenance department. Vehicles are serviced in our fleet maintenance shops where materials
are collected and recycled including, hydraulic, engine oils and coolants, batteries, paints & cleaners, etc...
c) Is this facility a Large Quantity Generator (1000 kg. or more of hazardous waste generated per month) of
hazardous waste?
X No ❑ Yes
d) Type(s) of waste:
Aggregate and cementitious materials from basins, vehicle & equipment lubricants.
How is material stored:
Aggregate and cementitious materials will be regularly removed from wash basin(s) and accumulated
in a designated drying area on a pad that drains residual water back to the primary basin. Once dry,
these materials will be used for clean fill on other projects.
Preventive Maintenance and servicing of our vehicles is performed offsite. Limited supplies of engine
oil, coolant and washer fluid will be maintained onsite and stored in the admixture containment area.
These containers are <5 gallons each and minimal quantities will be maintained onsite.
Used plant / equipment lubricants will be collected and returned to the maintenance shop in Boone,
INC for recycling.
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NCG140000 N.O.I.
Where is material stored:
• As described, cementitious residual materials will be stored in a drying bin.
• Aggregates (sand & stone) will be stored in walled bins on a concrete pad adjacent to the
pond and in overhead bins on the plant itself.
• Cement and Flyash will be stored in Silos above the batch plant.
• Vehicle and equipment materials will be stored in the admixture containment area.
How many disposal shipments per year: Zero anticipated. These materials are predominantly
recycled by our maintenance departments (plant & fleet) from their respective shops.
No hazardous material disposal is anticipated.
Name of transport/ disposal vendor: Noble Oil
Vendor address:
5617 Clyde Rayne Dr.
PO Box 4419
Sanford, NC 27331
Final Checklist
This application will be returned as incomplete unless all of the following items have been included:
X Check for $100 made payable to NCDENR.
T
X This completed application and all supporting documentation. See Question 10.
NA If an Erosion & Sedimentation Control (E&SC) Plan is required from Division of Land Resources (DLR)
or local designee: documentation verifying applicant has developed and submitted that Plan to the
governing agency (required per 15A NCAC 02H .0138).
X Two (2) site plans depicting the site plan with numbered outfalls which indicate stormwater and wastewater
1 outfalls. See Question 10.
X A county reap or USGS quad sheet with location of facility clearly marked.
28) Signatory Requirements (per 40 CFR 122.22)
All applications, reports, or information submitted to the Director shall be signed and certified.
a. All notices of intent to be covered under this General Permit shall be signed as follows:
(1) For a corporation: by a responsible corporate officer. For the purpose of this permit, a responsible corporate officer means: (a) a president,
secretary, treasurer or vice president of the corporation in charge of a principal business function, or any other person who performs similar
policy or decision making functions for the corporation, or (b) the manager of one or more manufacturing production or operating facilities
employing more than 250 persons or having gross annual sales or expenditures exceeding 25 million (in second quarter 1980 dollars), if
authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures.
(2) For a partnership or sole proprietorship: by a generai partner or the proprietor, respectively: or
(3) For a municipality, state, federal, or other public agency: by either a principal executive officer or ranking elected official.
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NCG 140000 N.O.I.
Certification: North Carolina General Statute 143-215.6 B(i) provides that:
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; or who knowingly makes a false statement of a material
fact in a rulemaking proceeding or contested case underthis Article; orwho falsifies, tampers with, or knowingly renders inaccurate any recording
or monitoring device or method required to be operated or maintained under this Article or rules of the [Environmental Management] Commission
implementing this Article shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000),
I hereby request coverage under the referenced General Permit. I 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.
certify that I am familiar with the information contained in this application and that to the best of my knowledge
and belief such information is true, complete, and accurate.
Printed Name of Person Signing: Kenneth E. Waegerle
Title: Cor or E ironmenta ealth & Safety Manager
Z
June 16, 2021
{S. ature of pplicant) (Date Signed)
Notice of Intent must be accompanied by a check or money order for $100.00 made payable to: NCDENR
Mail the entire package to:
Stormwater Permitting Unit Program
Division of Energy, Mineral and Land Resources
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Note
The submission of this document does not guarantee the issuance of an NPDES permit.
For questions, please contact the DEMLR Regional Office for your area.
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office
... [phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
Central Office .........
[phone]
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NCG140000 N.O.I.
Supplemental Information:
Trimmed Site Plan as attached on attached 24"x36" drawings.
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1 �
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f E',
— :FtEwwLedAra�s
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1►[9jesEtiliI eme Well
Application item 3. EXCERPT OF NCGIS QUAD MAP —SPRUCE PINE, NC
i21
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NCG140000 N.O.I.
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NCG140000 N.O.I.
F
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NCG140000 N.O.I.
'Place/6945+US-19E,+Spruce+Pine,+NC+28777/@35.9256351,-82.0367745,557m/data-!3m1! 1e3!4m5!3m4!1sOA850bcb�
Slice Gallery Imported Fram IE * Bookmarks
Total Property Area: Approximately 12 acres.
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NCG 140000 N.O.I.
Cleared area: —4 Acres graded
Approximately 1.5 Acres Impermeable (12.5% total area) and 2.5 Acres of graded area
will be Permeable for a total of 10.5 acres (87.5% total area) will remain permeable.
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NCG140000 N.O.I.
Process / Production Area —1.5 Acres,
Including: Approximately .25 acres concrete and compacted 6"+ Stone Base classified as
impermeable.
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NCG140000 N.O.I.
Plant erection & site configuration.
control & aesthetics
OUTFALLS & DISCHARGE CONTROLS
OF 1— Northwest Corner, Process Waste Water commingled with Stormwater. Storm and Process
water from the manufacturing areas commingle and flow to a series of two concrete sedimentation
basins. A berm surrounds the stone production area to direct storm and process water to basin 1. The
second basin will be treated with CO' for pH control. Solids from the basins will be placed in a drying
bin adjacent & draining to Basin 1. Excess water from basin 2 will flow into the adjacent pond which
has additional sediment filter fabric to also limit solids transfer.
Pond 1 discharges through a rip -rap berm, then through fabric weirs to a small pond were water can
accumulate and then discharge through piping designated as Outfall 1 sample point.
Water from basin 2 will be recycled for truck washing and dust control in the yard.
OF 2 & OF 3 will be stormwater discharge points for the cleared area in green. No production activities
are to be performed in this area. The north side of the property is on the downslope of Buck Ridge.
The South side of the property is fully bermed and directs stormwater to outfalls 2 & 3. Due to the
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Settling Pond 1 with Silt fence
Settling Pond 2 with Silt fence
- r
Settling Basin 1 for
collection of heavy
Settling Basin 2
for carry-over
solids Water
recycled for truck
Rip -Rap Erosion7.
Ak - -
• Small Collection
OF
l DCo11L1U1 JYJLClll-

NCG140000 N.O.I.
General Basin Design:
14" Reinforced w.
Doweled to ht
* General dimension subject to dimensional
and location changes per site drawing
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NCG140000 N.O.I.
PLANT PRIMARY UNITS:
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Al BUSINESS CORPORATION ANNUAL REPORT
0
r0-2ot7
NAME OF BUSINESS CORPORATION: Chandler Concrete Co., Inc.
SECRETARY OF STATE ID NUMBER: 0026213 STATE OF FORMATION: NC
REPORT FOR THE FISCAL YEAR END: 12/31 ! 2020
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Chandler, Thomas E. , Jr.
2. SIGNATURE OF THE NEW REGISTERED AGENT:
E - Filed Annual Report
0026213
CA202107605212
3/17/2021 11:45
❑X Changes
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
1006 S Church St PO Box 131
Burlington, NC 27215-5046 Alamance County Burlington, NC 27216
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Ready MIX Concrete
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] x 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS 5. PRINCIPAL OFFICE MAILING ADDRESS
1006 S Church St PO Box 131
Burlington, NC 27215-5046 Burlington, NC 27216
6. Select one of the following if applicable. (Optional see instructions)
The company is a veteran -owned small business
The company is a service -disabled veteran -owned small business
SECTION C: OFFICERS (Enter additional officers in Section E.)
NAME: Madeline B Chandler
TITLE. Assistant Secretary
ADDRESS:
P O Box 131
Burlington, NC 27216
NAME: Robert B Chandler
TITLE: Vice President
ADDRESS:
P.O. Box 131
Burlington, NC 27216
NAME: T. E. Chandler
TITLE: f`hoirmon Of The Rncirri
ADDRESS:
PO Box 131
Burlington, NC 27216
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business
en't E. Chandler Jr. 3/17/2021
I SIGNATURE DATE
Form must be signed by an officer listed under Section C of this form.
T. E. Chandler Jr. President
Print or Type Name of Officer
Print or Type Title of Officer
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626.0525