NCC216750_FRO Submitted_20211207

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
EXPRESS PERMITTING OPTION 08012007
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before
this form and an acceptable erosion and sedimentation control plan have been completed and approved
by the Land Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the
appropriate Regional Office. (Please type or print and, if the question is not applicable or the e-mail and/or
fax information unavailable, place NIA in the blank)
Part A. Reco US
1. Project Name
2. Location of land -disturbing activity: County Lenoir City or TownshipKinston
Highway/Street Parrott Dickerson Rd. Latitude 35.2715 Longitude-77.6614
3. Approximate date land -disturbing activity will commence: December 2021
4. Purpose of development (residential, commercial, industrial, institutional, etc.): industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 18
6. Amount of fee enclosed: $ 3,170 _.The Express Permitting application fee is a dual charge.
The normal fee of $65,00 per acre is assessed without a ceiling amount. In addition, the Express
Permitting supplement is $250.00 per acre up to eight acres, after which the Express Permitting
supplemental fee is a fixed $2,000.00 (Example: 9 acres total is $2,585). NOTE: Both fees are
rounded up to the next whole acre and need to be paid by separate checks to NCDENR.
7. Has an erosion and sediment control plan been filed? Yes No Enclosed X
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity
Name Kent Warren
E-mail Address [e-mail]
Telephone [phone]
cell # [phone] Fax #
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Reco US, Inc.
[phone] [phone]
Name
Telephone Fax Number
1180 W. Peachtree Street, Ste. 2100 1180 W. Peachtree Street, Ste. 2100
Current Mailing Address
Current Street Address
Atlanta, GA 30309
Atlanta, GA 30309
City State
Zip City State Zip
10, Deed Book No. 1934
Page No. 519-523 Provide a copy of the most current deed.
Part B.
1. Company(ies) or firm(s) who are
financially responsible for the land -disturbing activity (Provide a
comprehensive list of all responsible
parties on an attached sheet.) If the company or firm is a sole proprietorship,
the name of the owner or manager may be listed as the financially responsible party.
Reco US, Inc.
[e-mail]
Name
E-mail Address
1180 W. Peachtree Street, Ste. 2100 1180 W. Peachtree Street, Ste. 2100
Current Mailing Address
Current Street Address
Atlanta, GA 30309
Atlanta, GA 30309
City State
Zip City State Zip
Telephone [phone]
Fax Number [phone]

2. (a) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina Agent:
Kent Warren [e-mail]
Name
E-mail Address
PO Box 148
1608 W. Grantham St.
Current Mailing Address
Current Street Address
Goldsboro, NC 27533
Goldsboro, NC 27530
City state Zip
City State Zip
Telephone [phone]
Fax Number
(b) If the Financially Responsible Party is a Partnership or other person engaging in business under an
assumed name, attach a copy of the Certificate of Assumed Name. If the Financially Responsible
Party is a Corporation, give name and street address of the Registered Agent:
Cogency Global, Inc.
[e-mail]
Name of Registered Agent
E-mail Address
212 South Tryon St., Ste. 1000
212 South Tryon St., Ste. 1000
Current Mailing Address
Current Street Address
Charlotte, NC 28281
Charlotte, NC 28281
City State Zip
City State Zip
Telephone [phone]
Fax Number
(c) In order to facilitate Express Permitting, it
is necessary to be able to contact the Engineer or other
consultant who can assist in providing any necessary information regarding the plan and its preparation:
B. R. Kornegay, Inc.
[e-mail]
Engineering Firm or other consultant
E-mail Address
Jeffrey L. Kornegay, PE, PLS
919-735-5886 919-580-9053
Individual contact person (type or print)
Telephone Fax Number
The above information is true and correct to the best of my knowledge and belief and was provided by me
under oath (This form must be signed by the Financially Responsible Person if an individual or his attorney -in -
fact, or if not an individual, by an officer, director, partner, or registered agent with the authority to execute
instruments for the Financially Responsible Person). I agree to provide corrected information should there be
any change in the information provided herein.
Ryan A. Kurtz Secretary
Type or print name Title or Authority
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I, C_ � A Ole) /? e _ a Notary Public of the County of
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State of Now-6a"e�, hereby certify that i y Y' ✓� 1� `� ✓ � appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him.
Witness my hand and gSjsi ►"gtgI this day of ��� , 20 C
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