NCG020809_Name-Owner Change Application_20220418

NC DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF Energy, Mineral, and Land Resources
STORMWATER PROGRAM
NORTH CAROLINA
Environmental Quality
NPDES STORMWATER PERMIT NAME/OWNERSHIP CHANGE FORM
CURRENT PERMIT INFORMATION:
Permit Number: NCS����_ /_ or NCG 0/2/0/8/0/9
1. Facility Name (prior to change): Clark Pit #2
NEW OWNER/NAME INFORMATION:
2. This request for a name change is a result of:
_X_a. Change in ownership of property/company
b. Name change only (Facility and/or Company)
c. Other (please explain):
(for example, facility address update. Include additional attachments if necessary.)
3. New owner's name (name to be put on permit as Permittee):
FSC II, LLC dba Fred Smith Corn
4. New owner's or signing official's name and title: Andrew J. Norton
(Person legally responsible for permit)
Vice President - Legal Affairs
(Title)
5. Mailing address: 701 Corporate Center Drive, Ste 101
City: Raleigh
State: NC Zip Code: 27607 Phone: (919
E-mail address:
[e-mail]
6. New facility name (if applicable): FSC II, LLC - Compass Creek
7. Effective date of transfer or name change: 4/17/2022
818-1264
North Carolina Department of Environmental Quality 1 Division of Energy. Mineral and Land Resources
512 North Salisbury Street 1 1612 Mall Service Center I Raleigh. North Carolina 27699-1612
/ 919.707.9200

NPDES Stormwater Permit Name/Ownership Change
Page 2 of 2
III. PERMIT AND FACILITY CONTACT INFORMATION
8. New permit contact's name and title: Andrew Norton
(Permit Contact)
Vice President - Legal Affairs
(Title)
9. Mailing address: 701 Corporate Center Drive, Ste 101 City: Raleigh
State: NC Zip Code: 27607 Phone:( 919 ) 818-1264
E-mail address:
[e-mail]
10. New facility contact's name and title: Jeff Allen
(Facility Contact)
Vice President - Eastern Division
(Title)
11. Mailing address: 701 Corporate Center Drive, Ste 101 city: Raleigh
State: NC Zip Code: 27607 Phone: (919 ) 235-7817
E-mail address: leff.allen fredsmithcompany.net
12. New billing contact's name: Jessica Roberts
(Billing Contact)
13. Mailing address: 701 Corporate Center Drive, Ste 101
city: Raleigh
State: NC Zip Code: 27607 Phone:( 919 ) 422-7893
E-mail address: Jessica roberts2�fredsmithcompany.net
IV. FACILITY ACTIVITIES AND DISCHARGE INFORMATION
1. Will industrial activities at the facility remain the same as under the previous owner?
Yes 12 No ❑
2. Will the stormwater discharge location(s) remain the same? Yes ® No ❑
NOTE: If either of these questions is answered "No," then more information is needed to review
the request. Please attach documentation to describe and explain the changes to the facility
activities, stormwater discharges, and/or outfall location. Depending on the information
provided, the Division may require that the new owner file a new permit application.
Last Revised 3/13/2022

NPDES Stormwater Permit Name/Ownership Change
Page 2 of 2
THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION UNLESS
ALL OF THE ITEMS LISTED BELOW ARE INCLUDED.
REQUIRED ITEMS:
1. This completed application form (with original signature)
2. Legal documentation of transfer of ownership (such as relevant pages of a deed or a bill of sale) is
required for an ownership change request. Articles of incorporation are not sufficient for an
ownership change but can be provided for a name change.
3. Information to document facility, industrial activities, stormwater discharges, or outfall changes
as noted in item IV above (if appropriate)
Why is this information needed?
Regulations in 40 CFR §122.63 allow for minor modifications to NPDES permits for a change of
ownership or operational control of a facility, provided that information supports that no other change
in the permit are necessary.
Why does this form need to be mailed in?
Permittees and applicants must fulfill signatory requirements in the NPDES federal
regulations in 40 CFR §122.22 (please see those regulations for guidance). Until NCDEQ's
electronic submission process meets Cross -Media Electronic Reporting (CROMERR)
requirements, this original signed (not digital signature) form must be mailed to the
address below. The uploaded copy is stored as part of the permit record in the Division's
digital repository.
Applicant's Certification:
I, LJrC'w T. Worj-y(t , attest that the application for a name and/or ownership
change submitted has been reviewed and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this application are not completed, or if all
required supporting information is not included, this application package will be considered
incomplete and may be returned.
Signature: - Date: �//b,1c)-a a
THE COMPLETED APPLICATION AND ALL SUPPORTING INFORMATION SHOULD BE SENT TO:
DEMLR Stormwater Program
512 North Salisbury Street, 61h Floor (Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
Last Revised 3/13/2022

BILL OF SALE
PLT Construction Company, Inc., a North Carolina corporation ("Seller"), for good and
valuable consideration paid to it, the receipt and sufficiency of which are hereby acknowledged,
and pursuant to the Asset Purchase Agreement dated June 21, 2021 (the "Closing Date") to which
Seller is a party with FSC Il, LLC, a North Carolina limited liability company ("Purchaser"), and
certain other parties (the "Asset Purchase Agreement"), and notwithstanding that the following
property may be conveyed by separate and specific transfer documents, by these presents does sell,
convey, assign, transfer and deliver to Purchaser all of Seller's right, title and interest in and to the
Purchased Assets.
TO HAVE AND TO HOLD such Purchased Assets, as a going concern or otherwise, unto
Purchaser and its successors and assigns to and for its or their use forever, other than the Excluded
Assets, subject to and in accordance with the terms of the Asset Purchase Agreement.
All capitalized terms not otherwise defined herein shall have the definitions given to such
terms in the Asset Purchase Agreement.
The representations, warranties, covenants, agreements and indemnities contained in the
Asset Purchase Agreement shall not be altered, modified, waived, or superseded hereby but shall
remain in full force and effect to the full extent provided therein. In the event of any conflict or
inconsistency between the terms of the Asset Purchase Agreement and the terms hereof, the terms
of the Asset Purchase Agreement shall govern.
This Bill of Sale shall be governed by and construed and enforced in accordance with the
internal, substantive laws of the state of North Carolina, without giving effect to the conflict of
laws principles that would apply the laws of any other jurisdiction.
Delivery of an executed counterpart of this Bill of Sale by facsimile or in electronic
(i.e., "pdf' or "tiI ") format shall be effective as delivery of an original, and execution by use of an
electronic signature or digital signature shall be valid for all purposes.
This Bill of Sale shall not be amended, modified or supplemented except by a written
instrument signed by an authorized representative of each of Purchaser and Seller.
[Signature page follows]
310016961.2

IN WITNESS WHEREOF, Seller has caused this Bill of Sale to be duly executed and
delivered to Purchaser effective as of the Closing Date.
PLT CONSTRUCTION COMPANY, INC.
By: — 4 1 ,—,
Name: r-t' If,
del
Title: P/e.S 1 AX-itiT
STATE OF NORTH CAROLINA
COUNTY
I, �11a juu �� k 1`�e L t 1 , a Notary Public in and for said County in said State,
hereby certify that, , whose name as of
PLT Construction Co pa , Inc. is sed to the foregoing instrument and who is known to
me, acknowledged bef6fe me on this day that, being informed of the contents of the instrument,
he, in such capacity and with full authority, voluntarily executed the same as and for the act and
deed of said corporation on the day the same bears date.
Given under my hand this day of , , 2021.
tel, h'IL-x k- iA
Notary Public
My Commission Expires: a K C Z 2
o -
NOTARY "=
aik PUBLIC
IPCO UN'(
0/m1111110
Signature Page to Bill of Sale
310016961.2