NCC223964_FRO Submitted_20221129

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
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.G. 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 address or phone
number is unavailable, place NIA in the blank.)
Part A.
1. Project NameSterigenics
2. Location of land -disturbing activity: CountyAlamance City or Township Graham
Bakatsias LanelPorter Avenue 36.0682-79.3489
Highway/Street Latltude(decimal degrees) LOngltude(decimal degrees}
3. Approximate date land -disturbing activity will commence: November 12 2022
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 7.0 acres
6. Amount of fee enclosed: $700.00 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7
N.
9
Has an erosion and sediment control plan been filed? Yes ❑ Enclosed ❑x No ❑
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Adam Whitmer, Project Manager
Phone: Office # [phone] x 2325
E-mail Address aWhltmer [e-mail]
Mobile # [phone]
Landowner(s) of Record (attach accompanied page to list additional owners):
Sterigenics Radiation Technologies, LLC 440-262-1410 NIA
Name
9100 South Hills Blvd. Suite 300
Current Mailing Address
Broadview Heights OH 44147
Phone: Office # Mobile #
2015 Spring Road Suite 650
Current Street Address
Oak Brook IL 60523
City State Zip City
10. Deed Book No.4062 Page No.879
1020 998
State
Zip
Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) if the company is a sole proprietorship or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Sterigenics Radiation Technologies, LLC NIA
Company Name E-mail Address
9100 South Hills Blvd. Suite 300 2015 Spring Road Suite 650
Current Mailing Address Current Street Address
Broadview Heights OH 44147 Oak Brook IL 60523
City State Zip City State Zip
Phone: Office # 440-262-1410 Mobile # NIA
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Corporation Service Company NIA
Name of Registered Agent E-mail Address
2626 Glenwood Ave. Suite 550 2626 Glenwood Ave. Suite 550
Current Mailing Address Current Street Address
Raleigh NC 27608 Raleigh NC 27608
City State Zip City State Zip
Phone: Office # N/A Mobile # NIA
NIA
Name of Individual to Contact (if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
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(s)
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 Party). I agree to provide
corrected information should there be any change in the information provided herein.
Type or print
/na
rpe
Signature
President, Sterigenics Radiation Technologies, LLC and Sterigenics U.S., LLC
Title or Authority
O � ! '2,•� 2c� ZZ�
Date
Laura A. Wilson a Notary Public of the County of Cuyahoga
U `3' Michael P. Rutz
State of Nor-th-Carolina, hereby certify that appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this day of October 2022
Notary—
,i
My commission expires
sy
LAURAA WILSON
e:
a
Notary Public
a °
state of Ohio
o
My comm. wrest
may 6, 2027

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
Sterigenics U.S., LLC 440-262-1410 NIA
Name Phone: Office # Mobile #
9100 South Hills Blvd. Suite 300 2015 Spring Road Suite 650
Current Mailing Address Current Street Address
Broadview Heights OH 44147 Oak Brook IL 60523
City State Zip City State Zip
Deed Book No. 1020 Page No. 998 Provide a copy of the most current deed.
Landowner 3 of Record
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip
City State Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.
Landowner 4 of Record:
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip
City State Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.
Landowner 5 of Record:
Name
Phone: Office # Mobile #
Current Mailing Address
Current Street Address
City State
Zip
City State Zip
Deed Book No.
Page No.
Provide a copy of the most current deed.

Continued from Item 9 in Part B of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
Company 2 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
Company 3 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
Company 4 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
Company 5 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #