HomeMy WebLinkAbout20230175 Ver 1_Clayton_Pond_Project_Signed_Authorization_Signed_Form_Jan_2023_20230130DocuSign Envelope ID: 9A5944F6-89FF-4FF6-BE98-BD252C8C5AB0
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AGENT AUTHORIZATION FORM
PROJECT NAME: Finch Dam (JOHNS-009 Breach Evaluation
PROPERTY LEGAL DESCRIPTION: DB: 06281 PG: 0960; DB: 0126 PG: 0051
PARCEL ID. 05I05001C; 05I04002A
STREET ADDRESS: Grifols Therapeutics, LLC Caterpillar, Inc.
8368 US 70 Business West
Clayton, North Carolina 27520
Caterpillar, Inc.
954 NC Highway 42 East
Cla)ton, North Carolina 27527
Representative: Grifols Therapeutics, LLC; Caterpillar, Inc.
(If Representative) Titles: Mr. David D. Auge, Grifols Therapeutics, LLC - Manager, Environmental Affairs;
Dave Emonson
The undersigned do hereby authorize:
Jon Swaim McGill Associates P.A.
(Contractor / Agent) (Name of consulting firm)
to act on my behalf and take all actions necessary for the processing, issuance and acceptance of this permit or
certification and any and all standard and special conditions attached.
Representative's Address (if different than property above):
Telephone: Grifols - (919) 553-5011
Caterpillar - (9191550-1100
We hereby certify the above information submitted in this application is true and accurate to the best of our
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Authorized Signature Authorized Signature
Date: J ✓%,-J 4 Date: 1/27/2023
MCGILL ASSOCIATES 1240 19- Street La ie N Hicko Nu 28601 828 328 20 4 , AACGILLASSOC IATE S (,'ON1