NCC230512_FRO Submitted_20230303

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,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 address or phone
number is unavailable, place NIA in the blank.)
Part A.
1. Project Name Boom Supersonic — Final Assembly Line (FAL)
2. Location of land -disturbing activity: County Guilford City or Township Greensboro
N360707.532 w0795623 ass
Highway/Street Latltude(decimaidegreees) Long itude(decirmaldegrees)
3. Approximate date land -disturbing activity will commence:January 2, 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 28.5
6. Amount of fee enclosed: $ 2,900.00 . 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. Has an erosion and sediment control plan been filed? Yes 0 Enclosed 0 No ❑
8. Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Tommy Morrow E-mail [e-mail]
Phone: Office # Mobile # [phone]
9. Landowner(s) of Record (attach accompanied page to list additional owners):
Piedmont Triad Airport Authority 336.665.5666
Name
Alex Rosser
Current Mailing Address
City State
10. Deed Book No, 2851
Phone: Office # Mobile #
1000A Ted Johnson Parkway
Current Street Address
Greensboro NC 27342
Zip City
State
Zip
Page No. 403 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 companyis a sole proprietorship orifthe landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
Boom Technology, Inc.
Company Name
12876 E Adam Aircraft Cir
Current Mailing Address
Centennial CO 80112
City State Zip
Phone: Office # 720-598-2666
richard.harris@boom. aero
E-mail Address
Current Street Address
City State Zip
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:
Boom Technology, Inc
Name of Registered Agent
12876 E Adam Aircraft Cir
Current Mailing Address
Centennial CO 80112
city
State Zip
Phone: Office # 720-598-2666
Rich Harris
richard. harris @ boom, aero
E-mail Address
Current Street Address
City State Zip
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:
Registered Agent Inc
Name of Registered Agent
4030 Wake Forest Rd Suite 349
Current Mailing Address
Raleigh NC 27609
City
[e-mail]
E-mail Address
Current Street Address
State Zip City
Phone: Office # (919) 400-41 38 Mobile #
Daniel Lamarche
Name of Individual to Contact (if Registered Agent is a company)
State Zip

(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.
Richard Harris Chief Legal Officer
T e or print ame Title or Authority
�-
Sknature Date
a Notary Public of the County of
State of I#AAQU%AWJUD11jf&by certify that __t
before me this day and being duly sworn ackn
1
Witness my hand and notarial seal, this;)day of
.�'��,r,�,�� µYE �rrre� �''•
KRY pro
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car.9MISSION -
c EXPIRES '
Nam' 214/2()27
OF
r,l frelrurf Li, N�31,�
4 r,4 r-t 0v-d , _appeared personally
that the above form was executed by him/her.
My commission expires
Timothy J, Brown
Notary Public, District of Columbia
My Commission Expires 2/14/2027

Continued from Items 9 & 90 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:
Piedmont Triad Airport Authority 336.665.5666
Name Phone: Office # Mobile #
Alex Rosser 1 OOOA Ted Johnson Parkway
Current Mailing Address Current Street Address
Greensboro NC 27342
City State Zip City State Zip
Deed Book No. 002848 Page No. 00628 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 7 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
Phone: Office #
Company 3 Name
Current Mailing Address
City
Phone: Office #
Company 4 Name
Current Mailing Address
City
Phone: Office #
Company 5 Name
Current Mailing Address
City
Phone: Office #
State Zip City
Mobile #
E-mail Address
Current Street Address
State Zip City
Mobile #
State Zip
State Zip
E-mail Address
Current Street Address
State Zip City State
Mobile #
E-mail Address
Current Street Address
State Zip City State
Mobile #
Zip
Zip