NCC232731_FRO Submitted_20230919

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 and/or fax information
unavailable, place N/A in the blank.)
Part A.
1. Project Name International Logistics Park
2. Location of land-disturbing activity: Brunswick County
Highway/Street U.S. 74-76 Latitude 34-17-43.933 Longitude 78-11-27.875
3. Approximate date land-disturbing activity will commence: ASAP
4. Purpose of development(residential, commercial, industrial, institutional, etc.):Industrial
Additional. New
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas 284.82 Acres Total 390.48
6. Amount of fee enclosed: $18,525 The application fee of$65.00 per acre(rounded up to the next acre)is
assessed without a ceiling amount (Example: a 9-acre application fee is$585).
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 Allen Jefferson Earp E-mail Address [e-mail]
Telephone [phone] Cell# 910-262-5764 Fax#
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Brunswick-Columbus International Park, Inc. 910-762-2676 910-762-2680
Name Telephone Fax Number
PO BOX 249 75 Courthouse Drive NE
Current Mailing Address Current Street Address
Bolivia NC 28422 Bolivia NC 28422
City State Zip City State Zip
10. Deed Book No 3059 Page No.1041 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.
Funston Company, INC jearpabrunswickforest.com
Name E-mail Address
1007 Evangeline Drive 1007 Evangeline Drive
Current Mailing Address Current Street Address
Leland NC 28451 Leland NC 28451
City State Zip City State Zip

Telephone [phone] Fax Number
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:
Name E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Telephone 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:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
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.
Allen Jefferson Earp President
Type or pr' Title or Authority
Date
I, CO r I G. GarrCxSin , a Notary Public of the County of N€1,) nG no U"e<
State of North Carolina, hereby certify that � �.l( appeared
personally before me this day and being duly sworn acknowledged that the Love form was executed
by him.
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Witness my hit ag vl seal, this day of 1 20(23
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