NCC233438_NOI Signed Certification_20231117

ALBEMARLE CORPORATION SIGNATURE REQUEST FORM
Submitted by
(Name/Contact Number/E-mail) John Kuhn 704-231-4208
[e-mail]
Date Submitted 11/7/2023
Business Unit
Lithium Resources/Mine
Subsidiary Name(s)or Company Code
Deadline Date for Return 11/13/2023
(please build one week into timeline)
Number of Documents Submitted 1
Brief Description,in English,of This certification form is required for NCDEQ-DEMLR to
Each Document Submitted
issue the permit we are requesting for geotechnical drilling.
Purpose or Action Effected by
Document(s) permit enable the to be issued and allow
drilling required for the project to commence.
Individual(s)Whose Signatures are
Required: Jim LaBauve
Reviewed and Approved for Signature by: Name/Position
THIS SECTION IS REQUIRED By entering the person's name,I hereby certify that this person
has reviewed the document and given me permission to submit
this for signature.
Finance /Accounting
Tax
Legal
✓ Other John Kuhn/Mine Environmental Permitting Lead
Document Return* (check all needed and provide information as applicable).
Originals: 111 Return ri Shred
PDF/ Email(provide email address) [e-mail]
✓ UPS/FedEx Josh Allen
Receiver's Name 6011 Hunter Ln
Company Name:
Address(NO P.O. BOXES) Weddington, NC 28104
Address
Telephone:
Check if needed Notarization Apostille—Country of Use(required):
Special Instructions:
Please Fedex original signed form to Josh Allen at the address above, and email a pdf to John Kuhn.
*A copy of all completed documents should be sent by email to subsidiaries aalbemarle.com

NCGO1 Notice of Intent (NOI) Certification Form
Directions:
Print this form, complete,scan and upload to the electronic NOI.
Then, mail the original form to the NC DEMLR Stormwater Program (with $120 check if paying by check)
at:
Division of Energy, Mineral& Land Resources Stormwater Program
512 N. Salisbury Street, 6th Floor(Office 640K)
1612 Mail Service Center
Raleigh, NC 27699-1612
THE FORM YOU MAIL MUST BE COMPLETED WITH AN ORIGINAL SIGNATURE(NOT DIGITAL) [40 CFR 122.22]
Per NC General Statute 143-215.68(i), any person who knowingly makes any false statement, representation, or
certification in any application, record, report,plan, or other document filed or required to be maintained under this
Article or a rule implementing this Article. . .shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed ten thousand dollars($10,000).
Under penalty of law, I certify that(check all boxes to indicate your agreement):
✓Q I am the person responsible for the construction activities of this project,for satisfying the requirements of this
permit,and for any civil or criminal penalties incurred due to violations of this permit.
�✓ The information submitted in this NOI is,to the best of my knowledge and belief,true, accurate, and complete
based on my inquiry of the person or persons who manage the system,or those persons directly responsible for
gathering the information.
❑✓ I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control
Plan.
E If the approved Erosion and Sediment Control Plan is not compliant with Part II (Stormwater Pollution
Prevention Plan)of the NCG010000 General Permit, I will nonetheless ensure that all conditions of Part II of the
permit are met on the project at all times.
✓0 I hereby request coverage under the NCG010000 General Permit and understand that coverage under this
permit will constitute the permit requirements for the discharge(s)and is enforceable in the same manner as an
individual permit.
Project Name (must match Ala): Albemarle Kings Mountain - South
Specific Lot Numbers(must match Alb): See attached table
Permittee(must match 81): Albemarle U.S., Inc.
Legally Responsible Person (must match 82& 83): Donald J. LaBauve, Jr.
Title of Legally Responsible Person (must match B3b): Vice President and Chief Financial Officer
Print Name&Title of Signed if Authorized
Individual Differs from Legally Responsible Person:
Phone Number:
11/9/23
Sig Legally Responsible of Le all Res onsible Person or Authorized Individual Date
* IMPORTANT NOTE: This form must be signed by a responsible corporate officer that owns or operates the construction activity,
such as a president,secretary, treasurer,or vice president, or a manager that is authorized in accordance with Part IV,Section B,
Item(6)of the NCG010000 permit.