NCS000349_NameOwnership Change request_20150826

� PIMA Division of Energy,Mineral&Land Resources FOR AGENCY USE ONLY
LandQuality Section/Stormwater Permitting Date Received
Q � g Year Month Day
NC�ENR National Pollutant Discharge Elimination System
PERMIT NAME/OWNERSHIP CHANGE FORM
FJINHON.tCMf•MD NQyR.LL RLDWRCCS
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N I C S 0 10 10 1 3 4 9 N C G
II. Permit status REiff to requested change.
a. Permit issued to(company name): Lumberton Investment 1,LLC
b. Person legally responsible for permit: Thomas J Mckittrick
First MI Last
Managing Memeber
Title
5320 Old Pinevill Road
RECEIVED Permit Holder Mailing Address
Charlotte NC 28217
JUN 2 9 2015 City State Zip
[phone] [phone]
DENR-11_4 J QUALITY Phone Fax
c. Facility nar&T(�i j'0 :PERi�,1iTTiNG Lumberton Investment I,LLC
d. Facility address: 1866 Hestertown Road
Address
Lumberton NC 28358
City State Zip
e. Facility contact person: Steven R. Ingle [phone]
First /MI/Last Phone
III. Please provide the following for the requested change(revised permit).
a. Request for change is a result of: ® Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to(company name): North Carolina Renewable Power-Lumberton,LLC
c. Person legally responsible for permit: Steven R Ingle
First MI Last
Vice-President Of Engineering
Title
4599 East Lake Boulevard
Permit Holder Mailing Address
Birmingham SAL- 32517
City State Zip
[phone] [e-mail]
Phone E-mail Address
d. Facility name(discharge): North Carolina Renewable Power-Lumberton, LLC
e. Facility address: 1866 Hestertown Road
Address
Lumberton NC 28358
City State Zip
f. Facility contact person: Steven R Ingle
First Ml Last
[phone] [e-mail]
Phone E-mail Address `f1ti�
IV. Permit contact information(if different from the person legally responsible for thepermit) >V
Revised Jan.27,2014 l�

NPQES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: Mark Fowler
First Ml Last
Title
4599 East Lake Boulevard
Mailing Address
Birmingham NC 32517
City State Zip
(205)3974143 [e-mail]
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
❑ Yes
North Carolina Renewable Power-Lumberton, LLC will not use coas a
® No(please explain) fuel source;only biomass and poultry litter. The former maintenance
building is being renovated to store all poultry litter undercover.
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership(such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
.....................................................................................................................
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request,the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION(Permit holder prior to ownership change):
I,Thomas J. zi t ick, attest that this application for a name/ownership change has been reviewed and is
accurate comp to to the best of my knowledge. I understand that if all required parts of this
applic ion are n completed and that if all required supporting information is not included,this application
pa ge will be eturned s incomplete.
a s
Signature bate
APP CANT CERTIFICATION
1, even R. In le,attest that this application for a name/ownership change has been reviewed and is
ccurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included,this application
package will be re mplete.
ignature Date
....................................
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy,Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh,North Carolina 27699-1612
Ravicwi.Ian.27.2014

NC Division of Energy, Mineral and Land Resources
NPDES Stormwater Permit Contacts Summary
N'C D) \1LR has the followine contact information in our Permit Database for tour permit as of 9/312015.
Permit Number: NCS000349
Permit Type: Stormwater Discharge.Individual
Facility Name: North Carolina Renewable Power Lumberton,LLC
Facility Addressl: 1866 Hestertown Rd
Facility Address2:
City,State&Zip: Lumberton. NC 28358
O-Wner Information Details:
*11ST submit a Change of NamelOwnership form to DEMLR to make any changes to this Owner information,
See"Miscellaneous Forms"at htt : ortal.ncdenr.or web [r n es-stormwater
Owner Name: North Carolina Rgnew7ble Power-Lumberton LLC
Owner Type: Non-Government Owner Type Group: Organization
*�* Legally Responsible for Permit***
(Responsible corporate offiicer/principle executive officer or ranking elected official/general partner or proprietor-,
ur:aoy other person with delegated signatory authority from the legally respe sibkWperson:}
Owner Affiliation: Steven R InIle Title: Vice President of Engineering
Addressi: 4599 E Lake Blvd
Address2:
City,State&Zip: Birmingham,AL 35217
Work Phone: [phone] Fax:
Email Address: singleZgreenfuelsenergv.cgm
Owner Contact Person(s)
Contact Name Title Address Pan F�� Email
Contact Name Title Address Phone Fax Email
Steven R Ingle 4599 E Lake Blvd, Birmingham,AL 35217 205-275-9200 sin gleLg?greenfue3sen
ergy.com
Permit Coact Person(s)
Contact Name Title Address Phong FM Email
Steven R Ingle 4599 E Lake Blvd, Birmingham,AL 35217 205-275.9200 single@greenfuelsene
rgy.com
Contact Name Title Address Phone Fax Email
Mark Fowler 4599 E Lake Blvd,Birmingham,AL 35217 205-397-4143 mfowler@georgiaren
ewable wer.com
?r,ge

Book 1988 Page 14
Y.0 5002458
ESONT'hls certifies that PIN: 1 of a o3 ool of S ATE OF NCO REAL ESTATE:EXT
Is free of any delinquent ad valorem Tax liens &1300.00
charged to the Robeson County Tax Collector; PRESENTED&RECORDED
and does certify that the deed description � LOCKLEAR PM
matches this PIN. REGISTER OF DEEDS
BY:KYNIA JOHNSON
DEPUTY
416l15 BK:D 1988
MaPPin9 echnic(an Signature Date NC PG:14-16
Excise Tax: $t, &Q0.00 PIN(s):030015086300
i
Prepared by and-Retimrtu^ Return To:
Seyfarth Shaw LLP First American Title Insurance-NCS
1075 Peachtree St.NE,Suite 2500 6 Concourse Parkway,Suite 2000
Atlanta,GA 30309 Atlanta,GA 30328
A61ca4im: Daniel H. Sherman IV,Esq. Attn: JON1 —Cpare r
7001142,
Brief Description for the Index 13.03 acre parcel in the Township of
d
Lumberton,Robeson County,NC
0
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0
N a NORTH CAROLINA SPECIAL WARRANTY DEED
roc
t:
U ce THIS DEED made this 26th day of March,2015, by and between
om
v
v
a� GRANTOR GRANTEE
9V Lumberton Investments 1,LLC,a
`V N North Carolina limited liability company North Carolina Renewable Power-
.0 c/o Forsite Development, Inc. Lumberton,LLC,a Delaware limited
W.°ce 5320 Old Pineville Road liability company
C W Charlotte NC 28217 4599 East Lake Boulevard
om Birmingham,AL 35217
i.e i Fitter inappropriate block for each party:name,address,and,if appropriate,character of entity,e.g,corporation or
>.°.+'a Partnership.
.-mac
M ed U
w�s t•+d
N 61
ro e ro The designation Grantor and Grantee,as used herein,shall include said panics,theirltcirs,successors,and assigns.and shall
include singular,plural,masculine,feminine or rncuter as required by context.
oa
I e WITNESSATIA,that Grantor,for and in consideration of the siun of TEN DOLLARS
u; (S10)and other good and valuable consideration in hand paid to the undersigned by Grantee,the
1 0 receipt and sufficiency of such consideration being hereby acknowledged,has GRANTED,
�L SOLD AND CONVEYED,and by these presents does hereby GRANT,SELL,CONVEY and
o CONFIRM unto Grantee that certain real property being more particularly described on Exhibit
Pr
„» A attached hereto and made a part hereof for all purposes,together with all improvements and
fixtures situated thereon(collectively,the"Property");SUBJECT TO all real estate taxes not
yet delinquent;covenants,conditions,restdctions,easements,rights of way and other matters of
record;applicable laws,ordinances,statutes,orders,requirements and regulations to which the
Property is subject;and all matters disclosed by an accurate survey of the Property.
I
' The Property hereinabove described was acquired by Grantor by instrument recorded in
Book 1960,Page 235,Instrument No.20144005988,Robeson County Registry.

v.
EXHIBIT A
Legal Description
Al Itl.:l;cefta:n tract b:"mrCCl of lacer!vi Lurllbefton To;%avr'x.Re.Lm ii f ointy. NoAh Ca:ulr:ia,iptuj
.fbc-"t .r 0 WO tentt_f elf the City of Lurllb0ton, V.C.,on tt?e%mL-i L`In skle of but r1Ut
';k!" crit;:,I'ov;:-:1 S%cordary Road 2202 aryJ adlomifg ttv-0,vJS."tY foittiefly,Of Rum fl R.W ittlllanb
•.,n r)1!•t`Jtil,!i;>rrard Cc4vplur+Sfl WA-1 s,WUl ar:d West Po:lt•Ptpfxteil, Inc-,can all al:cr sxje>and tx im
erc;: rtu41[eFf dv;m%LtiJ sfol',jm,i
rrJ.:t Jr:tx•>Lrrg c'11K,02 mcfiuf ttt,111,'SntCMnth LOr'Vi 01 IN.:Of:gifkil 51.S acre:0 tract of
„I:'Ch;!:;,,a nct,:s sIxm")In CK.!•d aac:k 562,at Page 777.also t)CUtq a ccrr:er of Russ&*R.W Ill sams
sn:S!i:::; {e C:r,p r,flea c:f fv micrly(<4ra mint of boyinrung ha irx;tiv h,C. Gred cwtda'.!tus
62, p:305,111.1 22)..%W:,:ns tl'.t:rice imth the!ula of sat]or+gir x!tract and the iivae cf
�:�.1',cR;',•' ',drrs,c.'(•Jr r.o:oi S fsegftus•12 rm tvxi_-;20 t,ecvids FsSt !013.40 feet to all Cron
rJ;U>_:::.,, :L+th S!i tY;rr,:f 17 iri:, !�;it}.1k<on,'s we( 'G?5.30 foot to an I-.on roc;tner"ce 5(y_L11 3
2;)ti.:%cf ,35'=';c•.l 7,7.Ci furl to in vOtl q'rx1.,!t'):fm w-ul W:.d:U coop:"
sJ:. C'. ..:i1:.'r. :�!t::lcl;L'u. ,;'p,.::h s.11d ung:nil§i1_`ti�,`ri 63 ct<,sec�37
} :r^,':'';sit•_rc*, Lwl Q!4 rtsa'<).::1 PI:VNY)f Vlil�l ri._, t 1�St:erturn!n[.r urt Jr U✓�Or.,.r1N
'Jct; t'r.th s is o:.3iria!;: e SU_lh 52 dCy:Cvi 50 inmu:u:>_13 sc_o:. s East 100.0 ft't
;•J t!k': rtx1a:•trrrg li.U3 af.rr-s, mtfC of !Cis,is ft:ury parlicutaty.:,+••r;n Cfl a•Sane/for
(:f.;crt: . LC:r,:ng CA;r,'•9r;;Uw'*t.'.'tW 0:tot>et 10, 19S•1 by 'Ch1lriy W.tkbl4;and;,',.:~fate:,
A"J t*_'wq a;:Jrt i f th:t 57.8 aue two Loii•.i�red py Cxwl L*wcirpmCrtt Crxpc:ativi and!cOvft E.
ftiti m'Jn,!(d v.-A!, Mable mcK.rroewa i.to West Pee -N-ppereU,:sl..,t:y dCCJ dltt:d tugtr! t 1, 11)84
.�Q rtccrced m Decd Book 562.of P;N,c 177,RCQX-san Ccurty Rtgistty.

e
All or a portion of the Property herein conveyed does not include the primary residence
of Grantor.
TO HAVE AND TO HOLD the Property,together with all and singular the rights,
hereditaments, and appurtenances thereto in anywise belonging, unto Grantee, its successors and
assigns, and Grantor hereby agrees to WARRANT AND FOREVER DEFEND all and singular
the Property unto Grantee, its successors and assigns,against every person whomsoever lawfully
claiming,or claim the same,or any part thereof, by,through,or under Grantor but not otherwise.
IN W ITN SS WHEREOF,Grantor has caused this instrument to be signed in its name
thisb%Nay of MArCh _,2015, and delivered as of the date indicated on the first page of
this Deed.
GRANTOR:
GRANTOR:
LUMBERT N ESTv1ENTS 1, LLC,
a North C olina ited liability company
By:
e: G t
Title: Wayw jgr,
P.ik County, N bae—ohv1 CV
1 certify that the following person personally appeared before me this day and
acknowledged to me that he or she voluntarily s' ed the forego'ng docume!t for a pu ose G
stated therein and in the capacity indicated: (t�X bey- �15
Date: M&12kL_;tG _, 20.1!7 1
No rary Public
Printed Name: 1Gt�f
My Conunission Iixpires: 1 0 3 drL6 1
[Affix Notary Stamp or Seal]
\xx� �pN 1H'Do cinl Ff urranN Ured.eiRnoture puq.
`' Nototy County
M�y{enbwg Ices_
`MY C 0912312017Ion xA
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