NCC241245_FRO Submitted_20240423

4/16/24,2:34 PM Rowan County
Financial Responsibility/Ownership Form Sedimentation Pollution Control Ordinance
No person may initiate any land-disturbing activity on one or more acres as covered by the ordinance before this form and
an acceptable erosion and sedimentation control plan have been completed and approved by the Rowan County
Environmental Management Department.
Part A Parcel ID Number
111079
1.Project Name*
ALTEC CHINA GROVE EXPANSION
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2.Location of land-disturbing activity(Highway/Street)*
800 HWY 152 E
Latitude Longitude
35.5722222 -80.5496667
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3.Approximate date land-disturbing activity will be commenced
5/1/2024
4.Purpose of development(residential,commercial,industrial,etc.)
Commercial
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5.Approximate acreage of land to be disturbed or uncovered*
6.Person to contact should sediment control issues arise during land-disturbing Cell Phone Number*
activity*
205-790-6166
Tom Traylor
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*this information will be made available on the Rowan County Planning 8 Development website.
https://www.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 1/4

4/16/24,2:34 PM Rowan County
Email Address
[e-mail]
7.Landowner of Record Landowner of Record
Altec Industries, Inc
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Name Name
Current Mailing Address Current Mailing Address
210 Inverness Center Drive,
Birmingham,AL 35242
8.Recorded in Deed Book Number Page Number
1136 184
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Part B
1.Person or Firm who are financially responsible for this Person or Firm who are financially responsible for this land-
land-disturbing activity disturbing activity
Altec Industries, Inc
Name of Person(s)or Firm(s) Name of Person(s)or Firm(s)
Current Mailing Address Current Mailing Address
210 Inverness Center Drive,
Birmingham,AL 35242
Phone Number Phone Number
205-991-7733
a.if the Financially Responsible Party is not a resident of North Carolina,give name and street address of a North Carolina
Agent.
Name of Agent Name of Agent
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https://www.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 2/4

4/16/24,2:34 PM Rowan County
Current Mailing Address Current Mailing Address
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Phone Number Phone Number
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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 the name and street
address of the Registered Agent.
Name of Registered Agent
Capitol Corporate Services,Inc.
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Current Mailing Address Current Street Address
176 Mine Lake CT
Suite 100
Raleigh,NC 27612
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Telephone Number Telephone 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 authority to execute instruments for the Financially Responsible Person).I
agree to provide correctional information should there be any change in the information provided herein.
Name Title or Authority
Daniel DeLoach Corporate Counsel&Real Estate Manager
Signature Date
/ j !) 04/17/2024/// (/
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I,V Ired.1 W► Wlwl li n5 ,a Notary Public of the County of 3- . Gt(S OV1 State of N -�rrt -Gtwoliva,
hereby certify that D JU ti Dele0Ctslet appeared personally before me this day and being duly sworn acknowledged
that the above form was executed by him/her.Witness my hand and seal of Notary,this (61+1.day of Arl ,2014
https://www.rowancountync.gov/FormCenterlPrint?formlD=96&Preview=YES&Save=False&savedProgresslD= 3/4

4/16/24,2:34 PM Rowan County
Notary My commission expires
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Seal
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Checklist i'i'S'j.••:QRY Pj. 'Q, �
Download a copy of the Erosion and Sedimentation � OF A;P�` �`��\
Control Plan Checklist(PDF)
https://www.rowancountync.gov/FormCenter/Print?formlD=96&Preview=YES&Save=False&savedProgresslD= 4/4