NCG021041_Application_20240729

045
FOR AGENCY USE ONLY
NCG02IL N 1
Assigned to
ARO FRO MRO R WARO WIRO WSRO
Division of Energy, Mineral, and Land Resources Land Quality Section
National Pollutant Discharge Elimination System
NCG020000 Notice of Intent
This General Permit covers STORMWATER AND/OR WASTEWATER DISCHARGES associated with activities under
SIC(Standard Industrial Classification)Code 14(Mineral Mining Industry)except for:peat mining,coal mining,
metal mining, oil and gas extraction, tourist gem mines, NCDOT borrow pits,in-stream sand mining, and
discharges from mining operations which are intermixed on site with stormwater from concrete operations. You
can find information on the DEMLR Stormwater Program at deq.nc.gov/SW.
Directions: Print or type all entries on this application. Send the original,signed application with all required
items listed in Item (9)below to: NCDEMLR Stormwater Program, 1612 MSC,Raleigh,NC 27699-1612. The
submission of this application does not guarantee coverage under the General Permit. Prior to coverage under
this General Permit a site inspection will be conducted.
1. Owner/Operator(to whom all permit correspondence will be mailed):
Name of legal organizational entity: Legally responsible person as signed in Item(10)below:
P Lrwfev foci e
Street address: City: State: Zip Code:
37-04 Ala 11 S��etfN�v�1� vlu` W,I' NG
Telephone
number: Email address: n
2-V_ _�_-50 — q61 14 L6 41lv4P b
Type of Ownership:
Government
❑County ❑Federal ❑Municipal ❑ State
Non-government
(Business(If ownership is business,a copy of NCSOS report must be included with this application)
❑ Individual
2. Industrial Facility(facility being permitted):
Facility name: Facility environmental contact:
PuP 1`G kk M,`vlc� flaw v ultvt4e
Street address: `L E City:S nS�jj State: Zip Code: v 2
J
Parcel Identification Number(PIN) County:
36L{ 7 kl,'16ovi
Telephone number: Email address:
a- -23n-yob hkyttt� ,_� wa�r;�l� �•�
Latitude of entr nse:b„�1 Longitude of entrance:
5r 7 ,7 dal
4-digit SIC code: Facility is: Date operation is to begin or began:
/� El New g Proposed
❑ Existing
Types of minerals mined at this facility:
❑ Clay ❑Feldspar Ore ❑ Lithium Ore ❑ Phosphate PtSoil ❑Construction Sand ❑Industrial Sand
Other: .f AµLl? 4u
Page 1 of 11

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Is this a processing-only facility for materials mined elsewhere? Is this an inactive mine site?
❑Yes ❑Yes
X No JXNo
Does total area of this mine site include ready-mixed concrete plant and/or asphalt plant areas?
❑Yes,and has separate NPDES stormwater permits(provide permit numbers):
❑Yes,and does not have separate NPDES stormwater permits
%.No
Does this facility already have a valid Mining Permit from DEMLR's Land Quality Section?
❑Yes(please provide the Mining Permit Number)
No(please indicate the status of the Mining Permit application)
Are you applying for a discharge permit in the same location as a previously permitted mine?
❑Yes(please provide permit number and mine name)
No
If the stormwater discharges to a municipal separate storm sewer system(MS4),name the operator of the MS4:
1A N/A
3. Consultant(if applicable):
Name of consultant: Consulting firm:
Street address: City: St to Zi Code
ao�g >7dr t /UZ Rd 1<<jlaL 7i
Telephone number: Email address:
4l —7�s1-77y ezS Cv6�//tau A,hr
4. Development Activities and Buffers
Mining operation will precede development activities at this site:
❑Yes
1,XNo
Mine is located within one of the 20 Coastal Counties,and will it add more than 10,000 ft2 of impervious surface:
❑Yes(to both)
D4 No,this mine is within one of the 20 Coastal Counties,but will not at more than 10,000 ft'of impervious surface
❑ No,this mine is not within one of the 20 Coastal Counties
Mine is in the Neuse,Tar-Pamlico,or Catawba River Basins,OR in the Randleman or Jordan Water supply Watersheds?
tZ Yes(specify size of stream buffers) 4I cob f
❑ No
Mine site will include wastewater discharges from a ready-mix concrete batch plant?
❑Yes(please seek additional coverage under General Permit NCG140000: Ready-Mix Concrete)
�4 No
5. Mine Dewatering
Mine dewatering will occur at this site:
❑Yes )Q No(mark N/A for the rest of this section)
Mine dewatering from this facility will be discharged to:
❑Surface Waters and/or Wetlands
El Other(specify)
❑Mine will not discharge dewatering to Surface Waters and/or Wetlands;specify how dewatering will occur and where
water will be directed:
N/A
Page 2 of 11

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Wetlands and/or Surface Waters are within 4W of the mine pit perimeter: 404/401 Certification permits required:
N Yes(specify distance) ❑Yes(briefly describe)
❑ No El No
❑ N/A ® N/A
Have you been required to obtain a wetland delineation certified by the US Army Corps of Engineers?
[]Yes(please attach to this application) KNo
6. Wastewater Treatment
Will this facility wash mined materials?
❑Yes X No
Will discharges of process wastewater treatment systems occur(including possible recycle system overflows)
❑Yes(please describe)
N No
Will this facility employ chemical additives to flocculate suspended solids?
❑Yes(specify name/manufacturer/quantity of daily use)
'I No
Note: please visit:https:Hfiles.nc.gov/ncdeg/Water+Quality/Environmental+Sciences/ATU/PAM8 30 18.pdf for list of
approved PAMS
Will any of the wastewater treatment facilities at this mine overflow only during rainfall events that exceed the 10-yr,24-hr
rainfall event? -
❑Yes(specify which systems)
tQ No
Are wastewater treatment facilities(including recycle systems)planned in the 100-year flood plain?
❑Yes X No
Wastewater Treatment Alternative Review as required by 15A NCAC 2H.0305(c)(2)
Types of wastewater this mine site will discharge: ❑ Mine Dewatering ❑ Process Wastewater
Types of wastewater considered for this alternative review: ❑ Mine Dewatering ❑ Process Wastewater
Are there existing sewer lines within a one-mile radius?
❑Yes
❑Wastewater treatment plant will accept wastewater
❑ Is feasible to connect(explain)
❑ Is not feasible to connect(explain)
❑ Wastewater treatment plant will not accept wastewater(please attach letter documenting this)
No
Page 3 of 11

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Are you already proposing a closed-loop recycle system(CLRS)that meets design requirements of 15A NCAC 2T.50000?
❑Yes,for dewatering
❑Yes,for process wastewater
❑Yes,for both
❑ No,this option is technologically feasible(explain)
>kNo,this option is not technologically feasible(explain)
❑ No,this option is otherwise feasible(explain)
❑No,this option is otherwise not feasible(explain)
What is the feasibility of building a CLRS compared to direct surface water discharge?
Surface or Subsurface Disposal System OVA..
❑ A surface or subsurface disposal system is technologically feasible(explain)
❑A surface or subsurface disposal system is not technologically feasible(explain)
❑ A surface or subsurface disposal system is otherwise feasible to implement(explain)
❑ A surface of subsurface disposal system is not otherwise feasible to implement(explain)
What is the feasibility of employing a subsurface of surface discharge as compared to a direct discharge to surface waters?
Direct Discharge to surface waters is the most environmentally sound alternative to all reasonably cost-effective options
for the wastewaters being considered?
09 Yes
❑ No
If this review included all wastewater discharge types,would excluding some types make any of the above non-discharge
options feasible for some the wastewaters?
❑Yes
09 No
7. Outfalls(s)At least one outfall is required to be eligible for coverage.
3-4 digit identifier: Name of recpiv' Rwater: Classification: El This water is impaired.
D0, ulrrr/ �y�ruwl t
Lea Gr f/f�c� ❑ThiswatershedhasaTMDL
Discharge from this outfall is from:
Stormwater ❑ Mine Dewatering ❑Process Wastewater
7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HOW,
ORW,Tr,WS-1,WS-II,WS-111,SA,or PNA):
Dischar a occurs from this outfall:
Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFs)
Latitude of outfall: 3 Longitud�of gAll: 3
kk
Brief description of the industrial activities that drain to this outfall: �4��**jj
iNiH
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar ear?
3-4 digit identifier: Name of receiv'n water: Classification: El This water is impaired.
u � G �Y fIV6ft/ ❑This watershed has a TMDL
Page 4 of 11

Discharge from this outfall is from:
Stormwater ❑ Mine Dewatering ❑ Process Wastewater
7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HOW,
ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA):
Marge occurs from this outfall:
Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
Latitude of outfall: 36i ��U 3 Longitude of outfall,
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities ccur in the drainage area of this outfall? ❑ Yes * No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar ear?
3-4 digit identifier: Nam of ivi girt e : Classification: ❑This water is impaired.
o �s SI
5 U-1 1 ❑This watershed has a TMDL.
Discharge from this outfall is rom:
Stormwater ❑ Mine Dewatering ❑ Process Wastewater
7Q30 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HOW,
ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA): PIA'
Discharge occurs from this outfall:
14 Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
Latitude of outfall: 3S 5 6D3+Y9 Longitude of outfall:
O - ?7, ;z
Brief description of the industrial activities that drain to this outfall:
M•'4e
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes W No
If yes, how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier: I Nam2 oKk+nf recgving water: Classification: [I This water is impaired.
t[N �d �Cluw� 'hG
0 0 L{' ' f f-t� El This watershed has a TMDL.
Discharge from this outfall is from:
❑ Stormwater ❑ Mine Dewatering ❑Process Wastewater
7Q10 Flow of receiving waterbody(if dischargin Mine Dewatering or Process Wastewater to waters classified as HOW,
ORW,Tr,WS-I,WS-Il,WS-III,SA,or PNA):
Discharge occurs from this outfall:
ji Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
Latitude of outfall: • S �k 3(� Litude of ou ong II:
3 6 -77.O ?
Brief description of the industrial activities that drain to this outfall:
ffik
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year? II
3-4 digit identifier: Name.of recgivi g water Classification: ❑This water is impaired.
u Dt✓�rAn
r Jul i/ ❑This watershed has a TMDL
Discharge from this outfall is from:
❑ Stormwater ❑ Mine Dewatering ❑ Process Wastewater
7Q10 Flow of receiving waterbody(if discharginP�Mine Dewatering or Process Wastewater to waters classified as HOW,
ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA): ,�//�
Discharge occurs from this outfall:
Page 5 of 11

Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
Latitude of outfall: �r 33 N Longitude ofiuutf 1��72
Brief description of the industrial activities that drain to this outfall: l
rf4r
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑Yes P(No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year?
All outfalls must be listed and at least one outfall is required.Additional outfalls may be added in the section
"Additional Outfalls"found on the last page of this NO].
S. Other Facility Conditions (check all that apply and explain accordingly):
❑This facility has other NPDES permits. If checked,list the permit numbers for all current NPDES permits:
This facility has Non-Discharge permits(e.g. recycle permit). If checked,list the permit numbers for all current Non-
Discharge permits:
❑This facility uses best management practices or structural stormwater control measures.
If checked,briefly describe the practices/measures and show on site diagram:
❑This facility has a Stormwater Pollution Prevention Plan(SWPPP).
If checked,please list the date the SWPPP was implemented:
❑This facility stores hazardous waste in the 100-year floodplain.
If checked,describe how the area is protected from flooding:
❑This facility is a(mark all that apply)
❑ Hazardous Waste Generation Facility
❑ Hazardous Waste Treatment Facility
❑ Hazardous Waste Storage Facility
❑ Hazardous Waste Disposal Facility
If checked,indicate:
Kilograms of waste generated each month: Type(s)of waste:
How material is stored: Where material is stored:
Number of waste shipments per year: Name of transport/disposal vendor:
Transport/disposal vendor EPA ID: Vendor address:
❑This facility is located on a Brownfield or Superfund site
If checked, briefly describe the site conditions:
❑ Facility provides appropriate secondary containment for bulk storage of liquid materials
If checked,briefly describe these measures:
❑ Site has an active landfill within the mining permit boundary
If checked, please indicate type:
a) ❑ LCID(Land clearing and Inert Debris)
b) ❑ other(specify)
Page 6 of 11

9. Required Items(Application will be returned unless all of the following items have been included):
'%Check for$120 made payable to NCDEQ
Copy of most recent Annual Report to the NC Secretary of State(if applicable)
tKThis completed application and any supporting documentation
1P Copy of the approved mining permit or indication of mining permit application status.(4,4 d M re vs'et*1
❑ Copy of US Army Corps—approved wetland delineation(if applicable) —14)4,t a rn r 'e I"CW
❑ Line drawing of the water flow through the facility or block flow diagram
❑ Pictorial description of the nature of any sources of water and any collection and treatment measures
Fdl A site diagram showing,at a minimum,existing and proposed:
a) outline of drainage areas
b) surface waters
c) stormwater management structures
d) location of stormwater outfalls corresponding to the drainage areas
e) runoff conveyance features
f) areas where process materials are stored
g) impervious areas
h) site property lines
2 copies of large scale(24"06"minimum)site plan showing:
a) topographical lines
b) all outfall locations
c) applicable buffers and delineated wetlands
d) receiving waters
e) 100-year flood plain(if applicable)
Copy of county map or USGS quad sheet with the location of the facility clearly marked
If mines site is in one of the 20 Coastal Counties(if applicable)
Applicant has check with the appropriate regional office to verify the need for a Coastal State Stormwater permit.
a) Indicate the Regional Office Contact:
Detailed list of:
a) impervious surface areas and percentages
b) sub-drainage areas
c) total drainage area
If mine is dewatering and near wetlands,or may otherwise impact surface waters or groundwater
2 copies of large scale(24"06"minimum)plans delineating areas on the listing acreage including:
a) wetlands
b) ditches
c) well-placements
d) pits
e) borrow areas
f) overburden storage
g) stormwater controls/BMPs
h) vehicle maintenance areas
i) settling basins
j) product process(such as screening,stockpiles,and waste piles)
k) total drainage area
1) impervious surface percentages(if state Stormwater programs apply)
m) applicable buffers
n) access and/or haul roads
❑ Pump dewatering size and information on its specifications
Page 7 of 11

❑well information(design,depths,maintenance)
❑physical monitoring for the wetland areas
Settling pond size information,if applicable
❑level spreader design,if applicable
❑Details about dewatering method
❑Cone of influence calculations
❑Description of measures to prevent erosion and flooding
❑Description and information about 401/404 permits that have been obtained
E)Copy of US Any Corps of Engineers wetlands delineations or approved wetland delineation(if applicable)
❑I have contacted my local regional office about a Pumping Operation and Monitoring(POM)plan
a) Regional Office Contact
b) Date Contacted:
10.Applicant Certification:
North Carolina General Statute 143-275.60(1)provides that Any person who knowingly makes any false statement,
representation,or certfication 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:
❑I am the person responsible for the permitted industrial activity,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.
O 1 will abide by all conditions of the NCG020000 permit.I understand that coverage under this permit will constitute the
permit requirements for the discharges)and is enforceable in the same manner as an individual permit
❑I hereby request coverageeannddgyt��N/,��G020000Geneeral Permit.
Printed Name of Applicant:� /. ,
Title: *14e A /
(Sig ature of Applicant) (Dat geed)
Mail the entire package to: DEMLR—Stormwater Program
Department of Environmental Quality
1612 Mail Service Center
Raleigh,NC 27699-1612
Page 8 of 11

Additional Outfalls
3-4 digit identifier: Name of r el ing water- Classification: ❑This water is impaired.
444 , r!a D
(J C& G V6W IV S N/ ❑This watershed has a TMDL
Discharge from this outfall is from:
kstormwater ❑ Mine Dewatering ❑ Process Wastewater
7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HQW,
ORW,Tr,WS-1,WS-11,WS-111,SA,or PNA): IfIlk
Discharge occurs from this outfall:
($,Only during a rainfall event ❑ Intermittently(indicate how often) ❑Continuously(indicate flow in CFS)
Latitude of outfall: 6 ✓ 1 U 3 3 Longitude of outfall:
^ 77; 6,7-O"'VA
Brief description of the industrial activities that drain to this outfall:
vt
Do Vehicle Mai nance Activities occur in the drainage area of this outfall? ❑ Yes ANo
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier: Name of receiving water: Classification: ❑This water is impaired.
❑This watershed has a TMDL.
Discharge from this outfall is from:
❑ Stormwater ❑ Mine Dewatering ❑ Process Wastewater
7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HQW,
ORW,Tr,WS-1,WS-II,WS-III, SA,or PNA):
Discharge occurs from this outfall:
❑ Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
Latitude of outfall: Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes ❑ No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit Identifier: Name of receiving water: Classification: ❑This water is impaired.
❑This watershed has a TMDL
Discharge from this outfalI is from:
❑ Stormwater ❑ Mine Dewatering ❑ Process Wastewater
7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HQW,
ORW,Tr,WS-I,WS-II,WS-ill,SA,or PNA):
Discharge occurs from this outfall:
❑ only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
Page 9 of 11

Latitude of outfall: Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑ Yes ❑ No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier: Name of receiving water: Classification: ❑This water is impaired.
❑This watershed has a TMDL.
Discharge from this outfall is from:
❑Stormwater ❑ Mine Dewatering ❑ Process Wastewater
7Q30 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HOW,
ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA):
Discharge occurs from this outfall:
❑ Only during a rainfall event ❑ Intermittently(indicate how often) ❑Continuously(indicate flow in
CFS)
Latitude of outfall: Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑Yes ❑ No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier: Name of receiving water: Classification: ❑This water is impaired.
❑This watershed has a TMDL.
Discharge from this outfall is from:
❑Stormwater ❑ Mine Dewatering ❑ Process Wastewater
7Q10 Flow of receiving waterbody,(if discharging Mine Dewatering or Process Wastewater to waters classified as HQW,
ORW,Tr,WS-I,WS-Il,WS-III,SA,or PNA):
Discharge occurs from this outfall:
❑ Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
Latitude of outfall: Longitude of outfall:
Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑Yes ❑ No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar year?
3-4 digit identifier: Name of receiving water: Classification: El This water is impaired.
❑This watershed has a TMDL.
Discharge from this outfall is from:
❑Stormwater ❑ Mine Dewatering ❑ Process Wastewater
7Q10 Flow of receiving waterbody(if discharging Mine Dewatering or Process Wastewater to waters classified as HQW,
ORW,Tr,WS-I,WS-II,WS-III,SA,or PNA):
Discharge occurs from this outfall:
❑ Only during a rainfall event ❑ Intermittently(indicate how often) ❑ Continuously(indicate flow in CFS)
Latitude of outfall: Longitude of outfall:
Page 10 of 11

Brief description of the industrial activities that drain to this outfall:
Do Vehicle Maintenance Activities occur in the drainage area of this outfall? ❑Yes ❑ No
If yes,how many gallons of new motor oil are used each month when averaged over the calendar ear?
Page 11 of 11

LIMITED LIABILITY COMPANY ANNUAL REPORT
11V20 z
NAME OF LIMITED LIABILITY COMPANY: H & S Land, LLC
Fu ng Office Use Only
SECRETARY OF STATE ID NUMBER: 0669933 STATE OF FORMATION: NC E-Filed Annual Report
0669933
CA202407100275
REPORT FOR THE CALENDAR YEAR: 2024 311 W024 08:30
SECTION A.REGISTERED AGENT'S INFORMATION ❑Changes
1.NAME OF REGISTERED AGENT: Stone, A. Hunter
2.SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS&COUNTY 4.REGISTERED AGENT OFFICE MAILING ADDRESS
3204 West Nash Street,Suite C 3204 West Nash Street,Suite C
Wilson,NC 27896-3002 Wilson County Wilson, NC 27896-3002
SECTION B:PRINCIPAL OFFICE INFORMATION
1.DESCRIPTION OF NATURE OF BUSINESS: Tree Farm
2.PRINCIPAL OFFICE PHONE NUMBER: [phone] 3.PRINCIPAL OFFICE EMAIL: Privacy Redaction
4.PRINCIPAL OFFICE STREET ADDRESS 5.PRINCIPAL OFFICE MAILING ADDRESS
3204 West Nash Street,Suite C 3204 West Nash Street,Suite C
Wilson, NC 27896-3002 Wilson,NC 27896-3002
6.Select one of the following If applicable.(Optional see Instructions)
❑ The company is a veteran-owned small business
❑ The company is a service-disabled veteran-owned small business
SECTION C:COMPANY OFFICIALS(Enter additional company officials in Section E.)
NAME: L Wayne Hoskins NAME: A Hunter Stone NAME:
TITLE: Manager TITLE: Member TITLE:
ADDRESS: ADDRESS: ADDRESS:
4801 St George Drive 4460 Old Raleigh Rd
Wilson, NC 27896 Wilson,NC 27896
SECTION D:CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a personibusiness entity.
L Wayne Hoskins 3/11/2024
SIGNATURE DATE
Forth must be signed by a Company Official listed under Section C of This form. '
L Wayne Hoskins Manager
Print or Type Name of Company Official Prof or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO:Secretary of State, Business Registration Division,Post Office Box 29525,Raleigh,NC 27626-0525

JO-
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BASIN 5
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ENGINEERING&ENVIRONMENTAL
SCIENCE COMPANY
3008 ANDERSON DR.,SUITE 102
RALEIGH,NORTH CAROLINA 27609
(919(781-7798
BALE:
Vicinity Map o7i26na
Scale: I" — 1000' Dunnie Hole Mine �� N
H&S Land, LLC
Wayne County, INC