20160173 Ver 1 _Agent Authorization Form _20160223

Name:
Address:
City, State, Zip:
Phone:
KELLER ENVIRONMENTAL
ENVIRONMENTAL CONSULTANTS
7921 Haymarket Lane, Raleigh, NC
[phone]
[phone] Fax
AGENT AUTHORIZATION FORM
Project Name/Description
Date:
BCP Lufkin LLC
4000 West North Street
Raleigh, NC 27603
919-239-4195
Apex Summit Church
January 12, 2016
To: US Army Corps of Engineers
Raleigh Regulatory Office
Attn: staff
3331 Heritage Trade Drive
Suite 105
Wake Forest, North Carolina 27587
To Whom It May Concern:
NC Division of Water Resources
401 Oversight and Express Permits Unit
Attn: Staff
Mail Service Center 1650
Suite 250
Raleigh, NC 27699-1650
As a representative concerning the subject site, I do hereby authorize and give
permission for Keller Environmental to represent or act as agent on my behalf and allow
the COE or any other regulatory agency to go on the property with a Keller
Environmental representative for such purposes as necessary to perform the job tasks.
0, 9A
Owner's Name ner's Signature
Jay Keller
Keller Environmental, LLC
Preliminary Wetland & Stream Assessments—Jurisdictional Wetland Delineations—Neuse & Tar River Stream Buffer
Evals & Coordination -401/404 Water Quality Permitting—Stream & Wetland Restoration—Threatened & Endangered
Species Surveys—Benthic Macroinvertebrate Sampling—Phase I-IV Environmental Site Assess ments—Tree Surveys