NCC243283_NOI Signed Certification_20241113

then road the original mire,to the NI' I1f MI P Ctrhnswatec Tristram tooth 3110 rhei IP DOYing eit emit PI
At
Otvision of Energy, Mineral R l and Resources Story*water►mgrit"
S12 N Salisbury St►eet, Sr- flow $Offce 64010
11512 Mien Serest!Center
Raleigh, Nt 7 7699-1,117
T?fE FORM YOU MAR MUST St COMPUT1O WITH AN O1111G1NAI SOGNAMIllt INOT MITAII WO C1ftt Mai
Prr NC General Stature 143 215.68 hi. any person woks linow,ngly mattes any forte r►oternenr reprewroottese rr
rertifiration in any opplbrarron, record ',Vol. Orin, or other document pled or rertored to be morrrtoirred vrrder rr
Article or o rule rmokmenting this Article shoe!be guilty of o Class 2 misdemeanor whit,'map tncfrde a ft,w nu'
exceed ren rhocrsand dollars(S10.0001
Unger penary of law, I certify that (check all boxes to indicate your agreement)
[]✓ ram the person responsible for the const'action activities at Ihn oroiett, for satisfying the requirement.
Permit.and for any civil or criminal penal:let, incurred due to v el anions of this permit
Qr Thr i,,formatioe submitted in this NOI is,to the tsest of my knuw,edge and belief,true. accurate and LumpMRe
based on MY inquiry of the person or persons who manage the system,or those persons directly responsible tot
gathering the information
p✓ I welt abide by all conditions of the 'JCGO10000 Central Permit and the approved Erosion and Sediment Canute
Plan
rJ rf the approved Erosion and Sediment Currlrvl Plain is not compliant with Part II (;torrr+w.rer PoIlLtree
Prevention Plan)of the Nr:G010000 Geteral Permit,I will nonetheless ensure that all conditions of Part u of ttsr
permit arc me: on the project at all times.
Q✓ I hereby request coverage under the NCG010000 Get tal Permit and understand that coverage uncret this
Der n,i1 will constitute the permit requirements for the d.scha►ge(s)and is enforceable in the same manner as an
individual permit
Project Name (must match Also) Circle Tracks Warehouse
Specific Lot Numbers(must match Alb):
Permittee (must march 81): M2 Investments of Race City, LLC
tegally Responsible Person(must match 82& 83). Lade Rogers
Title of legally Responsible Person (must match 83b): President
Print Name& Title of Signed if Authorized
;ndivrdual Differs from Legally Responsible Person-
Phone Number: 813-843-2221