20160279 Ver 1 _agent authorization _20160316

CAROLINA
ECOSYSTEMS, INC.
AUTHORIZATION FORM
Property Information
Property Address
and/or Description
Parcel Identification
Number(s) (PIN)
3040 NC Hwy 42 West; Clayton, NC 27520
P:919-359-1102 — F:919-585-5570
WI High Point Landfill, 5822 Riverdale Drive, High Point NC
7820619560
City: High Point State: NC
Type of Project: Wetland & Stream Delineation
Property Owner Information
Legal Owner
Name WI High Point Landfill
Authorizing
Owner's/Agent's Name
& Title W C, AQ -e
(Title must be listed as Owner,
Owner's/Agent's
Street Address 3301 Benson Drive Suite 601
City: Raleigh StateNC
County: Guilford
Property Size (Acres): 154 (approx.)
r
av & a Pe e r �f . I��: c,e�-lbr_ CP
Officer, or Authorized Agent. Authorized Agent must attach proof of such status fbi QG� S
Zip Code:27609
Please sign the appropriate line(s) below for the access being authorized to Carolina Ecosystems, Inc.
Property Access Authorization
I hereby grant Carolina Ecosystems, Inc. (CEI) staff, their designated contractors and representatives, as well as Federal,
State or local authorities access to the above referenced property when necessary for the purposes of conducting on-site
environmental consulting services. These services may include regulatory determinations of environmental features on my
property such as issuing a determination associated with Waters of the U.S. subject to Federal jurisdiction under Section
404 of the Clean Water Act and/or Section 10 of the Rivers and Harbors Act of 1899. 1 certify that I am the legal owner
or authorized agent of the legal owner of the bove propperty and have authority to grant such access. I
Owner/Agent (signature) IJ L r Date iE l `{
Agent Authorization
I authorize CEI to act as authorized agent on behalf of the owner of the above listed property for the communication,
submission, and/or application to relevant government entities, including local, state, and federal authorities, for the
review, acceptance, concurrence, and/or approval of environmental information, documents, and/or permit requests
concerning the above listed property. I have made CEI aware of, and supplied all available records related to, previous
environmental investigations on the subject p erty of hick I have knowledge
so .
Owner/Agent (signature) D - Date—7 � (:5 ( H