NCS000456_Name-Ownership Change Form_20180316

----'STORM WATE R-DIVI SION-CODI N G-SH EET
PERMIT N0.
MCC:,
DOC TYPE
El FINAL PERMIT
❑ MONITORING INFO
❑ APPLICATION
COMPLIANCE
❑ OTHER
DOC DATE
❑ 20I i� 0 (a ZD
YYYYMMDD

�
' 'AQ
RCDENR
Np 'H Curou DE NiTN —
ENvi "mN mo Nr{R1 R[lounc"
L'f
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
National Pollutant Discharge Elimination System
PERMIT NAME/OWNERSHIP CHANGE FORM
(at '-toj I CF-
F R AGENCY USE ONLY
Date Received
Year
Month
Da
Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N C S 10 0 0 14 1 5 1 6 1 N 10 10
U. Permit status prior to requested change.
a. Permit issued to (company name):
b. Person legally responsible for permit:
MAR 16 2019
ND )0L\V G
c. Facility name (discharge):
d. Facility address:
Cove City Wood Preserving Inc
Jane House
First MI Last
Director, Ehs
Title
H 065 Old Hwv 70 West
Permit Holder Mailing Address
RE C E I� 1E ISove City NC 28523
City State Zip
J U N 2 0 9018 [phone] ( )
Phone Fax
CENTRAL FILES Cove City Wood Preserving Inc
DWR SEC I ION 11065 Old Hwy 70 West
Address
Cove City NC 28523
City State Zip
e. Facility contact person: Jane House (803) 6644014
First / MI / Last Phone
111. Please provide the following for the requested change (revised permit).
a. Request for change is a result of. ❑ Change in ownership of the facility
® Name change of the facility or owner
!f other please explain:
b. Permit issued to (company name): Culpeper of Cove City, LLC
c. Person legally responsible for permit: Josh Adkins
First MI Last
Ehs Director
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
Title
I ] 065 Old Hwv 70 West
Permit Holder Mailing Address
Cove City
NC 28523
City
State Zip
[phone]
[e-mail]
Phone
E-mail Address
Culpeper
of Cove City, LLC
11065 Old Hwy 70 West /
Address
Cove City
NC 28523
City
State Zip
Josh
Adkins
First MI Last
[phone] jadkins c�7rculpeperwood.com
/27, 2014
Phone E-mail Address
Permit contact information (if different from the person legally responsible for the permit)

NPDES PERMIT NAIVE/OWNERSHIP CHANGE FORM
• Page 2 of 2
Permit contact:
First MI Last
Title
Mailing Address
City State Zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
AR
INCOMPLETE OR MISSING:
This completed application is required for both name change and/or ownership change
requests.
Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
.....................................................................................................................
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, Jane House, attest that this application for a name/ownership change has been reviewed and is accurate
and complete to the best of my knowledge. I understand that if all required parts of this application are not
conIVIFeNd and that if all requir supporting information is not included, this application package will be
re med s incomplete. /
Signature Date
APPLICANT CERTIFICATION
1, Josh Adkins, attest that this application for a name/ownership change has been reviewed and is accurate
and complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014

BILL OF SALE,_ ASSIGNMENT AND ASSUMPTION AGREEMENT
. THIS BILL OF SALE, ASSIGNMENT AND ASSUMPTION AGREEMENT (this `Bill
of Sale") is made and entered into as of January 8, 2018, by and among COVE CITY WOOD
PRESERVING, INC,, a North Carolina corporation (the "Seller"), and CULPEPER OF COVE
CITY, LLC, a Virginia limited liability company (the "Purchaser" and together with the Seller,
the "Parties");
RECITALS:
WHEREAS, the Boards of Directors of the Seller and the members of the Purchaser have
each approved the execution, delivery and performance of this Bill of Sale;
WHEREAS, the Seller and the Purchaser are each party to a Contract of Purchase and
Sale of Real Estate and Personal Property, dated as of the date hereof, (the "Purchase
Agreement") as partially assigned to the Purchaser as of the date hereof (the "Assignment"),
pursuant to which the Purchaser will acquire certain assets used by Seller in connection with the
operations of its treated wood products business located at Old Route 70, Craven County, North
Carolina (the "Business");
WHEREAS, the Purchase Agreement contemplates that Seller shall sell, transfer, convey
and deliver to Purchaser all of its right, title, and interest in certain equipment, fixtures and
machinery utilized in the Business;
WHEREAS, Section 3 of the Purchase Agreement contemplates that the Seller shall sell,
transfer, assign, convey and deliver to the Purchaser all of its right, title, and interest in certain
inventory, finished goods, raw materials, work in progress, packaging materials, supplies,
contractual rights and obligations, purchase orders and other tangible and intangible property;
WHEREAS, Section 10(a) of the Purchase Agreement further contemplates that the
Seller shall deliver an executed Bill of Sale, Assignment and Assumption Agreement, pursuant
to which Sellers shall transfer such assets (and certain associated liabilities) to Purchaser at the
Closing; and
WHEREAS, Section 10(b) of the Purchase Agreement contemplates that the Purchaser
shall deliver an executed Bill of Sale, Assignment and Assumption Agreement pursuant to which
Purchaser shall accept and assume such assets (and certain associated liabilities) from Sellers at
the Closing.
NOW, THEREFORE, in consideration of the foregoing and the mutual agreements
contained herein, and other good and valuable consideration, the receipt and sufficiency of which
are hereby acknowledged, and intending to be legally bound, the Parties hereby agree as follows:
SECTION 1. Defined Terms. The following terms shall have the meanings set forth in
this Section 1. Capitalized terms which are used but not otherwise defined in this Bill of Sale
shall have the meaning ascribed to such terms in the Purchase Agreement,
NPHH1;503604.3-0TRANs-(EMH) 031844-00002
WBD (U5) 41486557v1

"Acquired Assets" shall mean, collectively:
(a) Tangible Personal Property. The machinery, equipment, furniture,
office equipment, supplies, materials, vehicles and other items of tangible personal
property of every kind owned by Seller and used in connection with the Business listed
on Schedule 1.1, together with any express or implied warranty by the manufacturers or
sellers of any item thereof.
(b) Inventories. The inventories of the Business as of the date hereof,
including; without limitation, all finished goods, work in process, raw materials and spare
parts, the location and an approximation of which are described on Schedule 1.2.
(c) Contracts. Each of the contracts, leases of personal property, other
leases and other agreements that are described on Schedule 1.3 (the "Contracts").
(d) Intellectual _P_ roperty. All of the intellectual property of Seller
listed on Schedule 1.4 that is used in connection with the operations of the Business,
including the following: (a) trademarks, service marks, trade names, logos and all
registrations relating thereto; (b) copyrighted works and registrations therefor; (c) patents
and applications therefor; and (d) confidential or proprietary processes, formulas, trade
secrets and technical and other similar information, together with the goodwill related
thereto and any royalty income therefrom accruing on and after the Closing Date.
(e) Permits. .The permits, authorizations, certificates, approvals and
licenses relating to the operation of the Business listed on Schedule 1.5.
"Assumed Liabilities" shall mean, collectively:
(a) all obligations for payment of each of the amounts set forth on
Schedule 1.6;
(b) all liabilities and obligations arising under or relating to the
Contracts;
(c) except as otherwise provided in this Bill of Sale, the Purchase
Agreement or the Transition Services Agreement, all liabilities of Purchaser relating to
employee benefits, compensation or other arrangements with respect to any Transferred
Employee arising on or after the Closing;
(d) all liabilities and obligations for taxes relating to the Business, the
Acquired Assets or the Assumed Liabilities for any taxable period ending after the
Closing Date; and
(e) all other liabilities and obligations arising out of or relating to
Purchaser's ownership or operation of the Business or the Acquired Assets on or after the
Closing.
NPHH1:503604.3-OTRANS-(EW 031844-00002

"Permitted Liens" shall mean;
(a) imperfections of title and encumbrances, if any, which, in the
aggregate, are not material, do not materially detract from the marketability or value of
the property or assets subject thereto, and do not materially impair the operations of the
owner thereof,
(b) liens for taxes not yet due and payable;
(c) the leases described on Schedule 1.7; and
(d) liens described on Schedule 1.8, all of which will be removed at or
prior to Closing.
"Transferred_ Employees" shall mean the employees of Seller (or its affiliate) who
will be hired by Purchaser on and as of the Closing Date, which Transferred Employees
shall be set forth on Schedule 1.9 hereto.
SECTION 2. Assignment.
(a) Subject to the terms and conditions of the Purchase Agreement and
the Assignment, the Seller hereby sells, assigns, conveys, transfers and delivers to the
Purchaser, and the Purchaser hereby acquires and accepts from the Seller, all of its right,
title and interest in the Acquired Assets.
(b) The Acquired Assets shall be sold and conveyed to Purchaser free
and clear of all liabilities, obligations, liens, security interests and encumbrances
whatsoever; except for Permitted Liens;. provided, however, that Purchaser will assume at
Closing the obligations under the Contracts that are unperformed as of the Closing.
SECTION 3, Assumption. Subject to the terms and conditions of the Asset Purchase
Agreement and the Assignment, the Purchaser hereby agrees to assume, satisfy, perform, pay
and discharge each of the Assumed Liabilities.
SECTION 4, Prorations. The operation of the Business and the income and expenses
attributable thereto up the Closing Date shall be for the account of Seller and thereafter for the
account of Purchaser. Expenses, including, without limitation, such items as ad valorem
property taxes, prepaid items, utility charges and rents shall be prorated between Seller and
Purchaser as of the Effective Time. Such prorations shall be made and paid insofar as is possible
at the Closing, and in any event within thirty (30) days thereafter.
SECTION S. Disclaimers. EXCEPT AS EXPRESSLY SET FORTH IN THIS BILL
OF SALE AND THE PURCHASE AGREEMENT, CONSISTENT WITH SECTION 14 OF
THE PURCHASE AGREEMENT, IN CONSIDERATION FOR CERTAIN INSPECTION
RIGHTS EXTENDED TO THE PURCHASER WITH RESPECT TO THE ASSETS
ACQUIRED PURSUANT TO THIS BILL OF SALE AND THE PURCHASE AGREEMENT,
ALL ACQUIRED ASSETS ARE SOLD, TRANSFERRED, OR ASSIGNED "AS IS, WHERE
IS" AND "WITH ALL FAULTS." EACH SELLER EXPRESSLY DISCLAIMS ALL
NPHH1:503b04.3-oTRANS-(EMH) 031844-00002

WARRANTIES OR REPRESENTATIONS NOT EXPRESSLY SET FORTH IN THIS BILL
OF. SALE OR IN THE ASSET PURCHASE AGREEMENT (WHETHER EXPRESS OR
IMPLIED, ORAL OR WRITTEN) WITH RESPECT TO THE ACQUIRED ASSETS,
INCLUDING ANY IMPLIED OR EXPRESS WARRANTY OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE, WHETHER ALLEGED TO ARISE BY LAW,
BY REASON OF CUSTOM OR USAGE IN THE TRADE, OR BY COURSE OF DEALING.
SECTION 6. No Brokers. Each Party represents and warrants to the other (a) that no
brokers or agents have been retained or employed by it; and (b) that there are no claims for any
brokerage commission, finder's fee or similar payment due or claimed to be due from it with
respect to this transaction.
SECTION 7. Successors. This Bill of Sale shall be binding upon and inure to the
benefit of and be enforceable by the successors and permitted assigns of each Party hereto.
SECTION S. No Third Party Beneficiaries. Except as provided in the Assignment, this
Bill of Sale is solely for the benefit of the Parties hereto and no provision of this Bill of Sale shall
be deemed to confer upon third Parties any remedy, claim, liability, reimbursement, claim of
action or other right in excess of those existing -without reference to this Bill of Sale.
SECTION 9. SeyerabilitY, The provisions of this Bill of Sale are severable, and, in the
event that any one or more provisions are deemed illegal or unenforceable, the remaining
provisions shall remain in full force and effect unless the deletion of such provisions shall cause
this Bill of Sale to become materially adverse to either Party, in which event the Parties shall use
reasonable best efforts to arrive at an accommodation that best preserves for the Parties the
benefits and obligations of the offending provision.
SECTION 10. Amendment. Neither this Bill of Sale nor any term hereof may be
amended, waived, discharged or terminated, except by a written instrument duly executed on
behalf of each Party by its duly authorized officer or employee,
SECTION 11. Notices. All notices, demands and other communications made hereunder
shall be in writing and shall be given pursuant to the provisions of the Purchase Agreement.
SECTION 12, Counterparts. This Bill of Sale may be executed in two or more
counterparts, each of which shall be deemed an original, but all of which together shall constitute
one and the same instrument. This Bill of Sale shall become effective when each Party hereto
shall have received counterparts thereof signed by the other Party hereto.
SECTION 13. Governing Law. This Bill of Sale shall be governed by, and construed in
accordance with, the laws of the State of South Carolina, regardless of the laws that might
otherwise govern under applicable principles of conflicts of laws thereof.
SECTION 14. Descriptive Headings. The division of this Bill of Sale into Sections and
other subdivisions and the insertion of headings are for convenience of reference only and shall
not affect or be utilized in construing or interpreting this Bill of Sale. Any reference in this Bill
of Sale to any "Section" is to the corresponding Section of this Bill of Sale unless otherwise
specified.
NPHH1:503604.3-0TRANS-(EMH) 031W-00002

IN WITNESS WHEREOF, each of the Parties has caused this instrument to be signed in
its name by its proper and duly authorized corporate officer as of the date first set forth above.
COVE CITY WOOD PRESERVING, INC.
By:
Name: R. Michael . alvl. n
Title: President and icf Executive Officer
CULPEPER OF COVE CITY, LLC
By: Jefferson Homebuilders, Inc., its Member
Name: Joseph R. Daniel, Jr.
Title: President
[Signature Page to Bill of Sale, Assignment and Assumption Agreement]

IN WITNESS WI-IEREOF, each of the Parties has caused this instrument to be signed in
its name by. its proper and duly authorized corporate officer as of the date first set forth above.'
COVE CITY WOOD PRESERVING, INC.
By:
Name: R. Michael Johnson
Title; President and Chief Executive Officer
CULPEPER OF COVE CITY, LLC
By; Jefferson Hom_wkurs, IOc., its Member
Joseph R.eoidl;'Jr.
President
[Signalure. Page. lo Bill of Sale, Assignment and Assumption Agreement]

l
.4'?
i�
J
s
i
�:
�S.
•fit

Exhibits/Schedules to Bill of Sale, Assignment and Assumption Ageement
Schedule 1.1:
Tangible Personal Property
Schedule 1.2:
Inventories
Schedule 1.3:
Contracts
Schedule 1.4:
Intellectual Property
Schedule 1,5:
Permits
Schedule 1.6:
Accounts Payable
Schedule 1.7:
Leases
Schedule 1.8:
Liens
Schedule 1,9:
Transferred Employees
NPHH1:5036D4.3-OTRANS-(EMH) 031844-00002

SCHEDULES
TO
BILL OF SALE, ASSIGNMENT AND ASSUMPTION AGREEMENT
WBD (US) 4E486569vI

WASWHDI:`.-_',
I �-Suf--_ I I F-i'mcein SUVICeDate-T PSaws-
007
Cove City
NC
O135
I PLANT MACHINERY CHEMICAL TANKS (3)
911A981
$4,194.SD
Note: Listing of "Sellers Cost
007
Cove city
NC
01365
1 PLANT MACHINERY 2013 Hyau 19OHD w/ forks
W24/2016
$125,249-90
Basis" on this Schedule does -
007
Cove City
NC
0184
1 BLDG & IMPROV BUILDING
4/18/1988
$15,000.00
not reflect any agreement
007
Cove City
NC
0185
1 BLDG & IMPROV BUILDING— PLANT
4/18/1988
$22,DOO.00
007
Cove oty
NC
0186
1 BLDG & IMPROV BUILDING — STORAGE
4/18119M
$30,WO.Do
between the parties as to
007
Cave City
NC
0188
1 PLANT MACHINERY TREATING EQUIPMENT
4/1811986
$165,OD0-00
designation or allocation of
OU7
Cove city
NC
0189
1 RANT MACHINERY TREATING EQUIPMENT
4/18/1988
$40,000.00
007
Cove City
NC
0190
1 FURN & EQUIP VAR10LI5 OFFICE EQUIPMENT
4/1811988
$30,000.00
values for tax purposes.
007
clove City
NC
0191
1 YARD IMPROV YARD IMPROVEMENTS
4/18/1988
$13,350.00
007
COVE My
NC
0192
1 POLLUTION CTRL POLLUTION CONTROL EQUIPMENT
4/18/1988
$15,000.00
007
GDve City
NC.
0209
1 RANT MACHINERY STEAM CLEANER
12/111988
$2,617.12
007
Owe My
NC
0210
1 BLDG & IMPROV SHED
0111989
$33,664.23
007
Cove Ctty
NC
0232
1 PLANT MACHINERY STACKER
9/30/1989
$117,272_18
007
Cove CXY
NC
02SB
I AUTOMOTIVE 1978 EVANS TRAILER SN#15104
12J111990
$3,000.00
007
Cam CIty
NC
0271
1 PLANT MACHINERY AIR COMPRESSOR
9128/1991
$8,134.S4
007
Cove Oty
RC
0275
1 YARD IMPROV PAVING
11=1991
$37,619-15
DD7
Cove city
NC
0286
1 RANT MACHINERY 10000 GALLON TANK
2/2811992
$1,900.00
DD7
rMM city
NC
0289
1 PLANT MACHINERY HOLTE-C TRIM SAW
3/25/1992
$61900.00
007
Cove city
NC
0299
1 PLANT MACHINERY ASOMA ANALYZER
12a1/I992
$12,874.22
OEY7
Ca" city
HC
0314
1 RANT MACHINERY PALLET RACKS
7/3011993 '
$3,674.40
O07
Cove city
NC
0320
1 PLANT MACHINERY (2) LOW PROFILE TRAMS
11115/1993
$6,262-00
007
Cove city
NC
0321
1 PLANT MACHINERY TREATING COMPUTER
UJ15/1993
$13,213.48
007
coft Cltv
NC
M76
1 PLANT MACHINERY HYSTIER FORKLIFT HSD)a- SIN B11836F
10/30/1996
$5_%D.DO
ON
Cove City
NC
0391
1 YARD IMPROV PAVING
10f28/1997
$21,975.DO
O07
Cove Cltv
NC
0398
1 LAND LAND
I/1/1998
$25,000.00
007
Cove ctty
NC
0427
1 POLLUTION CTRL Drip Pad Exbertslon
8/1/1998
$79,821.82
007
Cove City
NC
0503
1 PLANT MACHINERY ELECTRONIC SCALE
10/30/20DO
$10,724.87
007
Cove city
KC
0561
1 LAND LAND
8/14/2003
$40,000.00
007
Cove city
NC
0566
1 PLANT MACHINERY OC.A Treating Ptant Insta Mon
11/15/20M
$113,002-56
007
Cove city
NC
0571
1 PLANT MACHINERY COPPER AZOLE TREATING PLANT MODIFICATION
3115/2004
$25,373-69
Di
Cave Oty
NC
0595
1 PLANT MACHINERY POWER SWEEPER MODEL 640D (sft# 6400-1042)
12120/2004
$16,OSO.00
007
Cade city
KC
0615
1 YARD 114PROV STORM WATER CONTROL PROTECT
6/30/2005
$141-89.91
007
Cave MY
NC
0621
1 RANT MACHINERY STACKER HOIST UPGRADE
911r2005
$68,541.31
007
com City
KC
0632
1 YARD IMPROV WATER DRAINAGE PROJECT -YARD IMPROVEMEN
2A/2006
$25,672.98
00
Cove City
NC
0670
1 81DG & IMPROV 26'x SW LUMBER STORAGE SHED
5124f2006
$20,945.08
OD7
Cove City
NC
0671
1 R1 pG & IMPROV 261 x SW LUMBER STORAGE SHED
5/2.4/2OD6
$20,945.08
007
cme city
NC
0672
1 BLDG& IMPROV IV x 94' LUMBER STORAGE SHED
5/24/2006
$12,889.28
007
Cove City
NC
0673
I BLDG& IMPROV 2V x 91'LUMBEP STORAGE SHED
5/24/20D6
$20,276.62
00
Cove City
NC
0674
1 BLDG& IMPROV 16 x 49 FUEL TANK SHED
5/2412OD6
$S,473.66
007
Cove City
NC
0701
1 PLANT MACHINERY HYSTER FORnIFT MODEL H19OHD
7P1/2006
$92,894.00
()07
Cave City
NC
D953
I PLANT MACHINERY CYLINDER
111/2010
$24_388-43
O07
owe city
NC
D976
I RANT MACHINERY CCA TANK UPGRADE
I011M10
$9,568.43
DD7
Cove city
NC
D986
I PLAN MACHINERY Kubato M5400 TractnrffmM end loader
311MII
$10,7m.00
DIV
cum Cky
NC
D992
I BUDG& IMPROV SHED REBUILD
3/1/2012
$68,750.OD
00
Cove City
NC
1205
1 AUTOMOTIVE 2012 GMC Slenz
1/30PO13
$31,000.OD
007
Cove city
NC
I236
I PLANT MACHINERY Drip Pad Repaits
12/3I/2013
$35,S81,41
007
Cove city
NC
IMS
1 PLANT MACHNERY Tram Maintenance
5 RO1
$12173838

Row Labels
BRANCHV9
CH
LM
LU
Sv
COLERDG4
I.. --
FC
LM
LU
PW
Sv
COVECITY7
FC
LM
LU
Pi
PW
Iv -
Sum of ONHANDINT Sum of ONHANDDEC Sum of Dollars
50809
7823,862 339,072.88
0
7390 - -21,315,0,
3946
88.168 140,354.63
31800
331735 171,295.48
15063
12.959 4,673.27
360
l,rs
15
S6
350876
52989.749 2,607,512.49
0
4.5206 3 , 7
1600
a 3,392.00
1093
14.191 31,518.73
315775
3457.921 2,171,231.20
1946
43.072 30,536,56
31062
45.565 24,104.20
9010
0.79
151
2.09
910
2.19
210
2.19
so
20
7
26
5
310013
94222.799 2,399,541-74
0
83392 8
1I520
0 18,475.20
526
10.89 23,907.97
278028
3465.305 1,908,456.05
411
3204.913 35,929.10
3850
123.2 76,605.23
15678
26,491 16,964.91
385
2.3 885 5 0]
17
56
2
40
718511
114097.846 4,596,650.06
0
87282'..".-:., 14,39 i3l",
500
0 899.20
7501
180.907 350,280.61
622485
6148.439 3,377,330.43
1
4,8 33.00
11860
379,52 271,434.90
76164
102.18 69,157.63
28
56.
—,
71 `5 if 8:0W
1766
2.01
3,549.66d
1846
2.65
5,L4,891.'90.,
1800
1.73
Graniiio.ial 1L . .1 r. ., ..r[' 69,i
i4 1,942,777,17,
Total . Chemical '
LTROLI,
Total Lumber 8,726,580.30
9,942,777.17

Schedule 1.3
Contracts
Each of the Leases set forth in Schedule 1.7
Uniform contract with UniFirst

Schedule 1.5
Permits
COVE CITY — Cove City Wood Preserving
• EPA ID # - NCD003197704
• Storm Water Permit — NCS000456/SW7040514 (Pond)

Vendor Invoice Date Amount Status Date Pd.
Cherry Energy 12/28/2017 $268.49 Unpaid Diesel fule purchased 12/28 - post inventory
$ 268.49

ftm Cam
NgUral C� Lease 4
DggiptiGn
Lessor
Start Rate
Term
Lease ind
In
t
Lift truck 007
"' F'` i
60721 8697019-008
1007EO1913K
NMHG
11/1/2012
72
10/31/2018
$3,071.92
Lift truck o07
R ``
60721 86970194)07
1007EO1914K
NMHG
11/1/2012
72
10/31/2018
$3,304,10
Lift truck 007
'ii ty
60721 8697019-001
J007E017051
NMHG
3/31/2012
72
3/30/2018
$2,670.65
Lift truck 007
,R"`>;ir
60721 8697019-014
K007EO2096M
NMHG
12/1/2014
72
11/29/2020
$2,135.22
Auto 007
iR i
59105 2266VC Leonard Byrd
2015 Ford F-150
Enterprise
4/1/2016
48
3/31/2020
$685,25

f
�
•
1
t
1.
'.•1
Y
14
S �
'

FMA Division of enemy'; Mineral & Land Resource's
_.,�„�. rl.:�nd tt.tli � �eetinn/Stormtr':tterItermittiri
d� A�
NCDENRNational Pall>itant Discharge. Elimination System
PERMIT NAME/OWNERSN[P''CHANGE FORM.
FOR AGENCY USE ONLY
Dale Received
Your
Month
-Dal
I. Please enter lilt permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
0 10
11. Permit status jEiLor to requested change..
a. Permit issued to (company name): Cove ChY Wood Press ruing Inc
b. Person legally responsible for permit: Jane ]-louse
First N-i 1 Last
Director. Clis
't'itic
11065 Old Fhti : 70 ,]Vest
1'ernYil ttt�tt[u,r 1�It�itittg.ritldresy-_
Cove Cily NC 28523
Cit}' St,uc %ip
[phone] ( )
i'IionG Far
c: Facility name.(disch.irgt ): Cave City Wood 'Preserying lne
d. Facility address: 11065 Old F wt o 70 W6t
Address
Cove City NC 28523
01V Mate - Zip
c . 1=acility contact pCfSOlI: .lane House (RQ ) 664-4014
First / Ml'1 [-;is( t'har3u
I l I. Please provide the following for the requested change (revised permit).
u. Request for change is a result of- ❑ Change in ownersliip of dw facility
® Nanic change of'the'fiicility or owner
ff miller plccise e ploiu:
b. Permit issued to (company flame):
c. Person legally responsible for permit:
d. Facility name (dischnfge):
C. Facility address:
f. Facility cotititct person:
Cttl e er. cif Cove. City, I_LC
Josh Adkins
First NI 1..tsi
I-hs Director
Title
1.065•01d I-Iwv 70 West
Permit I.Jolder Klailing Address
Cove City
NC 28523
City
Siale !ip
803) 566-3270
judkins u,culpcp'cr�vood-cniii
111tone
1 Rmatl'Address
Culpeper
cif Clive City. L L,C:
^
11,065 Old,l-Iwy70 West
Addrwss
Cove City
NC 28523
C:ily
State Zip
Josh
Adkins
First
N11 ]Nast
803 566-32,70__jadkiiis@cuIpt:perwood.com
Pbol e. Addrey5.
IV. Permit contact information (if different From the person legally resptins.ible for the permit)
Revised Jan. 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact:.
First Nit I ::Isl
Title
Nlzjiling lVldres
Cily slat. Zip
}
Phone 1:-snail Address
V. Will the permitted facility continue to conduct the same industr6il activities conducted prior
to this ownership or name change?
Yes
❑ i�'o (��lcasceslilain}
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITENW
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the -transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required loran ownership change request. Articles of incorporation are
not sufficient fear an�owrtership change.'
`rhe certircations.below must be completed and signed by both the permit bolder prior io the change, and
the new applicant in the: case: of'an ownership change request. Fora name char a request, the signed
Appllcani's Certification 14spffi6ent.
PERM.IT'TEE CERTIFICATION (Permit holder prier to ownership changej:
1, Jane (.louse, .•thirst that this application fora name/ownership change has been reviewed and 1s accurate
and complete to the best ofniy kno"Medge. 1 understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
A,—r, VA a., I I C) - I
Signature ^Kato
A ),LlCANTCERT1 FICATION
1, Josh Adkins, attest that this application for a name/ownership change has been reviewed and is accurate
and coniplcte to,the best of m}• know.ledge:. I understand that if all required parts of this application are. licit
completed and that if all required supoorting inforriiaticin is not included, this application package will be
returned as incomplete..
Signature Date
PLEASE SEND TIIE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Miperal and Land Re.sop.rccs.
Stormwatcr Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27090-1.612
Revised Jan: 27, 2014