NCC230730_FRO Submitted_20230320

FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land -disturbing activity on one or more acres as covered by the Act before this form
and an acceptable erosion and sedimentation control plan have been completed and approved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.)
Part A.
1. Project NameWashington Solar, LLC
2. Location of land -disturbing activity: County ROCKINGHAM City or Township Reidsville
U S H WY 158 36.273628°-79.789828'
Highway/Street Latltude(decimal degrees) LOngltude(decimal degrees)
3. Approximate date land -disturbing activity will commence: 06/30/22
4. Purpose of development (residential, commercial, industrial, institutional, etc.): • Industrial
5. Total acreage disturbed or uncovered (including off -site borrow and waste areas): 37.40
6. Amount of fee enclosed: $3,800 . The application fee of $100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
Has an erosion and sediment control plan been filed? Yes ❑ Enclosed ❑x No ❑
Person to contact should erosion and sediment control issues arise during land -disturbing activity:
Name Ryan Brick E-mail [e-mail]
Phone: Office # 303-431-7895 Mobile # [phone]
Landowner(s) of Record (attach accompanied page to list additional owners):
John N. Hester III
Name Phone: Office # Mobile #
4511 DEERTRAIL DR
Current Mailing Address Current Street Address
NORTH CHESTERFIELD, VA 23234
City State Zip City State Zip
10. Deed Book No. 778 Page No. 821 Provide a copy of the most current deed.

Part B.
1. Company(ies) who are financially responsible for the land -disturbing activity (Provide a comprehensive list
of all responsible parties on accompanied page.) If the company is a sole proprietorship or if the landowner(s) is
an individual(s), the name(s) of the owner(s) may be listed as the financially responsible party(ies).
National Renewable Energy Corporation [e-mail]
Company Name E-mail Address
801 Wood Ridge Center Dr. Suite A 801 Wood Ridge Center Dr. Suite A
Current Mailing Address
Charlotte, NC 28217
Current Street Address
Charlotte, NC 28217
City State Zip City State Zip
Phone: office # 704-200-2914 Mobile #
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
R. Andrew Cox [e-mail]
Name of Registered Agent E-mail Address
801 Wood Ridge Center Dr. Suite A 801 Wood Ridge Center Dr. Suite A
Current Mailing Address Current Street Address
Charlotte, NC 28217 Charlotte, NC 28217
City State Zip City State Zip
Phone: Office # 704-200-2915 Mobile #
Name of Individual to Contact (if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Name of Individual to Contact (if Registered Agent is a company)

(c) If the Financially Responsible Party is engaging in business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
or his attorney -in -fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.
Mark Caddell
Type o print r3ame
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Signature
I Sanja C. Ryan
Executive Vice President - EPC
Title or Authority
6/27/22
Date
a Notary Public of the County of
Mecklenburg
State of North Carolina, hereby certifythat Mark Caddell appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this 27
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C-1 Seal
Notary Public
Mecklenburg
County
My Comm. Exp.
Z 10-21-2023 Q-
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day of J u ne 2022
Notary
My commission expires l b -021 -2U23

Continued from Items 9 & 10 in Part A of the Financial Responsibility/Ownership Form for multiple
owners. Attach copies of this page as needed to list all landowners.
Landowner 2 of Record:
William Shepherd Hester, II
Name
Phone: Office # Mobile #
1944 Rankin Mill Rd.
Current Mailing Address
Current Street Address
Greensboro, NC 27405
City State Zip
City State Zip
Deed Book No. 08E Page No. 299 Provide a copy of the most current deed.
Landowner 3 of Record:
Hugh Scott Hester, II
[phone]
Name
Phone: Office # Mobile #
812 Poplar Street
Current Mailing Address
Current Street Address
Reidsville, NC 27320
City State Zip
City State Zip
Deed Book No. 08E Page No. 299 Provide a copy of the most current deed.
Landowner 4 of Record:
Elisabeth Scott Daley
(757) 566 - 4530
Name
Phone: Office # Mobile #
9077 Marmont Lane
Current Mailing Address
Current Street Address
Williamsburg, VA 23188
City State Zip
City State Zip
Deed Book No. 08E Page No. 299 Provide a copy of the most current deed.
Landowner 5 of Record:
W. Edwin Gunn, Jr., Trustee under the Will of John Nicholas Hester Jr.
(336) 627-1 323
Name
Phone: Office # Mobile #
613c Business Park Dr.
Current Mailing Address
Current Street Address
Eden, NC 27288
City State Zip
City State Zip
Deed Book No. 70E Page No. 488 Provide a copy of the most current deed

Continued from Item 1 in Part 8 of the Financial Responsibility/Ownership Form for multiple parties.
Attach copies of this page as needed to list all financially responsible parties.
TBD
Company 2 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
TBD
Company 3 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
TBD
Company 4 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #
TBD
Company 5 Name
E-mail Address
Current Mailing Address
Current Street Address
City State
Zip
City
State
Zip
Phone: Office #
Mobile #