SW4190901_Supplemental Info Review_1/20/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/20/2020 5:34:35 PM (Supplemental Submittal)
Submit by Strickland, Shane 1/21/2020 11:56:28 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 1/20/2020 5:34 PM

Submittal Dated: 1/20/2020
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Existing Project Information:
Rease suDDly the Derrrit nunber for this urciect.
D# * Perait Nurrber
SW4190901
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* O'Reilly Auto Parts Lexington, NC #3
County: Davidson
Name: Dylan Gideon
Vft is subrritting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach docurrent
LexingtonNC3-Final-Civil sheets 12-16-19.pdf 23.31 MB
Operation & Maintenance Agreement (XG3).pdf 1.12MB
SuppEZ-2018-Version-2.1.1-2-Signed.pdf 542.31K13
NCDEQ Stormwater Response Letter.pdf 644.92KB
Stormwater Report - Auto Table(with Appendix) 01-
2.57MB
08-2020 Small.pdf
Only pdf files are accepted.
Please alert us to any confidential information contained in the uploaded documents.
Uploads contain r NO
Confidential r YES
Information * NOTE The following information cannot be clairred as confidential: the narre and address of any pernit applicant or
perrrittee, perrrit applications, permits, effluent data, inforrretion required by NR7ES application forrrs provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Attached are the items requested for review for the O'Reilly Auto Parts in Lexington, NC
* V By checking the box and signing box below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this Supplemental Information form is a "transaction" subject to Chapter 66, Article 40 of the
NC General Statutes (the "Uniform Electronic Transactions Act")

I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Dylan Gideon
Signature:
� � ��, : �&,q P
Date Submitted: 1/20/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW4190901
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Winston-Salem Regional Office — 336-776-
9800
Select RO Reviewer:*
[e-mail]