SW3210101_Supplemental Info Review_20210429

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/29/2021 12:51:16 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 4/29/2021 1:49:50 PM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 4/29/2021 12:51 PM

Submittal Dated: 4/29/2021
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 urolect.
D# * Perait Nurrber
SW3210101
Examples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* The Glenns
County: Union
Name: Michael Duval
Vft is subrritting the inforrretion?
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
The Glenns_AGREEMENT_operation and
3.39MB
maintenance -Union County_42621.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 inforrretion 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:
O&M Agreement
* V By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o 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)
o 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');
o 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:* Michael Duval
Signature:
e aw10"4L
Date Submitted: 04/29/2021

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW3210101
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Review Date * 04/29/2021