Food Mart - 6/11/2018 4:10:40 PM

WW "Arpplemental Information Upload Fon
Staff Review:
Updated ID#:
Updated Version:
Who needs a copy?*
SW3180102
2
V Central
Office
r Regional
Office
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Central Office Reviewer:
Rick Riddle - eads\rlriddle1
Select RO Reviewer:*
[e-mail]
SUBMITTED PROJECT INFORMATION
Existing Project Information:
ID# SW3180102
Version: 2
Facility Name: Food Mart
County: Catawba
Name: Nick Fitzgerald
Vft is submitting the information?
Email Address: [e-mail]
Describe the attachments:
Updated drawings and calculations certifying that the sand filter meets requirements of MDC 1.
Please upload all files that need to be submitted.
C5.0 DETAILS.pdf 1.1MB
Sand Filter Certification. pdf 108.58KB
Only pdr files are accepted.
Water Resources
ENVIRONMENTAL QUALITY

fJ By
checking
the
box
and
signing
box
below,
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
• I intend to electronically sign and submit the Supplemental Information form.
Full Name: Nicholas Fitzgerald
Signature:
Date Submitted: