SW3140802_Supplemental Info Review_8/22/2019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/5/2019 1:27:39 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 8/22/2019 1:39:26 PM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 8/22/2019 11:16 AM

Submittal Dated: 8/22/2019
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 supply the perrrit nunber for this project.
D# * Permit Namber
SW3140802
Exarrples: SWxxxxxxx, NOCaaxxxx, or NOSxxxxxx
Facility Name:* GOLDMINE CONVENIENCE CENTER
County: Union
Name: Pam Brinkley
Who is subrritting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
tick the upload button or drag and drop files here to attach document
SIGNED SPF7-Permit-Minor-Mod-Form-
80.88KB
GoldmineConvCtr 8-5-19.pdf
Goldmine Conv Cntr Revised Footprint 7-15-19.pdf 11.86MB
Only pdf files are accepted.
Describe the attachments:
Application for Minor Modification to SW3180802
Revised plans for Goldmine Convenience Center
* 7 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
• I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Pamela A. Brinkley

Signature:
Date Submitted: 8/5/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3140802
Who needs a d Central Office
copy?* F Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]