NCG060402_Supplemental Info Review_5/8/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/8/2020 9:33:17 AM (Supplemental Submittal)
Submit by Strickland, Shane 5/13/2020 6:46:20 PM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 5/8/2020 9:33 AM

Submittal Dated: 5/8/2020
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 Drolect.
D# * Fbrnit Nurrber
NCG060402
Examples: SWxxxxxxx, NCa <xxxxx, or NCSxxxxxx
Facility Name:* Novo Nordisk DAPI-US
County: Johnston
Name: Jeremy Keltner
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
NCG060402-Period 1-2020. pdf 211.12 KB
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 claimed as confidential: the narre and address of any permt applicant or
pernittee, pernit applications, permits, effluent data, information required by I FDES application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
NCG060402 - Storm water Sampling DMR for Period 1 -2020
* W 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');
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
• I intend to electronically sign and submit the Supplemental Information form."

Full Name:* Jeremy Keltner
Signature: _
Date Submitted: 5/8/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
NCG060402
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Shane Strickland - eads\sstrickland9
Select Reviewing Office*
Raleigh Regional Office — 919-791-4200
Select RO Reviewer:*
[e-mail]