NCS000003_Supplemental Info Review_20200730

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/30/2020 10:16:58 AM (Supplemental Submittal)
Submit by Gwinn, Matt 8/3/2020 3:13:12 PM (Supplemental Info Submittal)
• The task was assigned to EADS\mbgwinn 7/30/2020 10:16 AM

Submittal Dated: 7/30/2020
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 urolect.
D# * Perait Nurrber
NCS000003
Examples: SWxxxxxxx, NCacxxxxx, or NCSxxxxxx
Facility Name:* Elementis
County: New Hanover
Name: Sean Coury
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
07302020 Elementis Stormwater DMR -
456.17KB
NCS000003. 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, permt applications, permits, effluent data, inforrretion required by MODES application forrrs provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Stormwater DMR for Permit NCS000003 1 st half of 2020
* 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
• I intend to electronically sign and submit the Supplemental Information form."

Full Name:* Sean Coury
Signature:
,ter COV�-r
Date Submitted: 07/30/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
NCS000003
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Matt GWnn - eads\mbgWnn
Review Date * 08/03/2020