20201194 Ver 1_401 Application_20200918

STATE
Staff Review Form
NORTH CAROLINA
£nWrcnmenrcl Qua fay
Updated September 4,2020
Staff Review
Does this application have all the attachments needed to accept it into the review process?*
6* Yes r No
ID#* Version* 1
20201194
Is this project a public transportation project?* (' Yes
r No
Is this a DOT ( Yes C No
project?*
Reviewer List:* Garcy Ward:eads\gpward
Select Reviewing Office:* Washington Regional Office-[phone]
Does this project require a request for payment to be sent?*
Yes
r
No

Project Submittal Form
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.
Project Type:* r For the Record Only(Courtesy Copy)
r New Project
✓ Modification/New Project with Existing ID
✓ More Information Response
✓ Other Agency Comments
r Pre-Application Submittal
✓ Re-Issuance\Renewal Request
✓ Stream or Buffer Appeal
Project Contact Information
Name: Kristi Lynn Carpenter for Chris Rivenbark
Who is submitting the information?
Email Address: [e-mail]
Project Information
Project Name: US 70 Improvements(U-5713 R-5777AB)
Is this a public transportation project?
a Yes
✓ No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
✓ Yes r No r Unknown
TIP#: WBS#:
U-5713 R-5777AB 50111.3.1
(Applies to DOT projects only)
County(ies)
Craven
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach document
Only pdf or kaz files are accepted.
Describe the attachments
or comments:
Original submitted via email.
Sign and Submit
rJ 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 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 online form."
Signature:
{# n Aea C',x r,c pre e.
Submittal Date: Is filled in automatically.