Tractor Supply Co. - 2/15/2018 2:42:00 PM

PMW"`-WW "A
upplemental Information Upload Fon
Staff Review:
Updated ID#: sw6180101
Updated Version: 1
Who needs a copy?* 17 Central Office
r Regional Office
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Central Office Reviewer:
Rick Riddle - eads\rlriddle1
Select RO Reviewer:*
[e-mail]
SUBMITTED PROJECT INFORMATION
Existing Project Information:
ID# sw6180101
Version: 1
Facility Name: Tractor Supply Co.
County: Cumberland
Name: Triangle Site Design
Vft is subrritting the information?
Email Address: [e-mail]
Describe the attachments:
Plans and Calcs
Please upload all files that need to be submitted.
GraysCreek_Civil_1-31-18.pdf 9.01 MB
GraysCreekTSC—Calcs.pdf 5.01 MB
Only pdr files are accepted.
PF By checking the box and signing box below, I certify that:
Water Resources
ENVIRONMENTAL QUALITY
• 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: Cody Clawson
Signature:
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