20150931 Ver 5_Modification_20180816

Action History (UTC-05:00) Eastern Time (US & Canada)
�brrrit by Carpenter,Kristi 8/16/2018 3:43:16 PM (Message Start Event)
Accept by Carpenter,Kristi 8/16/2018 3:44:02 PM (DOT project)
. The task was assigned to Carpenter,Kristi. The due date is: August 21, 2018 5:00 PM
8/16/2018 3:43 PM

Staff Review
i�#*
20150931
Version* 5
Is this project a public transportation project? *
Is this a DOT F Yes f No
project?*
Reviewer List:*
Select Reviewing Office:*
Submittal Type:*
Modifications
C•' Yes
�' No
Donna Hood:eads\drhood
Mooresville Regional Office - [phone]
Does this project require a request for payment to be sent? *
r
Yes
r•
No
Water Resources
ENVIRONMENTAL �UPLITV

Project Submittal Dated 8/16/2018
*
Please note: fields marked with a red asterisk beloware required. You will not be able to submit the form until all
mandatory questions are ans�red.
Project Type: �' New Project
C' Pre-Application Submittal
C' More Information Response
r Other Agency Comments
l' For the Record Only (Courtesy Copy)
New Project - Please check the new project type if you are trying to submit a new project that needs an official approval
decision.
Pre-Application Submittal - Please check the pre-application submittal if you just want feedback on your submittal and
do not have the e�ectation that your submittal will be considered a complete application requiring a formal decision.
More Information Response - Please check this type if you are responding to a request for information from staff and
you have and ID# and version for this response.
Other Agency Comments - Please check this if you are submitting comments on an ebsting project.
Project Contact Information
Name: Kristi Lynn Carpenter for Carla Dagnino
Who is subrritting the irrforrration?
Email Address: [e-mail]
Project Information
Project Name: I-77 HOT Lanes (I-3311C, I-5405, I-4750AA)
Is this a public transportation project?
�' Yes
�' No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
C' Ye�" No �' Unknown
TI P#: WBS#:
I-5405 45454.1.1
(Applies to DOT projects only)
County (ies)
Mecklenburg
Iredell
Please upload all files that need to be submited.
aick the upload button or drag and drop files here to attach docurrent
I-5405 I-77 HOT Mod Mecklenburg August 13
2.16MB
2018.pdf
Only pdf or krre files are accepted.
Describe the attachments:
Original submission via email.
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 AcY')
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 AcY');
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:
f� �/tr�j�s'N[.}��f-r�9�lllxt
Submittal Date: