GOLDMINE CONVENIENCE CENTER - 1/15/2019 8:57:16 AM

Submittal Dated: 1/15/2019
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 supply the perrrit nunber for this project.
D# * Permit Namber
SW3140802
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* GOLDMINE CONVENIENCE CENTER
County: Union
Name: Pamela Brinkley
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Qick the upload button or drag and drop files here to attach document
SW3140802_UnionCoGoldmine_ErosionCtrlPackag... 34AMB
SW3140802 UnionCoGoldmine StormwaterPermit... 32.57MB
Only pdf files are accepted.
Describe the attachments:
Per Suzanne McCoy's email to CEC on 1/14/19, we are submitting online the files for the Union County Goldmine
Convenience Center:
Stormwater Permit Modification package and accompanying Erosion Control Package.
These are the electronic files previously sent to DEQ via FedEx on 12/14/2018.
* V By checking the box and signing box below, I certify that:
• I have given true, accurate, and complete information on this form;
o 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:* Pamela A. Brinkley

Signature:
Date Submitted: 1/15/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3140802
Who needs a d Central Office
copy?* F Regional Office
Central Office Reviewer:
Rick Riddle - eads\rlriddle1
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]