SW3190901_Supplemental Info Review_10/23/2019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/23/2019 12:08:16 PM (Supplemental Submittal)
Submit by Strickland, Shane 10/24/2019 11:00:58 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 10/23/2019 12:08 PM

Submittal Dated: 10/23/2019
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 nun-ber for this project.
D# * Flarrrit Ninber
SW3190901
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Dollar General - Salisbury Old Concord Road
County: Rowan
Name: Jennifer Edwards
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
tick the upload button or drag and drop files here to attach document
DG_SALISBURY_REVISED_SHEETS.pdf 3.53MB
RESPONSE_LETTER.pdf 190.65KB
STORMWATER MANAGEMENT_app.pdf 1.39MB
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 nacre and address of any perrrit applicant or
perrrittee, permit applications, permits, effluent data, information required by Wl� application forms provided by
the Director inclusive of all forms and attachn ents [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Revised sheets only, and the revised page of the application, and a response letter
* W 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 Supplemental Information 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');
• 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 Supplemental Information form."
Full Name:* Jennifer Edwards
Signature:
07MA'y�L(�ilz!?X!!4
Date Submitted: 10/23/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3190901
Who needs a d Central Office
copy?* F Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]