NCG160104_Supplemental Info Review_11/15/2019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 11/15/2019 11:51:12 AM (Supplemental Submittal)
Submit by Strickland, Shane 11/15/2019 12:18:28 PM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 11/15/2019 11:51 AM

Submittal Dated: 11/15/2019
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 suDDly the Derrrit nunber for this Drolect.
D# * Perrrit Nurrber
NCG160104
Examples: SWxxxxxxx, NCa <xxxxx, or NCSxxxxxx
Facility Name:* APAC Atlantic Hendersonville
County: Henderson
Name: Donald Mason
Vft is subrritting the inforrretion?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach docurrent
DOC1 1 1519-11152019114746.pdf 664.96KB
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 inforrretion cannot be claimed as confidential: the narre and address of any permt applicant or
pernittee, perrrit applications, perrrits, effluent data, information required by WCM application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Outfall locations for APAC Atlantic Hendersonville Asphalt Plant to correct incorrect location and receiving water in
NCDEQ records
* V By checking the box and signing box below, I certify that:
• 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:* Donald Mason
Signature:
Date Submitted: 11/15/2019

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
NCG160104
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Shane Strickland - eads\sstrickland9
Select Reviewing Office*
Asheville Regional Office — 828-296-4500
Select RO Reviewer:*
[e-mail]