NCS000508_Supplemental Info Review_20200122

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/22/2020 2:32:30 PM (Supplemental Submittal)
Submit by Strickland, Shane 1/23/2020 9:44:15 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 1/22/2020 2:32 PM

Submittal Dated: 1/22/2020
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
NCS000508
Examples: SWxxxxxxx, NCacxxxxx, or NCSxxxxxx
Facility Name:* Piedmont Triad International Airport
County: Guilford
Name: Richard Darling
Vft is subrritting the infornation?
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
20E1.pdf 282.5KB
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 infornation cannot be claimed as confidential: the nave and address of any perrrit applicant or
perrrittee, 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:
First 2020 Deicing Event DMR
* W 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');
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:* Richard Darling
Signature:
Date Submitted: 1/22/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
NCS000508
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Shane Strickland - eads\sstrickland9
Select Reviewing Office*
Winston-Salem Regional Office — 336-776-
9800
Select RO Reviewer:*
[e-mail]