NCG030589_Supplemental Info Review_1/28/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/28/2020 11:07:16 AM (Supplemental Submittal)
Submit by Strickland, Shane 1/28/2020 11:35:53 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 1/28/2020 11:07 AM

Submittal Dated: 1/28/2020
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# * Fbrrrit Nurrber
NCG030589
Examples: SWxxxxxxx, NCa <xxxxx, or NCSxxxxxx
Facility Name:* Elkay Plumbing Products
County: Robeson
Name: Dustin Canady
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
2019 DMR Report.pdf 193.18KB
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 perrrit applicant or
pernittee, perrrit applications, perrrits, effluent data, information required by I FDES application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Attached is the Discharge Monitoring Report for the second sample period of 2019 here at Elkay Plumbing Products.
I am also sending a paper copy of this report via certified mail. The original "wet' copy will soon follow in the next few
days as I wait for my plant manager to return to the facility so I can get his wet signature, instead of this version in
which was scanned and sent to him. He then signed this report and scanned it back to me.
* 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');
• 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:* Dustin Craig Canady
Signature:
40a,zewa 9
Date Submitted: 1/28/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
NCG030589
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Shane Strickland - eads\sstrickland9
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Select RO Reviewer:*
[e-mail]