NCG030213_Supplemental Info Review_5/28/2020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/28/2020 4:10:48 PM (Supplemental Submittal)
Submit by Strickland, Shane 5/29/2020 10:09:08 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 5/28/2020 4:10 PM

Submittal Dated: 5/28/2020
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
NCG030213
Exarrples: SWxxxxxxx, NCa <xxxxx, or NCSxxxxxx
Facility Name:* Mitek Edenton
County: Chowan
Name: Ryan Cook
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
NCG030213 Jan -June 2020.pdf 61.23KB
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 I FDM application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
NCG030213 Storm\Aater Discharge Monitoring Report for Jan -June 2020 Sample Period
* 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:* Ryan Ray Cook
Signature:
Date Submitted: 5/28/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
NCG030213
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Shane Strickland - eads\sstrickland9
Select Reviewing Office*
Washington Regional Office — 252-946-6481
Select RO Reviewer:*
[e-mail]