SW1190801_Supplemental Info Review_20200604

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/4/2020 10:13:04 AM (Supplemental Submittal)
Submit by Strickland, Shane 6/5/2020 10:10:10 AM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 6/4/2020 10:13 AM

Submittal Dated: 6/4/2020
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 N irrber
SW 1190801
Exarrples: SWxxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* Leicester Fire Station
County: Buncombe
Name: Jacob Grieb
Vft is subrritting the information?
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
3827 C000 COVER-3827 C000 COVER.pdf 580.91 KB
SuppEZ Combined.pdf 277.3KB
SW-SWU-1 01 -Application 6-4-2020.pdf 540.27KB
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 claimed as confidential: the name and address of any perrrit applicant or
perrrittee, perrrit applications, permits, effluent data, information required by NRJES application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
electronic copies requested per email dated 06/03/2020.
* 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:* Jacob Grieb
Signature:
Date Submitted: 06/04/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW 1190801
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Review Date * 06/05/2020