NCG140484_Supplemental Info Review_20200817

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/17/2020 2:43:28 PM (Supplemental Submittal)
Submit by Gwinn, Matt 8/17/2020 3:03:27 PM (Supplemental Info Submittal)
• The task was assigned to Gwinn, Matt 8/17/2020 2:43 PM

Submittal Dated: 8/17/2020
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 supply the Derrrit nunber for this Drolect.
D# * Fbrait Nurrber
NCG140484
Exarrples: Swxxxxxxx, Wamxxx, or NCSxxxxxx
Facility Name:* McCarthy Buncombe County Concrete Batch
Plant
County: Buncombe
Name: Jacki Congleton, Terra Consulting, LLC
Mo is subaitting 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 document
NCG140484 Site Loaction Map and Site Plan .pdf 1.37MB
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 clairred as confidential: the narre and address of any pernit applicant or
perrrittee, pernit applications, permits, effluent data, inforrretion required by MODES application forrrs provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Location Map and Site Plan for McCarthy Buncombe County Concrete Batch Plant.
* 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:* Jacki Congleton
Signature:
Date Submitted: 08/17/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
NCG140484
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Paul Clark - eads\pbclark
Review Date * 08/17/2020