NCS000209_Supplemental Info Review_20201020

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/20/2020 3:33:48 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 10/22/2020 12:37:08 PM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 10/20/2020 3:33 PM

Submittal Dated: 10/20/2020
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# * Perait Nurrber
NCS000209
Examples: SWxxxxxxx, NCa mxxx, or NCSxxxxxx
Facility Name:* Haynes International dba Haynes Wlre
Company
County: Henderson
Name: ANGELA BECK
Mo is subaitting the inforrration?
Email Address:* [e-mail]
Please upload all files that need to be submited.
aick the upload button or drag and drop files here to attach document
9-18-20 Sampling DMR.pdf 973.21 KB
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 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:
Completed storm water discharge outfall monitoring report attached
* 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:* ANGELA BECK
Signature:
Date Submitted: 10/20/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
NCS000209
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Aana Gamble - eads\acgamble
Review Date * 10/22/2020