SW3201002_Supplemental Info Review_20210106

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/6/2021 12:51:20 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 1/7/2021 7:51:59 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 1/6/2021 12:51 PM

Submittal Dated: 1/6/2021
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 urolect.
D# * Perrrit Nurrber
SW3201002
Examples: Sftxxxxxx, NC Gxxxxxx, or NCSxxxxxx
Facility Name:* 7-Eleven Long Ferry Road
County: Rowan
Name: Jonathan Woodard
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
200 - 7-11 Long Ferry - Geotech Report. pdf 3.67MB
100- 7 Eleven Long Ferry Road Construction
48.22MB
Drawings 210105.pdf
300 - 7-Eleven Long Ferry Road SIA - 210106.pdf 18.11 MB
400 - Response to Comment Letter.pdf 516.78KB
500 - send original - SuppEZ - sealed.pdf 1.42MB
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 perrrit applicant or
perrrittee, perrrit applications, permits, effluent data, inforrretion required by NR7ES application forms provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Construction Drawings
Geotech Report
SIA
Response to Comment Letter
SuppEZ - Signed
SWU Application - Signed

* 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:* Jonathan Woodard
Signature:
Date Submitted: 01/06/2021

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW3201002
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Review Date * 01/07/2021