NCG210136_Supplemental Info Review_20210322

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/22/2021 8:22:11 AM (Supplemental Submittal)
Submit by McCoy, Suzanne 3/23/2021 7:41:14 AM (Supplemental Info Submittal)
* Used wrong upload form.
• The task was assigned to McCoy, Suzanne 3/22/2021 8:22 AM

Submittal Dated: 3/22/2021
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 Drolect.
D# * Perrrit Nurrber
NCG210000
Examples: SWxxxxxxx, NCa <xxxxx, or NCSxxxxxx
Facility Name:* Columbia Forest Products
County: McDowell
Name: Jarrett Rhinehart
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
3-22-21 DWR Stormwater.pdf 628.68KB
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 perrrit applicant or
pernittee, perrrit applications, perrrits, effluent data, information required by I FDES application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Storm Water Discharge Outfall Monitoring Report
* 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:* Jarrett Rhinehart
Signature:
Date Submitted: 03/22/2021

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
NCG210136
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Michael Meloy - eads\mkmeloy
Review Date * 03/23/2021