SW4210302_Supplemental Info Review_20210324

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/24/2021 3:18:56 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 3/25/2021 8:39:17 AM (Supplemental Info Submittal)
• The task was assigned to EADS\smccoy2 3/24/2021 3:18 PM

Submittal Dated: 3/24/2021
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 Drciect.
D# * Fbrnit Nurrber
SW4210302
Exarrples: SWxxxxxxx, NC Gxxxxxx, or NCSaxxxx
Facility Name:* ASU Poplar Grove Child Development Center
Expansion
County: Watauga
Name: Michael Cain
Vft 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
2021-03-10 StormFilter O&M Agreement.pdf 72.34KB
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 NR7ES application forrrs provided by
the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
StormFilter Operation and Maintenance Agreement
* 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:* Michael Cain
Signature:
Date Submitted: 03/24/2021

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
SW4210302
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Review Date * 03/25/2021