WM0100489_Permit Signature Documentation_20210427

Certificate Of Completion
Envelope Id: C3683F2F16194ECDB0B24BB9DDD66C2A Status: Completed
Subject: Please DocuSign: WM0100489 Monitoring Well Construction Permit.pdf
Source Envelope:
Document Pages: 2 Signatures: 2 Envelope Originator:
Certificate Pages: 1 Initials: 0 Brett Laverty
AutoNav: Enabled
EnvelopeId Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
217 W. Jones Street
Raleigh, NC 27699
[e-mail]
IP Address: 149.168.204.10
Record Tracking
Status: Original
4/27/2021 1:20:57 PM
Holder: Brett Laverty
[e-mail]
Location: DocuSign
Security Appliance Status: Connected Pool: StateLocal
Storage Appliance Status: Connected Pool: North Carolina Department of Environmental
Quality
Location: DocuSign
Signer Events Signature Timestamp
G. Landon Davidson
[e-mail]
Asheville Regional Office, Regional Supervisor
DEQ, Division of Water Resources, Water Quality
Regional Operatoins
Security Level: Email, Account Authentication
(None)
Signature Adoption: Uploaded Signature Image
Using IP Address: 149.168.204.10
Sent: 4/27/2021 1:21:53 PM
Viewed: 4/27/2021 1:27:15 PM
Signed: 4/27/2021 1:28:40 PM
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp
Certified Delivery Events Status Timestamp
Carbon Copy Events Status Timestamp
Witness Events Signature Timestamp
Notary Events Signature Timestamp
Envelope Summary Events Status Timestamps
Envelope Sent Hashed/Encrypted 4/27/2021 1:21:53 PM
Certified Delivered Security Checked 4/27/2021 1:27:15 PM
Signing Complete Security Checked 4/27/2021 1:28:40 PM
Completed Security Checked 4/27/2021 1:28:40 PM
Payment Events Status Timestamps