WM0100491_Permit Signature Documentation_20210603

Certificate Of Completion
Envelope Id: 9FC6B3F179BC4285A14946F58C1A4B23 Status: Completed
Subject: Please DocuSign: Monitoring well permit shell.docx
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
6/3/2021 11:05:45 AM
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
Tim Heim
[e-mail]
DWR
DEQ
Security Level: Email, Account Authentication
(None)
Signature Adoption: Pre-selected Style
Using IP Address: 149.168.204.10
Sent: 6/3/2021 11:06:40 AM
Viewed: 6/3/2021 11:08:20 AM
Signed: 6/3/2021 11:08:26 AM
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 6/3/2021 11:06:40 AM
Certified Delivered Security Checked 6/3/2021 11:08:20 AM
Signing Complete Security Checked 6/3/2021 11:08:26 AM
Completed Security Checked 6/3/2021 11:08:26 AM
Payment Events Status Timestamps