SW4190902_Designer Certification_20210225

State Stormwater Permit
Permit No. SW4190902
Circle K Stores, Inc.
Circle K - R&R 2723188
Forsyth Count
Designer's Certification
1, Ri,:r- 13.114, r- , as a duly registered PF- in the
State of North Carolina, having been authorized to observe (periodically/ weekly/
full time) the construction of the project,
(Project Name)
for L. .-t _ 14 (Project Owner) hereby state that, to the
best of my abilities, due care and diligence was used in the observation of the project
construction such that the construction was observed to be built within substantial
compliance and intent of the approved plans and specifications.
Noted deviations from approved plans and specification:
SEAL
Signature a,1+0�,H CARO'''�.,
Registration Number 22 S 3 a ?Zak y{9
S •_
Date
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Submit to: NCDEQ-DEMLR Winston-Salem Regional Office
450 W. Hanes Mill Rd., Ste 300
Winston-Salem, NC 27105
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