NCG030717_Supplemental Info Review (ROS Renewal)_20211005

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/5/2021 12:24:34 PM (Supplemental Submittal)
Submit by Georgoulias, Bethany A 3/15/2022 10:25:56 AM (Supplemental Info Submittal)
• Georgoulias, Bethany A assigned the task to Georgoulias, Bethany A 3/15/2022 10:12 AM
• Georgoulias, Bethany A reassigned the task to DEMLR SW Admin 2/16/2022 5:18 PM
• The task was assigned to McCoy, Suzanne 10/5/2021 12:24 PM

Submittal from 10/5/2021
Permit Information:
Please provide specific hermit details below.
What Type of Permit? Choose one:
*
• NPDES Industrial or MS4 Permit
State Stormwater (Post -Construction) Permit
Other
Permit Number*
NCG030717
Begins with "SW", "NCG", or "NCS'
What DEQ Office is
Reviewer: Please correct if misidentified, close this review form, and reassign task to the appropriate contact.
the Primary Contact?
• Central Office
*
Washington Regional Office (Attn: Carl Dunn)
Wilmington Regional Office (Attn: Christine Hall)
Facility Name* Jim Myers and Sons, Inc.
For NPDES permits
Owner/Operator* Jlm Myers and Sons, Inc.
County: Mecklenburg
Submitter Name: * Derek Fleetwood
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 704-554-8397
Additional E-mail for [e-mail]
Submittal (Optional)
Confirmation:
NPDES Permit Information Uploads
Choose file type and upload attachment (Reviewer may remove unnecessary submittals)
File Type* Representative Outfall Status Renewal Request
File Upload Click the upload button, or drag and drop files to attach
JMS NPDES permit amendment 10.12.20 (002).pdf 67.37KB
ROS-Renewal.pdf 525.45KB
Only PDF files are accepted.
Uploads contain • NO
Confidential YES
Information* NOTE: The following information cannot be claimed as confidential: the name and address of any permit applicant
or permittee, permit applications, permits, effluent data, information required by NPDES application forms provided
by the Director inclusive of all forms and attachments [Ref. 40 CFR 122.7(b) and (c)].

Notes about the attachments:
ROS Renewal Request along with approval for initial ROS have been attached.
* 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')
o 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 Upload form.
Full Name:* Derek Lewis Fleetwood
Signature:
Date Submitted: 10/05/2021

Initial Review
Verify Permit No.* IMPORTANT. REVIEWER SHOULD VERIFY and revise here if necessary.
NCG030717
Who needs a Copy?* Reviewer selections will only be required for offices checked here.
Central Office Staff
Regional Office Stormwater Contact
State Stormwater RO Staff
No Copy Needed
Central Office Reviewer:*
Notifies CO Staff with Email
Brittany Carson
Any Comments or ROS entered into BIMS; monitoring suspension on 002 entered effective COC
Added Info for CO renewal date.
Staff Reviewer?
Review Date* 03/15/2022