NCG080607_Supplemental Info Review (ROS Renewal)_20210917

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/17/2021 1:31:35 PM (Supplemental Submittal)
Submit by Georgoulias, Bethany A 3/29/2022 4:50:51 PM (Supplemental Info Submittal)
P ROS recorded in BIMS for outfall 005 and monitoring suspensions added for other outfalls.
• Georgoulias, Bethany A reassigned the task to Georgoulias, Bethany A 3/23/2022 9:56 AM
• Georgoulias, Bethany A reassigned the task to DEMLR SW Admin 2/17/2022 11:07 AM
P Disregard - just reassigning to Team
• Reese, Deborah W assigned the task to Reese, Deborah W 2/17/2022 9:32 AM
• Georgoulias, Bethany A reassigned the task to DEMLR SW Admin 2/16/2022 5:15 PM
• The task was assigned to McCoy, Suzanne 9/17/2021 1:31 PM

Submittal from 9/17/2021
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*
NCG080607
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?
e Central Office
*
Washington Regional Office (Attn: Carl Dunn)
Wilmington Regional Office (Attn: Christine Hall)
.................................................
Facility Name*
Owner/Operator*
NC Air Guard
For NPDES permits
Sam Ingram
County:
Mecklenburg
Submitter Name: *
Sam Ingram
Who is submitting this information?
E-mail Address:*
[e-mail]
Phone Number*
704-391-4327
Additional E-mail for (Optional)
Submittal
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
NC Air Guard ROS-Renewal-Certification-Form-
2021-v3-fillable Sept 2021.pdf
Rep Outfall Status Chlt_March_2010.pdf
Only PDF files are accepted.
631.87KB
393.55KB

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:
* 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 Upload form.
Full Name:* Sam Ingram
Signature:
d a
Date Submitted: 09/17/2021

Initial Review
Verify Permit No.* IMPORTANT. REVIEWER SHOULD VERIFY and revise here if necessary.
NCG080607
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
Review Date* 03/29/2022