NCG170218_Supplemental Information_20211007

. ,DENC Stormwater Supplemental
pp tol
Information Upload
Fields marked with an asterisk * are required.
NOTE: Do not use this form to upload industrial stormwater Data Monitoring Reports
(DMRs). Please use this DMR Upload form instead.
Permit Information:
Please provide specific permit details below.
What Type of Choose one -
Permit? * @ NPDES Industrial or MS4 Permit
0 State Stormwater (Post -Construction) Permit
Q Other
Permit Number* NCG170000
Begins with "SW", "NCG", or "NCS"
Post -construction projects in the 20 coastal counties are reviewed by the regional office, and other
projects are reviewed by the Central Office. To see counties handled by each coastal office, view
information for the Wilmington Regional Office or Washington Regional Office. Be sure to choose
the office below that matches the one listed in your confirmation email.
Facility Name* Shuford Yarns, LLC
For NPDES permits
Owner/Operator* Shuford Yarns, LLC
County: Catawba
Submitter Beth Anderson
Name: * Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 704-477-8825
Additional E-mail (optional)

iE� NC Stormwater - Supplemental Information Upload
Fields marked with an asterisk *are required.
NOTE.- Do not use this form to upload Industrial stormwater Data Monitoring Reports (DMRs). Please use this
DMR Upload fonn instead.
Permit Information:
Please provide specific permit details below.
...... ... ... . I.... . ... .. .......... .1 . ..... ­.." .................... ..... . . ...... ................. . .. .. .. . . .... ...... . ....... ...... . . . . ....... ... .... ... . ......... ..
What Type of Permit? choose one:
@ NPDES Industrial or M84 Permit
0 State Stormwater (Post -Construction) Permit
0 Other
Permit Number* NCG170000
Begins with "SW'. "NCG". or "NCS"
Post -construction projects in the 20 coastal counties are reviewed by the regional office, and other projects are reviewed
by the Central Office. To see counties handled by each coastal office, view information for the Wilmington Regional
Office or Washington Regional Office. Be sure to choose the office below that matches the one listed in your
confirmation email.
.I......'... ... .. ... .......... ...................... . ... ....... ..... I ............. ......... . ........................... . ....... .......... . . .. .... .. ... .... .... ...... ....... .......... .... .... . .... ..... ................. .... .... .... ... ..... .. ...... .. . . ... ...
Facility Name* Shuford Yams, LLC
For NPDES permits
owner/Operator* Shuford Yarns, LLC
County: Catawba
Submitter Name:* Beth Anderson
Who is submitting this information?
E-mail Address: [e-mail]
Phone Number* 704-477-8825
Additional E-mail for (Optional)
Submittal
Confirmation:
NPDES Permit Information Uploads
Choose rite type and upload attachment
.. .... ....... ........ ... ..... .
File Type* Representative Outfau status Renewal Request
File Upload* Click the upload button, or drag and drop files to attach
NPDES-ROS Request-20171026-DEMLR-SW - Remove... 142.66KB
Only PDF files are accepted.

Please alert us to any confidentfal information contained in the uploaded documents. Also, please do NOT
upload copies of checks with routing number Information,
Uploads contain Q NO
Confidential Q YES
Information �` NONE. The ►oiiowing information cannot be Maimed as confidential: the name and address of any permit applicant
or permittee, permit applicabons, permits effluent data, information -squired by NPOES apolication forms provided
by the Director inclusive of all forms and attachments (Ref 40 CFR 1221(b) and (a)l
Notes about the attachments:
* (D 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:* Beth Anne Anderson
Signature: *
Date Submitted: 10/07/2021