SW5240501_Supplemental Info Review_20240814

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 8/14/2024 10:54:52 AM(Supplemental Submittal)
Accept by Jacob Beeker 8/14/2024 2:43:12 PM(Supplemental Info Submittal)
• The task was assigned to DEMLR Post-Construction Team 8/14/2024 10:54:52 AM
• Jacob Beeker assigned the task to Jacob Beeker 8/14/2024 2:40:09 PM

=DEQ •
Submittal from 8/14/2024
Permit Information:
Please provide specific permit details below.
................................................................................................................................................................................................................................................................................................................................................................................................
What Type of Permit? Choose one:
* NPDES Industrial or MS4 Permit
State Stormwater(Post-Construction)Permit
Other
Permit Number* SW5240501
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)
................................................................................................................................................................................................................................................................................................................................................................................................
Project Name* Gaston Concrete
Owner/Operator* Gaston Concrete, Inc
County: Franklin
Submitter Name:* Josh Crumpler
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 9194131704
Additional E-mail for (Optional)
Submittal
Confirmation:
State Stormwater (Post-Construction) Information Uploads
Choose file type and upload attachment(Reviewer may remove unnecessary submittals)
File Type* Supplement-EZ Form
File Upload Click the upload button,or drag and drop files to attach
Gaston SuppEZ-2020-Version-2.1.3-20201203
296.8KB
DEMLR-SW-Signed.pdf
Only PDF files are accepted.
File Type* O&M Agreement/Plan
File Upload Click the upload button,or drag and drop files to attach
0-M-EZ-20201215-2.1--3-.pdf 82.77KB
Only PDF files are accepted.

Is this project funded No
with ARPA grant Yes
funds?*
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');
cl I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature;AND
o I intend to electronically sign and submit the Supplemental Information Upload form.
Full Name:* Josh Crumpler
Signature:
Date Submitted: 08/14/2024

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
SW5240501
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
Jacob Beeker
Any Comments or
Added Info for CO
Staff Reviewer?
Review Date* 08/14/2024