NCG050129_Supplemental Info Review (Qual Mon Report)_20240819

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 8/19/2024 4:31:52 PM (Supplemental Submittal)
Accept by bethany.georgoulias 8/20/2024 12:35:09 PM(Supplemental Info Submittal)
•Qualitative Monitoring Report. Permit number corrected to NCG050129(not NCS).
• The task was assigned to DEMLR Post-Construction Team 8/19/2024 4:31:53 PM
• bethany.georgoulias assigned the task to bethany.georgoulias 8/20/2024 12:33:21 PM

pEQNC Stormwater - Supplemental Information Upload
Submittal from 8/19/2024
Permit Information:
Please provide specific permit details below.
...................................................................................................................................................................................................................................................................................................................................................................................................
What Type of Permit? Choose one:
* 0 NPDES Industrial or MS4 Permit
0 State Stormwater(Post-Construction)Permit
Other
Permit Number* NCS050129
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* Forbo Movement Systems
For NPDES permits
Owner/Operator* William Graham
County: Mecklenburg
Submitter Name:* William Graham
Who is submitting this information?
E-mail Address:* [e-mail]
Phone Number* 9804518950
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* Monitoring Information
File Upload Click the upload button,or drag and drop files to attach
Qualitative Monitoring Report_1-25-24.pdf 94.03KB
Only PDF files are accepted.
....................................................................................................................................
Is this project funded QQ No
with ARPA grant Q 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:
o I have given true,accurate,and complete information on this form;
o 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');
o 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:* William Graham
Signature:
V"11YUrrar e-1 to 1?1W
Date Submitted: 08/19/2024

Initial Review
Verify Permit No.* IMPORTANT:REVIEWER SHOULD VERIFY and revise here if necessary.
NCG050129
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* 08/20/2024