Canisteo - 9/11/2017 10:08:27 AM

ww "Arpplernental Information Upload Fon
Staff Review:
Updated ID#: SW3170604
Updated Version: 2
Who needs a copy?* 17 Central Office
r Regional Office
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Central Office Reviewer:
Robert Patterson - eads\rdpatterson
Select RO Reviewer:*
[e-mail]
Submitted Information:
What type of project is this?
f• E)asting Project
r Pre -Application Information
Existing Project Information:
ID# 03170604
Version: 2
Water Resources
ENVIRONMENTAL QUALITY
Facility Name: Canisteo
County: Union
Name: Josh Breed
Mo is subrritting the information?
Email Address: [e-mail]
Describe the attachments:
Attached is the updated sheet 3 of the SWU-101 form for the Canisteo project with revisions based on our
conference call this morning, 9/11/17.
The permit number for this project is SW3170604. It would not let me place the entire permit number into the entry
field because it is 9 digits and not 8.
Thank you,
Josh Breed

Please upload all files that need to be submitted.
635-002 - Canisteo - Updated SWU-101 Sheet 3 - 091117.pdf 68.32KB
Only pdf files are accepted.
W 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
o I intend to electronically sign and submit the Supplemental Information form.
Full Name: Josh Breed
Signature:
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