20161131 Ver 2_DWR - 401 Staff Project Review Form_20171023

Water Resources
ENVIRONMENTAL �UPLITV
*
Please note: fields marked with a red asterisk beloware required. You will not be able to submit the form until all
mandatory questions are ans�red.
Project Information
ID#:
201611 Version:
31 2
Project Name: B-5345 - Replacement of Bridge No. 456 over Brush Creek on SR
2136 (Fleming Road)
County(ies):
Guilford
Contact Emails:
[e-mail]
[e-mail]
Project Folder Web Access
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Staff Review Documentation
Decision:* Approval Letter
Has your decision letter been uploaded into Laserfiche?*
�' Yes - Uploaded separately
C' Yes - Attaching it to this form
r No - Sent for signature (TPB Unit Only)
C' f�UA
Staff review documentation: (�) F�Forjpg only