Food Mart - 2/1/2018 4:19:43 PM

PMW"`-WW "A
upplemental Information Upload Fon
Staff Review:
Updated ID#: sw3180102
Updated Version: 1
Who needs a copy?* 17 Central Office
r Regional Office
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Central Office Reviewer:
Rick Riddle - eads\rlriddle1
Select RO Reviewer:*
[e-mail]
SUBMITTED PROJECT INFORMATION
Existing Project Information:
ID# sw3180102
Version: 1
Facility Name: Food Mart
County: Catawba
Name: William Pugh
Vft is subrritting the inforrration?
Email Address: [e-mail]
Describe the attachments:
Please upload all files that need to be submitted.
CIVIL PLANS-12-21-17.pdf
Only pdf files are accepted.
I7 By checking the box and signing box below, I certify that:
2.58MB
Water Resources
ENVIRONMENTAL QUALITY
• 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: William Pugh
Signature:
m&ff 14