NCG020929_Supplemental Upload Form_20180430

WW "Arpplemental Information Upload Fon
Staff Review:
Updated ID#:
Updated Version:
Who needs a copy?*
NCG020929
1
V Central
Office
r Regional
Office
Select Reviewing Office*
Wilmington Regional Office — 910-796-7215
Central Office Reviewer:
Julie Ventaloro - eads\jwventaloro
Select RO Reviewer:*
[e-mail]
SUBMITTED PROJECT INFORMATION
Existing Project Information:
ID# NCG020929
Version: 1
Facility Name: Parker & Associates, Inc.
County: Onslow
Name: Timothy Stewart
Who is subnitting the inforrration?
Email Address: [e-mail]
Describe the attachments:
Please upload all files that need to be submitted.
Temp00003.PDF 819.36KB
Only pdf files are accepted.
Water Resources
ENVIRONMENTAL QUALITY

fJ By
checking
the
box
and
signing
box
below,
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
• I intend to electronically sign and submit the Supplemental Information form.
Full Name: Timothy Stewart
Signature:
R -"—r* t - 5 �& e fG-
Date Submitted: