Crawford Townes - 5/3/2018 7:27:57 AM

Water Resources
ENVIRONMENTAL QUALITY
Staff Review:
Updated ID#:
Updated Version:
Who needs a copy?*
SW5180301
1
17 Central
Office
r Regional
Office
Select Reviewing Office*
Raleigh Regional Office — 919-791-4200
Central Office Reviewer:
Julie Ventaloro - eads\jwventaloro
Select RO Reviewer:*
[e-mail]
SUBMITTED PROJECT INFORMATION
Existing Project Information:
I D# SW5180301
Version: 1
Facility Name: Crawford Townes
County: Franklin
Name: Chase Massey
Who is subrritting the inforrration?
Email Address: [e-mail]
Describe the attachments:
Signed/Sealed supplement form
Please upload all files that need to be submitted.
Appx. J_Supplement Form Signed.pdf 211.28KB
Only pdf files are accepted.

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: Chase Massey
Signature:
Date Submitted: