NCG020931_Supplemental Upload Review Form_5/25/2018

WW "Arpplemental Information Upload Fon
Staff Review:
Updated ID#:
Updated Version:
Who needs a copy?*
NCG020931
1
V Central
Office
r Regional
Office
Select Reviewing Office*
Raleigh Regional Office — 919-791-4200
Central Office Reviewer:
Bethany Georgoulias - eads\bagorgoulias
Select RO Reviewer:*
[e-mail]
SUBMITTED PROJECT INFORMATION
Existing Project Information:
ID# SW0000000
Version: 1
Facility Name: Whitley Borrow Pit (NCG020931)
County: Johnston
Name: T. Patrick Shillington
Who is subnitting the inforrration?
Email Address: [e-mail]
Describe the attachments:
Stormwater Plan Drawing
Please upload all files that need to be submitted.
Sheet 1- Stormwater Plan.pdf 963.57KB
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: Thomas Patrick Shillington
Signature:
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Date Submitted: