NCG020935_Supplemental Upload Form_8/22/2018

Water Resources
ENVIRONMENTAL QUALITY
Staff Review:
Updated ID#: NCG020935
Updated Version: 1
Who needs a copy?* 17 Central
Office
r Regional
Office
Select Reviewing Office*
Fayetteville Regional Office — 910-433-3300
Central Office Reviewer:
Annette Lucas - eads\amlucas1
Select RO Reviewer:*
[e-mail]
SUBMITTED PROJECT INFORMATION
Existing Project Information:
ID# NCG020935
Version: 1
Facility Name: Fields Road Mine
County: Cumberland
Name: Russ Patterson
Vft is submitting the infon-re icn?
Email Address: [e-mail]
Describe the attachments:
Please upload all files that need to be submitted.
2018.08.08 FIELDS ROAD.pdf 8.79MB
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: O.F. 'Russ" Patterson, III
Signature:
Date Submitted: