SW3180903_Staff Review Form_11/6/2018 (2)

Submittal Dated: 11/6/2018
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are answered.
Existing Project Information:
Rease supply the perrrit nunber for this project.
D# * FL-rrrit Narrber
SW3180903
Exarrples: SWxxxxxxx, NOQaxxxx, or NOSxxxxxx
Facility Name:* Kewaunee Scientific
County: Iredell
Name: P. Scott Bell, PE
Who is subrritting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Qick the upload button or drag and drop files here to attach document
10- Storm EX2016-090 pond design. pdf 1.28MB
signature page 13-1.pdf 1.77MB
Only pdf files are accepted.
Describe the attachments:
Copy of Storm EX attached in pdf format, excel file emailed to Corey Anen
* W By checking the box and signing box below, I 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');
o 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:* P. Scott Bell, PE
Signature: c
ems- att �cc�

Date Submitted: 11/6/2018

Initial Review
Updated ID#: SW3180905
Who needs a W Central Office
copy?* W Regional Office
Central Office Reviewer:
Corey Anen - eads\scanen
Select Reviewing Office
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]