20130223 Ver 7_Modifications_20190111

Water Resources
ENVIRONMENTAL �UPLITV
Staff Review
Does this application have all the attachments needed to accept it into the review process?
C•' Yes C' No
ID#* Version* �
20130223
Is this project a public transportation project? * r Yes
l' No
Is this a DOT C•' Yes l' No
project?*
Reviewer List:* April Norton:eads\arnorton
Select Reviewing Office:* Central Office -[phone]
Submittal Type:*
Modifications
Does this project require a request for payment to be sent? *
l'
Yes
r
No

Project Submittal Form
*
Please note: fields marked with a red asterisk beloware required. You will not be able to submit the form until all
mandatory questions are ans�red.
Project Type: �' New Project
C' Pre-Application Submittal
C' More Information Response
r Other Agency Comments
l' For the Record Only (Courtesy Copy)
New Project - Please check the new project type if you are trying to submit a new project that needs an official approval
decision.
Pre-Application Submittal - Please check the pre-application submittal if you just want feedback on your submittal and
do not have the e�ectation that your submittal will be considered a complete application requiring a formal decision.
More Information Response - Please check this type if you are responding to a request for information from staff and
you have and ID# and version for this response.
Other Agency Comments - Please check this if you are submitting comments on an ebsting project.
Project Contact Information
Name: Kristi Lynn Carpenter for Carla Dagnino
Who is subrritting the irrforrration?
Email Address: [e-mail]
Project Information
Project Name: Greensboro Western Loop (U-2524 C& D)
Is this a public transportation project?
�' Yes
�' No
Is the project located within a NC DCM Area of Environmental Concern (AEC)?
C' Ye�" No �' Unknown
TI P#: WBS#:
U-2524 C & D 34820.3.30
(Applies to DOT projects only)
County (ies)
Guilford
Please upload all files that need to be submited.
aick the upload button or drag and drop files here to attach docurrent
U-2524 CD Modification Guilford January 11
3.1 MB
2019.pdf
Only pdf or Ivre files are accepted.
Describe the attachments:
Original Submission sent via email.
rJ By checking the box and signing box below, I certify that:
� �_.._ _:..__ ._..- ---..__._ __� __.__�_._ :_r__.__.:__ __ .�:_ �__._.

o i nave yroen uue, a�curaie, anca cuin�ieie inwnnauun un inis iu�rn,
o I agree that submission of this form is a"transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the
"Uniform Electronic Transactions AcY')
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions AcY');
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 online form."
Signature:
rf (xr�rrr ,,�'fl.rrr C''rr r�cxs�rrrt
Submittal Date: