SW3190201_Supplemental Information Review Form_20190212

Submittal Dated: 2/12/2019
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
SW3190201
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Bohler Engineering
County: Union
Name: 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 docurrent
01 29 19 Stormwater Management Permit
254.77KB
Application Form (WGT).pdf
Signed Deed (Version=2). pdf 94.81KB
01 29 19 Operation & Maintenance Agreement
121.27KB
(WGT).pdf
SSW-SuppEZ-20170329-DEMLR-SW.pdf 288.08KB
O'Reilly Wingate, NC - Stormwater Report.pdf 8.27MB
190110 - Wingate (WGT) Civil Plans.pdf 17.34MB
8689 - O'Reilly Auto Parts - Wingate SHWT
1.14MB
Report.pdf
Only pdf files are accepted.
Describe the attachments:
Attached are the requested O'Reilly Auto Parts Wingate NC Stormwater Permit No. SW3190201 by Suzanne McCoy
on February 11, 2019 at 8:08 AM.
* W By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o 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:* Daniel Renckens
Signature:
Date Submitted: 2/12/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3190201
Who needs a d Central Office
copy?* rJ Regional Office
Central Office Reviewer:
Rick Riddle - eads\rlriddle1
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]