RANDY MARION FORD LINCOLN DEALERSHIP - 2/14/2019 4:31:53 PM

Submittal Dated: 2/14/2019
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
SW3190202
Examples: SWxxxxxxx, NO&xxxxx, or NCSxxxxxx
Facility Name:* RANDY MARION FORD LINCOLN
DEALERSHIP
County: Iredell
Name: JEFF WEHLING
Who is subrritting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Click the upload button or drag and drop files here to attach docurrent
2015-01-11-NCDENR Storm Trans 1- 012419.pdf
119.27KB
2017-06-10-NCDENR WQ REPORT. pdf
14.36MB
Randy Marion -signed NCDENR app.pdf
3.03MB
RM-SSW-SuppEZ-20170329-DEMLR-SW.pdf
248.73KB
Secretary of State- Business_RM-FL-LLC
53.42KB
Members.pdf
Secretary of State-Business_6K Prop- Members. pdf
52.81 KB
RANDY MARION FORD LINCOLN PLANS-NCDENR
14.46MB
SET-0 1 2319-SEALED.pdf
Only pdf files are accepted.
Describe the attachments:
2015-01-11-NCDENR Storm Trans 1- 012419.PDF (PDA Transmittal Sheet)
2017-06-10-NCDENR WQ REPORT (Stormwater Report)
Randy Marion -signed NCDENR app-STORMWATER PERMIT (Check)(SSW-SWU-101)(Storm E-Z)(O&M Docs)
RM-SSW-SuppEZ-20170329-DEMLR-SW (Supplemental Form)
Secretary of State-Business_RM-FL--LLC-Members (Randy Marion Ford Lincoln, LLC)
Secretary of State-Business_6K Prop -Members (61K Properties, LLC)
RANDY MARION FORD LINCOLN PLANS-NCDENR SET-012319-SEALED
* 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');
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:* Jeffrey Wehling
Signature:
Date Submitted: 2/14/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3190202
Who needs a d Central Office
copy?* rJ Regional Office
Central Office Reviewer:
Corey Anen - eads\scanen
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]