NCG140467_Supplemental Info Review_3/21/2019

Submittal Dated: 3/21/2019
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 nun-ber for this project.
D# * Flerrrit Ninber
NCG140467
Examples: SWxxxxxxx, NO&xxxxx, or NOSxxxxxx
Facility Name:* Lane Temporary Concrete Plant - GWL
Lawndale
County: Guilford
Name: Christopher Ange
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
GWL Lawndale - WW-SW Site Plan-1 1-29-2018
4.84MB
Rev_PRINT.pdf
Only pdf files are accepted.
Describe the attachments:
This is the site plan for the concrete plant site.
* 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');
• 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:* Christopher Ange
Signature:

Date Submitted: 3/21/2019

Initial Review
Updated ID#: IWORfANT: FEVEAERSHOLLDVERIFY and revise here if necessary.
NCG140467
Who needs a d Central Office
copy?* F Regional Office
Central Office Reviewer:
Bethany Georgoulias - eads\bagorgoulias
Select Reviewing Office*
Winston-Salem Regional Office — 336-776-
9800
Select RO Reviewer:*
[e-mail]