NCG160230_Supplemental Upload Form_3/28/2019

Submittal Dated: 3/28/2019
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# * Flarrrit Ninber
NCG160230
Ecarrples: SWxxxxxxx, NOCaaxxxx, or NOSxxxxxx
Facility Name:* Barnhill - Whiteville Asphalt Plant
County: Columbus
Name: Gordon A Rose
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Oick the upload button or drag and drop files here to attach docurrant
BAR1004_SWPPP-SITE-PLAN-20181127.pdf 553.84KB
Only pdf files are accepted.
Describe the attachments:
Whiteville Asphalt Plant: SWPPP Site Plan as submitted by letter dated November 29, 2018 and as requested via
email on March 28, 2019.
* V-J By checking the box and signing box below, I certify that:
• 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)
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 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
• I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Gordon A Rose
Signature:

Date Submitted: 3/28/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
NCG160230
Who needs a d Central Office
copy?* F Regional Office
Central Office Reviewer:*
Shane Strickland - eads\sstrickland9
Select Reviewing Office*
Wilmington Regional Office — 910-796-7215
Select RO Reviewer:*
[e-mail]