NCG020940_Supplemental Upload Review Form_20190506

Submittal Dated: 5/6/2019
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
NCG020940
Ecanples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Lennon Sand Mine #3
County: Brunswick
Name: Thomas Scheetz
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
tick the upload button or drag and drop files here to attach docurrant
18028 LENNON MINE - OVERALL C1.pdf 1.04MB
Only pdf files are accepted.
Describe the attachments:
* P 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:* Thomas Scheetz, E.I.
Signature:
0 ,;w c 5;-,' & �
Date Submitted: 5/6/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
NCG020940
Who needs a V 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]