NCG190107_Supplemental Info Review_8/7/2019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/7/2019 3:27:51 PM (Supplemental Submittal)
Submit by McCoy, Suzanne 8/8/2019 7:51:57 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 8/7/2019 3:27 PM

Submittal Dated: 8/7/2019
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 ansmred.
Existing Project Information:
Rease supply the perrrit nunber for this project.
D# * FL-rrrit Narrber
NCG190107
Ecanples: SWxxxxxxx, NO&xxxxx, or NOSxxxxxx
Facility Name:* Wanchese Marina
County: Dare
Name: Albemalre & Associates, Ltd
Who is submitting 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 document
08271A - NCG190000 Submittal - 2019-08-02.pdf 7.51 MB
08271A- NCG530000 Submittal - 2019-08-02.pdf 7.84MB
Only pdf files are accepted.
Describe the attachments:
* 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)
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
o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Derek Allen Hatchell Sr
Signature:

Date Submitted: 8/7/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
NCG190107
Who needs a d Central Office
copy?* F Regional Office
Central Office Reviewer:*
Shane Strickland - eads\sstrickland9
Select Reviewing Office*
Washington Regional Office — 252-946-6481
Select RO Reviewer:*
[e-mail]