SW3190701_Supplemental Info Upload_20190927

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/27/2019 12:10:20 PM (Supplemental Submittal)
Submit by Strickland, Shane 9/27/2019 12:22:06 PM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 9/27/2019 12:10 PM

Submittal Dated: 9/27/2019
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
SW3190701
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Harwood Automotive
County: Cabarrus
Name: Mitchell S. Latham, P.E.
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
1-Stormwater Permit Application 9-27-19.pdf 497.76KB
6-Supplement EZ-Signed.pdf 350.73KB
Only pdf files are accepted.
Please alert us to any confidential information contained in the uploaded documents.
Uploads contain r NO
Confidential r YES
Information * NOTE The following information cannot be clairred as confidential: the narre and address of any permit applicant or
pernittee, perrrit applications, permits, effluent data, information required by WDES application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
3rd Submittal Revisions:
Stormwater Permit Application
Supplement EZ
* 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:* Mitchell S. Latham
Signature:
Date Submitted: 9/27/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3190701
Who needs a d Central Office
copy?* r- Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]