NCG140482_Supplemental Info Review_20200508

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/8/2020 8:21:26 AM (Supplemental Submittal)
Submit by Strickland, Shane 5/13/2020 6:40:07 PM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 5/8/2020 8:21 AM

Submittal Dated: 5/8/2020
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 suDDly the Derrrit nunber for this Drolect.
D# * Perait Nurrber
NCG140482
Exarrples: Swxxxxxxx, NCa mxxx, or NCSxxxxxx
Facility Name:* McCarthy Greensboro Elm Street Concrete
Batch Plant
County: Guilford
Name: Jacki Congleton, Terra Consulting LLC
Mo is subrritting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
aick the upload button or drag and drop files here to attach document
Mccarthy Greensboro ES Batch plant 04-07-
3.66MB
2020.pdf
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 claimed as confidential: the narre and address of any perrrit applicant or
pernittee, pernit applications, perrrits, effluent data, inforrration required by WCM application forms provided by
the Director inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
McCarthy Greensboro Elm Street Concrete Batch plant NCG140482
* V 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

o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Jacki Congleton
Signature:
Date Submitted: 5/8/2020

Initial Review
Updated ID#: IWORfANT. RE\/1RAE 2SH0LLDVMFY and revise here if necessary.
NCG140482
Who needs a W Central Office
copy?* r Regional Office
Central Office Reviewer:*
Shane Strickland - eads\sstrickland9
Select Reviewing Office*
Winston-Salem Regional Office — 336-776-
9800
Select RO Reviewer:*
[e-mail]