SW4190901_Supplemental Info Review_9/30/2019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/30/2019 11:41:00 AM (Supplemental Submittal)
Submit by Strickland, Shane 9/30/2019 12:15:35 PM (Supplemental Info Submittal)
• The task was assigned to Strickland, Shane 9/30/2019 11:41 AM

Submittal Dated: 9/30/2019
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
SW4190901
Exarrples: SWxxxxxxx, NOC;xxxxxx, or NCSaxxxx
Facility Name:* O'Reilly Auto Parts Lexington NC
County: Davidson
Name: Aaron Hargrave
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 docurrent
08 22 19 Stormwater Management Permit
233.53KB
Application Form (XG3).pdf
All Civil Plans.pdf
30.2MB
North Carolina Secretary of State Search
185.34KB
Results.pdf
Recorded Deed.pdf
84.01KB
08 22 19 Sand Filter O&M Agreement (XG3) (2).pdf
91.16KB
Narrative.pdf
63.83KB
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 LEES application forms provided by
the arector inclusive of all forrrs and attachments [Ref. 40 CFR 122.7(b) and (c)].
Describe the attachments:
Signed permit application, All civil plans including erosion and stormwater sheets, Stormwater and Erosion narrative,
Recorded Deed, Signed O&M Agreement, Corporation Certification document
* 'W By checking the box and signing box below, I certify that:

o 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:* Aaron Tyler Hargrave
Signature:
Date Submitted: 9/30/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW4190901
Who needs a V Central Office
copy?* F Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Winston-Salem Regional Office — 336-776-
9800
Select RO Reviewer:*
[e-mail]