NC0047562_Submitter Change Request_20170227

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blvWon of Water'ltesaurves
Submitter Change Request Form — (Add/update users)
North Carolina Electronic Discharge Monitoring Report System
EDMR registered Owners may use this :form to add or update eDMR users to the NCDWR's Electronic
Discharge Monitoring Report system. If the Organization is not currently registered for eDMR, then the
Owner or designated Responsible Official will need to complete the required eDMR Registration Form
(available from the eDMR website) and submit it to the NCDWR eDMR Administrator at the address
below.
Type of Request (please select):
Add Subrnitter Permissions: (See Section B)
Update Submitter Permissions: (See Section B)
To add or update eDMR user permissions, please provide the 'Following information:
Section A: Owner Information
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Section B: Activate New Submitter or Update Existing User
Please complete the Submitter User Details on page 2 for the individuals who will need Submitter
permissions or to update Submitter details, such as adding additional permits, to an existing user.
Submitter permissions can only be assigned by the NCDWR eDMR Administrator. Note: The Owner
and Facility Administrator can deactivate or delete eDMR user permissions for any individual within
its organization, including Submitter permissions.
7 to Submitter is equivalent to the individual who signs the certification statement on the back of the
Discharge Monitoring Report. The Submitter must be an individual with delegated signatory authority
for the Owner/Organization. If individuals other than the Responsible Official for the Owner have been
delegated signatory authority, the Division of Water Resources must be notified in writing of such
delegations. A delegation of authority form is available from the eDMR website.
In addition to the User Details, please specify the NPDES permit(s) that each user will be associated with
for eDMR submittal_ Should additional space be needed for users and/or permits, please make additional
copies of the Submitter User Details page and complete as needed.
NCDWR eDMR Submitter Change Request Form - ver, 1.0 Page 1

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NCDWR eDMR Submttter Change Request Form - ver.1.0
Page 2

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Responsible Official Authorization
The Responsible Official, as identified in accordance with 40 CFR 122.22, is the appropriate individual
with the authority to sign reports for the organization.
T,J5nI than D.8 a 1nn (printed name), have the authority to make this request for
(owner/organization Name).
T request the NCDWR add • - • • ate the eDMR Submitter user permissions) as indicated above on the
Submi • • User Details
/App
esponstble Official Signature
Cif ITIzin c1 f92-627 2D/7
Title V Date
Please return the completed form to the NCDWR eDMR Administrator via:
Fax:
[phone]
or E-mail:
eDMRadmin(a7,ncdenr, ov
or Mali to:
Information Processing Unit
Attn: eDMR Registration
1617 Mail Service Center
Raleigh, NC 27699-1617
NCDWR eDMR Submitter Change Request Form - ver. 1.0
Page 3