NCG030436_DMR Upload Review_20220423

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/8/2022 11:22:25 AM (DMR Submittal)
Submit by Clark, Paul B 4/23/2022 12:01:44 PM (DMR Submittal Review)
• Georgoulias, Bethany A reassigned the task to Clark, Paul B 4/21/2022 11:33 AM
• The task was assigned to DEMLR SW Admin 2/8/2022 11:22 AM

DMR Submittal from 2/8/2022
Permit and Facility Information:
Permit Number* Enter COC or Individual Permit Number
NCG030436
Must begin with NCS or NCG
Facility Name:* Accu-Fab, Inc.
County: * Wake
Note: Facility name and county are used to help the reviewer verify the permit number entered, and to display the
Regional Office address on the submitter's form (not here). These metadata details will be pulled from current BIMS
information after the DMR(s) are filed. If the submittal is accepted, simply note any errors in the reviewer's comments.
Monitoring Period Information:
Monitoring Period What is the YEAR of the sample date(s)?
Year:* 2021
DMR Upload* Click the upload button or drag and drop files here to attach document.
[Untitled].pdf 297.94KB
Only PDFs are accepted.
Comments: This DMR is in reference to quarterly report (October -December 2021). This is late
due to covid and surgery. Did not have access to upload in January.
* 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 Discharge Monitoring Report (DMR) Upload 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");
o I understand that an electronic signature on this upload form 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 this DMR Upload form.
Full Name:* Sonya Walsh
Name of person submitting this form
Email Address:* [e-mail]
Phone Number:* 919-212-6400
Signature:
c54"
Date: * 02/08/2022

Review
Review Date: 04/23/2022
Confirm Permit No.* Correct the permit ID number if needed.
NCG030436
Confirm DMR Year* 2021
Multiple DMRs will be automatically filed in a subfolder denoting the sampling year entered above.
Can submittal be Yes
accepted?* No (Explain why below)
Do Central Office No
staff need to be Yes
alerted? *
Do Regional Office No
staff need to be Yes
alerted?
Type of Permit* General
Ensures DMR(s) filed correctly.