NC0023876_Form only no attachment_20220603

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/3/2022 10:39:55 AM (Supplemental Submittal)
Submit by Thedford, Wren 6/3/2022 11:09:32 AM (Supplemental Info Submittal)
• Thedford, Wren assigned the task to Thedford, Wren 6/3/2022 11:09 AM
• The task was assigned to Thedford, Wren, Bennett, Tilman B 6/3/2022 10:39 AM

Initial Review Information
Updated ID#: * IMPORTANT: REVIEWER SHOULD VERIFY and revise here if necessary.
NCO023876
How should this project be handled?*
File Discard
Information Submitted on 6/3/2022
Submitter Information
Name: Sharon M Wagoner
Who is submitting the information?
Email Address:* [e-mail]
Submittal Information
The Division of Water Resources (DWR) is providing this site to allow for the upload of required supplemental information
associated with discharge monitoring reports (DMR). All DMR data is required to be submitted electronically through
the eDMR system and should not be submitted here. Division staff will review all uploaded documents and will only
maintain required information. Documents such as laboratory reports are not required to be submitted and will not be
maintained in the system.
Project Information:
Please supply the permit number for this project.
......................................................................................................................................................................................................................................................................................................................................................................................................
Existing ID#* Permit Number
NCO023876
Examples: NCxxxxxxx or NCGxxxxxx
Facility Name: * South Burlington Wastewater Treatment Plant
County: Alamance
Please upload all files that need to be submited.*
Click the upload button or drag and drop files here to attach document
D00060322-06032022102024.pdf 405.07KB
Only pdf files are accepted.
Comments about the attachments:
* By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;

a 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)
a 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');
a 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: Sharon M Wagoner
Signature:
Date Submitted: 06/03/2022