NCG020721_DMR_20230110 (2)

JAN 17 2UZ3
CEN'1'RAL FILES
SeCTION
PROCESSAUNE DEWATERING WASTEWATER DISCHARGE MONITORING REPORT(DMR)
Please Mail Original And One Copy To MarT g Address Below
GENERAL PERMIT NO. NCGO20000
Part a:Farilffir Information
Samples Collected In Quarter. 19 2 3 all samples shall be reported within 30 da}x following monitoring period)
Certmeate Of Coverage No. NCCO2 County of Faculty r rmye n
Faculty Name it I l '{� Name of Laboratory �i►I��- 1 /�G.
Facility Contact Lab Certification - Q
Facility Contact Phone No Y.tfr� �de-
CL4 or-v
Part B:Process lVarteiraterand MineDeiralering iFarieit-aterMoniiortngRequiremenu !�• r � S t%3 1 �1�/
tr
Date SOOSO OWN' 8M9 00076 00545
tfall
Numbs RecdringStreamName Sample Collected Floc- -Tatal
Number �S PH Saspeaded Solids Tmbidtty Settleable Builds
molddlyr MGM unit If[Qs saw
D r
1 Manerd cauiannasly using a flow maa¢ing d-ine m cstimau:d using s anufaee s=1 pump arms and pomp tags
Part C-Cerlilicolion
"I certify,under penalty of law,that this document and all attachments were prepared under my.direction or snperviston in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my Inquiry of the person
or persons who manage the system,or those persons directly responsible for gathering the information,the information submitted Is,to the best
army knowledge and belief,true,accurate,and complete. I am aware that there are signillcant penalties for submitting false information,
including the possibility of ftIIeS and Imprisonment for knowing vtolah'gns'
(Sigaatu of Permittee) '(Date)
�
PartD:Afailing Address
Attn_ Central Files,DE'Vi R,N.0 Division of Water Quality,1617 Mail Service Center,Weigh,NC 27699-161 i
SNAR1-244-012005