NC0003425_Outfall 12B_20200106

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/6/2020 11:22:10 AM (Supplemental Submittal)
Submit by Bennett, Bradley 1/7/2020 9:36:59 AM (Supplemental Info Submittal)
• Bennett, Bradley assigned the task to Bennett, Bradley 1/7/2020 9:36 AM
• The task was assigned to Thedford, Wren, Bennett, Bradley 1/6/2020 11:22 AM

Initial Review Information
Updated ID#:* IWORTANf:FEVIBAERSl-IOLLDVERFYand revise here ifnecessary.
NC0003425
How should this project be handled?*
r File r Discard
Information Submitted on 1/6/2020
Submitter Information
Name: Robert Howard
Who is subrritting the inforrretion?
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 reviewall
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:
Rease SUDDly the Dernit nun ber for this
Existing ID#* PerrritNurrber
NC0003425
Exarrples: NOKxxxxxx or NO&xxxxx
Facility Name:* Roxboro Steam Electric Plant
County: Person
Please upload all files that need to be
submited. *
dick the upload button or drag and drop files here to attach docurrent
Roxboro Steam Plant NC0003425 12B November
32.33KB
2019.pdf
Only pdf files are accepted.
Comments about the attachments:
Please find attached outfall 12B for Roxboro Steam Electric Plant NC0003425
* V By checking the box and signing box below, I certify that:
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- I IICIVC IY.IVCII II UC, Cll.l.UI CIIC, CII IU I.VI I IF/ICLC II IIVI I I ICIIIVI I VII LI IIJ IVI II I,
• 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)
• 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');
• I understand that an electronic signature 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 the Supplemental Information form."
Full Name: Robert Howard
Signature:
,� PA ,er `l eA"W4,e,
Date Submitted: 01/06/2020

EFFLUENT
NPUFS Permit No. NCDO03425 Discharge No. 12B Month November Year 2019
Facility Name: Roxboro Steam Elet:lric Plan) Clam it County Person
(4vrator In Respemsibte Charge Ryan S. Enoch Grade III Phone (336) SM76DD
Certified Laboratories (1) Dt*e analyllcal Lab iZ NA
Check If ORC has Change) Mmm (s) Collecting Samples Ryan S. Enoch
Mail ORIGINAL. and ONE: COPY tot /
A1TN'CIWTKAL,19u;s (x1
DIVISION OI' WATCR QVAIAY (S1GNA P. 01:OPLRATOR IN RESPONSmi-r. CIIARGEI DATE
I (i 17 MAIL SLRVICi. CI:NM-Ft By This Sixnaturr, t Certify That This Report Is
RALUGy1. NC 27644.1617 Accunte And CompkteTo The Beat Or My Knowkdge.
8. of ki-a tad VwkaaN, a rs-", van b drPA pM j
I .neat P_". Ale 6.rYmar M. m.ar urtrw d r dvau U wv.aWit
Facility Status: (Pleare Clock one of the fntkswing)
All monitoring data and sarMl ny fropeacies,rove[ permit rcquitemems
AM monitoring data and sampling frequencies Lk) NOT meet Permit requirements
"I cenify, under penalty of taw, that this document and all attachments were prepaml under my direction or supenishm in ammLuee with it system designed
to assure that quahfsud Persomeel PngXlly gather and evaluate the information submitted. Based on my inquiry of the person or perxem who manage the system,
or ttv" ficrtsons directly responsible furyuhcring the information. the infumeatlm submittal is. to the hest of my knswlailp and belief, true, acnuam, and
armpletc. I am aware that them arc siorwani penalties for submitting fate information including the IdnsihibiLp4m and Igiprisunasem for knowing vk>tnktm.'
Tam
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Date
171M) Dunnawar Ruad. Semura, NC 27343 (336) 597 - MIX) Mamh 31. 2012
PcroshL eAJ&eu Phew Numly Permit Up. fate
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The arsrthly-,crate fir deal o4if rm is w be rvr reol as a GE:OAII!TMJC non. the rely desijn ml m» a in the rvpumsna WhtV. Permit 6a rq.ninr Jai.