NC0003425_Outfall 12B_20200127

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/27/2020 9:40:49 AM (Supplemental Submittal)
Submit by Bennett, Bradley 2/3/2020 7:39:00 AM (Supplemental Info Submittal)
• Bennett, Bradley assigned the task to Bennett, Bradley 2/3/2020 7:38 AM
• The task was assigned to Thedford, Wren, Bennett, Bradley 1/27/2020 9:40 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 1/27/2020
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 December
36.55KB
2019.pdf
Only pdf files are accepted.
Comments about the attachments:
* W 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: 01/27/2020

EFFLUENT
NPDES Pemtit No. NC0003425 IXschargc No 12B Month December Year 2019
Facility Name Roxboro Steam Eteeirie Plant Class II Crtumy Person
Operator In Responsible Charge Ryan S. Enoch Grade III Phamc [phone]
Certified laboratories (1) Duke analytical Lab (2} NA
Check if ORC has Changed Ito.- n Is! WICCting Samples Ryan S. Enoch_
Wit ORIGINAL and ONF COPY
AT[W: CENTRAL nits W /Lft'— CA1, f 19� i.0 Za
DIVISION OF WATrA QUALITY tiSIGNA'F;ifRF Oil OPERATOR IN RFSPON5inIL CIIARLi 11)
1617 h1AII. SLRVICIS CLNIER By ThhSignsture, I Certify That This Report Is
RAIdi1GIL NC 27699.1617 Acenrate And Complete To The Best Of hty Knowledge.
B®rd,�mmYl raabau a ps�end b-of VPA p. —w,
a.mnr..atrwr.�tlr urnry m. as �ar+�f o[we u.o Qow.W a Nr Dmk
Fadilay Status: (Please Check One ufthe following)
AA ttnmitudrd dau ant saOgokng frequencies met permit requirements
AN mmnituring dau and sampling 6e4uercies do NOT meet pcmmit rcgtdremenu
'I certify. under penalty of hw, that this tk cturicat and all anaclmams were prepare) under my direction or nepervision to acconhnce with a system designed
to assort that qualified personml properly galhr and evaluate the infomutkn suhmincd. Bared an my iryuiryof the person ur perwm whm manage the system.
or dense persona directly responsible for pit Bring the infumutirn, the infomutkn submitted it. in the best of my kn)wbdge alto better. insc, accarale. and
complete. I am aware dot there ate signiikam portables for submitting false infumrftatltn, inchutiag tbe puuibi6lyof fules,IN itfpuisoament for knowing viobtlom.'
Permiace (Plesse ptim or type)
Dare
1700 Dunaaway Road, Senora. NC 27343 [phone] March 31.2012
Pommimc AMim Phme plumes •• Pasnit Esp. Date
• DRC ma rw lead" mN "—i rlRmaewof Gary r nterwf M I2A NCAC to =2 {Dr (5)111I.
•• r.amw Mwaer na aw pvmatr, Jrusatre d.iyn.tvy rno.ay mew t. m n...va nr sown R ISA NCAC 2R II1os ta112] {DF
The aanlhty average Gr kotatftlam Is mho repanedn a GLoMEf WCaoean. lhemly.lni fwd aniu u t>r reporting Gdlioys pnmit fir reptrtina Jaev
DATic