NC0003425_Outfall 12B_20200224

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/24/2020 3:20:15 PM (Supplemental Submittal)
Submit by Thedford, Wren 2/25/2020 6:13:51 AM (Supplemental Info Submittal)
• Thedford, Wren assigned the task to Thedford, Wren 2/25/2020 6:13 AM
• The task was assigned to Thedford, Wren, Bennett, Bradley 2/24/2020 3:20 PM

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 2/24/2020
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 January
36.94KB
2020.pdf
Only pdf files are accepted.
Comments about the attachments:
Please find attached Outfall 12B for the 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 E Howard
Signature:
Date Submitted: 02/24/2020

EFFLUENT
NI'DES Permit NO, NC0003425 DssaF rgc No. 128
Facilliv Name Roxboro Steam Electric Plard C'lac. II Coumv
Operator In Responsible Charge Ryan S. Enoch [lade III
CrtifiedLahuralurics (1) Duke analyticalLab 13}NA
Chrx:k if ORC has Changcd Person (s) Collecting Samples Ryan S. Enoch
&W ORIGINAL and ONE COPY u,: I'll /y
ATTN: CENTRAL IILIS
DIVISION OF WATIA QUAIM
1617 MAIL SERVICE CEN I R
RAMIGH. NC27699.1617
Mrm11h January Year 2020
Person
Phone [phone]
:SIC.NAT I! Elf?OPMATOR IN RISKINSIBII! CHARCf7
By This Signature. I Certify That This Report Is
Accurate And Complete To The Rest Of My Knowledge,
&wrddosanml v..eaeu a pouw sW b-ct EPA mvdw-
.k�r...+d.W k.nasrura.waw.»sr�narw.m oe,.:1Kt
Facility Status: IPlease Cheek one of the fidLowingl
ALL monitoring data and sampling frcqueocdn raw permit requirements
All WKWuniag data and sampling fnequencies do NOT meel permh requirements
'1 ecnify, under penalty of law that this d;wumcm and all attachments were pmpamd under my Jirec[hmnr supervision in acconWce with a system desigmd
to aswrc dot yualifial pers,Kuel properly gather and evaluate the infonmatem submittal. Basal an my inquiry of the person or persons wlus manage the system,
Of darts PCssrns oldrcetly rcspmmihle fargothering the infarmatxon, the infumu hm submittal is. to the best of my kow]edge and belief, true, accurate. and
complete. 1 am aware that Jere arc significant Pcmltio fin suhmining false information. including the possibility r. f Mes apt imprisonment for knowing viutarurns.
Tom
Pcrmiucc (Please print or type)
rM
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171N) Dunnaway Road. Semura, NC27343 (336) 597 614f1 March 31, 2012
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