NC0085359_Supplemental DMR Information Form_20200421

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/21/2020 3:48:05 PM (Supplemental Submittal)
Submit by Bennett, Bradley 8/17/2020 10:57:23 AM (Supplemental Info Submittal)
• Thedford, Wren reassigned the task to Bennett, Bradley 4/21/2020 5:31 PM
• The task was assigned to Thedford, Wren, Bennett, Bradley 4/21/2020 3:48 PM

Initial Review Information
Updated ID#:* IWORTANf:FEVIBAERSl-IOLLDVERFYand revise here ifnecessary.
NCOO85359
How should this project be handled?*
r File r Discard
Information Submitted on 4/21/2020
Submitter Information
Name: Jonathan Jordan
Vft is subrritting 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 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 number for this
Existing ID#* PerrritNunber
NCOO85359
Examples: NCKxxxxxx or NO&xxxxx
Facility Name:* Twelve Mile WRF
County: Union
Please upload all files that need to be
submited. *
dick the upload button or drag and drop files here to attach docurrent
12 Mile Rolling Phos Average- March 2O2O.pdf 188.9KB
Only pdf files are accepted.
Comments about the attachments:
* V By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;

• 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: Jonathan Brian Jordan
Signature:
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Date Submitted: 04/21/2020