NCG020721_2020 DMR_20200928

PROCESS 1AUNE DEWA'TERINi G WASTEWATER DISCHARGE MONrl ORIING REPORT (DMR)
Please Mail Original And One Copy To Mailing Address Below
Parf.t: FaCURYlnfonnatioo
GENERAL PERMI-r NO. NCGO20000
Samples Collected Ia Quarter= 10 I 3 d (nil samples sbafi be reported -Mtbin 30 days follusviog monitoring period)
Certificate Of Coverage !a KCG02 County of Vacuity
Facility Flame Will Name of Laboratory
Facility Contact r Lab Certification R
Facility Contact phase No. (.,rLt� r ✓ � LLj--�
Part$_ ProcPYe lirasfeuaferand sepe,referingTPasteaafer,lla,iforingRequiremer+fs l e5 S- - r
Outfail RecelringSprearalys.e
Number
Date 50e50 1 me
5nmpleCdlfected DaiirFl-1 pH
vieaaacd cantiuunnsiy usiaga Ror.- �Qai„g device W es6ola[ed using nM=&Cml=a pump cuss and pump lags.
Part C.- Certification
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Loi�il-'D
M76 a0545 ( �✓
S¢spended SoAds I Tarbldity I Settleable Sundt
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"I certify, under penalty sflaw, that this document and all attachments were prepared under my. direction Or sapervisfon 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 systeu; or those persons directly responsible for gathering the information, the information submitted is, to the best
of my larowledge and belie true, acertrate, and complete. I am aware that there are significant penalties for submitting false information,
Including the possibility of fines and imprisonment for knonjug violations, '
(8fg'nat6re of rerurittee) (Date)
PartD_ Elailnig 4ddress
,kttn- Central piles, DE,NR, X-C. Division ofWnter Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617
SAYU-244-012005