NCG100008_DMR Upload Review_20201204

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/1/2020 9:20:07 AM (DMR Submittal)
Submit by McCoy, Suzanne 12/4/2020 12:03:39 PM (DMR Submittal Review)
• The task was assigned to McCoy, Suzanne 12/1/2020 9:20 AM

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DMR Submittal from 12/1/2020
Permit and Facility Information:
Permit Number* Enter ODCor Individual Fbrrrit Ninber
NCG100008
Mast begin w ith NCS or Na,-
Facility Name:* Lewisville Motor Company
County:* Forsyth
Note: Facility name and county are used to help the reviewer verify the permit number entered, and to display the
Regional Office address on the submitter's form (not here). These metadata details will be pulled from current BIMS
information after the DMR(s) are filed. If the submittal is accepted, simply note any errors in the reviewer's comments.
Monitoring Period Information:
Monitoring Period VUTatisthe YEAR ofthe sanpledate(s)?
Year:* 2020
DM R Upload* aickthe upload button or drag and drop files hereto attach document.
scan.pdf
Only FDFs are accepted.
Comments:
* W By checking the box and signing box below, I certify that:
3.43MB
have given true, accurate, and complete information on this form;
• I agree that submission of this Data Monitoring Report (DMR) upload 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 on this upload form 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 this DMR upload form.
Full Name:* Justin Lee Myers
Nerre of person subnitting this form
Email Address:* [e-mail]
Phone Number:* 336-768-6357
Signature:
J"ft , Iw

Date: * 12/01 /2020

Review
Review Date: 12/04/2020
Confirm Permit No.* Correct the perrritIDnurrberifneeded.
NCG 100008
ConfirmDMRYear* 2020
Multiple DMRs will be automatically filed in a subfolder denoting the sampling year entered above.
Can submittal be r Yes
accepted?* r No (Explain why below)
Do Central Office r No
staff need to be r Yes
alerted?*
Do Regional Office r No
staff need to be r Yes
alerted?
Type of Permit* General
Ensures DUZ s) filed correctly.