NCG020487_2020 DMR_20210106

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a z � Stormwater NPDES Permit Data Monitoring
J Report
NORTH CAPLr A (DMR) Upload
Permit and Facility Information:
Please enter the permit number and other details for this upload-
IMPORTANT- Until the eDMR system is implemented for DEMLR Stormwater Program permits, an original
signed hardcopy of the DMR MUST be mailed to the address in your permit in addition to this electronic
upload_
Fields marked with a red asterisk* are required.
Permit Number* Enter CQC or Individual Permit Dumber
NCG020487
Must begin with NCS or NCG
Facility Name:' Cameron Pit
County: * Harnett v
After uploading here, the original signed hardcopy must be mailed to:
DEQ Fayefteville Regional Office
Attn: DEMLR Stormwater Program
225 Green Street
Suite 714
Fayetteville, NC 28301-5095
Further contact details at hops://deq.nc.gov/contact/regional-officeslfayetteville
(hftps.1/deq.nc.gov/contact/regional-ofrtces/f`ayetteville)
Monitoring Period Information:
Monitoring Period What is the YEAR of the sample date(s)?
Year:* 2020
Multiple DMRs from sampling periods within the same year can be uploaded together, but please upload different
years with a new submittal form.
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DMR Upload* Click the upload button or drag and drop files here to attach document.
Upload
Only PDFs are accepted_
Comments:
Cutfall C-1 No Flow
* By checking the box and signing box below, I certify that:
a I have given true, accurate, and complete information on this form;
o 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");
a 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");
o 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
o I intend to electronically sign and submit this DMR upload form.
Full Name:* R. G. Kirkpatrick Jr, President
Name of person submitting this form
Email Address: * [[e-mail]
Phone Number:* 336-554-1745
Signature: * X
Date:* Date captured on form submission
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