NCG160223_DMR Upload Review_20210204

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/2/2021 5:02:42 PM (DMR Submittal)
Submit by McCoy, Suzanne 2/4/2021 8:26:37 AM (DMR Submittal Review)
• The task was assigned to McCoy, Suzanne 2/2/2021 5:02 PM

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NORTH LAROLI NA
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DMR Submittal from 2/2/2021
Permit and Facility Information:
Permit Number* Enter ODCor Individual Fbrrrit Ninber
NCG160223
Mast begin w ith NCS or Na,-
Facility Name:* Fibrecrete Preservation Technologies Inc
County:* Surry
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* Oickthe upload button or drag and drop files here to attach document.
NCG160223- DMR- Form-
20200810_signed_Fibrecrete Preservation 657.35KB
Tech nologies_SWM_Y1 P2 S2 2020.pdf
Only R Fs are accepted.
Comments: Stormwater Discharge Outfall Monitoring Report (DMR)
Year 1, Period 2, Sample 2 (Permit Term: July 1, 2020 to December 31, 2020)
Fibrecrete Preservation Technologies Inc (Surry County)
General Permit NCG160000; Certificate of Coverage Number NCG160223
17 By checking the box and signing box below, I certify that:
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:* Bart Pharr
Nane of person subrritting this form
Email Address:* [e-mail]
Phone Number:* [phone]

Signature:
Date: * 02/02/2021

Review
Review Date: 02/04/2021
Confirm Permit No.* Correct the perrritIDnurrberifneeded.
NCG 160223
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.