NCG020721_DMR_20200622

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3029ZM
PROCE&R/M VE DEWATFIMG WASTEWATER DISCHARGE MONMRMG REPORT (DMR)
Please Mail Original And One Copy To Address Below
Part A: Facftitvinjormmloa
GENERAL PERMIT NO. NCGO20000
Samples Collected Lo Qaarw 10� (aD sampks skA be reported with 30 days fatlswior moohMst period)
Certificate Of Coverage No. 14CGM County of Fadwy
Fad Nam Name of Laboratory
Faci ty l.oataet Lab Cati6ntion #
Faduty Coutaet Phone NIL
/4,C14 r o-E Ltt�
1 Nodded com.asadr aside a fi--WWbs ae.iee ar eW=aleduAg m6wxw-s pomp wvcsam r-n io$L
Part C Gaiificafion
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'i eMNY, under' penalty of taw. thu this document and aA attachments were prepared trader my. direction or sopervWon in accordance with a
system designed to assure that ept =W F mond properly gather and mdamte tie formation submitted. Based on my hMahry of the person
OrPersmWbOVISMOVdiesysNalkorthosel,tswas dhetdy respeodble for gotha ft the hrfermatks, the Lfantnthe submitted % to the hest
of my lmawledge and bdK bw. wmrate. and oottgdete, Ism aware that (here are SigaiflnDt pesmiffia for ssbtotlting ffte isformaden,
usdodiog tie pouibflky of floes a� imprBa�ent for kfmwbsg dofatioss.
-V �-o �-o
(Sigaa f Permitter) (Date)
PartD. MaflmgAd&vm
Attar Central Files, DENR, N C- Dlvisfoa of Water Qua(tty,1617 Main Service Center, Rakigh, NC 276W1617
SR'U-244-013005