NCG120040_DMR Upload Review_20210813

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/26/2021 9:34:00 AM (DMR Submittal)
Submit by McCoy, Suzanne 8/13/2021 12:51:26 PM (DMR Submittal Review)
• The task was assigned to McCoy, Suzanne 7/26/2021 9:34 AM

d� 4
NORTH LAROLI NA
Enrlmnmenfcl Quouty
DMR Submittal from 7/26/2021
Permit and Facility Information:
Permit Number* Enter ODCor Individual Fbrrrit Ninber
NCG120040
Mast begin w ith NCS or NOG
Facility Name:* Halifax County Landfill
County:* Halifax
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:* 2021
DM R Upload* aickthe upload button or drag and drop files hereto attach document.
Halifax 1 H 2O21 Signed DMR.pdf 108.04KB
Only FDFs are accepted.
Comments: 1 st half of 2021 semi-annual monitoring report for Halifax County Landfill. Signed
by permittee, uploaded electronically on behalf of permittee by Michael Liebl of
Smith Gardner. Inc.
rJ 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:* Michael Liebl
% e of person subrritting this form
Email Address:* [e-mail]
Phone Number:* 9193457610

Signature:
Date: * 07/26/2021

Review
Review Date: 08/13/2021
Confirm Permit No.* Correct the perrritIDnurrberifneeded.
NCG 120040
ConfirmDMRYear* 2021
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.