NCG160233_DMR Upload Review_20210903

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/19/2021 10:20:34 AM (DMR Submittal)
Submit by McCoy, Suzanne 9/3/2021 8:16:05 AM (DMR Submittal Review)
• The task was assigned to McCoy, Suzanne 8/19/2021 10:20 AM

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DMR Submittal from 8/19/2021
Permit and Facility Information:
Permit Number* Enter ODCor Individual Fbrrrit Ninber
NCG160233
Mast begin w ith NCS or Na,-
Facility Name:* Carolina Sunrock - Butner Asphalt Plant
County:* Granville
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* aick the upload button or drag and drop files here to attach document.
Butner Asphalt NCG16 P3 2021 Signed.pdf 84.3KB
Only FDFs are accepted.
Comments:
* W 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:* Alex Culpepper
%rre of person subnitting this form
Email Address:* [e-mail]
Phone Number:* 9197476400
Signature:
Alex Copeppey-

Date: * 08/19/2021

Review
Review Date: 09/03/2021
Confirm Permit No.* Correct the perrritIDnurrberifneeded.
NCG 160233
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.