NCG050172_DMR Upload Review_20220311

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/19/2022 3:01:50 PM (DMR Submittal)
Submit by Georgoulias, Bethany A 3/11/2022 11:18:34 AM (DMR Submittal Review)
* Corrected typo in permit COC no. to NCG050172. This upload is qualitative monitoring results only
(not necessary to report but will be added to the permit file).
• Georgoulias, Bethany A reassigned the task to Georgoulias, Bethany A 3/8/2022 2:30 PM
• The task was assigned to DEMLR SW Admin 1/19/2022 3:01 PM

DMR Submittal from 1/19/2022
Permit and Facility Information:
Permit Number* Enter COC or Individual Permit Number
NCS050172
Must begin with NCS or NCG
Facility Name:* NCFI Polyurethanes
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 What is the YEAR of the sample date(s)?
Year:* 2022
DMR Upload* Click the upload button or drag and drop files here to attach document.
NCFI_SDO_DMR_01062022.pdf 595.57KB
Only PDFs are accepted.
Comments: According to the eDMR requirements, NCFI Polyurethanes is not required to set up
a eDMR account since the facility is not required to submit analytical results and has
no plans to need to conduct analytical sampling in the foreseeable future. Please
contact David Sikes if this information is inaccurate and NCFI is required to set up
an eDMR account to submit all SDO QMR's going forward.
* By checking the box and signing box below, I certify that:
• I have given true, accurate, and complete information on this form;
• I agree that submission of this Discharge Monitoring Report (DMR) Upload form is a "transaction" subject to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
o 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:* James David Sikes
Name of person submitting this form
Email Address:* [e-mail]
Phone Number:* 3365830502

Signature:
C/K�W rZI po1`a
Date: * 01 /19/2022

Review
Review Date: 03/11/2022
Confirm Permit No.* Correct the permit ID number if needed.
NCG050172
Confirm DMR Year* 2022
Multiple DMRs will be automatically filed in a subfolder denoting the sampling year entered above.
Can submittal be Yes
accepted?* No (Explain why below)
Do Central Office No
staff need to be Yes
alerted? *
Do Regional Office No
staff need to be Yes
alerted?
Type of Permit* General
Ensures DMR(s) filed correctly.