HomeMy WebLinkAboutNCG120072_Monitoring Report_2021102710/26/21, 8:49 AM
New Submission
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Permit and Facility Information: M
Please enter the permit number and other details for this upload.
..................................................................................................................................................................................................................................................................................................... _.......................,... ...........
ftlh�`01?
signed hardcopy of the DMR MUST be mailed to the address in your permit, in addition to this electronic
upload
Fields marked with a red asterisk * are required.
Facility Name:
Enter COC or Individual Permit Number (NOT General Permit number with all 0's)
NCG120072
Must begin with NCS or NCG
Cleveland County Landfill Facility
Cleveland
0
After uploading here, the original signed hardcopy must be mailed to:
DEQ Mooresville Regional Office
Attn: DEMLR Stormwater Program
610 East Center Avenue
Suite 301
Mooresville, NC 28115
Further contact details at hftps://deq.nc.gov/contact/regional-offices/mooresville
(hftps:Hdeq.nc.gov/contact/regional-offices/mooresviIle)
Monitoring Period Information:
........................... .................._...._..............................,...._..................
Monitoring Period What is the YEAR of the sample date(s)?
Year:* 2021
Multiple DMRs from sampling periods within the same year can be uploaded together, but please upload different
years with a new submittal form.
https://edocs.deq.nc.gov/Forms/SW-DMR 1/2
10/26/21, 8:49 AM
New Submission
requestedAlso, copies of the lab results and qualitative (visual) monitoring should NOT be submitted unless specifically
i_t1 staff. Only upload the completedand signed DMR forms.
DMR Upload* Click the upload button or drag and drop files here to attach document.
Upload
Only PDFs are accepted.
Comments: See attached Discharge Monitoring Form. Only one of the nine outfalls had a
discharge at the time of the rainfall event.
* Ig By checking the box and signing box below, I certify that:
• I have given true, accurate, and complete information on this form;
o 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");
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");
4 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
o I intend to electronically sign and submit this DMR upload form.
Full Name:* Josh Davis
Name of person submitting this form
Email Address:* josh.davis@clevelandcountync.gov
Phone Number:* 704.476.5110
us i ;, Save as Draft
https://edocs.deq.nc.gov/Forms/SW-DMR 2/2
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206 HIGH HOUSE ROAD, SUITE 259
GARFJETT CARY NOR711 CAROLJNA 27513
TEL 919-M-19W CLEVELAND COUNTY LANDFILL FACILITY
& MOORE &AA FAX 666 - 311 - 72M LOCATION MAP
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610 EAST CENTER AVENUE
SUITE 301
XOOESVILLE, ME 28115
PHONE 704-663-INS
FAX: 704-663- 10
INDICATE BELOW THE DATE OF INSPECTION AND INITIALS OF SMWP TEAM MEMBER PERFORMING THE
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THE NATION& RESPONSE CENTER (ME) NOR-424-BG02
NO DEG 2A-H" EMERGENCY: 1- 800-MG-0368
EPA, REGION IV: I404) 347-4062
CLEVELAND COUNTY EAR: 704-484-4841
3. DOCUMENT
LOCATION OF SPILL ON PLAN. ESTIMATED QUANTITY. AND CONTAINMENT/CLEANUP NEASUES
EMPLOYED.
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I CERTIFY, UNDER PENALTY M LAM THAT THIS DOCUMENT AND ALL ATTACHMENTS WERE PREPARED UNDER
MY
DIRECTION OR SUPERVISION IN ACCORDANCE WITH A SYSTEM DESIGNED TO ASSUE THAT QUALIFIED PER'tiOiE-
PROPEALY PERSOS WHOATHER MANA6�E THE
9YSTTEN, �ITR RPER0""SSDDIIEECTLY FE�SPO SION BLEIFMEOIRY OR GAATHHERIING TTHE PERSON 00
IIFOWiAT1ON. TME INFOMATIOM SUBMITTED TS. TO THE MST M M KNOWLEDGE AND 6Ei.IEF.
ACCURATE, AND COMPLETE. I AN AWARE THAT THERE ATE SIGNIFICANT PENALTIES FOR SSXITTIHD FALL
INFORMATION, INCLUDING THE POSSIBLITY OF FINE AND IMPRISONMENT FOR KNOWING VIOLATION.
DATA, TDCaf'tETE TFE tDTTCE M INTENT I INANE/TITLE DATE
STORMWATER POLLUTION PREVENTION PLAN FIGURE
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CLEVELAND COUNTY SOLID WASTE