NCG020721_DMR_20221012

RECEINT-D
OCT 12 2022
CENT►Aq- FILE-
DWR S&ECTIW,1
PROCESS/MINE DEWATERING WASTEWATER DISCHARGE MONITORING REPORT(DMR)
Please Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCGO20000
Part d r Facilim ln(onnaliom
Samples Collected In Quarter 1 3 (all samples shall be reported within 30 days folloning monitoring period)
Certificate of Coverage Na. NCG62 County of Facility _t a.Ve n
Facility Name j ! C ' Name of Laboratory d =A Pr 1*—
Facility Contact t Lab Certification t: O
Facility Canteet Phony Na �GI K C in Qft
Part B:Proctrt TYacteuwterand Mine Denntering IYaste„wier Monitoring Requirements fi r�/ - +.+--�('3 �1/✓
Date 3D050 004M 00530Outful 0007f
Numb Receiving Stream Name Sample Collected Flow. -Total
Number �S ' P$ ShspendalShcit' Tm-hid(tY SettkabieSeitds
mold MGD unit 10911 IYrM ON
ODbewr B ra-n ZI Z
M-as mndaumdy using i flour n suripg do im or cstima"using o nufecmms p nm m -M and pomp logs
Parl Cc Certification
"t certify,ander penalty of law,that this document and all attachments were prepared under my.direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted Based on my inquiry of the person
or persons who manage the system,or those persons directly responsible for gathering the information,the information submitted is,to the best
of my knowledge and belief,true,aernraM and complete I am aware that them are significant penalties for submitting false information,
including the passibility of fines and imprisonment for knowing vfolatio
Te
(Signature of Permittee) (Date)
ParlD:Afailimg.9ddrrss
Attn, Central Files,DE,IR,N-C.Division of Water Quality,1617 Mail Service Center,Raleigh,NC 27699-161 i
SM.1-244-012005