NCG020721_DMR_20230404

PROCESSflVME DEWATERING WASTEWATER DISCHARGE MONITORING REPORT (DMR)
PIease Mail Original And One Copy To Mading Address Below
GENERAL PERMIT NO. NCGO20000
Part A: Faci7ih•Lfonnation
Samples Collected In Quarter 3 d (all samples sbal) be reported within 30 days following monitoring period)
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Certificate Of Coverage Na � L i
Countyof FacilityFacility
Name i
Name of Laboratory
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Facility Contact
Lab Certification fi
Facility Contact Phone No. -
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Part B: Proem JVariettwierand MireDotwlering lirasiettarerblonitoriugRequirements
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Pad C.- Certification
^I certifi4 ander penalty oflaw, 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 mounge the system, or those persons directly responsible for gathering the information, the information submitted is, to the best
of my knowledge and belief, true, accurate, and complete. I am aware that there are siguifieant penalties for submitting false information,
including the possibility of fines and Imprisonment for knowing violation"WInd\
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{Stgeature of pamittee) )
ParrD: AfaifFngA&,,ss
Attn: Central Files, DE�tt R, N.C. Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27644-1617
SWU-244-012005
APR 10 2023
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