NCG160158_DMR Upload Review_20230607

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 1/5/2023 12:26:38 PM (DMR Submittal)
Submit by Brittany.Cook 6/7/2023 2:11:55 PM (DMR Submittal Review)
0 Uploaded DMR has been electronically signed. Mailed in DMR should contain an original wet
sginature.
• The task was assigned to DEMLR SW Admin for DMRs 1/5/2023 12:26:43 PM
• bethany.georgoulias reassigned the task to Brittany.Cook 6/5/2023 3:12:22 PM

[rftDQ -
DMR Submittal from 1/5/2023
Permit and Facility Information:
..............................................................................................................................................
Permit Number* Enter COC or Individual Permit Number
NCG160158
Must begin with NCS or NCG
Facility Name:* APAC Atlantic, Inc. Plant 5
County:* Forsyth
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.
Sampling Event 17-signed APAC Plant 5-DMR.pdf 299.74KB
Only PDFs are accepted.
Comments: The client is still in the process of registering.
* By checking the box and signing box below, I certify that:
o I have given true,accurate,and complete information on this form;
o 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");
o 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
d I intend to electronically sign and submit this DMR Upload form.
Full Name:* John Parker Alvis
Name of person submitting this form
Email Address:* [e-mail]
Phone Number:* 9802412469
Signature:
0�"V 014"
Date:* 01/05/2023

Review
Review Date: 06/07/2023
Confirm Permit No.* Correct the permit ID number if needed.
NCG160158
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.