NCG020158_DMR Upload Review_20231012

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 10/9/2023 12:33:01 PM(DMR Submittal)
Submit by Brittany.Cook 10/12/2023 2:56:12 PM(DMR Submittal Review)
• The task was assigned to DEMLR SW Admin for DMRs 10/9/2023 12:33:01 PM
• Brittany.Cook assigned the task to Brittany.Cook 10/12/2023 2:49:26 PM

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DMR Submittal from 10/9/2023
Permit and Facility Information:
..............................................................................................................................................
Permit Number* Enter COC or Individual Permit Number
NCG020158
Must begin with NCS or NCG
Facility Name:* Luck Stone-Mount Airy Plant
Owner/Operator Luck Stone Corporation
Name:*
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.
Reason for not yet If applicable:
reporting data I have submitted forms and am waiting for an eDMR user id.
through eDMR for
this permit:
Monitoring Period Information:
..............................................................................................................................................................................................................................................................................................................................................................................................
Monitoring Period What is the YEAR of the sample date(s)?
Year:* 2023
DMR Upload* Click the upload button or drag and drop files here to attach document.
PDF 23 1009 Luck Stone DMR 3rd Qtr SW.pdf 275.99KB
PDF 23 1009 Luck Stone DMR 3rd Qtr WW.pdf 354.63KB
Only PDFs are accepted.
Comments:
* By checking the box and signing box below, I certify that:
o I have given true,accurate,and complete information on this form;
d 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");
• 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:* Mark Williams
Name of person submitting this form
Email Address:* [e-mail]

Phone Number:* 8044766404
Signature:
Date: 10/09/2023

Review
Review Date: 10/12/2023
Confirm Permit No.* Correct the permit ID number if needed.
NCG020158
Confirm DMR Year* 2023
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.