NCG020243 DMR WW (2)

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PROCESS/MINE DEWATERING WASTEWATER DISCHARGE MONITORING REPORT (DMR)
Please Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCG020000
Part A: Facility Information
Samples Collected In Quarter: 1 2 30 4Q (all samples shall be reported within 30 days following monitoring period)
(Mck One)
Certificate Of Coverage No. NCG02 �o� 3 County of Facility
Facility Name �U �{y Coir6a�y — Cif �iiDE G e//���// f/�,�f Name of Laboratory
Facility Contact 6A y4 eA Lab Certification #
Facility Contact Phone No. & 3l� y- r0lzls-
Part B: Process Wastewater and Mine Dewatering Wastewater Monitoring Requirements
MAR 0 2 20115
DVYRCT 1C*-�N
ani
Outfall
Number
Receiving Stream Name
Date
Sample Collected
50050
00400
00530
00076
00545
Daily Flowl
pH
Total Suspended Solids
Turbidity
Settleable Solids
Qy)
T
mo/dd/ r
unit
m
NTUs
mil
Goss '/)
0 C)ZLZ
JZ,3
< 2, L
4 0.,
1 Measured continuously using a flow measuring device or estimated using manufacturer's pump curves and pump logs.
Part C: Certification
"I certify, under 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, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations." _ ,
,a���
(Signature of Permittee) (Date)
Part D: Mailing Address
Attn: Central Files, DENR, N.C. Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617
SWU-244-012005