NCG050412_DMR Upload Review_20240530

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 5/21/2024 10:21:03 AM(DMR Submittal)
Submit by Brittany.Cook 5/30/2024 9:00:30 AM (DMR Submittal Review)
• The task was assigned to DEMLR SW Admin for DMRs 5/21/2024 10:21:03 AM
• Brittany.Cook assigned the task to Brittany.Cook 5/30/2024 8:28:25 AM

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DMR Submittal from 5/21/2024
Permit and Facility Information:
..............................................................................................................................................
Permit Number* Enter COC or Individual Permit Number
NCG050412
Must begin with NCS or NCG
Facility Name:* Wellmark LLC
Owner/Operator Wellmark LLC
Name:*
County:* Randolph
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 The system keeps locking me out.
through eDMR for
this permit:
Monitoring Period Information:
..............................................................................................................................................................................................................................................................................................................................................................................................
Monitoring Period What is the YEAR of the sample date(s)?
Year:* 2024
DMR Upload* Click the upload button or drag and drop files here to attach document.
20240521104011003.pdf 441.2KB
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");
d 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
o I intend to electronically sign and submit this DMR Upload form.
Full Name:* Paul Spangenberg
Name of person submitting this form
Email Address:* [e-mail]

Phone Number:* 9106943189
Signature: Ll
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Date:* 05/21/2024

Review
Review Date: 05/30/2024
Confirm Permit No.* Correct the permit ID number if needed.
NCG050412
Confirm DMR Year* 2024
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.