NCG160032_DMR Upload Review_20240603

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 5/30/2024 3:15:27 PM (DMR Submittal)
Submit by Brittany.Cook 6/3/2024 9:13:35 AM(DMR Submittal Review)
• The task was assigned to DEMLR SW Admin for DMRs 5/30/2024 3:15:27 PM
• Brittany.Cook assigned the task to Brittany.Cook 6/3/2024 9:10:27 AM

[rftDQ
DMR Submittal from 5/30/2024
Permit and Facility Information:
..............................................................................................................................................
Permit Number* Enter COC or Individual Permit Number
NCG 160032
Must begin with NCS or NCG
Facility Name:* Hayesville Asphalt Plant
Owner/Operator Harrison Division-Apac Tennesse Inc
Name:*
County:* Clay
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 Not working
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.
Signed DMR 2023.pdf 465.9KB
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:* Jeffrey Arnette
Name of person submitting this form
Email Address:* [e-mail]

Phone Number:* 8652796374
Signature:
0tYft�!' 1`!
Date:* 05/30/2024

Review
Review Date: 06/03/2024
Confirm Permit No.* Correct the permit ID number if needed.
NCG 160032
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.