HomeMy WebLinkAboutNCG020766 DMR WW (2)-&- 2-
PROCESS/MME
DEWATERING WASTEWATER DISCHARGE MONITORING REPORT (DMR):;
Please Mail Original And One Copy To Mailing Address Below
Part A: Facility Information GENERAL PERMIT NO. NCGO20000 APR 1.:Q'''2015`
CENTRAL FILES
Samples Collected In Quarter 1 3 4 (all samples shall be reported within 30 days following monitoring period) WR SECTI
Certificate or Coverage No, NCG020
�(2 County of Facility ?e.e+cA.t/' -
Facility Name % ��� Name of laboratory
Facility Contact 1 M dab Certification #
Facility Contact Phone No. ( 1 -
Pari B: Process Wastewater and Mine Dewatering Wastewater Monitoring Requirements
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Total Suspended Solids ''
Tprbi'dity 8ettieableS4Gds
Numher
Rerciving Stream Plume
Srmple Collected
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1 Measured continuously using a flow measuring device or estimated using manufacturer$ pump curves and pump loss.
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
system designed to -assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the persons'
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 signifi nt penalties for submitting false information,- '
Including the possibility of fines and imprisonment for knowing violati ,
17 10lS_
(Si a of Permittee) (Date)
Part D. Mailing Address
Atter: Central Files, DENR, N.C. Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617
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