NCG020766 DMR WW (3)

PROCESS/AIINE DEWATERING WAS'T'EWATER (DISCHARGE MONITORING
REPORT (i>a14IR)
Please Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCGO20000
Part A: Facility Information
Samples Collected in Quarter: 1 4 (ail samples Aall be reported within 30 days following monitoring period)
m.t
Certificate or Coverage No. NCG02 County of Facrtitye,l t/'
Facility Name Name of Laboratory
Facility ContactAtk
1 Lab Certification #
Facility Contnet Phone No. (--j
Par? B. Process Wastewater and Mine Dewatering Wastewater Monitoring Requirements
Date, 5005¢ 0040 OG53 U0076 00545•
Outfall > Y
?, i >
Number Rccricing Strcnm 1•lunti Srmplc t otlected Duily.Flowt pH `Total Suspended SoLds Tprbidiry Settleable l l I
-77
ri a� m`oIdle/vr ' TTGn utzlt , m - ivTUc mUl
JUL 2 .� 2015
t Measured continuously using a flow measuring device or estimated using rnanufacturerb pump curves and pump less,
Part C. Certijicanon
"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 submi false information,
Including the possibility of fines and imprisonment for knowing vlolatl ,
(Si a 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
i 1�s a ryy-4.a,,,,,L4,q/lA�q� �.are.1+�. p�— CL&L 's ll�r�� S �,o �.C� SWU-244-012005