NCG130027_DMR Upload Review_20241025

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Anonymous User 10/22/2024 12:02:12 PM(DMR Submittal)
Submit by Brittany.Cook 10/25/2024 10:46:12 AM (DMR Submittal Review)
• The task was assigned to DEMLR SW Admin for DMRs 10/22/2024 12:02:13 PM
• Brittany.Cook assigned the task to Brittany.Cook 10/25/2024 10:44:35 AM

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DMR Submittal from 10/22/2024
Permit and Facility Information:
..............................................................................................................................................
Permit Number* Enter COC or Individual Permit Number
NCG 130027
Must begin with NCS or NCG
Facility Name:* Safety Kleen Corp-Randolph
Owner/Operator Safety-Kleen Systems Inc
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 Submitted eDMR registration forms on 3/20/24.eDMR form is not available under
through eDMR for my online user account.
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.
Q3 2024 DMR SK
290.64K6
Archdale_N CG 130027_sig ned.pdf
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");
o 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:* Todd M. Blake
Name of person submitting this form
Email Address:* [e-mail]

Phone Number:* 3366440332
Signature:
Date: 10/22/2024

Review
Review Date: 10/25/2024
Confirm Permit No.* Correct the permit ID number if needed.
NCG 130027
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.