NCG020310 DMR WW

PROCESS/MINE DEWATERING WASTEWATER DISCHARGE MONITORING REPORT (DMR)
Please Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCG020000
Part A: Facility Inforination
Samples Collected In Quarte . 1 3 4Q (all samples shall be reported within'30 days following monitoring period),
• lard. One)
Certificate Of Coverage No. NCG02�� j County of Facility
Facility Name CJ'(�l Name of Laboratory '59 -
Facility Contact n' Lab Certification Al
Facility Contact Phone No. 1v,410
Part B: R: Process Wastewater and Mine Dewatering Wastewater Monitoring Requir enierits
oil -trill
Number
;Receiving Stream Nance
Date.
Sample Collected
50059
00400.
00530.
00076il
00Sd5
Daily Flowt
pIi ; .
Total Suspended Soltd� .:
Turb)dtty
Stt(�alie Sotuis
_
=:.mof�iill" �'. �
'i41CD '�
unit .
t1 b
r �1'i'�.►s%"
v ; ,,..int/1;
Measured continuously using a Flow measuring device or estimated using manufacturer's pump'cufves aid pump logs.
Part C: Certification 4
"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 ani aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
4(ignature of ern 'ttec) (Date)
Part D: Mailing Address
Attn:�. Central Files, DENR, N.C. Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617