NCG020243 DMR WW (4)

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PROCESS/MINE DEWATERING WASTEWATER DISCHARGE MONITORING REPORT (DMR)
11 Please Mail Original And One Copy To Mailing Address Below -
G1,7,NERAL PERNUT NO. NCG020000
Purl A. Facility hilbrrnution
Samples Collected In Quarter: 10 20 30-6-o"Ill samples shall he reported within 30 days following monitoring period)
Ir Irele Ony
Ctertitieate Of Covert e No. . �ti$11? Cnunh of T+acility
I blit, Natue Covera
C0,"y4,y_ - a le �t/ke %/,�i/� l�,'7� II ,1,,,. ,
Cuntad C1 /t /7 9!/ e!i L,ub Certification
F t, ilih' Conhet Phone No. 5/
IVasl,fwarc•r and Mme L7c;,rurcrrn, 06 I.,;c•,I',111 r -tdanrnrruIt' licyuir•elne)IIS
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Date
50050
00400
00530
00076
UUSdS
Sumber
Receiving Stream Name Sample Collcered
Daily Flowt
pli
notal Suspended Solids
Turbidity
Settleable Solids
I
unit
m�/f
:V 1'l;•
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671110211b7 �v 7� 0 � ri r � ©r 5
�lea,urcd conunuuu;ly u.;ul ;, !lu•.v uwa,"ling dev,cc e,r :.,uma[od u,,m nt.uulfauurcr; pump curve; .mei pump lu��
Part C Ccrtr/icatton
"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 submitting false information,
including the possibility of fines and imprisonment for knowing violations." ,
(Signature of Permittee) (Date)
Part L) - rlkriling /Idcb•ess
Attn: Central biles, DENIt, N.C. Division of Water Quality. 1617 Mail Service Center, Raleigh, NC 27699-1617
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