NCG020243 DMR WW (6)

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PROCESS/MINE DEWATERING WASTEWATER DISCHARGE MONITORING REPORT (DMR)
�I Please Mail Original And One Copy To Mailing Address Below
-- ED
GENET; AL PERItN'Ii'r NO. NCG020000 APR 11 W16
Pur! �(: Frrcilihr lrrJar•rauNorr
EN`
TFt�L FILES
Samples Collected in Quarter:1170 2 3 dQ (alt samples shall be reported within 30 drys following mC
monitoring period) [ENT SECTION
Ct•rtiticate Of Coveracre No. N p?' r Cuunh of l'acilih 0,7s 1
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,,IIIc, :Vance AGb $q �- 4A CAf1`c'1/Vv A t� /-�/ �/Id�
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i .,Lclit; Cunt.tcl /L�k j�_ U-1 ell L:rh C'crrificutiun 1F -
F'wilitt ('nntrtet Phone \o. f 9m) j72 y F17;�'_577
r i'roccs., WasY••rrure r curt! Aline Detrv,tcr irr, :4uvctnrtev .11urrrren ur,r Ruilrrirenrents
Date 50050 0040U 00530 00076 00545
Outfall-umbr r Receiving Stream Name Sample Collected Daily Flowl pll 'Total Suspended Solids Turbidity Settleable Solids
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l ! rno/dd.'w I -re�j� unit I m ^Il I,Ui 1111/1
bleaw l e0n1111110u,ly u,,u,g a Ilow mo.Isming dcvlee or :.,nut ,re(I umug ut.11t,rt,acruror, , 11111111) curve., .u„I t,u1111) los
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 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. 1 am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
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(Signature
(Signature of Permittee) (Date)
Pur -t D - Mailing Ac1ch-css
Attn: Central Files, DENI2, N.C. Division of Nater Quality, 1617 Mail Set -vice Center, Raleigh, NC 27699-1617
SWI 1-24 1- )12 1115