NCG140054_MRO Copy MONITORING REPORT_20201218

12/3/2020
New Submission
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Stormwater NPDES Permit Data Monitoring Report
(DMR) Upload
Permit and Facility Information:
Please enter the permit number and other details for this upload.
RECEIVED
DEC 18 1010
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IMPORTANT.- Until the eDMR system is implemented for DEMLR Stormwater Program permits, an original
signed hardcopy of the DMR MUST be mailed to the address in your permit, in addition to this electronic
upload.
Fields marked with a red asterisk* are required.
Permit Number* Enter COC or Individual Permit Number
Must begin with NCS or NCG
Facility Name: * ��'t. (���,�
County:
Monitoring Period Information:
Monitoring Period What is the YEAR of the sample date(s)?
Year:
Multiple DMRs from sampling periods within the same year can be uploaded together, but please upload different
years with a new submittal form.
DMR Upload* Click the upload button or drag and drop files here to attach document.
Upload
Only PDFs are accepted.
Comments:
* By checking the box and signing box below, I certify that:
https://edocs.deq.nc.gov/Forms/SW-DMR 1/2

12/3/2020
New Submission
o I have given true, accurate, and complete information on this form;
a I agree that submission of this Data 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:'
Name of person submitting this form
Email Address: * p� �� t. Alt-, c�-,- k ScO� Cd C
Phone Number:'"
Signature: * R'fit
Sign
Date: * Date captured on form submission
(, I'm not a robot
reCAPTC?-ids
Submit Save as Draft
https://edocs.deq.nc.gov/Forms/SW-DMR 2/2

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