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Home My WebLink AboutNCG120107_MONITORING INFO_20191125vvSR b STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /V C I a 00 l DOC TYPE ❑ HISTORICAL FILE IXMONITORING REPORTS DOC DATE ❑ d YYYYMMDD Semi-annual Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG120000 Date submitted June CERTIFICATE OF COVERAGE NO. NCG12_0 1 SAMPLE COLLECTION YEAR 2019 FACILITY NAME Great Oak Landfill ,y SAMPLE PERIOD N lan-June ❑ July -Dec COUNTY Randolph r C E I V C: C; or ❑Monthly' (month) PERSON COLLECTING SAMPLES Glenn Price DISCHARGING TO CLASS ❑ ❑ [-]Trout HQW Trout ❑PNA LABORATORY Research & Analytical Labs Lab Cert. A 34NOV ee...... 2 5 2019 ❑Zero -flow ❑Water Supply E]SA Comments on sample collection or analysis: Cr�h, - ❑Other 1 MItL FILES mein SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE --> Part A: Stormwater Benchmarks and Monitoring Results n Nn rlicrhnrna this narinrlZ OuHail No. Date Sample Collected (mo/dd/yr) 24-hour rainfall amount, Inchesa Chemical Oxygen Demand mg/L Fecal Collform Colonies per 100 mL Total Suspended Solids mg/L pH, Standard Units Benchmarks _ - 120 1000 100 or 50' 6.0-9.0 Paromeler Code - 46529 00340 32616 C0530 00400 S81W 06112/19 0.7 31 640 7.2 6.84 SB2W 08/12/19 0.7 9 327 <5. 6.65 S83W - 06/12/19 0.7 31 364 8.4 7.17 rvwnuny>dnlpung tlnseeaa or Semi-annual) must begin with the second consecutive benchmark exceeaance for the same parameter at the same outfall. ' For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. ' See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, NO, or other similar non - numerical format. When results are below the applicable limits, they must be reported in the format "<XX ma/L", where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX". Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Permit Date: 11/l/2018.5/31/2021 SWU-248, last revised 11/1/2018 Page 1 of 2 Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. T1 Outfall No. cot Date Sample Collected'. (mo/dd/yr) 24-hour rainfall amount, Inches3 Non -Polar Oil & Grease mg/L u IV u..x.uv, Total Suspended Solids, mg/L yc u,n pervuu- New Motor or. Hydraulic Oil Usage, gaVmon Benchmarks _ - 15 100 or504 _ Parameter Code - 46529 00552 C0530 NCOH. n warm 6 . ..... .... .. .. ..v ap V aLIES rnmro Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. see General Permit text. FOR PART AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO 0 REGIONAL OFFICE CONTACT NAME: Moil an original copy of this DMR, including all "No Discharge" reports within 30 days of receipt of the lab results for at end of monitoring period in the case of No Discharge reportsl to. - Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED "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 quallfied 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 bellef, 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." —7 ZZ Zee ? D e Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018 Page 2 of 2 Semi-annual Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NC13120000 Date submitted September 2019 CERTIFICATE OF COVERAGE NO. NCG12 0 t 0 7 FACILITY NAME Great Oak Landfill COUNTY Randolph PERSON COLLECTING SAMPLES Glenn Price LABORATORY Research It AnalyOcal Labs Lab Cert. It a4 Comments on sample collection or analysis: Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2019 SAMPLE PERIOD ❑ Jan -June ❑ July -Dec % rr-- I7 or 0 Monthly' July (month) RECUISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA ❑Zero -Row ❑Watersupply []SA NOV 2 5 2019 ❑Other CEN rtAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4 DWR SECTION n No dischorae this oeriodz Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches' Chemical Oxygen Demand mg/L Feral Colltorm Colonies per 100 mL Total Suspended Solids mg/L pH, Standard Units Benchmarks - - 120 1000 100 or 504 6.0-9.0 Parameter Code - 46529 00340 31616 C0530 0040D ' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. 'For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites maybe eligible for a waiver of the rain gauge requirement. ' See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BOIL, <PQL, Non -detect, NO, or other similar non - numerical format. When results are below the applicable limits, they must be reported in the format. "<XX me/L". where XX is the numerical value of the detection limit, reporting limit, etc, in mg/L. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX". Note: If you report a sample value in excess of the benchmark, youmustImplement Tier 1, Tier 2, or Tier responses. See General Permit text. Permit Date: 31/1/2018-5/31/2021 SW U-248, last revised 11/1/2018 Page 1 of 2 Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. Outfall No. Date Sample Collected' (mo/dd/yr) 24-hour rainfall amount, Inches' Non -Polar Oil & Grease mg/L 1�1 ••v uvcnv, Total Suspended Solids, mg/L Nc .nre Ycnuu ' New Motor or Hydraulic Oil Usage, gal/Mon Benchmarks - - 15 100 or 504 Parameter Code - 46529 ODS52 C0530 NCOIL ........e_ f P Fo rom artA also apply to tfus Parts Note; If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES- ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mail an or/a/nal copy of this DMR, including all "No Discharge"reports within 30 days of rece/pt of the lab results for at end of monitoring Period in the case of No Discharge reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mall Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED "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 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Signature of Permittee Permit Date: 11/1/2018.5/31/2021 SWU-248, last revised 11/1/2018 Page 2 of 2 Semi-annual Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG120000 Date submitted Seplomber2019 CERTIFICATE OF COVERAGE No. NCG12 0 t 0 7 SAMPLE COLLECTION YEAR 2019 FACILITY NAME Great 01axtandail SAMPLEPERIOD ❑Jan -June ❑July -Dec COUNTY Randoiph or QMonthly, August (month) PERSON COLLECTING SAMPLES Glenn Price DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA LABORATORY Research BAnatyncalLabs Lab Cert. it -14 `, ❑Zero -flow []Water Supply ❑SA Comments on sample collection or analysis; RECEIVE® ❑Other NOV 2 5 2019 PLEASE REMEMBER TO SIGN ON THE REVERSE 4 Part A: Stormwater Benchmarks. and Monitoring Results CEN I rat- FILES DWR SECTION 1M1 No discharae thisaerlod2 Outfall No. Date Sample collected' (mo/dd/yr) 24-hour rainfall amount, Inches' Chemical Oxygen Demand mg/L Fecal Coilforrn Colonies per 100 art. Total Suspended. Solids mg/L Standard Units a rd Benchmarks - - 120 1000 100 or 50' 6.0.9.0 Parameter Code - 46529 00340 31616 C0530 00400 ' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceeclance tortne same parameter at the same outran. 'For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement. 4 See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Note: Results must be reported In numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, NO, or other similar non - numerical format. When results are below the applicable limits, they must be reported In the format, "<XX mg/L!', where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX". Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier responses. See General Permit text. Permit Date: 11/1/2018=5/31/2021 SWU-248, last revised 11/1/2018 Page 1 of 2 Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging> 55 gal of new oil per month. ■ Outfall No. Benchmarks Date Sample Collected' (mo/dd/yr) _ 24-hour rainfall amount, Inches' - Non -Polar Oil & Grease mg/L 15 No discharge Total Suspended Solids, mg/L 100 or 504 thu penou- New Motor or Hydraulic Oil Usage, gal/mop _ Parameter Code - 96529 00552 C0530 NCOIL :nntnntac frnm DEN a �1 hr.. .., •t:.. n_.. o .., -rr•r .0 .�,.5 , a.. ., Note: If you report a sample value In excess of the benchmark, you must implement Tier 1, Tier 1, or Tier responses. See General Permit text. FOR PART A AND PART B MONITORING RESULTS: • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B. • 2 EXCEEDANCES INA ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION a. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO REGIONAL OFFICE CONTACT NAME: Mall an original copy of this DMR, including all "No Discharge" reports within 30 days of recelpt of the lab results (or at end of monitoring period In the case of No Discharge reports) to: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699.1617 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED, "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 forgathering 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 Permit Date: 11/1/2018-5/31/2021 Date SWU-248, last revised 11/1/2018 Page 2 of 2 RECF)\eE® NOV 2 5 2019 CEN I rcrtL HLES DWR SECTION! Semi-annual Stormwater Discharge Monitoring Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG120000 Date submitted May 2019 CERTIFICATE OFCOVERAGE NO. NCGIZO 1 0 7 FACIUTYNAME Mxu0tLCNe0 COUNTY Rmddch PERSON COLLECTING SAMPLES Gem Pam LABORATORY RalxxJ A MsNd.t Labs Lab Cert.4 3- comments on sample collection or analysis: - Part A: Stormwaler Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR =19 SAMPLEPERIOD QlanJune ❑IUIV-DK or ®Monthly, Apd fmonihl DISCHARGING TO CLASS ❑ORW QHOW ❑Trmst �PNA (kL�CliZero•Row Water SupPly ❑SA Other PLEASE REMEMBER TO SIGN ON THE REVERSE -), Outhll No- Date Sample Collocted' (coo/tltl/yr) 24.heur rainfall amount, Inches' Chamini Oxygen Demand mVL cobeh wf10 col p Total Suspended-" SPllds mg/L PH Sundard Units Benchmarks 120 IDDO I009r504 6.0.9.0 Pammelrrrode 4SS29 M340 31616 C0530 =Do sa2w 04r26119 0.15 0 69 106 771 ---^-, ...I ... r•••-- ••• —••-"••••-=v •• — KIs e.,,, r„c---1a vu I.re eanunnara axceeaarae car n o same parameter at I" same outrall. 'For sampling periods with no discharge at any single oulfall, you must still submit this discharge monitoring report with a checkmari, here. 'The total precipitation must be recorded using data from an on-slie rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement, ' See General Permit text, Table 1. Identifying the especially sensitive receiving water classifications where the more protective benchmark app'iles. Note: Results must be reported In numerical format. For example, do not report Below Detection Limit, BOL, 9FOL, 14on.dete0, NO, or other slmfar non, numerical format. When results are below the applicable limits, they mun be repmrted In the format -,U mefL".where XX [tithe numerical value of the detection limit, reporting limit, etc. In mg/L Conversely, where fecal coliform results exceed the dilution upper limit, report the result as "PXIe". Nate: 1/you report a sample value in excess of the benchmark, you must Implement Tier 1, Tier b or Tier 3 rdepemsas. See Generol permit text. Permit Date: il/l/2019-5131/2021 SWU-20A la l Rvhed 1111/2018 Past 1 of 2 O Part B: Vehicle Maintenance Area Monitoring Results: only for Eacilitles averaging > 55 gal of new oll per month. CaRetleds d)Yr{Im is -Fear ralnfallam0unt, ams _ NRmPalapliTOhis"pended5ogds,New E Nc discha 'nYt a this period' Molar or Mydmulk Dll Usage, OilmanI WDalcA OOS52 l50'4655 OOS30&13 NCOiI015108 { '00motor from Part A also apply to this part B Note: rf you report a sample value M access of the Benchmark, you must Implement Tier 1, Oer4pr Oar 3 responses. See General Permit text FOR PART A AND FART is 14 1N1TUa!N Pf a ABENCHMARK EKCEEDANCE TRIGGERS TIER I REQUIREMENTS. SEE PERMIT PART II SECTION • 2 E%CEEDANCE5 IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART II SECTION e • TIERS! HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK ERCEEOENCES FOR THE SAME PARAMETER AT ANY GNE OUTFAll7 YES ONCE) IF YES, HAVE YOU CONTACTEDTHE DEMLR REGIONAL OFFCE7 YES ONDO REG OVAL OFFICE CONTACT NAME Divismn of Water Chat" Aitn DWQCemra FLes 1617 ktall Sanhce Center Raleigh, Norm C81011A 27699-163: y: ctmhy.:1 der proms Ia' AhONi, do—, 1`1fDaM�tgIN RFGJRTiD 'Y certlly, under pmahY pilaw, it -at hn tloc:Inunt acd a!I aC.aNments were preyed uoder mY d ratticn or supel,ion in .mordant. with a ansu m d.F,gr" to assure mat qua Nkd personnel paper�ga;Her and evaba:e the Inicrmatian supmined. Based artmyinquiryofthe pemr. or persons who manage the Pru m.0r am awuestha;thisdihe elaransP n.fi4antic' 8athe,hn the inf0r:na•: on, Lae Iclnr. a: Rn submhtLd is, to the best of my kocv.ledgr ar:d bNial, troe, accurate. 3,1 cemplme. l 8 pena'Ops lot svbhm4lg WRhfiarmaVon, including the passft,///&YUf lines athisP,dmvrrnenl farknawlna Nplah"s., fo 5lgnatun of Prm eittee ._ Da rt I Permit Date 11/1(20185/31/2021 SW U.248, Ian rr6sed 1111R01g Page 2 of 2 Semi-annual Stormwater Discharge Monitorina Report for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG120000 Date submitted tune 2019 CERTIFICATE OF COVERAGE NO. NCG12 0' 1 O 7 SAMPLE COLLECTION YEAR 2019 FACILITY NAME Great Oak Landfill ( SAMPLE PERIOD ❑ lan-June ❑ July -Dec COUNTY Randolph - or [ Monthly' May (month) PERSON COLLECTING SAMPLES Robert Hill - �� , DISCHARGING TO CLASS ❑ORW ❑HQW []Trout❑PNA LABORATORY Research & Analytical Labs .Lab Cert. tt 34 EI VED ❑Zero -flow ❑Water Supply ❑SA Comments on sample collection or analysis: NOV 2 5 ;toj9 ❑Other CEN I r�mPLEASE REMEMBER TO SIGN ON THE REVERSE L t IL' c Part A: Stormwater Benchmarks and Monitoring Results Old ,%,-EC7-10 J No dischorge this period2 Outfali No. Date Sample Collected (mo/dd/yr) 24-Hour rainfall amount, Inches' Chemical Oxygen Demand ing/L Fecal Coliform Colonies per 100 mL Total Suspended Solids mg/L pH, Standard Units Benchmarks - - 120 3000 100 or 501 6.0-9.0 Parameter Code 46529 00340 31616 C0530 00400 I� ` Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceeda lice for the same parameter at the same outfall. ' For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkroark here. 'The total precipitation nitist he recorded using data from an on -site rain gauge. Unattended sites maybe eligible for a waiver ofthe rain gauge requirement. 4 See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <POL, Non -detect, ND, or other similar non - numerical format. When results are below the applicable limits, they mustbe reported in the format. "<XX n1g/L", where XX is the numerical value of the detection limit, reporting limit, etc. in mg/L. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX". Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text. Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018 - - Page 1 of 2 Part B: Vehicle Maintenance Are, Monitoring Rtsults: only for EedlitleS averaging s 55 gal of new all per month, - OuMal: No, Date Sample Collected' 34-hoer binhallamount, NomPolar 011&G¢asv lot Stop Na disch pedded5otlds, o a Ehis period] (mo/dd1YrJ Inchest mg/L New Molm or Hydraulic sage, OII U searhmarkr' m1dL gal/non . Parameter Cate - 46529 ES 100 At 50' _ SB74 D4ci6l13 Dts 00552 C0530 N[Oil <s tag 'ootnolm Gom Pan A alsoaFrPly to this Part 9 Note: If youreport a samplePafue In excess of the hMChmprk,Paumust implement Tier 1, T7er2, or Tier3 responses. See General Permit text LOP PARTA AND PART 0M;jFNrTpMB pESULTS • ABENCHMARK E%CFEOANCE TRIGGERS TIER I REQUIREMEN75, SEE PERMIT PART II SECTION • I EKCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFAU TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART U SECTION B • TIER 3: HAS YOUP FACILITY HAD A OR MORE BENCHMARK EKCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTTALK YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFF CE2 YES ❑NO❑ PEG ORAL OFFICE CONTACT NAME UMnpn pl Paler qua] tY Ann DWq C,i F:es 1617 Mail Service Center Ralaigh, North C9:011a 226991612 Y'i'I •.:V;t slculHt£ nns!an9,s."FD.?'+_.YJ Lda! tom!??giiTt Is, "I :ertlh/, under peoahy of Uw, that d+H document and ali anaehmenp were prepared under icy d rectian or mperv�ifon in aCcortlancv with a system iesiOneC m a ase persons dv tV n-onsple(A, rgne e.aro ova ua:c [he into:metinn S,:pmit;ed. eased on my Mculry of the pr,Soe ar persons who manage the system,at hr r g the iotormaton.Iee'.nfmma:01S,bmnled is. to the bestaimy,e_wledge;no hdlel, tn", aoswato and camPiel,I Am aware that there are Sr5ni.unt p,, Dipes Tor Subma"If farw ofit ma Von, indudla the Osslblh of lines And rm Nsonmevt for 4nowin Noi g P IT p R atipn3.` Signature of Permitter Oa re r Permit Date 11/1/2015513112011 SWU.248, ;.it revHvtl I1/l/2018 Paso 2 of 2