HomeMy WebLinkAboutwq0042178_Application_20201217State of North Carolina
Department of Environmental Quality
'R PWDivision of Water Resources
15A NCAC 02T .0200 — WASTEWATER PUMP AND HAUL SYSTEMS
Division of Water Resources INSTRUCTIONS FOR FORM P&H 01-16 & SUPPORTING DOCUMENTATION
Documents shall be prepared in accordance with 15A NCAC 02T .0100. 15A NCAC 02T .0200 and Division policies. Failure to
submit all required Items will necessitate additional processing and review time. For more Information, visit the Wastewater
Branch's website or contact the Regional Office serving your county.
General —This permit application applies to all pump and haul activities of wastewater under the authority of the Division on Water
Resources. Permit coverage is required for the system producing the wastewater. This permit does not apply to the transport of
animal waste from an animal waste management systems, not the transport of wastewater residuals or biosolids.
NOTE: Pump and haul permits are not acceptable long term domestic wastewater treatment alternatives and shall only be Issued
In cases of environmental emergencies, nuisance conditions, health problems, or for unavoidable delays in construction of system
previously permitted by the Division.
The Applicant shall submit one original and one copy of the application and supporting documentation.
A. Pre -submittal Contact & Cover Letter
® Contact the appropriate Regional Office prior to submittal
® Submit a cover letter explaining the circumstances associated with this pump and haul permit request
B. Application Fee (Domestic Wastewater Only)
® Submit a check made payable to: North Carolina Department of Environmental Quality (NCDEQ)
The appropriate application fee is: $810.00 for flows < 10,000 GPD and $1,310.00 for flows > 10,000 GPI]
C. Wastewater Pump and Haul (FORM: P&H 01-16) Application:
® Submit the completed and appropriately executed Wastewater Pump and Haul (FORM: P&H 01-16) application. Any
unauthorized content changes to this form shall result in the application package being returned. If necessary for clarity or
due to space restrictions, attachments to the application may be made, as long as the attachments are numbered to
correspond to the section and item to which they refer
D. Receiving Facility Letter:
® Submit a letter from the owner/authority of the receiving wastewater treatment facility, as required by 15A NCAC 02T
.0204 (b), stating that the pumped and hauled wastewater will be accepted and specifying the volume and type of
wastewater that will be accepted. The letter should be signed by an authorized signing official in accordance with 15A
NCAC 02T .01061bI
E. Contract Hauler Letter:
® Submit a letter from the hauler stating their capability and willingness to perform the pump and haul activity
® Letter shall include: Owner/Company Name, Contact Information, & Hauling Volume of Vehicle(s)
F. Certifications:
® The Applicant's Certification on Page 4 of the application shall be signed in accordance with 15A NCAC 02T .0106 b . Per
15A NCAC 02T .0106(cl. an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b)
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer (if required)
G. Plans and Specifications (Required for activities that result in the Practice of Engineering per G.S. 89C-3):
® Submit two sets of plans and specifications (signed, sealed and dated by a N.C. Licensed Professional Engineer)
® Plans must Include:
D A general location map
➢ Diagram of the components associated with the pump and haul activity (drains, piping, tanks, pumps, etc)
Tank Details that indicate high water alarm
Other items as required
INSTRUCTIONS FOR APPLICATION P&H 01-16 Page I of
Industrial Pump and Haul Activities
Per—A_NCAC 02T _0203(A1i2), Industrial pump and haul activities are deemed permitted provided the following criteria is met:
D The facility notifies the appropriate Division regional office in writing advising of the type of operation, type and quantity of
wastewater generated, location, and the receiving wastewater treatment facility. A letter from the facility accepting the
wastewater (type and quantity) specifically agreeing to accept wastewater from the applicant shall be included.
The wastewater does not contain any human waste.
D The waste is collected and discharged Into a sewer or treatment system designed and permitted to accept the type of
wastewater being pumped and hauled.
D The pump and haul activity is not to alleviate a failing wastewater system.
D The Division regional office concurs in writing that the activity meets the criteria in this Rule.
CONTACT THE REGIONAL OFFICE PRIOR TO INITIATING ANY INDUSTRIAL PUMP AND HAUL ACTIVITES. SUBMITTAL OF THIS
APPLICATION/DOCUMENTS AND WRITTEN APPROVAL 15 STILL REQUIRED FOR INDUSTRIAL PUMP AND HAUL ACTIVITIES
THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND MATERIALS, SHOULD BE SENT TO THE
APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Operations
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
(828) 296-4500
Macon, Madison, McDowell, Mitchell, Polk,
(828) 299-7043 Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water quality Operations
Fayetteville, North Carolina 28301
Montgomery, Moore, Robeson, Richmond,
(910) 433-3300
Sampson, Scotland
(910) 486-0707 Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Operations
Mooresville, North Carolina 28115
Gaston, Iredeli, Lincoln, Mecklenburg, Rowan,
(704) 663-1699
Stanly, Union
(704) 663-6040 Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Operations
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
(919) 791-4200
Northampton, Orange, Person, Vance, Wake,
(919) 788-7159 Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertle, Camden, Chowan, Craven,
Water quality Operations
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
(252) 946-6481
Jones, Lenoir, Martin, Pamlico, Pasquotank,
(252) 975-3716 Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Operations
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
(910) 796-7215
(910) 350-2004 Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
(336)-776-9800
INSTRUCTIONS FOR APPLICATION P&H 01-16 Page 2 of 5
I. PRESUBMITTAL INFORMATION:
W00o uz17 �
1. Contacted representative from regional office (Pre -submittal)?: ® Yes ❑ No
2. Contact name (For Regional Office): Jason Robinson. PE INC Mpt OflFirvh aamnitjill q,ehhny
II. APPLICANT INFORMATION:
T 17
1.
Applicant's name (Municipality, Individual, Corporation, etc): Primax Properties,
LLC
2.
Applicant type: ❑ Municipal ❑ State ❑ Privately -Owned Public Utility
Ral018b Regional offIC0
❑ County ® Other: Private developer
3.
Origin of Wastewater:
❑ Residential Subdivision ® Retail (Stores, Shopping Centers)
Domestic: %
❑ Apartments/Condominiums ❑ Institution
Commercial: %
❑ Mobile Home Park ❑ Hospital
Industrial: %
❑ School ❑ Church
Other: %
❑ Restaurant ❑ Nursing Home
❑ Office ❑ Other (specify)
4.
Signature authority's name: William Seymour per 15A NCAC 02T .0106(b)
Title: Manaeer
5.
Applicant's mailing address: 1100 E. Morehead Street
City: Charlotte State: NC Zip: 28204-
6.
Applicant's contact information:
Phone number: 704) 344-8200 Email: billseEnour@12rimaxi)rot)erties.com
III. CONTACT/CONSULTANT INFORMATION:
1.
Contact name: Matthew Lowder, PE
Title/Affiliation: Manager/Triangle Site Design. PLLC
2.
Contact's information:
Phone number: (919) 553-6570 Ismail: mlowder@trianglesitedesign.com
IV. RECEIVING FACILITY INFORMATION:
If more than 1 facility has agreed to accept the wastewater, please list all the owners, facility names, and permit
numbers as a separate attachment)
1. Owner: Johnston County
2. Facility name: Johnston Coun BioSolids Facility
3. Facility permit number: Central Johnston County Wastewater Treatment Facility
4. WWTF permit number: NC 0030716
5. WWTF contact name: Chandra Farmer, PE
Title/Affiliation: Johnston County, Director of Public Utilities
6. WWTF contact information:
Phone number: (919) 209-8333
Email: chandra.farmer@iohnstonnc.com
APPLICATION P&H 01-16 Page 3 of
V. PROJECT INFORMATION:
1. Location of Project (physical address): NC Highway 42
Approximate Coordinates (Decimal Degrees): Latitude: 35.6146120 Longitude:-78.543917o
2. Duration of Pump and Haul Request (Six Months Typical): 6 months
3. Has a prior permit been issued? ® New ❑ Prior Pump & Haul Permit
Permit No.:
4. Permanent Method of Wastewater Disposal: Sanitary sewer trunk
S. Date Permanent Disposal will be available: March, 2021
6. Have permits / approvals for permanent disposal been obtained?
® Yes ❑ No Permit Number: W 0041777
7. Is there a Pretreatment Program in effect? ❑ Yes ® No
8. Describe any pretreatment prior to pumping and hauling:
9. Volume of Wastewater Generated: 2292 Gallons per Day
10. Explain how the wastewater flow was determined: ®15A NCAC 02T .0114 or ❑ Representative Data
If representative data, describe:
11. Describe Tank / Container wastewater will be pumped from (attach description if necessary):
Sanitary sewer manhole
12. Is Tank / Container in place or will it be installed (attach description if necessary):
In place
13. What type of high water alarm does the container have (and/or):
® Audible and Visual ❑ Telemetry (Auto Dialer / SCADA)
VI. CERTIFICATION:
1. Applicant's Certification: (Signature of Signing Official and Project Name)
1, William G. Seymour , attest that this application for _ Tractor SuDoly - Johnston County
_ has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts
of this application are not completed and that if all required supporting documentation and attachments are not included,
this application package is subject to being returned as incomplete. I understand that issuance of a permit will require pump
and haul facilities or activities to be inspected at least daily by me or a designated representative. Note: In accordance with
North Carolina General Statutes 143-215.6A and 143-215.6B. any person who knowingly makes any false statement,
representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
r
Signing Official Signature
Date
ENGINEERING DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL.
ACTIVITIES SHALL BE INSPECTED AT LEAST DAILY BY THE PERM17TEE OR IT'S REPRESENTATIVE PER 15A NCAC 02T .0204(d).
APPLICATION P&H 01-16 Page 4 of 5
THE ENGINEER'S CERTFICATiON IS REQUIRED FOR ACTIVITIES THAT RESULT IN THE PRACTICE OF ENGINEERING PER G.S. 89C-3.
ENGINEERING DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL. IF CERTIFICATION BY AND ENGINEER IS REQUIRED..
THIS PAGE IS NOT NECESSARY.
Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
i, Matthew Lowder PE ,attest that this application for
Johnstpn CountyTractor Su I
has been reviewed lay me and is accurate, complete and consistent with the information in the
engineering plans, calculations, and all other supporting documentation to the best of my knowledge. I further attest that to
the best of my knowledge the proposed design has been prepared in accordance with all the applicable regulations.
Although other professionals may have developed certain portions of this submittal package, inclusion of these materials
under my signature and seal signifies that I have reviewed this material and have judged It to be consistent with the
proposed design. Note: In accordance with NC General Statutes 143-215.6A and 143-215.68. any person who knowingly
makes any false statement, representation, or certification In any application shall be guilty of a Class 2 misdemeanor which
may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Matthew Lowder, PE
Professional Engineer Name
12b. Triangle Site Design, PLLC
Engineering Firm
�2c. 4004 Barrett Drive, Suite 101
Mailing Address
12d. Raleigh 2e. NC 2f. 27609
City State Zip
2g. 919-553-6570 :2h.
L Telephone � Facsimile
2i. mlowder@trianglesitedesign.com
E-mail
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_NCPE Date
APPLICATION P&H 01-16
Page 5 of 5
TRIANGLE
S I T E D E S I G N
December 14, 2020
Mr. Jason T. Robinson, PE
Raleigh Regional Office
Water Quality Regional Operations
NC Division of Water Resources. DEQ
3800 Barrett Drive
Raleigh, NC 27619
RE: Tractor Supply Development - Johnston County, NC
Pump and Haul permit
Mr. Robinson.
4004 Barrett Drive, Suile 101
Raleigh, North Carolina 27609
(919)553-6570
NC Dept of Environrnc:ltw
OEf. I? 2020
Mcigh Regional Offica
The developer of the new Tractor Supply retail store, Primax Properties, LLC, that is located on NC Highway
42 in Johnston County, NC would like to request a 6-month pump and haul permit for their facility. The store
is currently under construction with an estimated opening date of February 6, 2020.
The store is located on an outparcel within the Ford Tract Mixed Use PUD project. The overall development
(inclusive of a single-family residential neighborhood, not yet started) will be served by an approved sanitary
sewer trunk that is currently under construction (NCDEQ Permit Number WQ0041777). A portion of the
sanitary sewer trunk has been instaIIed; however, the remaining section of the trunk was delayed due to
permitting and construction delays (see below) that impacted the construction schedule and the availability of
the system to provide service at the time of the Tractor Supply opening.
During the design and permitting of the single-family portion of the Ford Tract Mixed Use PUD project that is
adjacent to the Tractor Supply store a small portion of wetlands that was not originally identified by the project
Environmental Consultant was found to be a wetland feature. Unfortunately, this small wetland feature was in
conflict with the proposed route of the sanitary sewer trunk to serve the Tractor Supply development. The
Environmental Consultant worked with Johnston County, the US Army Corps of Engineers and other agencies
to secure the permits for the wetland impact (0.039ac impact) (USACOE General Permit4 SAW-2020-00880)_
Once the wetland permit was issued by the USACOE, Johnston County issued the land disturbance permit that
allowed the continued construction of the sanitary sewer trunk.
When the wetland feature was discovered, the contractor installing the sanitary sewer trunk had to stop work
on the project until the impact permits were acquired. This delay is what pushed the construction schedule of
the sewer trunk back to the point that it will not be available for the opening of the proposed store. Based on
the current construction schedule for the sewer trunk provided by the Contractor it appears the sanitary sewer
trunk will be completed in early March of 2021. With a scheduled Tractor Supply opening date of February
6'- the anticipated duration of the pump and haul process is a little over a month, There will be workers
stocking the proposed store as early as January 1 l 1; however, a temporary restroom facility can be provided
on -site during this time until the pump and haul process begins.
Chandra Fanner with Johnston County Utilities is aware of the proposed pump and haul request and has
indicated the flow will be accepted by the County at their BioSolids Facility near the Johnston County Landfill
on County Home Road. A septic hauler that has been approved by the County is contracted with the developer
to provide the pump and haul service until the sewer trunk main is available for use. One of the manholes for
the sanitary sewer trunk that has been installed will be used as the tank for the pump and haul operation. The
f� TRIANGLE
S I T E D E S I G N
4004 Barrett Drive, Suite 101
Raleigh, North Carolina 27609
(919)533-6570
site plumbing contractor has been contracted to install high-water alarms within the manhole to monitor the
discharge levels, The daily discharge for the Tractor Supply store was permitted at 2,292 gpd based on 15A
NCAC 02T _0114 standards. however, a typical Tractor Supply store generates less actual flow than this
amount.
The delay in the sewer trunk construction that created this need was caused by a wetland feature that was not
originally identified by the project Environmental Consultant. Once the feature was identified, the Consultant
worked diligently with the agencies to acquire the necessary permits for the impact, but this delay pushed back
the construction schedule for the sewer trunk_ The Contractor is currently on the project working on the
construction of the sewer trunk.
Thank you for your consideration of this pump and haul permit_ The developer of the project certainly
understands a pump and haul process is not ideal and does not want to operate the store under this condition
any longer than is necessary. Based on the construction schedule and the anticipated opening date, it appears
the pump and haul condition will be needed for a little over a month.
Please let me kno►%- if you need any additional information for your review of this request,
Yours Truly,
Matthew Lo%%der, PE
4
Triangle Site Design, PLLC
AUTHORIZATION TO DISCHARGE SEPTAGE TO A WASTEWATER
TREATMENT FACILITY
North Carolina Department of Environment and Natural Resources
Division of Waste Management - Solid Waste Section
401 Oberlin Rd., Ste.150, Raleigh, N.C. 27605
Fee assessments and waste determinations will be required at the discretion of the wastewater treatment
facility. The facility has the ultimate prerogative to deny discharges of any wastes to the incoming
wastewater stream. Septage cannot be brought in from outside of the County.
1, John D. Wall -Central Johnston County Regional Wastewater Treatment Plant
(Plant operator and Name of Plant)
Post Office Box 2263 Smithfield North Carolina 27577
(Address)
_(919) 989-5075 do hereby authorize
(Phone Number) (Owner/Operator of Seplage Management Firm)
of A+ Se tic Tank Pumping, LLC NCS# 01271
(Septage Management Firm Name
1089 Hannah Creek Road, Four Oaks, NC 27524
(Address)
to dispose of: domestic septage , portable toilet waste ,
grease septage (grease trap pumpings) commercial/industrial septage , from
*requires pre -approval from Johnston County
Johnston County, North Carolina
(County or other Geographic Area)
at the above named wastewater treatment facility. Septage shall be discharged at:
Johnston County Sludge Handling Facility. 680 County Home Road Smithfield North Carolina
(Location)
between the hours of 8:00 A.M. thru 4.45 P.M.-Mondgy through Friday.
Reintroducing partially treated liquid Into a grease trap is acceptable Yes X No
This authorization shall be valid until December 312021
(Usualiy December 31, Year)
Signed �L� Date 1214/20
John D. Wall (Facility operator)
Sworn to and subscribed before me this i— day of QD - aoao
My Commission expires: 4-1-23
Nancy House Q (Notary Public)
(OFFICIAL SEAL) NANCY HOUSE
NOTARY PUBLIC
JOHNSTON COUNTY, N.C.
My commission Expires 4-1-2023.
Note: Falsification of this document I y the sep9ge management firm shall lead to permit revocation.
ESTIMATE
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a..�.�...r� N..wc.rar...,� o...
A+ Septic Tank Pumping INC
PO Box 635 Estimate #
Willow Springs, NC 27592 Date
Phone: (919) 894-1919
Email: aplusseptictankpumping@gmail.com
Primax Properties, LLC
1100 E Morehead St
Charlotte, NC 28204
(704) 999-5780
(704) 344-8200
000161
12/15/2020
Description Quantity Rate Total
Pump and Haul
Pump and Haul For Tractor Supply Sewer System
$500 Per Truck Load
2300 Gallon Capacity
Due Upon Receipt Of Invoice Check/Cash
3% Will Be Applied To Credit Card Processing For a Total Of $515
$500 Check/Cash Per Load
$515 Credit Card Per Load
1.0 $500.00 $500.00
Subtotal
Total
Primax Properties, LLC
$500.00
$500.00
Page 1 of 1
R Trusted. Tested. Tough.",, SECTION: 2.50.010
Q�A, a FM0732
Product informal -on presented 1116
here reflects conditions at time �
of publicat on. Consu-t factory Supersedes
regarding d'screpancies or PUMP COMPANY 0713
inconsistent es.
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the condition is remedied. The all newAPako alarm is more compact and easier to install. It is cCSAus approved in a NEMA 1 enclosure,
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light indicates a high-level condition
Modds 1040 2
10.4012 APak®Alarm
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2nd Input for additional monitoring ability
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Dry contacts for connection to dome security
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• NEMA 3R enclosure (6.5" X 4.5" X 31)
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• Horn is rated 88 decibels at 10'
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• UL listed to Canadian standard cULus
`-} Copyright 2016 Zoeller Co All rights reserved
AUTO DIALER SYSTEM
10-2616 Auto -Dialer System
The Auto -Dialer is a single channel voice dialer that can be used with
any device that can provide a normally open/closed contact. It can
be programmed to store up to four numbers to dial, including standard
(voice) telephones, most cellular phones, and pagers. It will provide a
16 second pre-recorded message.
• Voice -Chip technology (NO TAPES)
• Record your own personal messages
• Dials each contact number up to four times
• Internal 9V battery back-up (Battery NOT Included)
• Tone or pulse dial only (NOT intended for digital phone lines)
(1 77num-
Model 10-2616 Auto Dialer
nnn
High water alarms provide the owner with early notification that the water level is continuing to rise in the application. This could be due to a
pump failure or power outage, or the pump is simply overwhelmed in the application.
Zoeller recommends that ALL systems be installed with a high water alarm whether it is a small sump pump, sewage system, or a large outdoor
lift station. Small alarms can be used on systems like water healers or drain sinks. For a low upfront cost, a high water alarm saves the
headache and stress of cleaning up a catastrophe after the fact.
An alarm system is designed to operate independently from the pump; meaning it can be used with any manufacturer's model. In fact, it is
recommended that all alarms are wired in to a separate circuit breaker. This protects the alarm from being tripped if the pump inadvertantly
trips the circuit breaker. The last thing a homeowner wants is to NOT have an alarm due to the system not getting power. For instances like a
complete power failure, most alarms include a battery backup that keeps power to the alarm during a storm or black -out
ALARM
r .4
EDEl1ER
RBERGLASS�
OR POLYETHYLENE
BASIN
ALARM
'ON'LEVE_
IDELLER
VARIABLE LEVEL
C0NTR0LSWrrCH
Pump -OW
LEVEL
PUMP -OFF'
LEVEL
DO NOT PLUG A-PAK ALARM SYMM
INTOTHE SAME CIRCUITASTHE PUMP
WELLER
UNK:HECK
/"�_ TO POWER SUPPLY
Ct li A
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e '102 mm) OF GRAVEL
SK2376
MAILTO: P.O. BOX 16347 • Louisville, KY 4025"347
z2K2E/�'tD S 0)0778-2731 81 00) 28--PUMP • Fne Run Road 0 LAX (502) 7 4-36lle, KY 241 Visit our web site:
zoellerpumps.com
COMPANY Trusted. Tested. Tough.""
0 Copyright 2016 Zoeller® Co. All rights reserved
TRIANGLE
5 1 T E DESIGN
Transmittal
4004 Barrett Drive, Suite 101
Raleigh. North Carolina, 27609
TEL (919)553-6570
Date: December 17, 2020 Job Number: 001048
Project Name: Tractor Supply
To: NC DWR, DEQ - Water Quality Regional Operations - Raleigh Regional Office
Attn. Mr. Jason T. Robinson
3800 Barrett Drive
Raleigh, NC 27609
We are sending These by
❑ U.S. Mail
❑ Other
0
NC Dept OfEnvironmentai Qttalir
DEC 17 20
UPS ® Hand Delivery
Raleigh RegionaLo f
We are sending you
❑ Attached ❑ Prider separate cover via the follon ing ileur.r
❑ Shop drawings ® Prints/Plans ❑ Samples ❑ Specifications ❑ Changc Orders
❑ OtherY—
C ` es vale No- Vescri lion
1 Cover Letter
1 Fee ($810)
2 Wastewater Pump and Haul Application
1 Receiving Facility Letter
I Contract Hauler Letter
2 Civil Drawings
I Specifications
These are transmitted as checked below
❑ For your use ❑ Approved as submitted ❑ Resubmit ❑ Copies for approval
❑ As requested ❑ Approved as noted ❑ Submit ❑ Copies for distribution
® For review and comment ❑ Returned for corrections ❑ Return ❑ Corrected prints
Remarks: Resubmission
Copy to:
Signed:--�
Cario Pardo