8602_Surry_MtAiry_MSWLF_CDLF_April24LFG_FID1837116_20240509

DocuSign Envelope ID: F49DBB31-917D-4D2D-AE8A-472CCC891682
DENR USE ONLY ❑Paper Report [:]Electronic Data - Email CD (data loaded: Yes / No Doc/Event #:
NC DENR I I Environmental Monitoring
Division of Waste Management - Solid Waste Reporting Form
Notice: This form and any information attached to it are "Public Records" as defined in NC General Statute 132-1. As such, these documents are
available for inspection and examination by any person upon request (NC General Statute 132-6).
Instructions:
Prepare one form for each individually monitored unit.
Please type or print legibly.
Attach a notification table with values that attain or exceed NC 2L groundwater standards or NC 2B surface water standards. The notification
must include a preliminary analysis of the cause and significance of each value. (e.g. naturally occurring, off -site source, pre-existing
condition, etc.).
Attach a notification table of any groundwater or surface water values that equal or exceed the reporting limits.
Attach a notification table of any methane gas values that attain or exceed explosive gas levels. This includes any structures on or nearby the
facility (NCAC 13B .1629 (4)(a)(i).
Send the original signed and sealed form, any tables, and Electronic Data Deliverable to: Compliance Unit, NCDENR-DWM, Solid Waste
Section, 1646 Mail Service Center, Raleigh, NC 27699-1646.
Solid Waste Monitoring Data Submittal Information
Name of entity submitting data (laboratory, consultant, facility owner):
Smith Gardner, Inc.
Contact for questions about data formatting. Include data preparer's name, telephone number and E-mail address:
Name: Seth C. Rickerts, P.G.
E-mail: [e-mail]
Phone: [phone] x135
NC Landfill Rule: Actual sampling dates (e.g.,
Facility name: Facility Address: Facility Permit # (.0500 or .1600) October 20-24, 2006)
Surry County Landfill 237 Landfill Rd. Mt Airy, NC 27030 86-02 .0500 April 29, 2024
Environmental Status: (Check all that apply)
❑ Initial/Background Monitoring ❑X Detection Monitoring ❑ Assessment Monitoring Corrective Action
of data submitted: (Check all that apply)
Groundwater monitoring data from monitoring wells ❑X
Groundwater monitoring data from private water supply wells ❑
Leachate monitoring data El
water monitoring data
Methane gas monitoring data
Corrective action data (specify)
Other(specify)
Notification attached?
e No. No groundwater or surface water standards were exceeded.
Yes, a notification of values exceeding a groundwater or surface water standard is attached. It includes a list of groundwater and surface water
monitoring points, dates, analytical values, NC 2L groundwater standard, NC 2B surface water standard or NC Solid Waste GWPS and
preliminary analysis of the cause and significance of any concentration.
❑X Yes, a notification of values exceeding an explosive methane gas limit is attached. It includes the methane monitoring points, dates, sample
values and explosive methane gas limits.
Certification
To the best of my knowledge, the information reported and statements made on this data submittal and attachments are true and correct.
Furthermore, I have attached complete notification of any sampling values meeting or exceeding groundwater standards or explosive gas
levels, and a preliminary analysis of the cause and significance of concentrations exceeding groundwater standards. I am aware that there
are significant penalties for making any false statement, representation, or certification including the possibility of a fine and imprisonment.
Seth C. Rickerts, P.G. Project Geologist 919-828-0577 x135
Facility Representative Name (Print)
Title
5/8/2024
S�D.SiG.e 2 v"k,
Signature 3B81-178EA0E6 Date
14 N Boylan Ave. Raleigh, NC 27603
Facility Representative Address
F1370
NC PE Firm License Number (if applicable effective May 1, 2009)
Revised 6/2009
(Area Code) Telephone Number
Affix NC Licensed/ Professional Geologist Seal
EA 5/ 2424
2758 r
s` O A Cc
sa 0d L Q ¢
Rtc-

DocuSign Envelope ID: F49DBB31-917D-4D2D-AE8A-472CCC891682
This page intentionally left blank.

DocuSign Envelope ID: F49DBB31-917D-4D2D-AE8A-472CCC891682
NC Division of Waste Management - Solid Waste Section
Landfill Gas Monitoring Data Form
Notice: This.form and any information attached to it are 'Public Records" as defined in NC General Statute 132-1. As such, these documents are
available for inspection and examination by any person upon request (NC General Statute 132-6).
Facility Name: SUrry County Landfill Permit Number: 86-02
Sampling Date: 04/29/2024 NC Landfill Rule (.0500 or .1600):
Sample Collector Name & Position: Kyle M. Bonnett - Environmental Technician
Gas Meter Type & Serial Number: GEM 5000, G506472 Gas Meter Calibration Date:
Field Calibration Date & Time: 04/29/2024, 1201
Field Calibration Gas Type (15115 or35/50): 35/50
Gas Meter Pump Rate:
0.5 L/min
01 /2024
ield Calibration Gas Canister Expiration Date: 02/26
Ambient Air Temperature: 79 F Barometric Pressure (in. or mm Hg): 29.02 Weather Conditions: Sunny
Instructions: Under "Location or LFG Well", list monitoring well # or describe monitoring location (e.g., inside field office).
Attach a test location map or drawing. Report methane readings as both % LEL and % CH4 by volume.
Convert % CH4 (by volume) to % LEL as follows: % methane (by volume)/20 = % LEL.
*Hydrogen Sulfide (H2S) gas monitoring may be required for Construction & Demolition Landfills (CDLFs). See
individual permit conditions and/or Facility LFG monitoring plan.
Location or
LFG Well ID
S ample
Tube
Purge
Time of
Day
Time
Pumped
(sec)
Initial
o
�o LEL
Stabilized
/o LEL
% CH4
(volume)
% 02
(volume)
% CO2
(volume)
% H2S*
(volume)
NOTES
MGP-2R
>60s
1337
>60s
0.0
0.0
0.0
19.4
0.6
0
MGP-3
>60s
1427
>60s
0.0
0.0
0.3
15.3
5.0
0
MGP-4
>60s
1415
>60s
190
190
12.9
13.5
6.2
0
MGP-5
>60s
1409
>60s
0.0
0.0
0.0
19.4
1.2
0
MGP-6
>60s
1412
>60s
32
32
0.0.
12.3
9.1
0
MGP-7
>60s
1330
>60s
742
742
19.6
11.9
12.0
0
MGP-8
>60s
1327
>60s
0.0
0.0
0.0
16.0
3.7
0
New Scalehouse
>60S
1446
>60S
0.0
0.0
0.0
20.6
0.0
0
Old Scalehouse
>60s
1452
>60s
0.0
0.0
0.0
20.6
0.0
0
Bailing Shed
>60s
1455
>60s
0.0
0.0
0.0
20.6
0.0
0
Attendant Building
>60S
1454
>60S
0.0
0.0
0.0
20.6
0.0
0
Page 1 of 2
NOTE: If needed, attach additional data forms to include additional LFG monitoring data locations for the facility.
ACTION LEVELS: Methane: >1.25% by volume (inside structures) AND >5% by volume (at facility boundary)
Hydrogen Sulfide: >1 % by volume (inside structures) AND >4% by volume (at facility boundary)
Certification
To the best of my knowledge, the information reported and statements made on this data submittal and attachments
are true and correct. I am aware that there are significant penalties for making any false statement, representation,
or certification including the possibility of a fine and imprisonment.
D ..Sig- by:
� B�u
`t6E66EEF9EA34E0..
SIGNATURE
Environmental Technician
TITLE
Revised - March 6, 2017

DocuSign Envelope ID: F49DBB31-917D-4D2D-AE8A-472CCC891682
NC Division of Waste Management - Solid Waste Section
Landfill Gas Monitoring Data Form
Notice. Thisform and any information attached to it are 'Tublic Records" as defined in NC General Statute 132-1. As such, these documents are
available for inspection and examination by any person upon request (NC General Statute 132-6).
Surry County Landfill 86-02
Facility Name: Permit Number:
Sampling Date: 04/29/2024 NC Landfill Rule (.0500 or .1600):
Sample collector Name & Position: Kyle M. Bonnett - Environmental Technician
Gas Meter Type & Serial Number: GEM 5000, G506472 Gas Meter Calibration Date:
Field Calibration Date & Time: 04/29/2024, 1312
01 /2024
Field Calibration Gas Type (15115 or 35/50): 35/50 Field Calibration Gas Canister Expiration Date: 02/26
Gas Meter Pump Rate:
0.5 L/min
Ambient Air Temperature: 79 F Barometric Pressure (in. or mm Hg): 29.02 Weather Conditions: Sunny
Instructions: Under "Location or LFG Well", list monitoring well # or describe monitoring location (e.g., inside field office).
Attach a test location map or drawing. Report methane readings as both % LEL and % CH4 by volume.
Convert % CH4 (by volume) to % LEL as follows: % methane (by volume)/20 = % LEL.
*Hydrogen Sulfide (H2S) gas monitoring may be required for Construction & Demolition Landfills (CDLFs). See
individual permit conditions and/or Facility LFG monitoring plan.
Location or
LFG Well ID
S ample
Tube
Purge
Time of
Day
Time
Pumped
(sec)
Initial
% LEL
Stabilized
% LEL
% CH4
volume
(volume)
% 02
(volume)
% CO2
(volume)
% H2S*
(volume)
NOTES
Page 2 of 2
Attendant Building 3
>60s
1449
>60s
0.0
0.0
0.0
20.6
0.0
0
New Shop
>60s
1444
>60s
0.0
0.0
0.0
20.7
0.0
0
Shop Shed
>60s
1442
>60s
0.0
0.0
0.0
20.6
0.0
0
Shop
>60s
1440
>60s
0.0
0.0
0.0
20.6
0.0
0
LFGE Office
>60s
1439
>60s
0.0
0.0
0.0
20.5
0.0
0
NOTE: If needed, attach additional data forms to include additional LFG monitoring data locations for the facility.
ACTION LEVELS: Methane: >1.25% by volume (inside structures) AND >5% by volume (at facility boundary)
Hydrogen Sulfide: >1% by volume (inside structures) AND >4% by volume (at facility boundary)
Certification
To the best of my knowledge, the information reported and statements made on this data submittal and attachments
are true and correct. I am aware that there are significant penalties for making any false statement, representation,
or certification including the possibility of a fine and imprisonment.
7 T7�� KA
SI'-rNATl p IOBWEEF9E 34ED...
Environmental Technician
TITLE
Revised - March 6, 2017

DocuSign Envelope ID: F49DBB31-917D-4D2D-AE8A-472CCC891682
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(CONTOUR INTERVAL = 5 FEET)
PERENIAL STREAM (LFG HYDRAULIC BARRIER)
ESTIMATED EXTENT OF WASTE
PROPERTY LINE
® SEDIMENT BASIN
GRAPHIC SCALE
300 0 300 600
( IN FEET )
1 inch = 300 ft.
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SCALE: 1 = 300'
DATE: 111112021
DRWN. BY: E. LAMBERT
CHKD. BY: J. PFOHL
PROJECT NUMBER
G20032.0
DRAWING NO. SHEET NO.
SHEET 1 1 OF 1

DocuSign
Certificate Of Completion
Envelope Id: F49DBB31917D4D2DAE8A472CCC891682
Subject: Complete with DocuSign: Surry C&D-MSW 86-02 Q2 2024 LFG Monitoring Report.pdf
Source Envelope:
Document Pages: 5 Signatures: 3
Certificate Pages: 2 Initials: 0
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC-08:00) Pacific Time (US & Canada)
Record Tracking
Status: Original
5/8/2024 10:51:12 AM
Signer Events
Kyle Bonnett
[e-mail]
Environmental Technician
Smith Gardner, Inc.
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Seth C. Rickerts
[e-mail]
Smith Gardner, Inc.
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
In Person Signer Events
Editor Delivery Events
Agent Delivery Events
Intermediary Delivery Events
Certified Delivery Events
Carbon Copy Events
Witness Events
Notary Events
Envelope Summary Events
Envelope Sent
Certified Delivered
Signing Complete
Holder: Kyle Bonnett
[e-mail]
Signature
E
"Do�c�uSigned by:10B569 F9` -41- E�D .
Signature Adoption: Pre -selected Style
Using IP Address: 75.177.187.48
ED—Sign1d by:
aa C_ 2 arts
368305CMEME6...
Signature Adoption: Pre -selected Style
Using IP Address: 24.106.183.110
Signature
Status
Status
Status
Status
Status
Signature
Signature
Status
Hashed/Encrypted
Security Checked
Security Checked
Status: Completed
Envelope Originator:
Kyle Bonnett
14 N. Boylan Ave
Raleigh, NC 27603
[e-mail]
IP Address: 75.177.187.48
Location: DocuSign
Timestamp
Sent: 5/8/2024 10:52:08 AM
Viewed: 5/8/2024 10:52:13 AM
Signed: 5/8/2024 10:52:19 AM
Sent: 5/8/2024 10:52:08 AM
Viewed: 5/8/2024 11:05:04 AM
Signed: 5/8/2024 11:05:16 AM
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Timestamp
Timestamps
5/8/2024 10:52:09 AM
5/8/2024 11:05:04 AM
5/8/2024 11:05:16 AM

Envelope Summary Events
Completed
Status
Security Checked
Timestamps
5/8/2024 11:05:16 AM
Payment Events Status Timestamps