4117_A1SandrockCDLF_GWMR_DIN27818_20160601

ENR USE ONLY: OElectronic Data -Email CD data loaded: Yes I No Doc/Event#:
C DENR
Division of Waste Management -Solid Waste
Environmental Monitoring
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 28 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 138 .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):
SCS Engineers, PC
Contact for questions about data formatting. Include data preparer's name, telephone number and E-mail address:
Name: Marta VanDussen
E-mail: [e-mail]
Facility name: Facility Address:
A-1 Sandrock C&D Landfill 2132 Bishop Road, Greensboro
Guilford County
Environmental Status: (Check all that apply)
0 Initial/Background Monitoring [g] Detection Monitoring
T e of data submitted: (Check all that apply)
Groundwater monitoring data from monitoring wells
Groundwater monitoring data from private water supply wells
Leachate monitoring data
X Surface water monitoring data
Notification attached?
Phone: [phone]
NC Landfill Rule:
Facility Permit# (.0500 or .1600)
EJEJ
Actual sampling dates (e.g.,
October 20-24, 2006)
June 1 and 2, 2016
0 Assessment Monitoring 0 Corrective Action
0 Methane gas monitoring data D Corrective action data (specify)
D Other(specify)
D 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. 0 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.
Donald Michael Cobb P.G. 704-504-3107
Signature Date
Fad\] R~rese[tive Name (Prin
<
Title
07/01/2016
2520 Whitehall Park Drive, Suite 450, Charlotte, North Carolina 28273
Facility Representative Address
C-1837
NC PE Firm License Number (if applicable effective May 1, 2009)