NCG100143_MONITORING INFO_20121031

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. �v � � Da
DOC TYPE ❑HISTORICAL FILE
� MONITORING REPORTS
DOC DATE p aDl a 1 0 3 1
YYYYMMDD

Permit: NCG100143
SOC:
County: Stokes
Region: Winston-Salem
Compliance Inspection Report
Effective: 11/01/07 Expiration: 10/31/12 Owner: Doanld H Pack
Effective: Expiration: Facility: Pack's Garage - Body Shop - Salvage
1139 Pack Rd
Contact Person: Doanld H Pack
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Title:
Inspection Date: 02/08/2011 Entry Time: 09:30 AM
Primary Inspector: Michael S Thomas
Secondary Inspector(s):
Walnut Cove NC 27052
Phone: [phone]
Certification:
Exit Time: 10:30 AM
Phone:
Phone:
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Used Motor Vehicle Parts Stormwater Discharge COC
Facility Status: ❑ Compliant ❑ Not Compliant
Question Areas:
® Storm Water
(See attachment summary)
Page: 1

60
Permit: NCG100143 Owner - Facility: Doanld H Pack
Inspection Date: 02/08/2011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Page: 2

Permit: NCG100143 Owner - Facility: Doanld H Pack
Inspection Date: 02/08/2011 Inspection 'type: Compliance Evaluation
Stormwater Pollution Prevention Plan
Does the site have a Stormwater Pollution Prevention Plan?
# Does the Plan include a General Location (USGS) map?
# Does the Plan include a "Narrative Description of Practices"?
# Does the Plan include a detailed site map including outfall locations and drainage areas?
# Does the Plan include a list of significant spills occurring during the past 3 years?
# Has the facility evaluated feasible alternatives to current practices?
# Does the facility provide all necessary secondary containment?
# Does the Plan include a BMP summary?
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plar?
# Does the facility provide and document Employee Training?
# Does the Plan include a list of Responsible Party(s)?
# Is the Plan reviewed and updated annually?
# Does the Plan include a Stormwater Facility Inspection Program?
Has the Stormwater Pollution Prevention Plan been implemented?
Comment:
Qualitative Monitoring
Has the facility conducted its Qualitative Monitoring semi-annually?
Comment:
Analytical Monitoring
Has the facility conducted its Analytical monitoring?
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
Reason for Visit: Routine
`0nnn
n n
n
nnnn
Annn
n n n
n
nnn
ynnn
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nnn
nn
nnnn
nnn
nnn
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nnn
Comment:
Permit and Outfails
Yes
No
NA
NE
# Is a copy of the Permit and the Certificate of Coverage available at the site?
n
n
n
n
# Were all outfalls observed during the inspection?
n
n
n
n
# If the facility has representative outfall status, is it properly documented by the Division?
n
n
n
n
# Has the facility evaluated all illicit (non stormwater) discharges?
n
n
n
n
Comment:
a r,- 5e, Page. 3

AVIA
NCDENR
North Carolina Department of Environment and Natura
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins
Governor Director
10 February 2011
Mr. Donald H. Pack
Pack's Garage
1139 Pack Road
Walnut Cove, NC 27052
Subject: Compliance Evaluation Inspection
NPDES General Stormwater Permit NCG100000
Certificate of Coverage NCG100143
Pack's Garage
Dear Mr. Pack:
Resources
Dee Freeman
Secretary
Mike Thomas of the Winston-Salem Regional Office of the NC Division of Water Quality
(DWQ) conducted a compliance evaluation inspection (CEI) at the subject facility on 8
February 2011. Your assistance and cooperation during the inspection was greatly
appreciated. An inspection checklist is attached for your records and the inspection findings
are summarized below.
The facility is located at 1139 Pack Road, in Walnut Cove, Stokes County, North
Carolina. Stormwater related to industrial activity is discharged to an unnamed tributary to
Coolico Creek, which is currently classified as class C waters in the Roanoke River Basin.
Documentation and Monitoring Review
The Stormwater Pollution Prevention Plan (SP3) is complete and well implemented.
Training sessions are conducted annually to keep staff informed and up to date. Records of
Qualitative Analysis were available and appeared to be complete. Sampling results from
qualifying events were made available for inspection and appeared to be complete.
Site Review
The facility was clean and well maintained at the time of inspection. The outfall was
easily accessible and well maintained. The receiving waters were free of pollutant indicators
and in good condition. Mr. Thomas observed that you have followed through on the
housekeeping items that were identified in the previous CEI.
North Carolina Division of Water Quality, Winston-Salem Regional Office
Location: 585 Waughtown St. Winston-Salem, North Carolina 27107
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www,ncwaterquality.org
NorthCarolina
An Equal Opportunity 1 Affirmative Action Employer

Mr. Donald H. Pack
Pack's Garage
Compliance Evaluation Inspection, NCG100143
2/10/2011
Page 2 of 2
We greatly appreciate your efforts to develop and implement an effective stormwater
pollution and prevention plan. Please continue your efforts to help safeguard the waters of our
State. Should you have any questions, please feel free to contact Mr. Thomas or me at (336)-
771-5000.
Sincerely,
W. Corey Basinger
Interim Regional Supervisor
Surface Water Protection
Winston-Salem Region
Attachments:
1. BIMS Inspection Checklist
cc: SWP — WSRQ
Central Files
Stormwater Permitting Unit

Permit: NCG100143
SOC:
County: Stokes
Region: Winston-Salem
Compliance Inspection Report
Effective: 11/01/07 Expiration: 10/31/12 Owner: Doanld H Pack
Effective: Expiration: Facility: Pack's Garage - Body Shop - Salvage
1139 Pack Rd
Walnut Cove NC 27052
Contact Person: Doanld H Pack Title: Phone: [phone]
Directions to Facility:
System Classifications:
Primary ORC: Certification: Phone:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Inspection Date: 0210812011 Entry Time: 09.30 AM Exit Time: 10:30 AM
Primary Inspector: Michael S Thomas Phone:
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Used Motor Vehicle Parts Stormwater Discharge COC
Facility Status: ■ Compliant ❑ Not Compliant
Question Areas:
N Storm Water
(See attachment summary)
Page: 1

Permit: NCG100143 Owner - Facility: Doanld H Pack
Inspection Date: 02I08I2011 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Page! 2

Permit: NCG100143 Owner -Facility: Doanld H Pack
Inspection Date: 02108/2011 Inspection Type: Compliance Evaluation
Reason for Visit: Routine
Stormwater Pollution Prevention Plan
Yes
No
NA NE
Does the site have a Stormwater Pollution Prevention Plan?
©
n
n n
# Does the Plan include a General Location (USGS) map?
■
n
n n
# Does the Plan include a "Narrative Description of Practices'?
■
n
n n
# Does the Plan include a detailed site map including cutfall locations and drainage areas?
■
n
n n
# Does the Plan include a list of significant spills occurring during the past 3 years?
n
❑
® n
# Has the facility evaluated feasible alternatives to current practices?
■
Cl
n n
# Does the facility provide all necessary secondary containment?
■
Q
n n
# Does the Plan include a BMP summary?
■
n
n n
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
■
n
n n
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
■
n
n n
# Does the facility provide and document Employee Training?
■
n
n n
# Does the Plan include a list of Responsible Party(s)?
■
n
n n
# Is the Plan reviewed and updated annually?
■
n
# Does the Plan include a Stormwater Facility Inspection Program?
■
❑
n n
Has the Stormwater Pollution Prevention Plan been implemented?
■
n
n n
Comment:
Qualitative Monitoring
Yes
No
NA
NE
Has the facility conducted its Qualitative Monitoring semi-annually?
■
❑
n
n
Comment:
Analytical Monitoring
Yes
No
NA
NE
Has the facility conducted its Analytical monitoring?
■
n
n
n
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
®❑
00
Comment:
Permit and Outfalls
Yes
No
NA
NE
# Is a copy of the Permit and the Certificate of Coverage available at the site?
■
n
n
n
# Were all outfalls observed during the inspection?
■
n
n
n
# if the facility has representative outfall status, is it properly documented by the Division?
n
n
0
n
# Has the facility evaluated all illicit (non stormwater) discharges?
®
n
n
n
Comment:
Page: 3

1
Michael F. Easley, Govemor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
CoIeen H. Sullins, Director
Division of Water Quality
September 15t, 2008
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
7008-0150-0002-7876-7716
i
Donald Pack, Owner
Pack's Garage — Body Shop -Salvage
1139 Pack Road
Walnut Cove, NC 27052
Subject: Compliance Evaluation Inspection & Notice of Violation
NOV-2008-PC-0631
NPDES General Stormwater Permit NCG100000
Certificate of Coverage NCG100143
Pack's Garage -- Body Shop -Salvage
Stokes County
Dear Mr, Pack:
1. Ron Boone of the Winston-Salem Regional Office of the NC Division of Water Quality (DWQ) conducted a compliance
evaluation inspection (CEI) at the subject facility on August 251h 2008. Your assistance and cooperation was greatly
appreciated. An inspection checklist is attached for your records and the inspection findings are summarized below.
2. According to our database records, the facility currently discharges stormwater to an unnamed tributary to Coolico
Creek, which is currently classified as Class C waters in the Roanoke River Basin. Our records reflect only one
stormwater discharge outfall (SDO), however there is no site plan and you did not know the number or location of the
SDO(s) at the time of the inspection.
Documentation Review
3. The facility does not currently have a stormwater pollution prevention plan (SP3) and neither qualitative nor analytical
monitoring have been conducted as required.
Site Review
4. The site was generally well kept, however there were some engines, transmissions, batteries and other automotive
components scattered about the yard. Some items still had automotive fluids leaking from them, Please note that the
discharge of such substances onto the ground or into surface waters is unlawful and all spills of this nature should
always be cleaned up immediately and the contaminated materials disposed of properly and in a timely fashion.
Please also note that such spills must be reported to the North Carolina Department of Environment and Natural
Resources (DENR). Development and implementation of the SP3, if done according to the permit, should facilitate
the development Best Management Practices (BMP) to address spills.
5. You recently cleared approximately one acre of land for the purpose of storing more salvaged vehicles. Please note
that the clearing of one acre or more of land requires a permit issued by the NC Division of Land Resources (DLR).
DLR has been notified of this activity and may be contacting you regarding this land clearing activity.
6. You may wish to commission the services of a professional environmental engineering or consulting firm to help in the
development and implementation of your SP3 as required by the permit. Please use your local phone book and/or the
Internet to locate a firm that can assist you. It is best to ensure such a firm has experience in stormwater
management and development of SP3s. Also, upon your request and once the SDOs at your facility have been
N�0na Carolina
silra!!y
North Carolina Division of Water Quality 585 Waughtown Street Winston Salem, NC 27107 Phone [phone] , Customer Service
Internet: ncwaterquality.org FAX [phone]
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper

r9
cp Postage $
r�
Certified Fee `7
- rlJ
M Return Receipt Fee
0 (Endorsement Required) 07— pZ Q
Q Restricted Delivery Fee
O (Endorsement Required)
cr) O
ri Total Postaoe & Fees
seorr Donald Pack
CO griwi, Pack's Garage, Body Sli
or POi 1139 Pack Road
ciry. s
Walnut Cove, NC 27052
N
A
Were YA
a

■ Complete items 1, 2, and.3. Also complete A.
item 4 If Restricted Delivery is desired. X
■ Print your name and address on the reverse
so that we can return the card to,you. B
■ Attach this card to the back of the mailplece,
or on the front if space permits.
Article Addressed to:
-Donald Pack
Pack's Garage, Body Shop, Salvage
1139 Pack Road
Walnut Cove, NC 27052
L- ------ ----- - - — l
❑ Agent i
9z ❑ Address
by (Printed Name) Q. Pao of geliv,
Is delivery address differed[ from item I V U �Ye:
If YES, enterdeliveryaddress below: ❑ No
3. SSe,l Type
4YCertlfied Mail ❑ Express Mail
❑ Registered ❑ Return Receipt for Merchandise
❑ Insured Mail 0 C.D.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
2. 7008.0150 0002 7876 771E
Ps Form 3811. February 2004 Domestic Return Receipt 9, / j r Q� 1o2ss5-o2-M-1s40

UNITLO STATES POSTAL SERVICE First -Class Maii
Postage & Fees Paid
LISPS
Permit No. G-10
• Sender:. Please print your name, address, and ZIP+4 in this box •
Surface Water Protection Section
N.C. Dept. of Lnvironment and Natural Resources
585 Waughtown Street
Winston-Salem, NC 27107
1F1iJiF11I1110 111F11111111JF11JJflll�Y�IIIIF111lli+FfJi1�1 `
1

Mr. Donald Pack
September 1", 2008
Page 2
identified, we can provide a list of certified NC laboratories that can conduct the required analytical monitoring of the
stormwater discharged from your facility.
7. Please be aware that the Division may assess civil penalties of up to $25,000 per day, per violation for failure to
comply with the requirements of NCG100000. Please reply to this letter within 30 days of receiving it. Your response
should include an action plans and implementation schedules for the correction of those violations listed above in
paragraphs 3 through 5.
8. Thank you for your cooperation in this .matter. Should you have any questions about the CEI, this letter or the
NCG100000 permit, please feel free to contact Mr. Boone or me at [phone].
Sincerely�T'ed�der
--eve
eveV�.
Water Quality Regional Supervisor
Winston-Salem Region
Division of Water Quality
Attachments:
1. BIMS Inspection Checklist
cc: SWP - WSRO
Central Files
Stormwater Permitting Unit

Permit: NCG100143
SOC:
County: Stokes
Region: Winston-Salem
Compliance Inspection Report
Effective: 11/01/07 Expiration: 10/31/12 Owner: Doanld H Pack
Effective: Expiration: Facility: Pack's Garage - Body Shop - Salvage
1139 Pack Rd
Contact Person: Doanld H Pack
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
24 hour contact name
On -site representative
Related Permits:
Inspection Date: 0812512008
Primary Inspector:. Ron Boone
Secondary Inspector(s):
Title:
Doanld H Pack
Doanld H Pack
Entry Time: 09:30 AM
Walnut Cove NO 27052
Phone: [phone]
Certification:
Exit Time: 11:00 AM
Phone:
Phone: [phone]
Phone: [phone]
Phone: [phone]
Ext.2202
Reason for inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Used Motor Vehicle Parts Stormwater Discharge COO
Facility Status: ❑ Compliant 0 Not Compliant
Question Areas:
® Storm Water
(See attachment summary)
Page: 1

Permit: NCG100143 Owner • Facility: Doanld H Pack
Inspection Date: 08/25/2008 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
Please see attached summary letter.
Page: 2

Permit: NCG100143 Owner - Facility: Doanld H Pack
Inspection Date: 08125/2008 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Stormwater Pollution Prevention Plan Yes No NA NE
Does the site have a Stormwater Pollution Prevention Plan? n ■ ❑ ❑
# Does the Plan include a General Location (USGS) map?
# Does the Plan include a "Narrative Description of Practices"?
# Does the Plan include a detailed site map including outfail locations and drainage areas?
# Does the Plan include a list of significant spills occurring during the past 3 years?
# Has the facility evaluated feasible alternatives to current practices?
# Does the facility provide all necessary secondary containment?
# Does the Plan include a BMP summary?
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
# Does the facility provide and document Employee Training?
# Does the Plan include a list of Responsible Party(s)?
# Is the Plan reviewed and updated annually?
# Does the Plan include a Stormwater Facility Inspection Program?
Has the Stormwater Pollution Prevention Plan been implemented?
Comment: NO SP3.
Qualitative Monitoring
Has the facility conducted its Qualitative Monitoring semi-annually?
Comment: No qualitative monitoring completed.
Analytical Monitoring
Has the facility conducted its Analytical monitoring?
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
Comment: No analytical monitoring completed.
Permit and Outfalls
# Is a copy of the Permit and the Certificate of Coverage available at the site?
# Were all outfalls observed during the inspection?
# if the facility has representative outfall status, is it properly documented by the Division?
# Has the facility evaluated all illicit (non stormwater) discharges?
Comment: Outfalls have not been identified.
Yes
No
NA
NE
n
■
❑
n
Yes
No
NA
NE
n■nn
❑■❑n
Page: 3

Michael F. Easley
Governor
William G. Ross Jr., Secretary
Department of Environment and Natural Resources
`1� Alan W. Klimek, P.E., Director
U950)" Division of Water Quality
June 6, 2003
Mr. Donald H. Pack
Pack's Garage Body Shop Salvage
9139 Pack Road
Walnut Cove, NC 27052
Subject: General Permit No. NCG100000
Pack's Garage Body Shop Salvage
COC NCG100143
Stokes County
Dear Mr. Pack:
In accordance with your application for discharge permit received on February 21. 2003, we are forwarding
herewith the subject certificate of coverage to discharge under the subject state - NPDES general permit. This permit is
issued pursuant to the requirements of North Carolina General Statute 143-215 .1 and the Memorandum of Agreement
between North Carolina and the US Environmental Protection agency dated December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are unacceptable to you,
you have the right to request an individual permit by submitting an individual permit application. Unless such demand is
made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division of Water
Quality. The Division of Water Quality may require modification or revocation and reissuance of the certificate of
coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the Division
of Water Quality or permits required by the Division of Land Resources, Coastal Area Management Act or any other
Federal or Local governmental permit that may be required.
If you have any questions concerning this permit, please contact Mack Wiggins at telephone number 919/733-
5083 ext. 542.
:,rs= Si1591AAL SIGNED BY
WIL LIAM C. MILLS
Alan W. Klimek, P.E.
cc: Winston-Salem Regional Office
Central Files
Stormwater and General Permits Unit Files
�,tt�DEP1�
Customer Service
1 800 623-7748
Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]

r
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG100000
CERTIFICATE OF COVERAGE No. NCG100143
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Donald H. Pack
Pack's Garage Body Shop Salvage
is hereby authorized to discharge stormwater from a facility located at
Pack's Garage Body Shop Salvage
1139 Pack Road
south of Walnut Cove
Stokes County
to receiving waters designated as an unnamed tributary to Coolico Creek, a class C water in the Roanoke River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, 1I, III,
IV, V, and VI of General Permit No. NCG100000 as attached.
This certificate of coverage shall become effective June 6, 2003
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
"SINAL SIGN
Signed this day June 6. 200PI, � $Y
.,AMC. MILLS
Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

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ROAD CLASSiFICATiON
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Primary highway, Light -duty road, hard or
c� ~000 FEET hard surface......,,..,..-_. — irnpr0Ved
I xjlorar°TFR Secondary highway,
hard surface.•.. ,n..,,�.. Unimproved roar4...
Interstate Routu ? LJ_ S. Route D State Route
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WALNUT COVE, N. C.
36080•C2-TF-024
Revisions shown in purple and woodland compiled from
aerial photographs taken 1982 and other sources. This 1971
infounatIon not field checked. Map edited 1986 PHOTOREVISED load
DMA 4956 1 SW —SERIES V842
8° W
Copyright (0) 1997, Mautech, Inc

i
Markers
Name: Discharge Site-NCG100143
Short Name: Dschrg
Coordinates: 0360 15' 34.8" N, 0800 09' 01.9" W
Comment: Pack's Garage Body Shop Salvage, Subbasin 030201, Roanoke River Basin, Stokes
County, unnamed tributary to Coolico Creek, Class C, Quad C18NW

North Carolina Department of Environmental Quality
Pat McCrory Donald R. van der vaart
Governor Secretary
Industrial Compliance Inspection Worksheet
Permit#: Cy/0O/y5 County: Compliant:
Facility Name: g -4, Gf � /— OSew;, y ..S'/y
Contact Name & Title: *1z lskfc
Date of Inspection: u��// tr-- _Time in:
Time out:
Who. is present for the i.nspectian? �> ��,tiy, 6Udy7
Watershed:
Are all,potertially pollutant materials stored inside or under cbJer•and protected from stormwater runoff?
r
Does this site perform onsite vehicle maintenance? k;r If so, is more'than.55.Gal used per month? -"id
j/�thGt f� /nI f i j 5 C Yam . 5 66.m Ary
If so, has analyticai monitoring being performed? 5 S � 7Sc
Has this site developed a SPPP? - Is 1 hie SPPP updated annually?
Does the SPPP contain an updated copy of the permit?
Does SPPP contain a siteplan showing contours, location of all outfalls, all streams and natural features, all
structures on the site, roads, etc?
Note any discrepancy with permit requirements::. i Q�
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612 • 919-107-9200/ FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: http://portal_.ncdenr.org/web/Ir/
An Equal Opportunity \ Affirmative Action Employer — 50Y Recycled \ 10% Post Consumer Paper

All parts of the permit should be contained in one 3-ring binder, including permit, siteplan, qualitative and
analytical monitoring records, operating procedures, employee training documentation, a record of all spills
and method of containment and corrective action. is site compliant? Note any discrepancies:
Self Monjtorin : %
Qualitative Monitoring maintained per permit requirements?
J
Note any discrepancies found: ' '_ /f!O "` .� � '�' X%9r.n .�
Is Analytical Monitoring required? s monitoring being performed as required?
Is p4 i, eadi6g' taken at time.of•sample collection?" Is pH`.rr eter calibrated regularly?
a=;4; Note'any*discfe.pancies in mon oring results: i 'Aid ,•=s'''.� �/�Gf�. %�, U�
Are all records maintain for minimum of 5 years? / R"
Outfalls:
Were all outfalls observed during the inspection?yf Does site have representative outfall status? /JO
Were all outfalls clear of debris and easily reached for inspection?
Sr46 .�ir�GAt-c . bS r r u/ / Pr4c�c C [�ry4�rz
6460S.- Ana" -
Note any discrepancies found: O,".=