Loading...
HomeMy WebLinkAboutNCG160041_MONITORING INFO_20180220STORMWATER DIVISION CODING SHEEP NCG PERMITS PERMIT NO. /v� DOC TYPE ❑HISTORICAL FILE MONITORING REPORTS DOC DATE ❑ -� �� D v �' 3 U WYYMMDD r� STORMWATER DISCHARGE OUTFALL (SDO) ANNUAL SUMMARY DATA MONITORING REPORT (DMR) Calendar Year: 2017 Individual NPDES Permit No. NCS UUUUUU or Certificate of Coverage (COC) No. NCG 160 041 This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP. Facility Name: APAC Atlantic, Inc. Plant # 41 County: Guilford County Phone Number: (336) 412-6800 Total no. of SDOs monitored: 3 18 . Outfall No. 001 RECEIVED Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ® RECEIVED Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ® FEB 2 1 2018 If this outfall was in Tier 2 last year, why was monthly monitoring discontinued? CENTRAL FILES Enough consecutive samples below benchmarks to decrease frequency ❑ DWR SECTION Received approval from DWQ to reduce monitoring frequency ❑ Other ❑ Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No Parameter, (units) Total Total Suspended inches Solids mg/I Date Sam { tw . S. _* . 1 d "4'S Ry�`�R✓f, t''v �_ t: SW, ry'. R - ollecte • - :•. �y f SWU-264-Generic-13Dec2012 r Additional Outfali Attachment Outfall No. 002 Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No If this outfall was in Tier 2 last year, why was monthly monitoring discontinued? Enough consecutive samples below benchmarks to decrease frequency ❑ Received approval from DWQ to reduce monitoring frequency ❑ Other ❑ Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No .41 x �a+ ?� .,� aTota ; Rainfall, inches -: T,ota[ Suspended Solids mgll f w�:'- .ara eter, units R ; t Benchmark �DatekSampie Collected, 'mmldd/ N/A 100 12/20/17 0.7 14 S WU-264-Generic-13 Dec2012 r Additional Outfall Attachment Outfall No. 003 Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No If this outfall was in Tier 2 last year, why was monthly monitoring discontinued? Enough consecutive samples below benchmarks to decrease frequency ❑ Received approval from DWO to reduce monitoring frequency ❑ Other ❑ Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No :, Parameter, units R x [a l Rainfall, inches ftota4 Suspended Solids mg1l si'I l Benchmark Date Sample Collected, mmlddlyrY N/A 100. 12/20117 0.7 is SWU-264-Generic-13Dec2012 r "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. I am aware that there are significant penalties for submitting false information, including the Signature `f Date �2/14/18 ,ibility of fines and imprisonment for knowing violations." For questions, contact your local Regional Office: DWQ Regional Office Contact Information: ASHEVILLE REGIONAL OFFICE FAYETTEVILLE REGIONAL OFFICE MOORESVILLE REGIONAL OFFICE 2090 US Highway 70 225 Green Street 610 East Center Avenue/Suite 301 Swannanoa, NC 28778 Systel Building Suite 714 Mooresville, NC 28115 (828) 296-4500 Fayetteville, NC 28301-5043 (704) 663-1699 (910) 433-3300 RALEIGH REGIONAL OFFICE WASHINGTON REGIONAL OFFICE WILMINGTON REGIONAL OFFICE 3800 Barrett Drive 943 Washington Square Mall 127 Cardinal Drive Extension Raleigh, NC 27609 Washington, NC 27999 Wilmington, NC 28405-2845 (919) 791-4200 (252) 946-6481 (910) 796-7215 �v To preserve, protect WINSTON-SALEM REGIONAL OFFICE_ CENTRAL OFFICE 1617 Mail Service Center 585 Waughtown Street Winston-Salem, NC 27107 Raleigh, NC 27699-1617 and enhance (336) 771-5000 (919) 807-6300 Mortb Carolina's water..." SWU-264-Generic-1 Mec2012 RECEIVED CE:NTRA' EIi_ES DWR SECTION Semi-annual Stormwater Discharge Monitoring Report (DMR) for North Carolina DEMLR General Permit No. NCG16000D - Asphalt Date submitted _07/20/2016_ CERTIFICATE OF COVERAGE NO. NCGI60041 FACILITY NAME: APAC Atlantic, Inc. Plant #41 COUNTY: Guilford PERSON COLLECTING SAMPLES: Richard Holland LABORATORY: Prism Lab Cert. # 402 Comments on sample collection or analysis: Part A: Stormwater Benchmarks and Monitoring Results SAMPLE COLLECTION YEAR 2016 SAMPLE PERIOD ® Jan -June ❑ July -Dec or ❑ Monthly'_ July (month) DISCHARGING TO CLASS ❑ORW ❑HOW ❑Trout ❑PNA []Zero -flow ❑Water Supply ❑SA ®Other: Richland Creek PLEASE REMEMBER TO SIGN ON THE REVERSE 4 No discharge this period?" Outfall No. Date Sample Collected (mo/dd/yr) 24-hour rainfall amount, Inches; Total Suspended Solids Benchmarks - 100 mg/L or 50 mg/ 0131 07/15/2016 5.0 002 07/15/2016 <3.1 003 07/1S/2016 <2.8 1 Monthly sampling {instead of semi-annual} must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. 2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here. 3The 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 3, 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, ND, or other similar non - numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mp,/L", where XX is the numerical value of the detection limit, reporting limit, quantitation limit, etc. in mg/L. Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier Z or Tier 3 responses. See General Permit text. Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month. Permit Date: 10/1/2014-9/31/2019 SWU-252, last revised 9/17/2014 Page 1 of 2 n No discharge this period?2 Outfall No. Date Sample Collected' (mo/dd/Yr) 24-hpur rainfall amount, Inches' Non -polar O&G by EPA 1664 JSGT-HEM) Total Suspended Solids Benchmarks ==n 15 mg/L 100 mg/L or 50 mg/L' Footnotes from Part A also apply to this Part B Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, rer 2, or Tier 3 responses. See General Permit text. FOR PART AND PART B MONITORING RESULTS: • A SINGLE BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. • 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑ IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE AS REQUIRED BY THE PERMIT? YES ❑ NO ❑ REGIONAL OFFICE CONTACT NAME: Mai! an original and one copy of this DMR, including all "No Dischorge" reports, within 30 days of receipt of the lab results (o► of end of monitoring period in the case Of "No Discharge" reports) to: Division of Water Resources Ann. DWR 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 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." 0\10� {Signature of Permittee (bate) Ra+16 Permit Date: 10/l/2014-9/31/2019 5WU-252, last revised 9/17/2014 Page 2of2 R RI SM PuaoFurani A lw_ Full -Service Analytical & Environmental Solutions El Group, Inc. - Morrisville Josh Dunbar 2101 Gateway Center Dr Ste. 200 Morrisville, NC 27560 NO Certification No. 402 NO Drinking Water Cert No. 37735 8C Certification No, 99012 FL NELAC Cert No. EB7519 VA NELAC Cert No. 460211 Project: APAC Stormwater Testing Project No.: Plant # 41 Lab Submittal Date: 07/20/2016 Prism Work Order: 6070316 Case Narrative 07/26/2016 This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed according to the referenced methods. Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case narrative. Please call if you have any questions relating to this analytical report. Respectfully, PRISM LABORATORIES, INC. a,---.1 Angela D. Overcash VP Laboratory Services Data Qualifiers Key Reference: Reviewed By Angela D. Overcash VP Laboratory Services BRL Below Reporting Limit MDL Method Detection Limit RPD Relative Percent Difference * Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and reporting limit indicated with a J. This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, tnc. 449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543 Phone: 7041529-0364 - Toll Free Number. 1-800152"364 - Fax: 7041525-0409 Page 1 of 7 APR I S M Fall -Servile al Solutions & Sample Receipt Summary � Environmental Solutions 0712612016 Prism Work Order: 6070316 Client Sample ID Lab Sample ID Matrix Date Sampled Date Received #1 6070316-01 Water 07/15/16 07/20/16 #2 6070316-02 Water 07/15/16 07/20/16 #3 6070316-03 Water 07/15/16 07/20/16 Samples were received in good condition at 1.8 degrees C unless otherwise noted. This report should not be reproduced, except in its entirety, without the written consent of Pnsm Laboratories, Inc. 449 Springbrook Road - P.O. Box 2406Q - Charlotte, NC 28224-0543 Phone. 7041529-6364 - Toll Free Number. 1-8001529-6364 - Fax: 70V52"409 Page 2 of 7 &Ac: Full-Service Analytical & R I S M Environmental Solutions D'�naonmon El Group, Inc. - Morrisville Attn: Josh Dunbar 2101 Gateway Center Dr Ste. 200 Morrisville, NC 27560 Project: APAC Stormwater Testing Project No.: Plant # 41 Sample Matrix: Water Laboratory Report Client Sample ID: #1 Prism Sample ID: 6070316-01 Prism Work Order: 6070316 Time Collected: 07/15/16 18:00 Time Submitted: 07/20/16 07:55 07/2612016 Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch Limit Factor DatelTime ID General Chemistry Parameters Total Suspended Solids 6.0 mg1L 2.8 0.80 1 'SM 2640 D 7/22116 9.08 SLS P6G0384 This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc. 449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0643 Phone: 7041529-6364 -Toll Free Number: 1-8001629-6364 - Fax: 7041525-0409 Page 3 of 7 IN �I�IR I S M Fun -Service Analytical x Enra �inmental Solutions - D'uson�TOniEs inc Laboratory Report 0712612016 El Group, Inc. - Morrisville Attn: Josh Dunbar 2101 Gateway Center Dr Ste. 200 Morrisville, NC 27560 Project: APAC Stormwater Testing Project No.: Plant # 41 Sample Matrix: Water Client Sample ID: #2 Prism Sample ID: 6070316-02 Prism Work Order: 6070316 Time Collected: 07/15/16 18:00 Time Submitted: 07/20/16 07:55 Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch Limit Factor Daternme ID General Chemistry Parameters Total Suspended Solids BRL mg1L 3.1 0.80 1 'SM 2540 D 7122116 9:24 SLS P6G03a4 This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc. 449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0643 Phone. 704/529.6364 - Toll Free Number: 1-8001629-6364 - Fax: 7041625-0409 Page 4 of 7 &AF ISM ✓uHoe�rOwES i�c Full -Service Analytical & Environmental Solutions Laboratory Report 07126/2016 El Group, Inc. - Morrisville Attn: Josh Dunbar 2101 Gateway Center Or Ste. 200 Morrisville, NC 27560 Project: APAC Stormwater Testing Project No.: Plant # 41 Sample Matrix: Water Client Sample ID: #3 Prism Sample ID: 6070316-03 Prism Work Order. 6070316 Time Collected: 07/15/16 18:00 Time Submitted: 07/20/16 07:55 Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch Limit Factor DatelTime ID General Chemistry Parameters Total Suspended Solids BRL mg/L 2.8 0.80 1 "SM 2540 D 7/22I16 9:24 SLS P6G0384 This report should not be reproduced, exoept in Its entirety, without the written consent of Prism I aboratories, Inc. 449 Springbrook Road - P-O. Box 240543 - Charlotte, NC 28224-OS43 Phone; 7041529-6364- Toll Free Number: 74s001529-6364- Fox; 704152"409 Page 5 of 7 4 •, 1 Full -Service Analytical & `s M Environmental Solutions '��weownvarc�iwt El Group, Inc. - Morrisville Project: APAC Stormwater Testing Attn: Josh Dunbar 2101 Gateway Center Dr Ste, 200 Project No: Plant # 41 Morrisville, NC 27560 General Chemistry Parameters - Quality Control Level II QC Report 7/26/16 Prism Work Order: 6070316 Time Submitted: 7/20/2016 7:55:OOAM Reporting Spike Source %REC RPD Anaiyte Result Limit Units Level Result %REC Limits RPD Limit Notes Batch PSG0384 - NO PREP Blank (P6G0384-BLK1) Prepared & Analyzed: 07/22/16 Total Suspended Solids BRL 5.0 mg/L LCS (1126G0384-BSIj Prepared &Anatyzed; 07/22/16 Total Suspended Solids 490 5.0 mgfL 477.0 103 90-110 This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratones, Inc. 449 Spring brook Road - P.O. Box 240543 - Charlotte, NC 28224,0643 Phone: 7041529.6364 -Toll Free Number: 1.8001529-6364 -Fax: 704425-0409 Page G of 7 ......... �.....�•,...u�.r�... a. n.,• r. •-+n•.. •e .. .���..�.. �.�.....�si�.r•usf .IJ:,iW.l.lJe„J.,., �.1..N.':liW.'. - .... iw+. w.0 +.f fr r. f._ J+��u�,��..�''=Y'il'i.,. �'.:I rL., . ,e f.l _.•,.uiiiL:•:i1'J�'a'. ...�. ...�..iu .a¢,�-. CHA N OF CUS' 'ODY RECORD Full -Service L,il. [IsmI Environmental Solutions PAGE ,L QUOTE p TO ENSURE PROPER B/f�TH3: gEf)RArORIE$INC- JA J 449 Springbrook Road • Charlotte, NC 28217 Project Name:/C /3' Phone 7041529.6364 Fax: 704I525-0409 Short Hold Analysis: (Yes) (No) UST Project: (Yes) (NO) Adk,"Please ATTACH any project specific reporting (QC LEVEL 1 II III IV) Client Company Name: °''� provisions and/or QC Requirements Report To/Contact Name; #� 25 r`c- ' Invoice To: Reporting Address: T•# Address: Phone: �`� lr Fax (Yes) ( � - -- ^ --- purchase rder NaiBilling Reference )' F+4 fi/f3o' TO BE FILLED IN BY CLIENTfSAMPLENG PERSONNEL Email Address: }requested Due Data Q 1 Day ❑ JDays Q 3 Days ❑ 4 Days ❑ 5 Days Certification: NELAC DoD FL NC EDD Type: PDF Excel,_,_Other "Working Days" ❑ 6-9 Days Standard 10 days ❑ Rush e AW rk Must Be oved Site Location Name: Lf Samples received after 14:00 wil11 a processed next business day. C OTHER NIA Site Location Physical Address: v �.'„� • Turnaround time is based on business days, excluding weekends and holidays, Water Chlorinated: YES NO (SEE REVERSE FOR TERMS & CONDITIONS REGARDING SERVICES RENDERED BY PRISM LABORATORIES, INC. TO CLIENT) Sample Iced Upon Collection: YES ND TIME MATRIX SAMPLE CONTAINER ANALYSIS REQUESTED PI21SM CLIENT DATE COLLECTED (SOIL, PRESERVA• 4 REMARKS LAB `TYPE NO SIZETRIES SAMPLE DESCRIPTION COLLECTED MlLrTARY HOURS WATER OR ID No. SLUDGE) SEE BELOW EL Name) 11tiC Sampler's Signature Sampled By (Print Affiliation Upon reiinquis g, thi Chain of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must be submitted in r' Ing to the Prism Project Manager. There will be charges for an hanges after analyses have been Initialized. RBlingws ed naluro Re d ign ure ate II ry Hours -� „rN 3' ta` ' �4 •'Li,-" ' Additional Comments Sda ArnvaliTime W, Baling y: S ecehwd ey: ro / - et :Site Departure Time.; Y �" �� Per s E3y: ural R or Priserr La era By: O to Flaltl %ch Fee �Mlleage •COC Group No. ".ALL Method of Shipm N :ALL SAMPLE COOLERS SHOULD BE TAP HUT wl TODY SEA OR TRANSPOR ATION T HE LABORATORY. ARE NOT ACCEPTED AND VERIFIED A C;�U�NT,ILRECEIVED AT THE LABORATORY. I� ��•' ❑ Fed Ex - S p Hantl'dtKriarod 0 Prism Field SaMca ther x "C/W „ > NPDES: UST: GROUNDWATER: D INKING WATER: SOLID WASTE: RCRA: CERCLA LANDFILL OTHER: •' ❑NC❑SC ❑NC ❑SC ❑NC ❑SC ❑NC ❑SC ❑NC ❑SC ©NC❑SC ❑NC ❑SC ❑NC ©SC 'DNC ❑SC ' ❑ d ❑ ❑ ❑ 171 n I'llF1 -.•r KIIAl - lJ ilr u,fvrtic 'CONTAINER TYPE CODES: A = Amber C = Clear G= Glass P = Plastic; TL = Teflon -Lined Cap VOA = Volatile Organics Analysis (Zero Head Space) STORMWATER DISC iGE OUTFALL (SDO) MONITORING REPORT GENERAL PERMIT NO. NCG160000 CERTIFICATE OF COVERAGE NO. NCG16 0 0 4 1 FACILITY NAME Larco Construction Co. — High Point PERSON COLLECTING SAMPLE(S) J D Frei (SwSG) CERTIFIED LABORATORY(S) Pace Analytical Lab # 12140 SwSG Lab # 5054 Part A: Specific Monitoring Requirements SAMPLES COLLECTED DURING CALENDAR YEAR: 2014 (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) COUNTY GUILFORD P ONE,q 336 885-0724 GNATURE OF PERMITTEE OR DESIGNEE By this signature, I certify that this report is accurate and complete to the best of my knowledge. Outfall No. Date Sample Collected mm/dd/yr Total Rainfall, inches 00530 00400 00556 Total Suspended Solids, mg/L pH, Standard Units Total Petroleum Hydrocarbons, mg/L EPA Method 1664 (SGT-HEM) Benchmark' - - 100 6.0 — 9.0 15 011 1 11 /23/14 0.70" 46.5 7.12 10.9 012 l l/23/14 0.70" 12.4 7.80 < 5.0 1 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit. Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN CERTIFICATION FOR ANY INFORMATION REPORTED: RECEIVED DEC 18 2014 CENTRAL FILES MAIR SECTION 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 those persons who manage the system, or those persons directly responsible for2athering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. 1 am aware that there are5*nific nt ties for submitting false information, including the passibility of fines and imprisonment for knowing violations. Of. (Date) _ .,..,... SWU-253-051409 Page 1 of 1 s R t' � . . .. � � '� �r � .r' � � � ,P �. � � ••r•' I',.' - -� •� i r .I � . '�r4i•� i . tr..,. , . a i• f . }. � - ' - _ � t 1 �. ..kIS' k�� � . +f�. ', n+�i; 1 � � f'h, ,r,, .. _ r - e r � _ > > e.- - r . . 1 _ is : r . ... l' . i .. •' • i S . - F 1 � k STORMWATER DISC ZGE OUTFALL (SDO) MONITORING REPORT GENERAL PERMIT NO. NCG160000 CERTIFICATE OF COVERAGE NO. NCG16 0041 FACILITY NAME_ Larco Construction Co. —High Paint PERSON COLLECTING SAMPLE(S) R W Hunter (SwSG) CERTIFIED LABORATORY(S) _ Pace Analytical Lab # 12/ 40 SwSG Lab # 5054 Part A: Specific Monitoring Requirements SAMPLES COLLECTED DURING CALENDAR YEAR: 2014 (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives die snnpling results from the laboratory.) COUNTY GUILFORD P N Er 336) 885-0724 IGNATURE OF PERMITTEE OR DESIGNEE By this signature, I certify that this report is accurate and complete to the best of my knowledge. Outfall No. Date Sample Collected mm/dd/vr Total Rainfall, inches 00530 00400 00556 Total Suspended Solids, mg/L pH, Standard Units Total Petroleum Hydrocarbons, mg/L EPA Method 1664 (SGT-HEM) Benchmark' - - 100 6.0 — 9.o 15 011 03/29114 0.21" 0.76 7.33 < 5.0 012 03/29/14 37.7 7.94 < 5.0 1 1f a value is in excess of the benchmark, or outside the benchmark range (for p1-1), you must implement the Tier I or Ticr 2 responses in the General Permit. Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN CERTIFICATION FOR ANY INFORMATION REPORTED: RECEIVED APR 3 4 Z014 CENTRAL FILES ❑WQIBOG 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 p pere ther and evaluate the information submitted. Based on my inquiry of those persons who manage the system, or those persons directly resp Bible for gat erininformation, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. 1 am aware that there s' #Ificant pfna es fmitting false information, including the possibility of fines and imprisonment for knowing violations. of Pernril fee} (Date) SWU-253-051409 Page 1 of I LARCO - 1330 Old Jackson Lake Rd, High P oint 4 V je sie WA4anSi o O C / 3tBlneusj adasloneKirkman Crossroad O9 C 9. a*OFreernan ldiir 311) "� 0 w Vka - �i Co Fr" Ave Charles Ave aContra[ Pine5C01MAve r r� t 'J►e ate R1 and Ave �` Ck 'Srrri kr@ V 1,e E-#,6Ave ca dye GO* pub Va &rIve K,vett Or 6