NCG210409_MONITORING INFO_20181109

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v (�i� a � �y C,
DOC TYPE
❑HISTORICAL FILE
q(MONITORING REPORTS
DOC DATE
1 / 0 g
YYYYMMDD

Semi-annual Stormwater Discharee Monitorine Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted _%Qre�r6c� ZOI�'
CERTIFICATE OF COVERAGE NO N G21-0 SAMPLE COLLECTION YEAR 210l
FACILITY NAME r,l SAMPLE PERIOD ❑ Jan -June July -Dec
COUNTY a or ❑ Monthlyl (month)
PERSON COLLECTING SAMPLES �. l DISCHARGING TO CLASS ❑ORW ❑HQW [:]Trout❑PNA
LABORATORY � 'O Lab Cert it C 15,P7 7 t ❑Zero -flow [:]water Supply ❑SA
Comments on sample collection or analysis [�6ther C-Ag_fti� �/�
Part A
GI PLEASE REMEMBER TO SIGN ON THE REVERSE 4
poz
Stormwater Benchmarks and Monitoring Results (Monitoring is Fid only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days T/p�S
❑ No discharge this penad ?'2
Outfall No
Date Sample
Collected'
(mo/ cted'
24-hour rainfall
amount.
amount,
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks ===>
-
-
120 mg/L
100 mg/L or 50 mg/L'
OS
/ 111r
O
? L
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall
z 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 maybe eligible for a waiver of the ram gauge requirement
4 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 me/L where XX is the numerical value of the
detection limit, reporting limit, etc in mg/L
Note if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses See General Permit text
Permit Date 8/1/2018-7/31/2023 SWU-245, last revised 8/6/2018
Page 1 of 2

s-
Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new oil per month
❑ No drschorge this period>2
Outfall No
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
iG64 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
_
-
15 mg/L
100 mg/L or SO mg/O
a le
Ae
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, Tier Z or Tier 3 responses See Genera! Permit text
FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART 11 SECTION 8
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART II SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Marl an original and one
in the case of "No Discho
f this DMR, including all "No
Division of Water Resources
Attn DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
to'
Darts, within 30 do
f the lab results for at end of monitoring period
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 I
am that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
I �
ignature of Permrttee) (Date)
Permit Date 8/1/2018-7/31/2423 SWU-245, last revised 8/6/2018
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEML.R General Permit No. NCG210000
Datesubmitted P_, 2 Z� 71-01-17
CERTIFICATE OF COVE AGE NO NCG21 � D 1-..
FACILITY NAME Ao 6 9 a t 0-ti.°� 0 ,`1
COUNTY ultzxe,
PERSON COLLECTING SAMPLES �.l
LABORATORY tab Cert #
Comments on sample collection or analysis
Part A
SAMPLE COLLECTION Y AR
SAMPLE PERIOD Lean -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RECEIV Zero -flow ❑Water Supply ❑SA
er 0-1/0SS c-
JUN 2 12018
LEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTPU,I FILES
Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the`fdath �rLQWxposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days )
❑ No discharge this period ;12
Outfall No
DaFe Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks
120 mg/L
100 mg/L or 50 mg/L4
s
—
r �-
' 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 me/L", where XX is the numerical value of the
detection limit, reporting limit, etc in mg/L
Note If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses See General Permit text
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new oil per month
No discharge this period ;12
Outfall No
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part S
Note If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses See General Permit text
FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALLTRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART II SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of monitoring period
in the case of "No Discharge" reports) to
Division of Water Resources
Attn DWR Central Files
1617 Mad 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 I
am awar there ar nificant penalties for subrr,tting false information, including the possibility of fines and imprisonment for knowing violations "
{Sign ure of Permittee) (Date)
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2

I- s
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted ZL 4 20/2r
CERTIFICATE OF COVERAGE NO NC621 Q 4 0 9
FACILITY NAME eansai Chip Mill
COUNTY Wake
PERSON COLLECTING SAMPLES John Cecil
LABORATORY Eneo Lab Cert #
Comments on sample collection or analysis
No Discharge since MAy 2017
SAMPLE COLLECTION YEAR 2017
SAMPLE PERIOD ❑ Jan -June Q July -Dec
or ❑ Monthly! (month)
DISCHARGING TO CLASS ❑ORW ❑HQW [-]Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
❑■ Other class C
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days )
0 No discharge this period a2
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks =__�
_
-
120 mg/L
100 mg/L or SO mg/L
No Discharge since May 2017
V
_1VFD
r
-ENTRAL Ell PS
Monthly sampling (instead of semi-annual) must begin with the second conse 4&b%E&Te0N 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 maybe 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 mg,/L", where XX is the numerical value of the
detection limit, reporting limit, etc in mg/L
Note if you report a sample value In excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month
❑■ No discharge this period?"
Outfall Na
Date Sample
Collected'
(rno/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg/L
N/A
NIA
NIA
N/A
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, Tier 2, or rer 3 responses See General Permit text
FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART 11 SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFAL0 YES ❑ NO 0
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mail an original and one copy of this DMR, including all "No Discharge' reports, within 30 days of receipt of the lab results (or at end of monitoring period
in the case of "No Discharge" reports) to:
Division of Water Resources
Attn 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 ersons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete I
aw that th are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
nature of Perms ee (Date)
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted ` tt Z �
CERTIFICATE OF CO ERAGE NO NCG21L k eE E COLLECTION Y R Zel
FACILITY NAME a t 0-14 �jd tn,'11 APR 2 SAMPLE PERIOD an -June ❑ July -Dec
2017 or ❑ Monthly) (month)
COUNTY Q e CENT CHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
PERSON COLLECTING SAMPLES 10 K l�� l RAL r=J
LABORATORY ti Lab Cert # O I (0 7 DWR SECTI�O ❑Zero -flow ❑Water Supply ❑SA
Comments on sj�mple colle ion or alysis [�Ather
Z. Sam 1177 [�s� o ►? �•` er4►? GE�� S
PLEASE REMEMBER TO SIGN ON THE REVERSE --1
Part A Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days )
❑ No discharge this period ;12
Outfall No
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks ==_>
-
-
120 mg/L
100 mg/L or 50 mg/0
7
t ak
wc//-
lzt !
, A
-3
e
L_
1.
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall
z 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 maybe eligible for a waiver of the rain gauge requirement
4 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 mg/L" where XX is the numerical value of the
detection limit, reporting limit, etc in mg/L
Note If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses See General Permit text
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new old per month
❑ No discharge this period;"
Outfall No
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or SO mg/0
L' to cc/
, e
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, Tier 2, or Tier 3 responses See General Permit text
FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION B
• 2 EXCEEDANCES M A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART 11 SECTION B/
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL7 YES ❑ NO L�
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mail an oriainal and one cony of this DMR. includina all "No Discharae" reports. within 30 days of receivt of the lab results for at end of monitorina veriod
in the case of "No Discharae" reports) to
Division of Water Quality
Attn DWQ 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 I
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
4 04-1 i' 1
of Permittee)
(Date)
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted Zy / 7
CERTIFICATE OF COVERAGE NO NCG21 0 =[ Ovq-
FACILITY NAME A%2nsq l
COUNTY 1&/g /(e /
PERSON COLLECTING SAMPLES 0424, <
LABORATORY 4i Cc0 Lab Cert #
Comments on sample collection or analysis
SAMPLE COLLECTION YEAR 10
SAMPLE PERIOD ❑ Jan -June u y-Dec
or ❑ Monthly' (month)
RECE &ING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
I`" ❑Zero -flow ❑Water supply ❑SA
JAN 1 0 [�Fer C
CENTRAL FILES
PLEASE REMEMBER TO SIGN ON THE REVERSE 4Dye SECTION
Part A Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days )
No discharge this period'-"'
OutFall No
Date sample
Collected)
(mo/dd/ r)
24-hour rainfall
amount,
Inches
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks =ram
_
-
120 mg/L
100 mg/L or 50 mg/L
v
iIla M CA,
cz .` ems-
r
.A ;
' 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 maybe 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 reoorted_in the format "<XX_mit/V, where XX is the numerical value of the
detection limit, reporting 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
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B Vehicle Maintenance Area Monitoring Results. only for facilities averaging > SS gal of new oil per month
No discharge this penod;>'
Outfall No
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inche?
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =_>
_
-
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, Ter 2, or Tier 3 responses See General Permit text
FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER i REQUIREMENTS SEE PERMIT PART 11 SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART II SECTIONS
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
]IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE-) YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mail an original and one copy of this DMR, includina alp ffNo Discharae" reports, within 30 days of receipt of the lob results for at end of momtorina Period
in the case of "No Discharae" reports) to
Division of water Quality
Attn DWQ 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 ersons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
a awa a that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
/-
( ig ature of Permittee) (Date)
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2

Semi-annual Stormwater Discharee Monitor_,ia Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted
a9mFicATE OF COVERAGE NO. NCG210 9
FACWTY NAM o `
COUNTY ot Ae,- l
PERSON COLLECTING SAMPLES
LABQRATORY Lab Cart. 0`rfo *0 -0
Comments on sample collection or analysis.
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
OCT
Part A: Storrawater Benchmarks and Monitoring Results (Monet rrequ r�edzon�jr d the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) day R4L r 11`ES
R S6C i f 01Y n No discharge this penode
SAMPLE COLLECTION YAM 16
SAMPLE PERIOD tan -June ❑ Ju4-Dec
or ❑ Mas►ttsly:_ _ Lmoreth�
DLSCHARGING TO CLASS ❑ORW []MQW ❑Trout ❑PNA
❑Zero-#iow ❑Water Su p!y []SA
r<Ecelveb
outfall ramorate
sample
collechme
(Tgjdd
24-lour rah!!
ire
Chemical Oxygen Dennaed
Total Suspended Solids
Oenc*nmwft ===>
-
-
!20 mg/L
100 mg/L or 50 v
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exeeedanee for the same parameter at the same outfall
i For sampling periods with no discharge at any single outfall, you must still submit this dischurge monitoring report with a checkmark here
3 The total precipitation must be recorded using data from an on -site rain gauge Unattended sites maybe 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 reviortBelow Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, _'ja SI&W where XX is the numerical value of the
detection limit, reporting hrnrt, etc. in nWL.
Note: If you report a sample value In excess of the benchmark you must lmpkment Teer 2, Teeer 2, or Tier 3 responses. see General Plemrlt tort.
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

w
Part B: Vehicle Maintenance Area Monitoring Results only for facilities averaging > SS gal of new all per month.
FJ No &wharge this period?;
�I,LIZ�I
W, W�
�,�r
Foatrtotes from Part A also apply to this Part B
4.11
Note' It you report a sampik value In excess of the benchmark, yotr mmt lmoonent filer 4 Tler 2, or Tier 3 respaumm see General Permit tart.
FOR PART A AND PART B MONITORING RESi,11.15
• A BENCHMARK EXCEEOANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECnON B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART it SECTION B
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE OEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mall an addiyal and are aom of thk DMR, hndrrdlna all No phWharae" rertWM within 30 days of reoeWt of the lab rg£{ &for at end Qf manhorino aericcf
ja the cue of'lUo Dlsdianae"'renc 10 tp•
Division of Water Quality
Attn DWQ Central Files
1617 Mail Ser Ace Center
Raleigh, North Carolina 27699-1617
YOLf MUST gIGN THIS CERTIFICA ON FOR M& INFORMA N RE TED.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance math a system designed to
assure that quatifled personnel property 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 knowlecke and belief, true, accurate, and complete I
ahhat there are srgnif`etant penalties for submitting false Information, including the possibility of fines and Imprisonment for knowing violations"
A & -
No
d��Q I =�
of Pernatttsee) (Date)
Permit Date 8/l/201.3-7/31/2018 SWV-245, last revised 7/31/W13
Page 2 of 2

r
E
0
Domtar
DATE July 29, 2016
TO File
FROM John Cecil
MEMO
Domtar Paper Company LLC
Marlboro Mill
Bonsal Wood Procurement
PO Box 62
New Hill NC 27562
Office [phone]
Fax [phone]
Mob [phone]
SUBJECT: TIER 1 RESPONSE TO STORM WATER RESULTS - JUNE 2016
This letter is in response to the Total Suspended Solids benchmark exceedence on the lab results
received in July 2016 from the samples collected in June 2016 It was observed that the ditch entering
the upper end of the pond, which contains a silt fence and straw bales that were previously installed in
has filled in and that chips and dust are now entering the pond Plans are underway to clean out this
ditch, and to reinstall the silt fence to minimize the amount of chips and dust entering the pond

Domtar Paper Company, LLC
Marlboro Mill
585 Willamette Road
PO Box 678
Bennettsville, SC 29512
Tel [phone]
Fax [phone]
Domtar
October 14, 2016
CERTIFIED MAIL
(7099 3220 0006 8767 9717)
RECEIVED
Central Files OCT 2 1 2016
Division of Water Resources CENTRAL FILES
1617 Mail Service Center DWR SECTION
Raleigh, NC 27699-1617
Attn Mr Bradley Bennett
RE Semi-annual Stormwater Discharge Monitoring Report (Jan -Jun 2016)
Bonsal Chip Mill (CoC NCG210409) — Wake County
Dear Mr Bennett
You may recall from previous discussions, that Domtar Paper Company owns the Bonsal Chip Mill
located in New Hill, NC However, Quercus Forest Products, owned by Mr Robert Williams, operates
the mill under contract with Domtar During an annual self -audit that we (Domtar) conduct for the
Bonsal Chip Mill's Stormwater permit, it was discovered that the January — June 2016 "Semi-annual
Stormwater Discharge Monitoring Report" was inadvertently not submitted to the Agency As follow-up
to a telephone call to Ms Bethany Georgoulias on 10/14/16, we are submitting the DMR to fulfill the
reporting requirement
Further, since the TSS benchmark was exceeded during this reporting period, as required by the permit, a
Tier 1 response was initiated A copy of this response, which is maintained with the Mill's SWPPP, is
attached
Please contact me at 843-454-8947 or woody graham@domtar com with any questions or comments
Serrell
Woodrow W Graham, Jr
Environmental Specialist
Domtar Paper Co
Attachments
cc John Cecil - Domtar Paper Co
Robert Williams — Quercus Forest Products
Ken Stuart — Domtar Paper Co
Athena Strickland — Domtar Paper Co
ouxx w��ux�
c, n�oH�:xser.
www domtar com

Semi-annual Stormw_ at_er Discharge _Monitoring ReDort
for North Carolina DEMLR General Permit No. NCG210OW
Date submitted
CERTIFICATE OF COVERAGE NO NCG210 Gt 0
FACILITY NAM oR k .` `l
COUNTY of
PERSON COLLECTING SAMPLES P_c..
LABORATORY gS © Lab Cert # 0':_r0 - O
SAMPLE COLLECTION YAM ,061(0
SAMPLE PERIOD Jan -June [ July -Dec
or ❑ Monthlyl�
DISCHARGING TO CLASS I -ORW ❑HQW
Comments on sample collection or analysis
RECEIVED
1)L 1$ 2016
low []Water Supply []SA
REMEMBER TO SIGN ON THE REVERSE 4
Part A Stormwater Benchmarks and Monitoring Results (Monitorn�g�h� me��rw the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) day R SECTION
El
No discharge this periods
Date Sample 244our rainfall
Outfall No Collected' antohhM,
(mo/dd ) Incite? Chemical Oxygen Desnand Total Suspended Solids
Benchmarks -==> _ - 120 mg/L 300 mg/L or 5o mg/L
D # - "TZ M 1_ oo &a0
CW
'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 maybe 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 Mmale, do not report Below Detection Limit, BOL, <PQL, Non -detect, ND, or other similar non -
numerical format When results are below the applicable limits, they -must be_rer-rted_tn the format.__"<XX mizLV where XX is the numerical value of the
detection limit, reporting limit, etc in mg/L
Note if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses See General Permit text
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B Vehicle Maintenance Area Monitoring Results- only for facilities averaging > S5 gal of new oil per month.
No drschorge this period r`2
Outfall No
Date Sample
Collected'
(mo/dd/yr)
24 mur rainfall
amount,
Indies
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks ==>
-
15 , VA
100 mg/L or SO mg/0
Mt
Footnotes from Part A also apply to this Part B
I/
Note If you report a sample value In excess of the benchmark you must implement Tier 1, Tier 2, or Tier 3 responses See General Permit text.
FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART iI SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mail an In ! and one cop v of dulsD R nd In l "No Discharge" within 30-dal"I MMIZ gi ft Lab rggja & in end of m2abEWO oeriod
m the case of No Discharae" rear") to
Division of Water Quality
Attn DWQ Central Fifes
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 property 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
a ar hat there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations"
' � ' ICt �!✓c'U �� I � I
i ature of Permittee) (Date)
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2

� i r
Semi-annual Stormwater Discharge Monitorimlleport
for North Carolina DEMLR General Permit No. NCG210000
Date submitted
CERTIFICATE OF CO RAGE NO NCG21 Q q 0
FACILITY NAME
COUNTY
PERSON COLLECTINGMSAMS
LABORATORY Lab Cert #
Comments on mple Ilection or� alysis
- � �la .✓ ffVA Qedr�C Ai- v� ®�.,//
SAMPLE COLLECTION Y R
SAMPLE PERIOD an -June ❑ July -Dec
or [] Monthly' (mont> j
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply [:]SA
QiDther .S
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A• Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facilit;stores ex sed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days )
No discharge this period
Outfall No
Date Sample
Collected
(mo/dd/yr]
24-hour rainfall
amount,
lnches'
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks r==>
-
-
120 mg/L
1W mg/L or SO mg/L
jib
EF' Vpm
21 2015
Ecro�
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall
Z 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 ram gauge Unattended sites maybe eligible for a waiver of the ram gauge requirement
4 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 ma/L". where XX is the numerical value of the
detection limit, reporting limit, etc in mg/L
Note if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses See General Permit text
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2
0
mlwii

Par: B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new oil per month
IVo discharge this period?'
Outfall No
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg/0
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, Tier 2, or Tier 3 responses See General Permit text
FOR PART A AND PART B MONITORING RESULTS
a A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION B
a 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART II SECTIO�N-�%B
a TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ICJ
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mall an onainal and one coov of this DMR, includina all "No Dlscharae" resorts. within 30 days of receipt of the lab results for at end of monitorina period
in the case of "No Dlscharae" reports) to
Division of Water Quality
Attn DWQ 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 sons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete I
aqwlawar4 that theys-qe s}gnificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
of Permittee)
Permit Date 8/1/2013-7/31/2018
_7-
(Date)
SWU-245, last revised 7/31/2013
Page 2 of 2

Semi-annual Stormwater Discharge Monitori,ng�ftersor!
for North Carolina DEMLR General Permit No. NCG210M
Date submitted 2- - // `/,=� _.
CERTIFICATE OF COV RAGE NO. NCG210 10 q
FACILITY NAME O rl a `
COUNTY WQ it
PERSON COLLECTING SAMPLES 411 C P-G_•
LABORATORYrj CO Lab Cert. sI
Comments on sample collection or analysis -
SAMPLE COLLECTION YEAR Zo I I
SAMPLE PERIOD ❑ Jan -June July -Dec
or ❑ Monthly' month
DISCHARGING TO CLASS []ORW []HQW Drout ❑PNA
(]Zero-f1� ater Supply OSA
R���i [other
FED zo
2 0 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
_ o$
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is regQQ4, rttvcildy stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days } ` `C?-ep
n No drseharae this nerlod?z
Outfall No
Date sample
Collected'
(mydd
244x w rainfall
amount
Inches
Chemical Oxygen Demand
Total Suspended solids
Benchmarks �>
_
-
120 awL
1W aig/L or 50 me
7
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall
I 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 maybe 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 m le. d9 1191 report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format When results are below the applicable limits, they mgg hgrr ed in th2 famid,'vM myJy, where XX is the numerical value of the
detection limit, reporting limit, etc in mg/L
Note. If you report a sample value In excess of the benchmark you must Implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text:
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > SS gal of new oil per month.
❑ No discharge this penode
Dutfa!! No
Date Sample
Collected'
(mo/d
24-four rainfall
amorart,
Inches
Non -polar 086 by EPA
1664 (SGT NEMW
Total Suspended Solhls
lend mad s ==>
_
-
is mg/L
100 mdL or 50 n
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, Tier 2, or fler 3 responses. See General Permit text
FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART 11 SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OU€FALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART 11 SECTION B
TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO O?'
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mail -an arlalnal and one caav of this DMR Inderdlna all o Dls rrcte~refiorft. witfyLn 32 dM of reeWPA of the tab Inuft or end of manfrorina grad
In the case O ANo plseharae'remrrtsl ta.
Division of Water Quality
Attn DWQ 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 f gnifi nt penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations"
Isignature of
Permit Date 8/1/2013-7/31/2018
/-01
(Date)
SWU-245, last revised 7/31/2013
Page 2 of 2

r - - =
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted
CERTIFICATE OF COVERAGE NO nNCG21.Q � O�
FACILITY NAME Goxs4 l 0- k `z) 1A1 • '//
COUNTY U/-4 K el �7 /
PERSON COLLECTING SAMPLES _ ,J D ft L_ ?��`
LABORATORY Zrtr do Lab Cert # jtD l14-�!
Comments on sample collection or analysis
JUN 2 6 20;; 4
�NF pA4 0!U PRt)r z3Cj4, , .,
SAMPLE COLLECTION Y Z �
R /
SAMPLE PERIOD an -June ❑ July -Dec
or ❑ Monthly] _ (month]
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow [:]waterSupply [:]SA
[i�ther C. &,:E � _.
PLEASE REMEMBER TO SIGN ON THE: REVERSE 4
Part A Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days )
No discharge this period,"'
Outfall No
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
lnchesl
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks =_>
_
-
120 mg/L
100 mg/L or 50 mg/L
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall
'For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here
3 The total precipitation must be recorded using data from an on -site rain gauge Unattended saes maybe eligible for a waiver of the ram 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 mrJL". where XX is the numerical value of the
detection limit, reporting limit, etc in mg/L
Note !f you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses See General Permit text
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page Iof2

Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new oil per month
❑ No discharge this period?'
Outfall No
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg/L
Lc/
ld
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 Her 1, Tier 1, or Tier 3 responses See General Permit text
FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART 11 SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO Er'
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mad an )da-8na/ and a n e cap of this DlWR, indudina all "No Discharae" reports, within 30 days of receipt of the lab results far at end of monitort na period
in the case of "No Discharae" reports) t
Division of water Quality
Attn DWQ Central Files
1617 Mad 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 I
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
(Sign of Permittee) (Date)
Permit Date 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2