NCG210249_MONITORING INFO_20180803

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
Iv cc 10 a 9
DOC TYPE
❑ HISTORICAL FILE
19 MONITORING REPORTS
DOC DATE
❑ j b%� D b o 3
YYYYM M D D

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted 8/1/2018
CERTIFICATE OF COVERAGE NO. NCG210249
FACILITY NAME Meherrin River Forest Products
COUNTY Halifax
PERSON COLLECTING SAMPLES Gary Middleton
LABORATORY ENCO - Cary Lab Cert. # NC 591
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2018
SAMPLE PERIOD ❑ Jan -June ❑X July -Dec
RECEIVED or ❑ Monthly' (month)
AUG 0 3 2018 DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply [:]SA
CENTRAL FILES ❑X Other Class-C Stream
DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
❑ No discharge this period?2
Date Sample M24!liourrnainfallCollected' emical Oxygen(mo/,dd/,yr)
120 mg/L 300 mg/L,or 50 mx/l�
NOT APPLICABLE
Bencbm�
=�
' 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 ms/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, J ler 2, or Tier 3 responses. See General Permit text.
Permit Date:8/l/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2

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Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
7
n No discharge this period?z
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
001
07 11 2018
0.2"
2.7 mg/L
11 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, 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 II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO Ej
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one copy of this DMR includina all "No Discharge" reports within 30 days of receipt of the lab results for at end of monitoring period
in the case of "No Discharge" 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."
8/1/2018
(Date)
Permit Date:8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2

t

Accurate.lies
l 7 1Innovative.
102-A Woodwinds Industrial Court
Cary NC, 27511
Phone: [phone] FAX: [phone]
Tuesday, July 24, 2018
Meherrin River Forest Products, Inc. (ME025)
Attn: Gary Middleton
71 N. Oak Street
Alberta, VA 23821
RE: Laboratory ResuRs for
Project Number: [none], Project Name/Desc: Stormwater- Weldon
ENCO Workorder(s): CB02726
Dear Gary Middleton,
Enclosed is a copy of your laboratory report for test samples received by our laboratory on
Friday, July 13, 2018.
Unless otherwise noted in an attached project narrative, all samples were received in
acceptable condition and processed in accordance with the referenced methods/procedures.
Results for these procedures apply only to the samples as submitted.
The analytical results contained in this report are in compliance with NELAC standards, except
as noted in the project narrative if applicable. This report shall not be reproduced except in
full, without the written approval of the Laboratory.
This report contains only those analyses performed by Environmental Conservation
Laboratories. Unless otherwise noted, all analyses were performed at ENCO Cary. Data from
outside organizations will be reported under separate cover.
If you have any questions or require further information, please do not hesitate to contact me.
Sincerely,
Bill Scott
Project Manager
Enclosure(s)
Fain •Ms mpmt vde ad, m a anrok w recce ea by nc lab"oy, and mn only be repmuosl b fut Page 1 of 7

www.eDmlabs.com
I SAMPLE SUMMARY/LABORATORY CHRONICLE
alent 1D: Sbwmyatay Iab M: C802726-01 Sampled: 07/11/1818:42 Received: 07113/1810:30
Parameter Irega2tlm Meld Da6a/Tmeyal Prep Dale/Timeycl Anahnds Da6eTmeiel
EPA 1664A EPA 1664A 08/08/18
SM 254OD-2011 NO PREP 07/18/18
07/18/18 16:05 07/20/18 13:55
07/17/18 12:50 07/17/18 12:50
FD This report fdat mN m , Sm * as reo ed by d, lammmry, and may mN ae eymduoed m M. Page 2 of 7

AC2116a
Total Suspended Solids
SAMPLE DETECTION SUMMARY
11
!QL PQL
2.5 2.5
mg/L
EIV
�..ncelab .�
SM 2540D-2011
T ie w ydates mh m the sample as mCeiml by tlm labmxmry, and may mM be IeNOftMd Ia U.
Page 3 of 7

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ANALYTICAL RESULTS LD
Description: Stormwater Lab Sample ID:CB02726-01 Received: 07/13/1810:30
Matrix: Water Sampled:07/11/18 18:42 Work Order: CB02726
Project: Stormwater- Weldon Sampled By:Gary Middleton
Classical Chemistry Parameters MINE
^ - ENCV Orr maflaf am" [NC 5911
Analybs rCASNumberl Results an unu RE Mu P91. Batch Method AOahD4d BY Roles
Total Susperrded 501I&A 11 m9/L 1 2.5 2.5 8G17017 SM 25400-2011 07/17/18 12:50 LBG
Classical Chemistry Parameters
Analyte rcAS Numberl RCSldL4 fin gab 12f Hu PQL Rauh Method Analyzed By Rots
Oil & Grease (HEM-SGr) Non -Polar Material 2.70 u mg/L 1 2.70 5.00 8GI8013 EPA 1664A 07/20/18 13:55 SMA
rnb repot rases 0* to the swt* n rc&led M the Was , are mar 00N be re,oawd In U. I Page 4 of 7

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QUALITY CONTROL DATA
Classical Chemistry Parameters - Quality Control
Wee
Banda W17017 - NO PREP
Blank (BG17017-BLK3)
Prepared & An lymd: 07/17/2018 12:50
Spike Source %REC
RPD
.Anal Yta
Result
Bait
PQL
units
Lend Result %REC Limits RPD
Unlit Hopes
Total Suspended Solids
2.5
U
2.5
mg/L
LCS (BG17017-851)
Prepared & Analyzed: 07/17/2018 12:50
Spike Source %REC
RPD
Analyte
Rmdt
ELM
COL
units
Lem BesdL %REC LJMIU RPD
1.11111111 Notes
TotalSuspended Sol&
98
2.5
nxyL
100 98 80-120
Duplicate (SG37017-DUPl)
Prepared &Analyzed: 07/17/2018 12:50
Source: CB07969-08
Spike Source %REC
RPD
.Ananda
Result
Elm
POL
welts
tam gtNldL %REC Limits RPD
Llntit Notes
Total Suspended Solids
68
10
mg/L
74 9
20
Duplicate (SG37017-DUP2)
Prepared &Aniseed: 07/17/2018 12:50
Source: CB07969-13
Spike Source %REC
RPD
ADehDo
Result
Elm
PQL
Units
Lem Re suR %REC Limits RPD
unlit N9$i
Total Suspended Solids
33
5.0
rtg/L
34 4
20
Classical Chemistry Parameters - Quality Control
Barth 9618013 - EPA J"40
Blank (BG38013-111.1(S)
Prepared: 07/18/2018 16:05 Analyzed: 07/20/2018 13:55
Spike Source %REC
RPD
.Ana hna
Rend t
Elm
Ml.
units
Level Result %REC LImRa RPD
um11 Nofts-
Oli & Grease (HEM-SG-1) Non -Polar Material
2.70
U
5.00
mg/L
LCS (8G38013.851)
Prepared: 07/18/2018 16:05 Analyzed: 07/20/2018 13:55
Spike Source %REC
RPD
Anahea
Result
Hall
POL
Units
Leval BSsdL %REC Limits RPD
unlit Notes
Oil & Grease (HEM-SGT) Non -Polar Material
79.8
5.00
mg/L
80.6 99 64-132
LCS Dup (BG18013-8501)
Prepared: 07/18/2018 16:05 Analyzed: 07/20201813:55
Spike Scum %REC
RPD
AnaDOs
ReSWt
fills
COL
units
level Result %REC umRs RPD
unlit Notes
Oil& Grease (HEM-SGT) Non -Polar Material
95.0
5.00
mg/L
81.3 104 64-132 6
34
Matrix Spike (8618013-M51)
Prepared: 07/18/2018 16:05 Analyzed: 07/20/201813:55
Source: OB03107-02
Spike Source %REC
RPD
_Ana hda
Result
Hall
PQL
units
lent Rena %REC unties RPD
unlit Notes
Oil & Grease (HEM-SGT) Non -Polar Material
41.9
5.00
mg/L
80.6 20.0 27 64-132
QM-07
FnUL This repot rel R only W the ample as reod,,ed by the laboratory, and may o* be reprmioM in full. Page 5 of 7

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FLAGS/NOTES AND DEFINMONS
a The analyte was detected in the associated method blank.
D The sample was analyzed at dilution.
J The reported value is between the laboratory method detection limit (MDL) and the laboratory method
reporting limit (MRL), adjusted for actual sample preparation data and moisture content, where applicable.
U The analyte was analyzed for but not detected to the level shown, adjusted for actual sample preparation
data and moisture content, where applicable.
E The concentration indicated for this analyte is an estimated value above the calibration range of the
instrument. This value is considered an estimate.
MRL Method Reporting Limit. The MRL is roughly equivalent to the practical quantitation limit (PQL) and is
based on the low point of the calibration curve, when applicable, sample preparation factor, dilution
factor, and, in the case of soil samples, moisture content.
PQL PQL: Practical Quantitation Limit. The PQL presented is the laboratory MRL
N The analysis indicates the presence of an analyte for which there is presumptive evidence (85% or greater
confidence) to make a "tentative identification".
P Greater than 25% concentration difference was observed between the primary and secondary GC column.
The lower concentration is reported.
QM-07 The spike recovery was outside acceptance limits for the MS and/or MSD. The batch was
accepted based on acceptable LCS recovery.
FP TW newtRk o*Wm SWk*W,.mwebrmwmbwdt�,aWm"orx rWolxed mnn Page6of7

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' a t�pI tOT]5 Conbal
Orlando, FL 02824
"- - - (407) B26-Wl4
QW Name
Mllhe ,in River Forest Products Inc. i lit
Port Dr. 4810 6eo,tNe Park Court, Suite 111
Jackaom Ue, FL =16.6069
Faa (407) M"945 (%M) 2963007 Fax (901)296'6210
project Number
frionel
project Name/Dmc
Stormrvater- Weldon
Po a / Bi9kg Into
Reponhtp Co acl
GaryMiddleton
Bitting ContaG
Gary Middleton
she Ixaw / Time Zwe
F-
C�
<
():1
pis
0GB02726
102A Waadwindt IndusMat Ct.
Cary. NC 27511
(919) d67-3030 Fax [phone]
Raqumtad Analyses
-
N
cA
�
Page _ of
Requested Turnar0 r
Times o
r—
Note : Rush raquesle su
axop anw by the ma9 m
a
_ Standard LJ
_ Expedited
Due
tab Workorder
,ld,me -
71 N. Oak Street
CiyrsTZp
AI berta, VA 23821
Tel
(6 78) 428 5233
Fw
Samplers) Name. Afille (Prim)
Setore
mper
Praxrva9on (See Codes) (Combine es Ireceseay)
Item a
Sample ID (Field Werra icatbn)
Cohecllon Dale
collection
Time
Comp / Grab
Matrlx
(son codas)
Total a of
Confermere
Sample Comments
1. ..
1
-
<--Total#of Containers
Sample Rh Prepared By
Oatemme
Rellnq had By ..
DateRme �� �� -
R vedB
DateMme
CammenWSpedel Reposing Requirements
-
eli cparoed
Dalarrme -
eceived y
Dale/nme
_
Relinquished By -
DatayNne
R B —
Delemma
Cooler e'e 6 Tempe on Receipt
u-u,4nn CJ19Cm4 NO-NnoN o-0mer1detdl
eerbltbn Raceipl
Acceptable _ Unacceptable
in commmnl _. .
Yehh:GW,Ci.ndwalarSO-SoJDWDMkWg Wale'ae-aaomem an-aurvce norm on-..a�e..e.=...-... ..�,..... ............ �....._._. -___
Note :Ae sampim wbmitled to ENCO Labs are in 8000 nce with the terms anti conditiom listed on the reverse or Nis Wrm, unless prior wrft en agrmmems exist

r
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted 4/6/2017
CERTIFICATE OF COVERAGE NO. NCG210249
FACILITY NAME Meherrin River Forest Products
COUNTY Halifax
PERSON COLLECTING SAMPLES Gary Middleton
LABORATORY ENCO - Cary lab Cert. # NC 591
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2017
SAMPLE PERIOD ❑X Jan -June ❑ July -Dec
or ❑ Monthly/ (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
X❑Other Class-C Stream
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
PaFt A - , SWFFmvater Rpinahmaicks and MeRitering Results (Nilenit9FiAg *5 FeqUiFed only if the fadlitY SWFes expesed accumulations of sawdust, weed ,
n No discharge this period?z
Outfall No.
F(mo1,qchdjyr,)
IlMniches3
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks =__>
0
12o mg/L
Soo rn or So mg/.L1�
NOT APPLICABLE
=�
®ems
' 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.
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.
a 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 1, 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.
n No disrhorae this aeriod;>2
Outfall No.
Date Sample
24-hour rainfall
a
Collected'
amount,
Non -polar O&G by EPA
(mo/dd/yr)
Inches
1664 (SGT-HEM)
Total Suspended Solids
-
Benchmarks
15 mg/L
100 mg/L or 50 mg/L
001
04/06/2017
0.3"
Lab did COD and
27 mg/L
not the O&G test
Will take another
sample upon the next
storm event
rootnotes 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 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 FKI
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 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."
6/18/2017
(Signature of P r ittee) (Date)
Permit Date: 8 1/2013-7/3,/2018 SWU-245, last revised 7/31/2013
Page 2 of 2

EN �r
v .encolabs.com
ANALYTICAL RESULTS
Description: Stormwater Lab Sample ID:CA05035-01 Received: 04/07/17 09,00 I
Matrix: Water Sampled:04/06/17 11:48 Work Order: CA05035
Project: Stormwater- Weldon Sampled By: Gary Middleton
Chemistry Parameters
Analrte rCAS Number]
Chemical Oxygen Demand^
Total suspended Solids^
Results EIM units PE MDL Mi, Batch Method Analyzed i71t Notes
69 mg/L 1 10 10 7D10034 SM 522OD-1997 04/10/17 17:17 10c
37 mg/L 6.67 17 17 7D10002 SM 2WD-1997 04/10/17 13:10 OMR
Hi
Thrs report relatr only to me s * as r Net by the w at«r, and may only oe rerrndu In fun. Page 4 Of a

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted 4/27/2016
CERTIFICATE OF COVERAGE NO. NGG2I,OZ_ 9_—=
FACILITY NAME Meherrin River Forest Products
COUNTY Halifax
PERSON COLLECTING SAMPLES Gary Middleton
LABORATORY ENCO - Cary Lab Cert. tf NC 591
Comments on.sample collection or analysis:
SAMPLE COLLECTION YEAR 2016
SAMPLE PERIOD © Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RFCEIVE® ❑Zero -flow ❑Water Supply ❑SA
APR 2 9 2016 QOther Class-C Stream
D1NRSECTION PLEASE REMEMBER TO SIGN ON THE REVERSE 4
INFORMATION RMESSINGl1AitT
,
No discharge this period?2
.OutfalLNo'
Date 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/L
NOT APPLICABLE
' 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.
'The 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.
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 iesponses. 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.
n No dischome this 4eriod?2
`
Outfall No...
-
Date Sample
1
Collected
(mo/dd/yr)' "
24-hour rainfall
� amo��
unt,
a =
` Inches
'Non -polar - 'O&G by EPA
1664 (SGT-HEM)
=
- Total Suspen deds d Soli -
Benchmarks =__>_
-
15 mg/L
100 mg/L or 50 mg/L
001
04 12 2016
0:4"
7.63 mg/L
17 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, 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 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? YE_ S ❑ 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 for at end of monitorina period
in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files-
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUSTSIGN THIS CERTIFICATION FOR ANY. INFORMATION REPORTED:
1 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
ain aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." '
4/28/2016
(Date)
Permit Date: 8/1/2013-7/31/2018 - - - - _ - -- - - - -- - SWU-245, last revised 7/31/2013
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