NCG060148_DMR_20230510

SDO-001
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfilliggout thisform,please visit* httP,//oortalncdenrorg/web/wa/ws/su/npdessw#tab-4
Permit No.: N/-C/_/_/_/_/_/_/_/ or Certificate of Coverage No.:
Facility Name: Sn der's Lance Incor orated �[
County: Mecklenburg Phone No. 704-554-5560 a
Inspector: Russell Everett (PAR Laboratories Inc.) -MAY 17 2023
Date of Inspection: 03/17/23
Time of Inspection: 17:45 GgNTR"' FILES
DWR SECTION
Total Event Precipitation (inches): 0.28
Was this a "Representative Storm Event' or "Measureable Storm Event" as defined by the permit?
(See information below.)
V Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event' is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event musthave been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office_ —
By tNs signature, IFktiDrNhat this r�rt is accurate and complete to the best of my knowledge:
of Permittee
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. SDO-001 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Kings Branch in the Catawba River Basin
Describe the industrial activities that occur within the outfall drainage area: Employee parking,
truck parking, loading/unloading, & material transfers. All processes & manufacturing
occur inside the facility.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Cloudy with a medium brown tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 V 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
V 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
V 3 4 5
7. Is there any foam in the stormwater discharge? Yes we
8. Is there an oil sheen in the stormwater discharge? Yes ve
9. Is there evidence of erosion or deposition at the outfall? Yes 'e
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
None
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

SDO-002
A � !
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: hnp;//porLai,ncdelir.org/web/wg/w5/su/npdessim#tab-4
Permit No.: I�/�_/_/_/_/_/_/_/ or Certificate of Coverage No.:
Facility Name: Snyder's Lance Incorporated
County: Mecklenburg Phone No. 704-554-SSRO
Inspector: Russell Everett (PAR Laboratories Inc.)
Date of Inspection: 03/17/23
Time of Inspection: 18:15
Total Event Precipitation (inches): 0_28
Was this a "Representative Storm Event" or "Measureable Storm Event' as defined by the permit?
(See information below.)
gYes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event' is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
j permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By th signature, I�c%e j.ha this report is accurate and complete to the best of my knowledge:
(Sia re of Permittee or Des` e
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. SDO-002 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Kings Branch in the Catawba River Basin
Describe the industrial activities that occur within the outfall drainage area: Employee parking,
truck parking, loading/unloading, & material transfers. All processes & manufacturing
occur inside the facility.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Clear with a very light brown tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
*/ 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
V 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
V 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes we
8. Is there an oil sheen in the stormwater discharge? Yes 4?
9. Is there evidence of erosion or deposition at the outfall? Yes W/
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

S DO-003
S�� _fir
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfillingout thisform,please visit http�// tales ncd rorg/web/wa/ws(5u/nodessw#tab-4
Permit No.: Iyf�/_/_/_/_/_/_/—/ or Certificate of Coverage No.:
Facility Name: Snyder's Lance Incorporated
County: McMer
Inspector: Russell
Date of Inspection: 031171,
Time of Inspection: 1 S_25
Phone No.
Total Event Precipitation (inches): 028
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
gYes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event"or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event' However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
I obtains approval from the local DWQ Regional Office
By
of Permittee
SWU-242, Las[ modified 10/25/2012
and complete to the best of my knowledge:
Pagel of 2

1. Outfall Description:
Outfall No. SDO-003 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Kings Branch in the Catawba River Basin
Describe the industrial activities that occur within the outfall drainage area: Employee parking,
truck parking, loading/unloading, & material transfers. All processes & manufacturing
occur inside the facility.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Cloudy with a medium brown tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 V 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 *,t 3 4 5
7. Is there any foam in the stormwater discharge? Yes *10
8. Is there an oil sheen in the stormwater discharge? Yes V
9. Is there evidence of erosion or deposition at the outfall? Yes Al?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

61i10 11
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance onfilling out thisform, please visit. http://portalncdynrgrg/web/wg/ws/su/npdessw#tab-4
Permit No.:
Facility Name: Sn
or Certificate of Coverage No.:
County: me=en=U q Phone No. 7fld-F54-5580
Inspector: Russell Everett (PAR Laboratories, Inc.)
Date of Inspection: 03/17/23
Time of Inspection: 18:40
Total Event Precipitation (inches): 0_28
Was this a "Representative Storm Event' or "Measureable Storm Event' as defined by the permit?
(See information below.)
Vr Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event' is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event' is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours j
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.__
By rlilis signattype,1�$rtiV tKat this report is accurate and complete to the best of my knowledge:
of
Page 1 of 2
S WU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. SDO-004 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Kings Branch in the Catawba River Basin
Describe the industrial activities that occur within the outfall drainage area: Employee parking,
truck parking, loading/unloading, & material transfers. All processes & manufacturinc
occur inside the facility.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Clear with a light brown tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
V 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
V 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes VIC
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

SDO-005
I
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfillingout thisform,please visit, http,//`portal.ncdenr.org/web/wg/ws/"5u/updessw#tab-4
Permit No.: N/-C/_/
Facility Name: Sn
or Certificate of Coverage No.:
County: Mecklenburg Phone No. 704-554-55R0
Inspector: Russell Everett (PAR Laboratories, Inc.)
Date of Inspection: 03/17/23
Time of Inspection: 21:05
Total Event Precipitation (inches): 028
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
9 Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event' or during a "measureable storm event." However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By tfi\s signaturpe, I c$rtMthat this report is accurate and complete to the best of my knowledge:
of
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. SDO-005 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Kings Branch in the Catawba River Basin
Describe the industrial activities that occur within the outfall drainage area: Employee parking,
truck parking, loading/unloading, & material transfers. All processes & manufacturing
occur inside the facility.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Clear with a light brown tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
V 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes 46
8. Is there an oil sheen in the stormwater discharge? Yes V
9. Is there evidence of erosion or deposition at the outfall? Yes .W
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

S DO-006
X��yA
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: htrp•//portal ncdenr orE/web/wq/ws/_su/npdessw#tab-4
Permit No.: N/C/_/_/_/_/_/_/_/ or Certificate of Coverage No.:
Facility Name: Snyder's Lance Incorporated
County: Mecklenburg Phone No. 70e-554_F560
Inspector: Russell Everett (PAR Laboratories Inc.)
Date of Inspection: 03/17/23
Time of Inspection: 20:50
Total Event Precipitation (inches): 0.28
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
g Yes ❑ No
Please verify whether Qualitative Monitoring must he performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
'MI
of Permittee or
SWU-242, Iasi modified 10/25/2012
is accurate and complete to the best of my knowledge:
Page 1 of 2

1. Outfall Description:
Outfall No. SDO-006 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Kings Branch in the Catawba River Basin
Describe the industrial activities that occur within the outfall drainage area: Employee parking,
truck parking, loading/unloading, & material transfers. All processes & manufacturing
occur inside the facility.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Cloudy with a light brown tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 %-e 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
y 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 V 3 4 5
7. Is there any foam in the stormwater discharge? Yes V
8. Is there an oil sheen in the stormwater discharge? Yes 44
9. Is there evidence of erosion or deposition at the outfall? Yes V
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

SDO-007
e.�n
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfillingout thisform,please visiC hU,//oortalncdenrorg/web/wq/ws/5u/npdessw#tab-4
Permit No.: N/C/_/_/_/_/_/_/_/ or Certificate of Coverage No.:
Facility Name: SnVtler'S
County: Mecklenb
Inspector: MUSSen ti
Date of Inspection: 03/17/23
Time of Inspection: 20:35
Phone No. 704_554-558fl
Total Event Precipitation (inches): 0.28
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Vf Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event' is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
QQI
of Permittee or
SWU-242, Last modified 10/25/2012
this report is accurate and complete to the best of my knowledge:
Pagel of 2

1. Outfall Description:
Outfall No. SDO-007 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Kings Branch in the Catawba River Basin
Describe the industrial activities that occur within the outfall drainage area: Employee parking,
truck parking, loading/unloading, & material transfers. All processes & manufacturinc
occur inside the facility.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Clear with a light brown tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1 V 3 4 5
7. Is there any foam in the stormwater discharge? Yes V
8. Is there an oil sheen in the stormwater discharge? Yes V
9. Is there evidence of erosion or deposition at the outfall? Yes Ve
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

r
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfillirlgout thisform,please visit: hUp://12ortalncdenrorg/web/wg/ws/su/npdessw#tab-4
Permit No.: 1�/ti/_/_/_/_/_/_/_/ or Certificate of Coverage No.:
Facility Name: Snyder's Lance Incorporated
County: Mecklenburg Phone No. 704-554-.556n
Inspector: Fib
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): 0_28
Was this a "Representative Storm Event" or "Measureable Storm Event' as defined by the permit?
(See information below.)
IRT Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event" However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours j
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
report is accurate and complete to the best of my knowledge:
of Permittee or
Page 1 of 2
SWO-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. SDO-008 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Kings Branch in the Catawba River Basin
Describe the industrial activities that occur within the outfall drainage area: Employee parking,
truck parking, loading/unloading, & material transfers. All processes & manufacturing
occur inside the facility.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Clear with a very light brown tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
V/ 2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes V
8. Is there an oil sheen in the stormwater discharge? Yes V
9. Is there evidence of erosion or deposition at the outfall? Yes V
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

SDO-009
k0k
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out thisform, please visit hap:I/portal.ncdenr.org/weblwq/ws/su/nl2dessw#tab-4
Permit No.: �&/—/—/_/_/_/_/_/ or Certificate of Coverage No.:
Facility Name: Snyder's Lance Incorporated
County: Mecklenburg Phone No. 70a-3.5a-.r,.r,RO
Inspector: Hussell tverett (VAlt I-aooramnes, Inc.)
Date of Inspection: 03/17/23
Time of Inspection: 20:05
Total Event Precipitation (inches): 0.28
Was this a "Representative Storm Event" or "Measureable Storm Event' as defined by the permit?
(See information below.)
gYes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event' is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By thA signature, l tifykhitjtiis repo�rt'saseurate and complete to the best of my knowledge:
of Permittee or
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. SDO-009 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Kings Branch in the Catawba River Basin
Describe the industrial activities that occur within the outfall drainage area: Employee parking,
truck parking, loading/unloading, & material transfers. All processes & manufacturing
occur inside the facility.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Clear with a very light brown tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
y 2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
6. Is there an oil sheen in the stormwater discharge? Yes 'X
9. Is there evidence of erosion or deposition at the outfall? Yes PI�
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

SDO-010
AS XWa
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidanceonfillingout thisform,please visit: http�//oortaiacdenrorg/web w/wq/ws/su/nodessw#tab-4
Permit No.: �I/�/_/_/_/_/_/_/_/ or Certificate of Coverage No.:
Facility Name:
County:
Phone No. 704-554-5,960
Inspector: Russell tyerelt (VAtt Laooratories, inc.)
Date of Inspection: 03/17/23
Time of Inspection: 19:50
Total Event Precipitation (inches): 028
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
g Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event' or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event' is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event' is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By t�\ sigi;aturet c"hat this report is accurate and complete to the best of my knowledge:
of
Pagel of 2
SWU-242, Laa modified 10/25/2012

1. Outfall Description:
Outfall No. SDO-010 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Kings Branch in the Catawba River Basin
Describe the industrial activities that occur within the outfall drainage area: Employee parking,
truck parking, loading/unloading, & material transfers. All processes & manufacturing
occur inside the facility.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Cloudy with a very light brown tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
V 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
V 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes W4
8. Is there an oil sheen in the stormwater discharge? Yes V
9. Is there evidence of erosion or deposition at the outfall? Yes V
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242, Last modified 10/25/2012

SDO-011
X NM
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance onfilling out thisform, please visit., http://oortalncdenrorg/web/wa/ws/su/ni2dessw#tab-4
Permit No.: N/C/_/_/_/_/_/_/_/ or Certificate of Coverage No.:
Facility Name: 5nyaer'S Lance incorporatea
County: Mecklenburg Phone No.
Inspector: Kusseii t'
Date of Inspection: 03/17/23
Time of Inspection: 19:20
Total Event Precipitation (inches): 0_28
Was this a "Representative Storm Event' or "Measureable Storm Event" as defined by the permit?
(See information below.)
9 Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event' is a storm event that results in an actual discharge from the
permitted site outfall. The previous measurable storm event must have been at least 72 hours j
prior. The 72-hour storm interval does not apply if the permittee is able to document that a shorter
interval is representative for local storm events during the sampling period, and the permittee
obtains approval from the local DWQ Regional Office.
By 's si tur r ' that this report is accurate and complete to the best of my knowledge:
i ature of Permittor ee)
Pagel of 2
SWU-242, Last modified 1012512012

1. Outfall Description:
Outfall No. SDO-011 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: Kings Branch in the Catawba River Basin
Describe the industrial activities that occur within the outfall drainage area: Employee parking,
truck parking, loading/unloading, & material transfers. All processes & manufacturinc
occur inside the facility.
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: Clear
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in
the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
S/ 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended
solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
2 3 4 5
7. Is there any foam in the stormwater discharge? Yes N?
8. Is there an oil sheen in the stormwater discharge? Yes V
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe None
Note: Low clarity, high solids, and/or the presence of foam, on sheen, or erosion/deposition
may be indicative of pollutant exposure. These conditions warrant further investigation.
Page 2of2
SWU-242, Last modified 10/25/2012

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG06 0 1 4 8
FACILITY NAME Snyders-Lance Incorporated
COUNTY Mecklenburg
PERSON COLLECTING SAMPLES Russell Everett
LABORATORY PAR Laboratories, Inc. Lab Cert. # 20
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2023
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? ❑YES ®NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event roinfal120.28 or ❑ No discharge this period3
Outfall No. Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coltform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark -
1:00 or SCr
Within 6.0 — 9.0
120
30
1000
Soo
DO-001 3/17/23
7.15 182
< 5.1
NA
NA
DO-002 3/17/23
.10
8
5.1
NA
NA
DO-003 3/17/23
18
7.08
2
< 5.2
NA
NA
DO-004 3/17/23
12
17.12
3
5.1
NA
NA
DO-005 3/17/23
120
ff.14
3
5.1
INA
NA
Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ® yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > SS gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
i00 or 50
6.0 — 9.0
-
DO-005
3/17/23
< 5.1
20
7.14
I Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
if yes, complete Part B)
SWU-249 last Revised: October 18.2012
Page I of 2

*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 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO PC
IF YES, HAVE YOU CONTACTED THE DWQ 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
ji Raleigh, NC 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."
of Permitfeej
S. /,a . Z,3
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/`npdessw#tab-4
SWU-249 Last Remised: October 18. 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG06 0 1 4 8
FACILITY NAME Snyders-Lance Incorporated
COUNTY Mecklenburg
PERSON COLLECTING SAMPLES Russell Everett
LABORATORY PAR Laboratories, Inc. Lab Cert. # 20
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2021
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? []YES ®NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall 20.28 or ❑ No discharge this period
Outfail No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
500
DO-006
3/17/23
17
7.09
6
< 5.1
NA
NA
DO-007
3/17/23
2
7.16
5
< 5.1
NA
NA
DO-008
3/17/23
10
7.17
8
< 5.1
NA
NA
DO-009
3/17/23
17.15
5
l< 5.1
A
A
DO-010
3/17/23
ill
17.14
1101
1< 5.3
PN A
A
' Only applies to facilities that use/process meats.
2 The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfails. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ® yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 5S gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor oil Usage,
Annual average.gal/mo
Benchmark
-
30
100 or 50
6.0 — 9.0
-
DO-006
3/17/23
< 5.1
17
7.09
DO-007
3/17/23
< 5.1
22
7.16
` Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
if yes, complete Part B)
SWU-249 I ast Revised: October 18. 2012
Page I of 2

'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
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES Q 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, NC 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."
of
�-. lo. z3
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenF.org/web/wq/ws/su/npdessw#tab-4
S WU-249
Last Revised: October 18. 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE NO. NCGO6 0 1 4 8
FACILITY NAME Snyders-Lance Incorporated
COUNTY Mecklenburg
PERSON COLLECTING SAMPLES Russell Everett
LABORATORY PAR Laboratories, Inc. Lab Cert. # 20
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2021
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? []YES ®NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event roinfall 20.28 or ❑ No discharge this period3
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Collform ,
Colonies per 100 ml
Enteroroeci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
500
DO-011
/17/23
11
.13
97
< 5.3
NA
NA
1 Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ® yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 50
6.0 — 9.0
-
1 Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
if yes, complete Part B)
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

*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 OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HADA OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO gfl
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 34 days of receipt of the lab results for at end of
monitoring period in the case of "No Discharae" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 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 bossibility of fines and imprisonment for knowing violations."
of Permittee}
S r� Z3
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-249
Last Revised: October 18.2012
Page 2 of 2