Loading...
HomeMy WebLinkAbout20092657.tiffHEARING CERTIFICATION DOCKET NO. 2009-52 RE: SITE SPECIFIC DEVELOPMENT PLAN AND USE BY SPECIAL REVIEW PERMIT #1703 FOR A MINERAL RESOURCE DEVELOPMENT FACILITY, INCLUDING OIL AND GAS SUPPORT AND SERVICES (COMPRESSOR STATION) IN THE A (AGRICULTURAL) ZONE DISTRICT - DOUGLAS AND DEBORAH DUGGAN, C/O PETRO-CANADA RESOURCES (USA) INC. A public hearing was conducted on September 30, 2009, at 10:00 a.m., with the following present: Commissioner William F. Garcia, Chair Commissioner Douglas Rademacher, Pro-Tem Commissioner Sean P. Conway Commissioner Barbara Kirkmeyer Commissioner David E. Long Also present: Acting Clerk to the Board, Jennifer VanEgdom County Attorney, Bruce Barker Planning Department representative, Kim Ogle Health Department representative, Lauren Light Public Works representative, Don Carroll The following business was transacted: I hereby certify that pursuant to a notice dated August 10, 2009, and duly published August 13, 2009, in the Windsor Beacon, a public hearing was conducted to consider the request of Douglas and Deborah Duggan, c/o Petro -Canada Resources (USA) Inc., for a Site Specific Development Plan and Use by Special Review Permit #1703 for a Mineral Resource Development Facility, including Oil and Gas Support and Services (compressor station) in the A (Agricultural) Zone District. Bruce Barker, County Attorney, made this a matter of record. Kim Ogle, Department of Planning Services, presented a brief summary of the proposal and entered the favorable recommendation of the Planning Commission into the record as written. He stated the site is located south of County Road 122, east of County Road 89, and within the three-mile referral area for the Town of Grover. He confirmed the response from the Town of Grover did indicate concerns regarding issues of noise, traffic, and visual aesthetics; however, he described the efforts Petro -Canada is willing to put forth to mitigate these concerns, and the Town is satisfied with the proposed efforts. He gave a brief description of the surrounding uses of the site, and confirmed the site was formerly utilized as a compressor station, leased by Juniper Gas Gathering System in 1986. He indicated there are six surrounding property owners within 500 feet of the property, and staff has not received any correspondence or telephone calls from surrounding property owners. He confirmed the access to the site is on County Road 122, which is a local gravel road, and the interior roads on the property are gravel as well. He indicated eleven referral agencies reviewed the application materials, and eight provided comments which have been addressed within the Conditions of Approval and Development Standards. Mr. Ogle displayed photographs of the site and the surrounding area. PL fit 2009-2657 PL2025 /29/ba /o HEARING CERTIFICATION - DOUGLAS AND DEBORAH DUGGAN, C/O PETRO-CANADA RESOURCES (USA) INC. (USR-1703) PAGE 2 Don Carroll, Department of Public Works, stated the compressor site is located within the Grover field system, and the traffic counts within the surrounding area are included in the map he provided, marked Exhibit D. He confirmed the second map included within Exhibit D indicates the placement of other oil and gas wells within the surrounding area. He stated the Department did receive inquiries regarding the addition of traffic within the surrounding area, and a request has been made for the Department to implement a four-way Stop sign for the intersection at the edge of the municipal limits for the Town of Grover. He clarified the compressor station will provide gas to the Lilli Gas Processing facility, located near the Town of New Raymer. He indicated the site contains a six-foot chain -link fence, and the gate to the entrance of the site is recessed by approximately 30 feet. He further indicated the compressor station is designed to operate unattended; however, employees will travel to the site approximately on a daily basis to check equipment. He confirmed up to twenty people will be on the site during construction activities, and the applicant is required to provide a water capture area on the site. He clarified the Department did not request a traffic study, since the site is unattended; however, the applicant will be required to obtain the necessary permits for the use of overweight vehicles traveling to the site during construction activities. In response to Commissioner Conway, Mr. Carroll indicated the drive into the site is currently flat, and does not require the installation of a corrugated metal pipe. Lauren Light, Department of Public Health and Environment, stated there will be no water or sewer service on the site, since it is an unattended site; however, portable toilets and bottled water will be provided during construction activities. She confirmed the applicant has submitted the Dust Abatement Plan, and the Air Emissions Permit and Discharge Permit Applications to the State, therefore, Conditions of Approval #1.C, #1.D, and #2.A may be deleted. She further confirmed the applicant is still working on the Waste Handling Plan, and she requested the deletion of Development Standard #13, since there is no permanent water supply on the site. She indicated the noise on the site will be limited to the levels allowed within the Industrial Zone District, and she confirmed the Department does not have any outstanding concerns. In response to Commissioner Kirkmeyer, Ms. Light confirmed the language within Development Standard #11, concerning septic systems, is placed within the Resolution for instruction regarding any future septic systems on the site; however, she confirmed the language could be deleted for this USR. Further responding to Commissioner Kirkmeyer, Ms. Light confirmed any future uses on the site which would require the use of restroom facilities would be considered a substantial change, and the uses would be required to be re -reviewed by the Board through an amendment to the permit. Responding to Commissioner Long, Ms Light indicated Development Standard #7 contains the language regarding the noise standard on the site. She confirmed if the Department receives a complaint regarding noise at the site, the noise will be measured from the property line to determine if the level exceeds the 80 decibel threshold during daytime hours, or the 75 decibel threshold during nighttime hours. Commissioner Long indicated the compressor station will contain loud motors, and it appears the site will only contain a chain -link fence. Ms. Light indicated she is not sure if the applicant will construct any type of sound barrier on the site. Commissioner Long indicated the site is within very close proximity to the municipal limits for the Town of Grover, which is a very quiet Town. He confirmed the community is already feeling the effects of the developing oil and gas industry, and he believes the residents of the Town should 2009-2657 PL2025 HEARING CERTIFICATION - DOUGLAS AND DEBORAH DUGGAN, C/O PETRO-CANADA RESOURCES (USA) INC. (USR-1703) PAGE 3 not be subjected to loud noise during nighttime hours. He indicated he has seen evidence that the construction of sound barriers do provide adequate screening for noises from the site, and he believes the Town needs to be provided with some type of remedy, should the sounds coming from the site prove to be obnoxious to residents. In response to Commissioner Rademacher, Mr. Ogle confirmed the existing compressor site was previously abandoned, and there are no operations currently occurring on the site. In response to Commissioner Kirkmeyer, Mr. Ogle confirmed the closest residence is approximately 1,500 feet from the proposed site of the compressor station. Commissioner Kirkmeyer explained a compressor station is located within close proximity to her residence, and she confirmed the facility does emit a substantial amount of noise. She indicated this particular compressor station near her residence is shielded by a berm and trees, to provide a noise barrier, and now that the trees have matured, they do block a majority of the noise coming from the site. She confirmed the construction of a building over the compressor station will also help to reduce noise on the site. Commissioner Long indicated the residents need to be able to request that the applicant install additional noise barriers if the noise is still a problem on the site in the future. He confirmed the surrounding area is very tranquil, and the Town recently had some issues with the placement of a large pipeline project; however, the company handling that project did accommodate the request of property owners to move some portions of the pipeline so that parcels were not being split. He indicated he hopes that Petro -Canada is willing to complete any necessary steps to ensure the tranquility of the surrounding area. Responding to Chair Garcia, Mr. Ogle confirmed he is not sure of the use of the property directly west of the site; however, the applicant may address this question within her presentation. In response to Commissioner Conway, Ms. Light explained a noise level of 80 decibels is comparable to the noise of a dishwasher, alarm clock, or garbage collection activities, and is classified as an "annoying level" of noise. Commissioner Conway concurred with Commissioner Long and indicated it is pertinent for the applicant to find an acceptable way to buffer the sound coming from the site. Commissioner Long indicated there is virtually no sound in the area, and the noise coming from the compressor station will be loud and persistent to the residences which are directly west of the proposed site. He further indicated he is unsure of whether the equipment utilized to detect the noise will capture the intensity of the high frequency of the noise, and the high pitch of the noise will be obnoxious. Commissioner Kirkmeyer concurred that compressor stations emit constant noise, which can be heard at all hours of the day and night. Sherri Robbins, Petro -Canada Resources (USA) Inc., represented the applicant and stated Petro -Canada is aware of potential noise issues. She confirmed representatives have met with Douglas and Deborah Duggan, the closest residents to the proposed facility, and the company is willing to work to abate noise issues on the site. Responding to Commissioner Conway, Ms. Robbins confirmed this is the first compressor station to be operated by Petro -Canada, therefore, she is not able to describe any successful past noise mitigation plans. Commissioner Long indicated he is pleased that the company is willing to work with Mr. and Ms. Duggan; however, representatives of the company also need to be committed to working with officials from the Town of Grover. In response, Ms. Robbins confirmed that the Vice President of Operations and Engineering did attend a Town Hall meeting, and did address noise concerns at 2009-2657 PL2025 HEARING CERTIFICATION - DOUGLAS AND DEBORAH DUGGAN, C/O PETRO-CANADA RESOURCES (USA) INC. (USR-1703) PAGE 4 that time. She indicated the company is willing to establish landscaping and construct a building over the compressor, to help mitigate noise. She further indicated there were no noise complaints or concerns presented at the meeting. Commissioner Long indicated many of the residents most likely have never heard the noise emitted from a compressor station, and he believes most of the residents will be surprised by the amount of noise generated once the facility is fully operational. He reiterated his request that residents of the Town be allowed to request additional noise mitigation, and that some sort of graduated enforcement requirements be added within the Resolution. He clarified the Town previously had complaints regarding the placement and appearance of tank batteries, and the Town needs to work with the oil and gas industry, since it is a dying Town which could benefit from new industry within the surrounding area. Mr. Ogle indicated Condition of Approval #1.H references the requirements for mitigating noise and providing screening at the site. He further indicated other similar uses have required a sound wall or an insulated building over the compressor, to help mitigate noise. Responding to Commissioner Long, Mr. Ogle confirmed additional language may be added to the Resolution, as a Development Standard, to indicate a Noise Mitigation Plan is required. Commissioner Long indicated a copy of the referral from the Town of Grover is not included within the file, and Mr. Ogle provided a copy, marked Exhibit E. In response to Commissioner Rademacher, Mr. Barker suggested an addition to Development Standard #7 to state, "The applicant shall buffer the adjacent property located west of the site, from the noise generated by the facility, by installing the appropriate fencing, structures, and/or landscaping." Responding to Commissioner Kirkmeyer, Mr. Barker confirmed the landscaping could include the installation of a berm. Commissioner Rademacher confirmed the applicant should only be required to provide noise mitigation for the property to the west, and not in all directions. Commissioner Kirkmeyer indicated she worked with DCP Midstream, the operator of the compressor station near her residence, to plant trees as an additional buffer; however, the noise is still annoying, and she concurs with Commissioner Long that additional buffering plans are necessary. She clarified the applicant needs to create a Noise Mitigation Plan, which will describe the trigger at which more noise mitigation is necessary. Commissioner Long concurred with Commissioner Kirkmeyer and confirmed he does not want to overburden the applicant; however, the residents were present in the area before the compressor station. He indicated he does not want the applicant to be required to provide additional mitigation measures up front, if they are not necessary; however, if they are found to be needed, the applicant needs to be held accountable to ensure proper noise mitigation. Mr. Barker indicated the County may require stricter standards than what is required by the State for these types of facilities; however, it must be accomplished through an Ordinance, and cannot be completed on a case -by -case basis. He clarified Development Standard #7 references the standards adopted by the State, and the only other noise category which may be utilized is the Residential Zone District, which is a maximum of 55 decibels during the day, and 50 decibels at night. He further clarified the limitations exist for the entire boundary of the property, and cannot be limited to just the west boundary. He confirmed the Colorado Oil and Gas Conservation Commission has also recently adopted the same standards, and he believes having a category of "triggers" is a good idea; however, under State law, the Weld County Code would have to be modified to allow for stricter standards. He clarified he understands the intent of the discussion; however, the Board is only allowed to require berming or another similar noise mitigation to protect the property owners to the west of the site, or require the applicant to comply with the levels allowed within 2009-2657 PL2025 HEARING CERTIFICATION - DOUGLAS AND DEBORAH DUGGAN, C/O PETRO-CANADA RESOURCES (USA) INC. (USR-1703) PAGE 5 the Residential Zone District, which would be required to be maintained on all portions of the property. Responding to Chair Garcia, Ms. Robbins indicated she is unsure at this point of how the site could maintain compliance with the maximum noise levels within the Residential Zone District. Ms. Light indicated the level of 55 decibels would most likely require the construction of some type of soundwall at the facility. Responding to Commissioner Conway, Ms. Robbins indicated she has not read the letter provided by the Mayor of Grover, and she was not in attendance at the Town meeting previously referenced. Commissioner Conway indicated it appears the mitigation measures were discussed during the meeting, and Ms. Robbins confirmed the company is willing to work with the Town of Grover to address any outstanding concerns. Commissioner Kirkmeyer indicated she understands the concerns voiced by Mr. Barker regarding the State requirements; however, within the issuance of the USR permit, the Board is allowed to determine whether the use is compatible with the surrounding uses, and is allowed the opportunity to create mitigation measures. She clarified the Board may call out specific actions which need to be completed for the use to be compatible, or the matter may be denied. She proposed that language regarding a Noise Mitigation Plan be added to the Development Standards, and if the language is able to include trigger points, they should be added as well, so that the matter regarding noise mitigation may be reviewed at some point in the future. Commissioner Rademacher indicated some noise from the site is expected, and it is not possible for the applicant to eliminate all sound on the site. Mr. Barker indicated he is not sure how the Board can require the applicant to provide additional noise mitigation measures for the property to the west without requiring the applicant to provide the measures for the entire site. Responding to Commissioner Conway, Ms. Light confirmed the maximum level of the Residential Zone District is the same as the Commercial Zone District, which is 55 decibels during the day, and 50 decibels at night. She confirmed at that level, people should be able to carry on conversations without being annoyed by the sound. Commissioner Long recommended that the applicant be required to adhere to the maximum level of the Residential Zone District, and then provide whatever mitigation measures are necessary to ensure the site complies with those levels. Mr. Barker stated Section 14-9-30 indicates a third non -specified category may be utilized, and the Board may concur that the site is non -specified and designate a specific noise level which must be adhered to. Commissioner Rademacher expressed his concern that the applicant will have undue expenses to bring the entire property into compliance with strict noise standards, when the sound really only needs to be mitigated to the west. Ms. Robbins indicated Petro -Canada is willing to work with residents within the community, since they realize the noise on the site may be a concern. She further indicated the Vice President of Operations personally took the time to attend the Town meeting in Grover, and met with landowners to create a relationship and discuss concerns. Responding to Commissioner Conway, Ms. Robbins confirmed the mitigation measures described within the letter from the Town of Grover are an adequate representation of the work Petro -Canada is willing to perform. No public testimony was offered concerning this matter. 2009-2657 PL2025 HEARING CERTIFICATION - DOUGLAS AND DEBORAH DUGGAN, C/O PETRO-CANADA RESOURCES (USA) INC. (USR-1703) PAGE 6 Responding to Commissioner Kirkmeyer, Mr. Ogle clarified the USR permit for the compressor facility will only encompass one acre of the overall 136 acres. In response to Chair Garcia, the Board concurred with the deletion of Conditions of Approval # 1.C and #1.D. Commissioner Long clarified that the applicant has already fulfilled the Conditions of Approval, which is why the Board is deleting the requirements from the Resolution. Further responding to Chair Garcia, the Board concurred with the deletion of Condition of Approval #2.A. Chair Garcia indicated his preference to require the applicant to adhere to the noise levels within the Industrial Zone District, as stated within Development Standard #7, and require additional buffering for the property to the west of the facility, as previously suggested. Commissioner Long clarified if the Board concurs with that option, the applicant will actually be required to provide additional noise mitigation measures for the entire property. He indicated the area is agricultural in nature, and he prefers to remove the designation of the Industrial Zone District and set a specific noise level as a non -specified area, as previously suggested by Mr. Barker. He further indicated if the proposed facility was at least one mile from the Town, he would not have as great of a concern; however, the facility will be in very close proximity to the Town. In response to Commissioner Kirkmeyer, Mr. Barker reiterated the site could be determined to be within a non -specified area, and he indicated he will draft a potential language modification. Responding to Chair Garcia, the Board concurred with the deletion of Development Standards #11 and #13. Mr. Ogle indicated Development Standard #24 could be modified to specifically require berming and opaque fencing on the site. Commissioner Conway confirmed the letter provided by the Town of Grover indicated the applicant will construct a fence, plant trees, and possibly build a structure over the compressor station, to increase visual appeal and reduce noise. Commissioner Long confirmed the applicant has previously indicated that it desires to be a great neighbor, and the applicant's representative has echoed the same sentiments today. In response to Chair Garcia, Mr. Ogle confirmed Development Standard #24 requires that the applicant submit a Landscape and Screening Plan, for approval, and staff will review the plan to ensure fencing, landscaping, and a possible structure are included. Further responding to Commissioner Long, Mr. Ogle clarified staff will require the applicant to uphold the agreements referenced within the letter. Mr. Barker recommended that the applicant be required to submit a Noise Mitigation Plan, and a requirement within the Plan will require that the noise level emanating from the facility, to the west, shall not exceed 55 decibels in the daytime, and 50 decibels during night hours, and other portions of the property may be maintained at the levels allowed within the Industrial Zone District. He confirmed his recommendation does not violate State statute by making a stricter rule. He indicated the requirement of the submission of the plan could be added as Condition of Approval #1.K, to state, "The applicant shall submit, to the Department of Planning Services, a Noise Mitigation Plan, which provides noise mitigation, such that noise emanating toward the west of the facility is maintained at the non -specified levels, as set forth in Section 14-9-30 of the Weld County Code. Levels elsewhere on the property shall be maintained at the levels allowed within the Industrial Zone District, as set forth in said section." Commissioner 2009-2657 PL2025 HEARING CERTIFICATION - DOUGLAS AND DEBORAH DUGGAN, CIO PETRO-CANADA RESOURCES (USA) INC. (USR-1703) PAGE 7 Kirkmeyer suggested that the permissible noise level of 55 and 50 decibels only be required for the one acre on which the facility is located, instead of the entire property boundaries. She confirmed the Landscape and Screening Plan will then be specific to the one -acre boundary, and in response, Mr. Barker recommended that the applicant be required to submit a Noise Mitigation Plan which addresses the non -specified levels as set forth in Section 14-9-30. Commissioner Rademacher reiterated his concerns regarding the excessive costs for the applicant to provide screening around the site, even though the lands are vacant to the north, south, and east. Commissioner Long clarified even when a site contains natural berming, it is possible to still hear compressor noises from several miles away when the breeze settles in a specific direction. He confirmed the neighbors will be able to hear the noise generated on the site, and he knows the community will be negatively impacted by the noise, therefore, the noise needs to be mitigated on all four sides of the property. He clarified he does not believe it will present a large cost to the applicant as the facility is small. Commissioner Rademacher clarified if the applicant is able to reduce the noise through berms, the cost will not be significant; however, if the applicant is required to construct a noise wall or similar structure, it will be a significant cost. Ms. Robbins indicated it is not known at this time which options will effectively mitigate the noise on the site, and she requested that the company be allowed to present the various options within the Noise Mitigation Plan. She confirmed the installation of trees, or the construction of a building over the compressor may be sufficient to mitigate the noise on the site, and she would like the option to research the best option to meeting the soundproofing and aesthetic needs of the site. In response to Chair Garcia, Mr. Ogle clarified the Noise Mitigation Plan will require a review by a representative of the Department of Public Health and Environment. He confirmed the site is very small, and the configuration of the site will be tight, therefore, a berm would be difficult to accommodate on the site. Ms. Robbins reiterated the company is willing to construct a soundproof building to house the compressor, if deemed necessary. Commissioner Rademacher indicated it is possible that the building will not be successful at mitigating noise on the site; however, he would rather have the applicant construct a soundproof building than sound walls. Commissioner Kirkmeyer suggested Development Standard #7 be modified to indicate that a Noise Mitigation Plan shall be required, and the facility shall adhere to the maximum permissible noise level allowed in the non -specified area, as delineated in Section 14-9-30 of the Weld County Code. She confirmed she understands the concerns presented regarding cost and aesthetics; however, the Board is trying to accomplish the least amount of noise possible for surrounding residents. She confirmed she desires for the applicant to spend the least amount of money possible while making the biggest positive impact of reducing noise for the neighbors, and Ms. Robbins concurred with Commissioner Kirkmeyer. Mr. Barker clarified the applicant is required to comply with the Development Standards, and if the Board desires to require the applicant to submit a Noise Mitigation Plan, a Condition of Approval must be added. In response to Commissioner Kirkmeyer, Ms. Robbins confirmed she prefers to submit a Noise Mitigation Plan, to provide clarification of what is required. Commissioner Kirkmeyer made a motion to modify Development Standard #7 to state, "The facility shall adhere to the maximum permissible noise levels allowed in the non -specified area, as delineated in Section 14-9-30 of the Weld County Code, which is a maximum of 50 decibels 2009-2657 PL2025 HEARING CERTIFICATION - DOUGLAS AND DEBORAH DUGGAN, C/O PETRO-CANADA RESOURCES (USA) INC. (USR-1703) PAGE 8 during night hours, and 55 decibels during daytime hours." The motion was seconded by Commissioner Long, and it carried unanimously. Commissioner Kirkmeyer further moved to add Condition of Approval #1.K to state, "The applicant shall provide a Noise Mitigation Plan, for review and approval. The plan shall address the concerns presented by the Town of Grover" In response to Ms. Robbins, Commissioner Kirkmeyer clarified the intent of the motion is to allow Petro -Canada to find the best solution to mitigate the noise on the site. The motion was seconded by Commissioner Long, and it carried unanimously. In response to Chair Garcia, Ms. Robbins indicated she has reviewed, and concurs with, the Conditions of Approval and Development Standards, as modified. Commissioner Long expressed his appreciation for Petro -Canada's efforts to please its neighbors and for the high standards it is committed to within the oil and gas industry. He confirmed he will personally be reviewing the progress of the site, and will receive feedback from the surrounding property owners. Commissioner Long moved to approve the request of Douglas and Deborah Duggan, do Petro -Canada Resources (USA) Inc., for a Site Specific Development Plan and Use by Special Review Permit #1703 for a Mineral Resource Development Facility, including Oil and Gas Support and Services (compressor station) in the A (Agricultural) Zone District, based on the recommendations of Planning staff and the Planning Commission, with the Conditions of Approval and Development Standards as entered into the record. His motion included the addition of Condition of Approval #1.K to state, "The applicant shall provide a Noise Mitigation Plan, for review and approval. The plan shall address the concerns presented by the Town of Grover."; the deletion of Conditions of Approval #1.C, #1.D, and #2.A, with the required re -lettering and re -numeration; the modification of Development Standard #7 to state, "The facility shall adhere to the maximum permissible noise levels allowed in the non -specified area, as delineated in Section 14-9-30 of the Weld County Code, which is a maximum of 50 decibels during night hours, and 55 decibels during daytime hours."; and the deletion of Development Standards #11 and #13, with the required re -numeration. The motion was seconded by Commissioner Kirkmeyer. In response to Commissioner Rademacher, Commissioner Long confirmed Suncor Energy has recently merged with Petro -Canada. Commissioner Conway expressed his appreciation that Petro -Canada is willing to do whatever is necessary to be a good neighbor. Chair Garcia indicated Weld County is blessed to have so much activity within the oil and gas industry, and he is encouraged by the proposed development to expand facilities. He expressed his appreciation to Petro -Canada for being willing to work with surrounding communities. There being no further discussion, the motion carried unanimously, and the hearing was completed at 11:00 a.m. 2009-2657 PL2025 HEARING CERTIFICATION - DOUGLAS AND DEBORAH DUGGAN, C/O PETRO-CANADA RESOURCES (USA) INC. (USR-1703) PAGE 9 This Certification was approved on the 5th day of October, 2009. BOARD OF COUNTY COMMISSIONERS Weld County Clerk to th Deputy CI • to the Boa David E. L WELQ COUNTY, COLORADO arbNa Kirkmeyer e.k .7) ong 2009-2657 PL2025 EXHIBIT INVENTORY CONTROL SHEET Case USR-1703 - DENNIS AND DEBORAH DUGGAN, CIO PETRO-CANADA RESOURCES (USA) INC. Exhibit Submitted By Description A. Planning Staff B. Planning Commission Planning Commission D. Public Works Staff G. H. J. K. L. M. N. O. P. Q. S. V. Planning Staff Inventory of Items Submitted Resolution of Recommendation Summary of Hearing (Minutes dated 9/1/09) Map indicating traffic counts, and Map indicating oil and gas wells in area Referral from Town of Grover, dated 07/28/09 ATTENDANCE RECORD HEARINGS ARE AS FOLLOWS ON THIS 30TH DAY OF SEPTEMBER, 2009: z a 0 C mz w — C F C v) zw a3 aw < 0 Ce D LL C • J N N 0) O) O O a O N N F w Y Y U 0 O 0 CC PLEASE legibly write or print your name and complete address. SSa aav 123 Nowhere Street, City, State, Zip c 3 ci Cr3 r\ -a C Ci C> .4- N ,v S. iM c er- CT 2 Q z John Doe c".16113?) "A''! • Hello