WQ0007144_Monitoring - 11-2020_20201210

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0007144
Name of Facility:* Camp Seafarer
Month:* November
Report Information
Type *
GW-59
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Year:* 2020
Upload Document*
GW-59-November 2020.pdf 410.55KB
FDF Only
Non -Discharge Reports 795.29KB
November 2020.pdf
FDF only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-7, NDAR-2, NDMLR, GW-59).
[e-mail]
Stanley Eudy
12/10/2020
This will be filled in &Aormtically

Initial Review
Reviewer: Williams, Kendall
Is the project number correct?* WQ0007144
Is the monitoring report r Yes r No
accepted?*
Regional Office* Washington
Accepted Date: 12/10/2020

SUBMIT FORM ON YELLOW PAPER ONLY
• .
DEPARTMENT OF ENVIRONMENTAL QUALITY DIV.OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
1NFORMA�170N PR0C(;SS1NG m
COMPLIANCE REPORT FORM
1617 KAILSHRVICE CENTER RALEIGH, NC 27699 1617, `Phone 949 8b7 6345.
FACILITY INFORMATION Please Print CleadyorType
PERMIT Number: Expiration Date 3Cl ,
Facility Name: Camp Seafarer
Non -Discharge W00007144 UIC
Permit Name (if different): YMCA of the Triangle Area, INC.
NPDES Other
Facility Address: 2744 Seafarer Rd Arapahoe NC
28510
TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe istre NC 28510
County Pamlico
Lagoon ❑Remediation: Infiltration Gallery
;city; (stale) (zip)
❑ Spray Field ❑ Remediation:
Contact Person: Mike Askew
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Lagoon
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): Well 2
Date sample collected: it LYJA 0
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH 00400:1J-2 units Temp. 000lo: 1J 5'' / °C
DRY at
Depth to Water Level 82546: 1f,0%it. below measuring point
Screened Interval: 10 ft. to 20
ft. Spec. Cord. 00094: µMhos
time of
sampling,
Measuring Point is 1.9 ft. above land surface
Relative M.P. Elevation: 24•2 ft.
Odor oosss:
check
Volume of water pumped/bailed before sampling: 4 -R
gallons
Appearance C� t{'�
here: ❑
Samples for metals were collected unfiltered: El YES ❑ NO and field acidified: El YES El NO
LABORATORY INFORMATION
S'),C,
Date sample analyzed: it/
Laboratory Name: d! I
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and
colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615 mg/L Pb - Lead o1051 ug/L
Coliform: MF Fecal 3161s , /100mL
Nitrate (NO3) as N 00620 lz� O. O mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P oo665 U . r 4- mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate70507 mg/L Other (Specify Compounds and Concentration Units):
O
isso[ved Solids:Total 70300 mg/L
Al -Aluminum o11os mg/L
pH (Lab) o0403 units
_
Ba - Barium 01007 ugfL
TOC omso mg1L
Ca - Calcium oo916 mg/L
Chloride 00940 mg/L
Cd - Cadmium o1o27 ug/L
Arsenic c1oo2 ug/L
Chromium: Total 01034 ug/L
Grease and Oils co552 mg/L
Cu - Copper o1o42 mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045 ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900 ug/L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 µMhos
K - Potassium 00937 mg/L VOC 7873 method #
Total Ammonia oosso C 0. D mg/L
Mg - Magnesium 00927 mg/L method #
(Ammonia Nitrogen; NH,as N: Ammonia Nitrogen, Total)
Mn - Manganese o1 ass ug/L , method #
TKN as N 00625 mg/L
Ni - Nickel 01067 ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%fl
Mike Askew, Director of Facilities and Boating Operations
Perrnittee (or Authorized Agent) Name and Title- Please print or type
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
c 11-FL1­owwnTlnf.f Please Print Clearly or
Facility Name: Camp Seafarer
Permit Name (if different). YMCA of the Triange Area, INC.
Facility Address: 2744 Seafarer Rd Arapahoe NC 28510
2744 Seafarer Rd Arapahoe cstreeq NO 26510 County Pamlico
Contact Person: Mike Askew
Well Location/Site Name: Spray Field 3
Teleph one#: 252-249-1212
No. of wells to be sampled: 5
PERMIT Number: Expiration Date: !�t_4 3CJ 1 -w.4
Non -Discharge WQ0007144 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
from Permit)
I
-
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): WELL 5
Date sample collected: r✓ ! G
FIELD ANALYSES: cs
% o F °C
WAS
DRY at
We[[ Depth: 20 fL
Well Diameter: 2 in,
pH 00400.1Wunits Temp. ooclo:
time of
ft. below measuring Dint Screened Interval:
Depth to Water Level 6zs46: �, g p 10 ft. to 20 ft.
S j .Z µMhos
Spec. Cond. 00094:
sampling,
Measuring Point is 22 ft. above land surface
Relative M.P. Elevation. 27.7 ft.
Odor 000as: NGP��`
check
Volume of water pumpedibailed before sampling: to
gallons
Appearance
here:❑
Samples for metals were collected unfiltered: El YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION ,
it �a
1,INC.
No.
Date sample analyzed:
Laboratory Name: Enviroment
Certification
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD co335 mg/L
Nitrite (NO2) as N 00615
mg/L
Pb - Lead olo51 ug/L
Coliform: MF Fecal 31616 l 1100mL
Nitrate (NO3) as N 00620 0,
mg/L
Zn - Zinc olo92 mg/L
Coliform: MF Total 31504 110DmL
Phosphorus: Total as P co665 ®. 0 _mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg1L
Other (Specify Compounds and Concentration Units):
issolved Solids:Tota[ 70300 37 mg/L
At - Aluminum oil o5
mg1L
pH (Lab) 00403 45 O units
Ba - Barium 01007
ug/L
TOC omw mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 mg/L
Cd - Cadmium o1o27
uglL
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552 mg/L
Cu - Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron o1o45
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate oo945 mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 00095 µMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia oo610 C 0. © + mg1L
Mg - Magnesium OD927
mg/L
method #
(Ammonia Nitrogen; N1­13as N; Ammonia Nitrogen, Total)
Mn _ Manganese 01055
ug/L
, method # -
TKN as N oo625 mg/L
Ni - Nickel 01067
ug/L
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Etf]uent Iota] VUGS: mgft- vLjL. Kemovaiiio
�v a,
Mike Askew, Director of Facilities and Boating Operationsp' ��`'
Perrnittee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee (or Authorized Agent) (Date)
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
or Type
Facility Name: Camp Seafarer
Permit Name (if different): YMCA of the Triangle Area, INC.
Facility Address: 2744 Seafarer Rd Arapahoe NC 2S510
2744 Seafarer Rd Arapahoe (S'reai) NC 28510 County Pamlico
act Person: Mike Askew Telephone#-. 252-249-1212
Location/Site Name: Spray Field 3 No. of wells to be sampled: 5
IT Number: Expiration Date:
ischarae W00007144 UIC
'DES Other
'PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remedlation: Infiltration Gallery
Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
SAMPLING INFORMATION
WELL 1D NUMBER (from Permit): Well 6 Date sample collected:
Well Depth: 20 ft. Well Diameter: 2 in.
Depth to Water Level 82546:5� ft. below measuring point Screened Interval: 10 ft. to 20 ft.
Measuring Point is 2-75 ft. above land surface Relative M.P. Elevation: 20.2 ft.
Volume of water pumped/bailed before sampling: 10 gallons
Samples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
FIELD ANALYSES: )c
pH c0400:.�, %units Temp. 000lo: l l • 7 °C
Spec. Cond. 000e4: �S Mhos
Odor 000s5:
Appearance CC 0!;fb
If WELL
WAS
DRY at
time of
sampling,
check
here:❑
LABORATORY INFORMATION j
Date sample analyzed: I / 1 G
Laboratory Name: Enviroment 1,INC.
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD o0335 mg/L
Nitrite (NO2) as N oo615
mg/L
Pb - Lead a1o5i ug/L
Coliform: MF Fecal 3ie16 /100ml-
Nitrate (NO3) as N 00620 -< 0, 0
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P oo665r0. /
mg/L
(Note: use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved So[ids:Total 70300 G� mg/L
AI - Aluminum o11o5
mg/L
PH (Lab) oo4o3 units
Ba - Barium 01007
ug1L
TOC oo6so mg/L
Ca - Calcium oo9is
mg/L
Chloride 00940 � _ mg/L
Cd - Cadmium 01027
ugfL
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552 mg/L
Cu - Copper o1o42
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 719oo
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
pacific Conductance o0095 pMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia oo6io C C�. O �}. mg/L
Mg - Magnesium oo927
mg/L
method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L
method #
TKN as N oo625 mg1L
Ni - Nickel 01067
ug/L
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent I otal VQUs: mgrt, vul- Kemovar is
Mike Askew, Director of Facilities and Boating Operations
Permittee (or Authorized Agent) Name and Title - Please print or type
GW-59 Rev.05-02-2017
(or Authorized Agent)

SUBMIT FORM ON YELLOW PAPER ONLY
•
DEPARTMENTOF ENVIRONMENTAL 0U.ALITY Dili: OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:.
'° INoRMAnoN PRocsNG ulr
COMPLIANCE REPORT FORM
1817 MAFLSERVIG,E CENTER RALEIGFI t�[C 27649 1617 :Phone 9T9 807 6306
FACILITY INFORMATION Please Fdnr creadyorType
PERMIT Number: Expiration Date: f1
Facility Name: Camp Seafarer
Non -Discharge W00007144 UIC
Permit Name (if different): YMCA OF THE Triangle Area, INC.
NPDES Other
Facility Address: 2744 $eafarer Rd Arapahoe NC
28510
TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe tStreetl NC 28510
County Pamlico
❑ Lagoon ❑ Remediation: Infiltration Gallery
(C�tyi Brace (zip)
© Spray Field ❑ Remediation:
Contact Person: Mike Askew
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well LocationlSite Name: Spray Field 2
No, of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
(from Perrrtit)
SAMPLING INFORMATION
j
If WELL
WELL ID NUMBER (from Permit): WELL 7
12
Date sample collected: r� 8-/ �Lo
Well Diameter: 2 in.
FIELD ANALYSES:
00400:, 7 units Temp. 00010: xCa °C
WAS
DRY at
Well Depth: ft.
pH
time of
Depth to Water Level B2546:1.72 ft. below measuring point
Screened Interval: 2 ft. to 12
ft. Spec- Cond. 94: ] b,% - 3 µ Mhos
0Do
—
sampling,
Measuring Point is 1 ft. above land surface
Relative M.P. Elevation: 25-8 ft.
Odor 00095: POA-Z-
check
Volume of water pumpedlbailed before sampling: jgallons
Appearance C4�&Jx
here: ❑
Samples for metals were collected unfiltered: El YES ❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION j
Date sample analyzed:_ 1 / / -5-1 Zo
Laboratory Name: Enviroment 1,INC.
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 m,g/L
Nitrite (NO2) as N omis
mg/L Pb - Lead D1051 ug1L
Coliform: MF Fecal 3161s /100mL
Nitrate (NO3) as N 0062D a,
mg/L Zn -Zinc olo92 mg/L
Coliform: MF Total 31504 1100mL Phosphorus: Total as P 00665 0. O �____
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 mg/L
Al - Aluminum o11o5
mg1L
PH (Lab) 00403 s. units
Sa - Barium 01007
ug/L
TOC 00680 mg1L
Ca - Calcium 00916
mglL
Chloride 00940 = mg/L
Cd - Cadmium 01027
ug1L
Arsenic o1002 ug1L
Chromium: Total 01034
ug1L
Grease and Oils 00552 mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
uglL (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
uglL Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 µMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia 00610 O! D �- mg/L
Mg - Magnesium 00927
mg/L.
method #
(Arnmonla Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese 01 D55
uglL method #
TKN as N 00625 mg/L
Ni - Nickel olos7
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCS: mg/L Effluent Total VOCs: mg1L VOG Removal%
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
*IQ
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: Camp Seafarer
Permit Name (if different): YMCA of the Triangl Area, INC.
Facility Address: 2744 Seafarer Rd Arapahoe NC 28510
2744 Seafarer Rd Arapahoe[Street'` NC 28510 County Pamlico
ctv) s'aie' ''P
Contact Person: Mike Askew Telephone#: [phone]
Well Location/Site Name: Spray Field 2 No. of wells to be sampled: 5
from Permit)
INFORMaTION PRocEsslNG0 UN
4617 MAILSERVlCE CENiE(? RALEIGH, NG 27599 16t7 " Plsone 979-$D7-6306
PERMIT Number: Expiration Date: 6/,j0Z X t✓
Non -Discharge WQ0007144 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
g Gallery
❑ Lagoon Remediation: Infiltration
❑■ Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
SAMPLING INFORMATION
Well 8
Date it/ d10 FIELD ANALYSES:
If WELL
WAS
WELL ID NUMBER (from Permit):
sample collected: .J
2
f
J Temp. 000la. / , $ °C
DRY at
Well Depth: 12 f . Well Diameter: in.
Depth to Water Level e2546: % 0 ft. below measuring point Screened Interval: 2 ft. to 12
pH 0040o:Jo ( units
a�
ft. Spec. Cond. 00094: i 1 • % pMhos
time
sampling ,
Measuring Point is 1 ft. above land surface
Relative M.P. Elevation: 15.3 ft.
Odor 000aa: Nor-6-
check
Volume of water pumped/bailed before sampling: 2, — OP '— gallons
Appearance C4
here:❑
Samples for metals were collected unfiltered: El YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: fi's j� U
Laboratory Name: Enviroment 1, INC.
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD C0335 mg/L
Nitrite (NO2) as N o0515
mg/L Pb - Lead olo51 ug/L
Coliform: MF Fecal 31616 C /100mL
Nitrate (NO,) as N 00620 d, Cr 4
mg/L Zn-Zinc olo92 mg/L
Coliform: MF Total 31504� /100mL
Phosphorus: Total as P co665 .
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Sollds:Tota170300 162 mg/L
j
Al - Aluminum oil o5
mg/L
pH (Lab) 00403 SO units
Ba - Barium 01007
ug1L
TOC omm mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 ( mg/L
Cd - Cadmium o1o27
ug/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552 mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GCIMS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
ug1L Lab Report Attached? ❑ Yes (1) ❑ No (0)
pecific Conductance 000s5 µMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia oo610 0. � � mg1L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese o1o55
ug1L , method #
TKIN as N ooe25 mg1L
Ni - Nickel o1067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): influent Total VOCs: mg1L Effluent Total VU(;s: mg1L vutr Kemoval is
GW-59 Rev.05-02-2017

GW-59A COMPLIANCE REPORT F®Rini Permit # �VQ
U00 7/44
(Submit one each manitoring perlod idth GW-59 forins)
1
Enter date monitoring results were due. (' �) Will this monitoring report (GW-59 and GW 59A)
YES
N�
✓
be submitted after the established due date?
2
Was any required information missing on the GW-59 report forms?
YES
IF the answer to question I or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged easing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? If the anmver is "Yes", contact the Regional Office for guidance.
4
Are any monitored constituents equal to or above the established standards?
NO
If the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s)
exceeding standards in the space provided below:
Y, sr
HS 4&iµ P8 S's-1; L&,Ea 14 1 ���,. NJ�
C-L L 14 G L u w- P11 7 ` -
}�Y.
U✓C,CC H 7 40 � PH J
5
For the constituents identified.. in question 4 above, have standards been ox.ceed, ed_ previously -for the.
YES
NO
same constituents) in the same wells) in the last two years?
If the answer to question 5 is "NO" skip to section 8.
If the answer to question 5 is "YES", list in the space provided below, each well with constituent ) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years),
#S 1,C, — PH 0/10av 5,07
�zc N 6 4col, Pr/ 1070 3/4-/1i: 5�2�1 71dl/zG
1
k,&4( It 7 40— PN 1//7/19 3//CAI- 6,a/ t 9 /)1/2c,
w&tt # T c L — PV Il ,r, 12, 3 0(l 15"• 5C 1 9z s% 8
6
Are the monitoring wells listed in section 5 located at or boyond # e eview boundary?
YES
N
If the answer is "YES", a groundwater quality problem maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO', monitoring wells maybe improperly
located; contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is. "NO", contact the Regional Office within 90 days: an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facllit . Failure to do so ma sub'ect the permittee to a Notice of Violation
fines and/or penalfies. c Gi,— r/9 cr* �-�R ]G PPCrv� fin• sf�l "-Grp r--
G 1 71 Ca
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW 59 forms for required wells to the address provided at the top of the current GW--59 form.
I hereby acknowledge that the above information was a ►aluateci and the information submitted in this
report (Compliance Report GW-59A) Is true and complete to the best of my knowledge, .
1
signature of Perini tee (or Author zed^Agent) Date
i
GW-59A 1218i2003