WQ0000265_Monitoring - 11-2020_20201223

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0000265
Name of Facility:* NCDPS - Washington Correctional Center WWTF
Month:* November Year:* 2020
Report Information
Type* Upload Document*
GW-59 2020_Nov.pdf
FDF Cnly
1.18MB
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* Nainesh Patel
Signature:
Date of submittal: 12/23/2020
This will be filled in automatically
Initial Review
Reviewer: Williams, Kendall

Is the project number correct? * WQ0000265
Is the monitoring report r Yes r No
accepted?*
Regional Office * Washington
Accepted Date: 1/4/2021

DocuSign Envelope ID: 4F1238D5-E41 F-4FB4-BBE7-1305DB151 D7C
SUBW FORM C :LOW PAPER ONLY
TER QUALITY MONITORING:.
E REPORT FORM
FACILITY INFORMATION P1wse~ CftWyorType
Facility Nana:: " ry U-CLL. ? ram: Sr N, W cI e- K rA R VA
Permit Name (if different): W A S N r N (oTD N Co.) ,- 5994 Y 1: r c LD
Facility Address: 11 156 S H W Y 9 y N
L 2 E S w gt,i- (steel) Al G 2'7 `(Z 16 Counter W 1i S)d i N lv e c +^ l
resw� rsr9ta� rzioi
act Person: S#,AD G oS5E2
Location/Site Name: W fl 5N )N &TG3
7i0NA
Talephone#: (262) -790 /0S5
No. of walls to be sampled:_ 5
eRMIT Number: W Q 01'-" try* Expiration Date: +CI S i / 2 04-
in-Disdiarge UIC
'DES Other
PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ water Source Heat Pump ❑ Other.
PIING INFORMATION
If WELL
-�J
WELL ID NUMBER (from PenMt): � � � '
Dais sample collected: 11 - 3 - 2 0
FIELD ANALYSES:
WAS
Well Depth: W ft.
Well Diameter. in.
PH, ooaoo: <- . '' units Temp. 00010: "" aC
DRY at
Depth to Wafter Level V.W-fL below measuring point
:.cneened Interval: �ft. to �ft.
Spec. Cond. 000st. µMhos
time
sampling,
Measuring Point is ft. above land surface
Rei,rwve M.P. Elevation: —ft
Odor oaoss:
check
Volume of water pumped/bailed before sampling: La- .. ga➢lons
Appearance
here:❑
,Samples for metals were collectdd unfl%ersd: ❑ YES ❑ NO
and field acidifiad: ❑ YES ❑ NO
Nate sample analyzed:,
PARAMETERS NO7
N` tt AA
Laboratory Name: '5-r y A i'46V i lie A rIA K u fI CA I Certification No. W 4
COD oo335
M911L
Colliform: MF Fecal 31616
/100mL
Conform: MF Total 315"
/1 OOmL
(P W'Use MPN method for Mghiy twM samples)
]issohred Solids. -Total 7o3oo I ( f
mg/L
PH (Lab) ooaos l o Z
units
MC 00880
mg,'L
Chloride oos4o '� 2 . t
mg/L
Arsenic o1om
ug/L
Grease and Oils ooss2
mg/L
Phenol 3273o _
ug/t_
Sulfate 00sas
mg/L
Specific Conductance 000ss
µMhos
Total Ammonia ooslo < U` , {
nt9 IL
(AmnerAa Nd cqW W6as N: Awvwft Nitrogen, Tot*
TKN as N oow
mg/L
For Remediation Systems Only (Attach Lab Reports):
anti cells' -dal concemratiors.
Nitrite (I402)•05 N 00s1e
0 , ( mg/L
Pb - Lead most ug/L
Nitrate (NO3) as N 0oaa
< p , f mgA_
Zn - Zinc mom mg(L
Phosphorus: Tabi as P oosss
O ` q mg/L
Orthophosphate 70507
^ mg/L
Other (Specify Compounds and Concentration Units):
A"-. - pauminum o1,cs_
Be - Barium olocr.7T
_ ug/L
Ca - Gaidium 0091A--
mg/L
Cd - Gedm am =27
Y ug/L
_
Chromium: Total olowa
.. T� ug/L
Cu - Copper 010.2
__ _ _ mg/L
ORGANICS: (by GC, GCJMS, HPLC)
Fe -;.en olors__..ug/L
(Specify test and method & ATTACH LAB REPORT.)
Hg - 1101emury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
K - Potassium 00937
--� mg/L
VOC 7873 method #
Mg - Magnesium uo927
mg/L
, method #
Mn - Manganese moss
ug/L
, method #
Ni - Nickel oins7—
ug/L
, method #
Influent Toted VOCs:
mg/L Effluent Total VOCs:
mg/L VOC Rernm1 i
i�lt�p, �nsrsE+t _� )�Ltt NE51•! PA'rEL
Permutes (or Authorlmd Ag wd) Nome and Title - Ptiti w POM or type S anek.-re of Purr:i (or Authwizad : tent) �o$t L 12 i4 1 TTiE (Daft) --
GW-59 Rev.05-02-2017

DocuSign Envelope ID: 4F1238D5-E41 F-4FB4-BBE7-1305DB151 D7C
SUBMIT FORM C _LOW PAPER ONLY
-R QUALITY MONITORING:
REPORTFORM
Facility Name: `'EZC l�5613 WOcK ff4R:41
Permit Name (if different): A S W i"& rbn1 CDuIJTy 2-iy f'it:
Facility Address: h '�,; K", s H W .Y c) 4 N
2-711219 County W 4!S H 116 6r- N3
Contact Person: k A D GOS Stt Telephone#: r 2 � -7 * - 10 $ Fj
Well Location/Site Name: W ft5 r4)N(��y14 t'nr.R .7,DN+4L No. of wells to be sampled: A
rune tnranaera I tv+r . /
L ID NUMBER (from Permit): , w ' 2
Depth: 7 fL
h to Water level s2so: = 'j _ '+ ft. below measuring point
luring Point is fL above land surface
PERMIT Number: v+i Q QCx V Fxpirati0n Date: i Cl 3 : 1
Non -Discharge 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.
Date sample collected:
Well Diameter. in.
Screened Interval: ft. to ,ft.
Relative M.P. Elevation: ft.
ne of water pumpediballed before sampling: 1 gallons
)lea for metals were collected unfiltered: ❑ YES ❑ NO i
Date sample analyzed: / 11; - f1Z Li:1 ;�
PARAMETERS NOTE: Values should reflect dissolvE
COD 00335
mg/L
Coliform: MF Fecal 31816 4 i
/100mL
Coliform: MF Total 31504
/100mL
(Note.' so MPN method for highly turbid samples)
)issolved Solids:Total 70300 23 J
mg/L
PH (Lab) omm (Q , 3
units
TOC oosso G . (96
mg/L
Chloride oomo IH , 15
mg/L
Arsenic 01002
ug/L
Grease and Oils oos52
mg/L
Phenol 32730
uglL
Sulfate 00M
mg/L
ipecific Conductance 000gs
µMhos
Total Ammonia oosio C " , '3
mg/L
(Amniorda Nitrogen: Nt%as N: Ammonia N"en. Total)
TKN as N 00625
mg1L
For Remediation Systems Only (Attach Lab Reports):
PerrniMee (or Authorized Aulvd) Name and true - Please print or type
GW 59 Rev. 05-02-2017
❑ YES ❑ NO
FIELD ANALYSES:
PH oo400: (- , A,, units
Spec. Cond. 00094:
Odor 000a5:
Appearance
Temp. 000io: eC DRY at
µMhos time of
LaboratoryName: s f. i i c" ,
lr �. *
f%j"t'r-r�tL_ Certification No. 144a
and colloidal concentrations.
Nitrite (NO2) as N oo5is , i
mg/L
Pb - Lead olos1 ugfL
Nitrate (NO,) as N 00620 L try )
mg/L
Zn - Zinc o1092 mg/L
Phosphorus: Total as P 00665 ; . =i
mg/L
Orthophosphate 70507
mg/L
Other (Specify- Compounds and Concentration Units):
Al - Aluminum o»os
mg/L
Ba -.Barium mom
ug/L
Ca - Calcium poste
mg/L
Cd - Cadmium 01027
ug/L
Chromium: Total o1o34
ug/L
Cu - Copper o1o42
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Fe - Iron o1045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
K - Potassium oo937
mg/L
VOC 7873 method #
Mg - Magnesium oo927
mg/L
method*
Mn - Manganese olom
ug/L
method #
Ni - Nickel osos7
ug/L
method #
Influent Total VOCs:
ma/L Effluent Total VOCs:
NGum'SL Pahl
mg/L VOC Removal%
check
here: 11
Nainesh Patel

DocuSign Envelope ID: 4F1238D5-E41 F-4FB4-BBE7-1305DB151 D7C
SUBMIT FORM C 1OW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print clearly or Type
Facility Name: TigectL eRi sot) W o ey- 1ii2xi
Permit Name (if different): 'VJ ASt-I itJ,=-rbN k,..0 tz&-GTi 1 AJAL COuNTV 5 v �i GL7
Facility Address: 19 5 S H W Y N
I,. t2 S ra a 11 (St-0 N G s -7 17, 19 County W r4S N iN & rdiJ
(tct Person: tZAD o5S6R Telephone#: (-t52 J %Y(s -106
Location/Site Name: WASt4jNGT0jj r vat' Gt�cra:4L No. of wells to be sampled: 5
PLING INFORMATION , - r ;. j -
L ID NUMBER (from Permit): My�' -3 Data sample collected: l
Depth: <: '� ft Well Diameter in.
h to Water Level 82546: ft. below measuring point Screened Interval: ft. to _
During Point is 1-- ft. above land surface Relative M.P. Elevation: ft.
no of water pumped/bailed before sampling: 1.0..._ gallons
)les for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
PERMIT Number: t Expiration Date: rc �
Non -Discharge UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
ft.
❑ Water Source Heat Pump ❑ Other.
If WELL
FIELD ANALYSES:
pH 00400:• ? units
Spec. Cond. 00094:
Odor 000e5:
Appearance
Temp. 000lo: B , °C
µMhos
LABORATORY INFORMATION
E i = i - I? /L 0
Laboratory Name: � 17 E 5 J r(,d
�N ALy T G+4 L Certification No. �ya
)ate sample analyzed:
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
46.1
os1
COD 00335
mg/L
Nitrite (NO2)-as N ooe15
mg/L
Pb -Lead o1 ug/L
Coliform: MF Fecal 31s1e
/100mL
Nitrate (NO3) as N 00620 O , 1
mg/L
Zn - Zinc olo92 mg/L
Coliform: MF Total 315o4
/100mL
Phosphorus: Total as P ooee5 Z
mg/L
(Now: Use MPN method for highly turbid samples)
Orthophosphate 7oso7
mg/L
Other (Specify Compounds and Concentration Units):
tissolved Solids:Total 70300
mg/L
All - Aluminum o11os
mg/L
pH (Lab) 00403
units
Be - Barium o1oo7
ug/L
TOC ooseo .9
mg/L
Ca - Calcium 00916
mg/L
Chloride oo94o 16.3
mg/L
Cd - Cadmium o1o27
ug/L
Arsenic 01002
ug1L
Chromium: Total o1o34
ug/L
Grease and Oils 00552
mg/L
Cu - Copper oio42
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 3273o
ug/L
Fe - Iron olo45
ug/L
(Specify tit and method #. ATTACH LAB REPORT.)
Sulfate ooms
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
specific Conductance 00095
µMhos
K - Potassium 00937
mg/L
VOC 7973 method #
<` �V>
Total Ammonia ooslo ••
mg/L
M Magnesium oos27
g - a9
mg/L
, method #
(Ammonia Nitrogen. NH3as N: ArrmoNa Mtrogen, Total)
Mn - Manganese oloss
ug/L
, method #
TKN as N ooe25
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%
• Ss�,. �iL
_.Z334^ f
ittee (or Aueiodzed Agent) Name and Title -
GW-59 Rev.0"2-2017
print or type
merged Agent)
Nainesh Patel
DRY at
time of
sampling,
check
here: ❑
12/23/2020 1 17:18:12 EST
(Date)

DocuSign Envelope ID: 4F1238D5-E41 F-4FB4-BBE7-1305DB151 D7C
SUBMIT FORM C '-LOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
M
COMPLIANCE REPORT FORM
PERMIT Number: : c
I . -
Fixpiration Date: r r S i -
PleesePrintCleadyorType
FACILITY INFORMATION
.,
^�
Faclity. Name: T Iu g , r 2i Sore W t7 A'e �7.4e_m
Non -Discharge
UIC
Permit Name (if different): Co Ll ry iV
SP4421LIEL0
NPDES
Other
Facility Address: 19 599 H W Y 9 4 t1i
TYPE OF PERMITTED OPERATION BEING MONITORED
C itI:S i1ie, L(, (street) N G 2 2 8
County LJ ASI IN 6 T-6 t -I
❑ Lagoon
❑ Remediation: Infiltration Gallery
(city) (6101) VO)
❑ Spray Field
❑ Remediation:
'GA14 a G o5 s �
Telephone#<252) ?�jL • f 0 8 5
❑ Rotary Distributor
El Land Application of Sludge
Contact Person:
Well Location/Site Name: U AS to i-) & T-0r i CO P4 c I ma"4-
No. of wells to be sampled: .5
El Water Source Heat Pump
❑Other:
` ' Tv �Ft `�'
ow parmm
If WELL
SAMPLING INFORMATION
WELL ID NUMBER (from Permit): M "
Date sam ple collected: =-
FIELD ANALYSES:
•
WAS
Well Depth: 14 ft.
Well Diameter. in.
< DRY at
pH oo400: > r •_� units Temp. 000lo: °C
time of
(
Depth to Water Level a254s: (o 1 S' #- below measuring point
Screened Interval: ft. to _ft.
Spec. Cond. 00094:
µMhos sampling,
Measuring Point is tL above land surface Relative M.P. Elevation: ft.
Odor 000ss:
check
volume of water pumped/bailed before sampling: 1 - gallons
Appearance
here: ❑
Samples for metals were collected unfiltered: ❑ YES ❑ NO
and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Data sample analyzed: %�/ _ �s : ''H0
'.^> r
LaboratoryName:
15+e4+e!S Q,
l
+f- Ti'c L Certification No. j� (,'©
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2)"as N oos15
0.
mg/L
Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 <I
/100mL
Nitrate (NO3) as N oo62o
< fj , I
mglL
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00065
O . Z.
mg/L
(Note:' Use MPN method for highly hubid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
]issolved Solids:Total 70300
mg/L
All -Aluminum o11os
mg/L
pH (Lab) oo4o3 77�
units
Be - Barium mo07
ug/L
TOC oosao . 3 L;
mg/L
Ca - Calcium oosle
mg/L
Chloride oos4o d ► - Ef
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug1L
Chromium: Total o1o34
ug/L
Grease and Oils oo552
mg/L
Cu - Copper o1o42
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug1L
Fe - Iron o1o45
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 oo937
mg/L
VOC 7873 method #
Total Ammonia ooslo k
mg/L
Mg - Magnesium oo927
mg/L
method #
(Artmords Nitrogen; NFyas N: Amnorda NhWen, Toth)
Mn - Manganese o1o55
ug/L
, method #
TKN as N oo625
mg/L
Ni - Nickel 01067
ug1L
method #
For Remediation Systems Only (Attach Lab Reports):
Influent Total VOCs:
mg/L
Effluent Total VOCs: mg1L VOC Removal%
Nails -SL Pata
12/23/2020 1 17:18:12 EST
Permfte (or Authorized Agent) Name and Title - Please Print or We
GW 59 Rev. 05-02-2017
Nainesh Patel

DocuSign Envelope ID: 4F1238D5-E41 F-4Fl34-BBE7-1305Dl3151 D7C
SUBMIT FORM C ' L LW_ PAPER ONLY
•
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Facility. Name: i21� 6;1.�I So N W o 2Yf7 rZ(a?
Permit Name (if different): *6.,4 , t C�- oro CooN'� S R,4 1s ij)
Facility Address: I G 5 S °(
C(',GSIJa)) (s'-Pq /1i(- 2-7 ZSS County it)A5r►I0bT7
(CIM (Stale) (Zip)
Contact Person: &A0 (SO SSe;,-L Telephone#: '25
Well Location/Site Name: Cc4,ft(,7-1 b N4u No. of wells to be sampled: L
PLING INFORMATION p ' 3 o%1 C.
L ID NUMBER (from Permit): /i^' S Date sample collected: Q i
Depth: 13,6 ft. Well Diameter. 2 in.
h to Water Level s254e: 71(c i � ft below measuring point Screened Interval: ft. to
luring Point is 1�7 ft. above land surface Relative M.P. Elevation: ft.
no of water pumped/bailed before sampling: gallons
)les for metals were collectdd unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
date sample analyzed: / 6 ,' 4 -' , .?V
7��
PARAMETERS NOTE: Values shouldreflectdissolve
COD oosss
mg/L
Coliform: IMF Fecal 31616 ;i
/100mL
Coliform: MF Total msm
/100mL
(Note:' Use MPN method for highly turbid samples)
)issolved Solids:Total 70300 7
mg/L
pH (Lab) 00403 r ,
units
TOC oosso i • 2`i
mg/L
Chloride oog4o 1 (, `
mg/L
Arsenic wom
ug/L
Grease and Oils ootim
m91L
Phenol 3273o
ug/L
Sulfate 00945
mg/L
Specific Conductance 00095
µMhos
Total Ammonia 00610 `g Q.
mg/L
(Ammonia Nitrogen: NFy as N: Ammorda Nitrogen, Total)
TKN as N oos2s
mg/L
For Remediation Systems Only (Attach Lab Reports):
PERMIT Number,6 1�k" E)iration Date: 10
Non -Discharge UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: infiltration Gallery
❑ Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
ft.
❑ Water Source Heat Pump ❑ Other.
1f WEL
FIELD ANALYSES:
pH 00400: C 3 units
Spec. Cond. 00094:
Odor 000ss:
Appearance
Temp. 000to: 1 0 • ` aC
µMhos
Laboratory Name: S,-r+f
ArJArt.'/ 7 i Cat, Certification No. —t 40
and colloidal concentrations.
Nitrite (NO2)•as N 00615 t: 1
mg/L
Pb - Lead wos? ug/L
Nitrate (NOs) as N oos2o C o ;, I
mg%L
Zn - Zinc olo92 mg/L
Phosphorus: Total as P 00e65 O . 1l
mg/L
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
Al - Aluminum wios
mg/L
Ba - Barium 01007
ug/L
Ca -Calcium oogte
mg/L
Cd - Cadmium olo27
ug/L
Chromium: Total olo34
ug/L
Cu - Copper oio42
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
K - Potassium 00937
mg/L
VOC 7873 method #
Mg - Magnesium oo927
mg/L
method #
Mn - Manganese cios5
ug/L
method #
Ni - Nickel o1os7
ug/L
method #
Influent Total VOCs: mg/L
Effluent Total VOCs: mg/L VOC Removal%
Naim,SL
DRY at
time of
sampling,
check
here: ❑
12/23/2020 1 17:18:'12 EST
permitlee (or Authorized Agent) Name d Title - Please pdrd or type
GW 59 Rev. 05-02-2017
Nainesh Patel

DocuSign Envelope ID: 4F1238D5-E41 F-4FB4-BBE7-1305DB151 D7C
u vv-z!fa %_vivirLitarNuE XLrvRT FORM
Permit # hi Q oo®0 2(05
(Submit one each monitoring period with GW-59 forms.)
1
Enter date monitoring results were due. ( 17-.-_ Zo_•-Zb) Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
V
2
Was any required information missing on the GW-59 report forms?
YES
N
iF the answer to question 1 or 2 is "YES". list in the space provided below the well identification numbers) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional Office for guidance.
4
Are any monitored constituents equal to or above the established standards?
YES
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 constituents) and concentration(s)
exceeding standards in the space provided below:
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) 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(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
If the answer is "YES". a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be 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
re uired to determine the impact the waste disposal s stem is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation
fines, and/or penalties.
g
The person completing this portion (G W-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 evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
6 RC ) 2 - s- Zo
Signature of Permittee (or Authorized Agent) Date
K.la Z%,f^'l._ P C �GR Q6fZM 1 T TES) 1 2�1.5^" Za
GW-59A 12/8/2003