WQ0000265_Monitoring - 11-2021_20211229 (2)

GW.59A COMPLIANCE REPORT FORM Permit# /4/ p)ho 26
(Submit one each monitoring period with GW 59 forms.)
Enter date monitoring results were due.( ) Will this monitoring report(GW-59 and GW-59A) YES NO
be submitted after the established due date? O
2 ; Was any required information missing on the GW-59 report forms? YES Nfa
iF the answer to question 1 or 2 is"YES", list in the space provided below the well identification number(s)and v'
explain the problems encountered in obtaining the required information.
CJ
C7
3 Are any of the monitor wells in need of repair or maintenance(damaged casing,unlocked or mXng c i,missing YES NO.
identification plate,area overgrown,etc.)?If the answer is "Yes",contact the Regional Office for guidan'c�l Gam/
4 i Are any monitored constituents equal to or above the established standards? I 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 constituent(s) 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 constituents) 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 hvo years).
6 Are the monitoring wells listed in section 5 located at or beyond the review boundary? YES i 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
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility. Failure to do so may subject the permittee to a Notice of Violation,
j } fines, and/or penalties.
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 evaluated and the information submitted in this
report(Compliance Report GW-59A)is true and complete to the best of my knowledge.
OeC ,!2 — '— ac 2
Sign ire offPP mil (or A horize gent) Date
6a, M A0a21
GW-59A 12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF ENVIRONMENTAL QUALITY-DIV.OF WATER RESOURCES
and 1 Copy to:and PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Pent Clearly or Type PERMIT Number: Expiration Date:
Facility Name: Tyrrrell Prison Work Farm Non-Discharge (i1/q ooeQZ 66" LAC
Permit Name(if different): Washington County Sprayfiekl NPDES Other
Facility Address: Creswell NC 27928 TYPE OF PERMITTED OPERATION BEING MONITORED
Creswell NC 27928 County Washington ❑ Lagoon ❑Remediation: Infiltration Gallery
l "`Spray Field ❑Remediation:
Contact Person: David Pharr Telephone#: [phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:Washington Correctional No.of wells to be sampled: 5 ❑ Water Source Heat Pump ❑Other:
item Penny
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-1 Date sample collected: /1it30boa/ FIELD ANALYSES: WAS
Well Depth: 24 ft. Well Diameter: 2 in, pH o0400: 7,2- units Temp. 00olo /6. `T °C DRY at
(Athos
time of
Depth to Water Level 82646: cf/,.2 r ft. below measuring point Screened Interval: ft. to ft. Spec.Cond. 00094: p sampling,
Measuring Point is 2,„- ft. above land surface Relative M.P. Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: /0 gallons Appearance L,' �if &e ,.� here:
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Environmental Chemists, Inc Certification No, 94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00616 mg/L Pb-Lead 01051 ug/L
Coliform: MF Fecal 31616 /100mL Nitrate(NO3) as N 00620 mg/L Zn-Zinc 01092 mg/L
Coliform: MF Total 31504 :.I 1100mL Phosphorus: Total as P 00365 , (nej mg/L
(Note: Use MPN method for highly turIA samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
(S,,Z Dissolved Solids:Total 70300 , mg/L Al-Aluminum of 105 mg/L /01474,4-71' N.'tie.to — /1/.'y'ggio.✓ 0®03 m1e.,
pH(Lab)00403 units Ba-Barium o1007 ug/L.
TOC oosao /5 9 mg/L Ca-Calcium 00916 mg/L -7'2 l7/V -. /.f .,,,,,/,
Chloride 00940 .3 mg/L Cd-Cadmium o1027 ug/L f`�
2 2,
Arsenic o1o02 uglL Chromium: Total o1o34 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 01045 ugiL (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00845 mg/L Hg-Mercury 71900 ug1L Lab Report Attached? Li Yes(1) ❑ No(0)
Specific Conductance 000ss- ItMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia oosto mg/L Mg- Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen;NH,as N;Ammonia Nitrogen,Total) Mn Manganese 01055 ug1L method#
TKN as N 00625 1./ mg/L Ni-Nickel 01067 ug/L ,method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg1L VOC Removal%
Atittlfy{hat,to the best of my%;Howled e and belief the T nforrrPIi.> �ubr-,le,-;i.tr is s'ort a_ i.ir,,--,ra:e,a.o cot.k ,8n1,nrt,itr-lat ,:I r;IV_iy-t,cal-+eta was,i•cdu. d using apnrovcd imel-ocs cf analysis by
m.ri2-certified laboratory. I a- z-varc that t-ore are sietiif,7,ani pen t.e%t_r sint hiu_:'•tin iorrrnl,on ;nauu n I ttro;;a sib-li:y of fces arm Tr pr •iiriiitt f;: ga,iclations.
Permittee(or Authorized Agent)Name and Title-Please print or type Signature of Permit(' (or'uthorized Agent) ( a
GW-59 Rev.3-1-2016

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF ENVIRONMENTALQUALITY-DIV.OFWATERRESOURCES
and 1 copy to:and PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL.SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date:
Facility Name: Tyrrrell Prison Work Farm Non-Discharge LvQOO f 5 UIC
Permit Name(if different): Washington County Sprayfield NPDES Other
Facility Address: Creswell NC 27928 TYPE OF PERMITTED OPERATION BEING MONITORED
Creswell NC 27928 County Washington ❑ Lagoon ❑Remediation: Infiltration Gallery
'Spray Field ❑Remediation:
Contact Person: David Pharr Telephone#: [phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name:Washington Correctional No. of wells to be sampled: 5 ❑ Water Source Heat Pump ❑Other:
(from Permit) _
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-2 Date sample collected: (.-/3a/ -.( FIELD ANALYSES: WAS
Well Depth: 27 ft. Well Diameter: 2 in. pH 00400: 76) units Temp.00010: l4. °C DRY at
Depth to Water Level 02546:// ./1/ ft. below measuring point Screened Interval: ft. to ft. Spec.Cond.00094: Athostime of
sampling,
Measuring Point is ,ft. above land surface Relative M.P. Elevation: ft. Odor ocoas_ /4,G}` 5w F„$c,• check
Volume of water pumped/bailed before sampling: gallons Appearance G..'*.tt ji'A,y„, here: 1
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Environmental Chemists,Inc Certification No. 94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 nig/L Ph-Lead o1os1 ug/L
Coliforrn: MF Fecal 31616 /100mL Nitrate(NO3)as N 00620 mg/L Zn-Zinc o1092 mg/L
Colifomi: MF Total 31504 C I /100m1. Phosphorus: Total as P 00665 , 0 g mg/L
(Note Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 eoz,' mg/L Al-Aluminum o11os mg/L t /`
H (Lab)00403 g /d:7�7`a �'7'ir.i� .v�,��-��p ��..
p units Ba-Barium o1007 ug/L
TOC°peso / 70 mg/L Ca-Calcium 00916 nig/L TZW ru,'7` o,"-- /
Chloride 00940 25- mg/L Cd-Cadmium 01027 uglL
Arsenic°tong ug/L Chromium:Total 01034 ug/L
Grease and Oils o0552 mg/L Cu-Copper 01042 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 000ss riMhos K-Potassium 00937 mg/L VOC 7873 , method#
Total Ammonia 00610 ..S-- mg/L Mg-Magnesium 00927 mg/L , method#
(Ammonia Nitrogen,NI-1,as N,Ammonia Nitrogen,Total) Mn_Manganese 01p55 Ug/L method#
TKN as N 00625 /3 mg/L Ni-Nickel 01067 ^ug/L ,method#
•
For Romedlation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
1 ceitrfy that,to the best of my 1.rcvaledye and belief-the information 1,110r,:it..:i this report is true accurate,a^a::cmpleto,arid tflat the laboratory vela„ticatdata was produced using orpnsed rrethobs of analysis lay a
DIA -cenifiei'aborriiory I an aware that Viere aro siy t i I(, ocn i i i n tt-^a r'itsr n smellor nob.ding the po sib,:ity of fines 2r i i' prf:;pnrr4 tt for unoeiing viola'iant.
Permittee(or Authorized Agent)Name and Title-Please print or type Signatu of Permittee(or uthorized Agent) (Dale)
GW-59 Rev.3-1-2016

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: INFORMATION
original DEPARTMENT OF ENVIRONMENTAL QUALITY-DIV.OF WATER RESOURCES
and I1 cOpy to: INFORMA`I ON PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699.1617 Phone:[phone]
FACILITY INFORMATION Please Pont Clearly or Type PERMIT Number: Expiration Date:
Facility Name: Tyrrrell Prison Work Farm Non-Discharge UIC
Permit Name(if different): Washington County 5prayfield NPDES y,,,2yoo !p S Other
Facility Address: Creswell NC 27928 TYPE OF PERMITTED OPERATION BEING MONITORED
Creswell NC 27928 County Washington ❑ Lagoon ❑ Remediation:Infiltration Gallery
Spray Field ❑ Remediation:
Contact Person: David Pharr Telephone#: [phone] . ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:Washington Correctional , No. of wells to be sampled: 5 ❑ Water Source Heat Pump ❑Other:
Mom Perrn()
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-3 Date sample collected: /1-30-, 02--/ FIELD ANALYSES: WAS
Well Depth: 25.5 ft. Well Diameter: 2 in. pH oo1oo: 6 4 units Temp.mom (S 9°C DRY at
i.
Depth to Water Level 82548: fv`-./ft.below measuring point Screened Interval: ft. to ft. Spec.Cond.00094: µMhos time of
sampling,
Measuring Point is 2, ft. above land surface Relative M.P. Elevation: ft. Odor cocas: V-v check
Volume of water pumped/bailed before sampling: gallons Appearance 1-° tf" 3 -� here: 1
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Environmental Chemists,Inc Certification No. 94
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N cosi s mg/L Pb-Lead 01051 ug/L
Coliform: MF Fecal 31616 /100mL Nitrate(NO3)as N 00620 mg/L Zn-Zinc()IOW mg/L
Coliform: MF Total 31504 < l /100mL Phosphorus:Total as P 00665 mg/L
(Vote: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 6()- mg/L Al-Aluminum of 105 mg1L ,y,77/,,07e ¢ 91.4'1`,f,i6,— ,rP/;'*,ys'-,• 0 Q,y *474
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 00680 //4 mg/L Ca-Calcium omsma mg/L ?7 s1-,5 i g60,wr (,, �
Chloride 00940 (QZ- mg/L Cd-Cadmium 01027 ug/L —=�`/�
1
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 01045 ug/L (Specify test and method 1/.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 o0610 o S mg/L Mg- Magnesium 00027 mg/L ,method#
(Ammonia Nitrogen:tdisas N;Ammonia Nitrogen,coral) „,Mn-Manganese 01055 ug/t. ,mo athod od#
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%
I certify that,to the ties`of nli knowledge ane, ,` ¢5y t 8t`ini., i g:f+ rl's t=ue, ace"'a1ee.e-d cot fe.and that the laboratory analyfroel' f „ r < 1 'l4`ja `Oi @ f itt fe'b a '
❑l''v'4-cert,tied lahot rtory. I em aware the�' � � e FaSU r -+ �'*.� �' �S.a-
�,�. p R't1RgH�., '� tim!ti�n9 take information inclucing the ooss;uihty o,fines ate, in•ptis�rr�ont for k.nowlr)�.-q l I[�-w � ��, �,;; c,�
pp,/ /'4 ,� 2 ,. . ' - � ,l,/i a �ao
415 AIlp� _
Permittee(or Authorized Agent)Name and Tilte-Please print or type Signa`re of Permittee .r Authorized Agent) (Date)
GW-59 Rev.3-1-2016

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALrjYt®N�MONITORING: Mail original' DEPARTMENT OF ENVIRONMENTAL QUALITY-Civ.OF WATER RESOURCES
and 'I copy to;` INFORMATION PROCESSING UMiT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone,:919-807.6306
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date:
Facility Name: Tyrrrell Prison Work Farm Non-Discharge (4) ,2(5 UIC
Permit Name(if different): Washington County Sprayfield NPDES Other
Facility Address: Creswell NC 27928 TYPE OF PERMITTED OPERATION BEING MONITORED
Creswell NC 27928 CountyWashington
Li Lagoon ❑ Remediation:Infiltration Gallery
-Spray Field Li Remediation:
Contact Person: David Pharr Telephone`: 2527253871 0 Rotary Distributor Li Land Application of Sludge
Well Location/Site Name:Washington Correctional No. of wells to be sampled: 5 ❑ Water Source Heat Pump ❑Other
(tom Permit)
SAMPLING INFORMATION if WELL
WELL ID NUMBER(from Permit): h1W-4 Date sample collected: /r/ d1.202-/ FIELD ANALYSES: WAS
Welt Depth: 24 ft. Well Diameter: 2 in. pH o040o. 7..`f units Temp. 000io: /6,C) °C DRY at
Depth to Water Level 82546: q -6 if ft. below measuring point Screened Interval: ft. to ft. Spec.Cond.00094: µMhos time of
MeasuringPoint is sampling,
.2. ft. above land surface Relative M.P. Elevation: ft. Odor 00085: .,,.,, 0 check
Volume of water pumped/bailed before sampling: /v gallons Appearance L.e&rn'- /},e,1,...--- here:
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: El ❑NO l
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Environmental Chemists, Inc Certification No. 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N oasis mg/L Pb-Lead o1051 ug/L
Coliform: MF Fecal 31616 /100mL Nitrate(NO3)as N 00620 mg/L Zn-Zinc 01o92 mg/L.
Coliform: MF Total a1s04 / /100mL Phosphorus: Total as P 00665 , /0 mg/L
(Note' use MeN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 785- mg/L Al-Aluminum oiios mg/L .4/,•74,4-i,e, 4y/144•ii r 03 je.—•
pH(Lab)00403 units Ba-Barium 01007 ug1L
TOC oosso 97.c2 mg/L Ca-Calcium 00916 Mg/L i�1`,cr/ /t 4 ay 43,2 �,,,., !.—
Chloride o0940 , � cf mg/L Cd-Cadmium 01027 ug/L 3st
Arsenic 01002 ug/L Chromium:Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper 01042 mg/1.. ORGANICS: (by GC, GC/NS, HPLC)
Phenol 32730 ug/L Fe-Iron o1o45 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 7190o uglL Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 0009b ftMhos K- Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia oosso mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen:NH,as N,Ammonia Nitrogen,Total)
Mn-Manganese 01055 ug/L ,method#
TKN as N 00625 /, 3 mg/L Ni-Nickel 01067 ug/L ,method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: tng/L Effluent Total VOCs: mg/L VOC Removal%
b
1 �.F,�tt �
h4 o t3 st? .0 . .. ,;,., I, t r 7r:a r 5uh ec m N11s report is truce 3_.d.atc,.a•tri comn c-ie,and that the laboratory am.4,:cal a.a w.is;:rodaced us:ng spprceer.•r,etntds cf 2naly,is by a
{0 ttifi l k.4 p , lr, fir.MO g ear--i' a t ;.,40e oriptt'mitting false rforration.IrcIs rig the.poss!bility or file a,0 Impriso.,met it to tirccc ii vpclat,ons.
,0441l P /)4/93 ()dee /1'1V "Mr I Wgq 1 asoa 1
Permittee(or Authorized Agent)Name and Title-Please print or type Signature of Permitie• or Authorized Agent) (Date)
GW-59 Rev.3-1-2016

, SUI3tvIII FORM ON YELLOW PAPER ONLY
,
Malt 6iiiiiiiii DEPARTMENT OF ENVIRONMENTAL QUALITY.DIV.OF WATER ESOURCES 1
GROUNDWATER QUALITY MONITORING: and 1 co to; INFORNIAT1CN PROCESSING UNIT
py
COMPLIANCE REPORT FORM ,,,,,,, ,,,,,.4, , s#wr, 1617 MAIL SERVICE CENTER,RALEIG-L NC 27699-1817 Phone:[phone]
FACILITY INFORMATION Please Pont Clearly or Type PERMIT Number: Expiration Date:
Facility Name: Tyrrrell Prison Work Farm Non-Discharge tA/4ita00,,/e)5. UIC
Permit Name(if different): Washington County Sprayfield NPDES Other
Facility Address: Creswell NC 27928 TYPE OF PERMITTED OPERATION BEING MONITORED
. ,
Creswell NC 27928 County Washington LI Lagoon El Remediation: Infiltration Gallery
.. .
Pray Field 0 Remediation:
Contact Person: David Phan Telephone#: [phone] 0 Rotary Distributor LI Land Application of Sludge
Well Location/Site Name:Washington Correctional No. of wells to be sampled: 5 0 Water Source Heat Pump El Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): MW-5 Date sample collected: (//342-1 FIELD ANALYSES: WAS
Well Depth: 23.5 ft. Well Diameter: 2 in. pH 00400: 64,1 units Temp.coolo: /4 ( °C DRY at
Depth to Water Level 82546: /4.,-,1 ft. below measuring point Screened Interval: ft. to ft. Spec.Cond.00094: gMhos
sampling,
Measuring Point is 2 ft. above land surface Relative M.P. Elevation: ft. Odor moss ,,,,,s,i , check
Volume of water pumped/bailed before sampling: gallons Appearance c...g.ete- geo---- here:
Samples for metals were collected unfiltered: El YES ID NO and field acidified: Ell YES El NO 1
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Environmental Chemists,Inc Certification No, 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead 01051 ug/L
Conform: ME Fecal aisis /100mt. Nitrate(NO3)as N 00620 nigii_ Zn-Zinc 01092 mg/L
Conform: MF Total 31504 e,1 /100mL Phosphorus:Total as P 00865 e/41 mg/L
(Note Use MPN method for highly turbid zarnoles)
Orthophosphate 70507 mg/L Other(Specify Cornpoundsand Concentration Units):
Dissolved Solids:Total 70300 838 mg/L Al-Aluminum 01105 mg/L it....14.4,44 -f.,44 V?ti,Ke Ai Wcy,e,--e a c73' ,''',gii, Agyie2_,
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOG oosso ,(6,5- mg/L Ca-Calcium 00916 mg/L .,-? ei,--- 4.
Chloride 00940 24(8 mg/L Cd-Cadmium 01027 tg&
Arsenic 01002 ug/L Chromium:Total 01034 uglt.
Grease and Oils o05s2 mgfL Cu-Copper 01042 mg/L ORGANICS: (by GC,GC/MS, HPLC)
Phenol 32730 119/1_ Fe-Iron 01045 ught. (Specify test and method tt.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 71900 ughl. Lab Report Attached? Li Yes(1) El No(0)
Specific Conductance 00095 pMhos K-Potassium 00937 rrig/L VOC 7873 ,method#
Total Ammonia oosto .-5— mg/L. Mg-Magnesium 00927 mg/L ,method it
(Ammonia Nitrogen;NIA,as N,Ammonia Nitrogan,Total(
Mn-Manganese otosfi ug/L ,method#
TKN as N 00525 A.5. mg/L Ni-Nickel 01067 ug/L. ,method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mgfL Effluent Total VOCs: mg/L VOC Removal%
I ctsla';thot,tO the Oast Of Illy i.,c.„,o,:dne•and -,,1,1070,04V044010,4*,60.40;i0,7004:Kgrid'.11,3'the'.1b0"at,'Avimakilleal. 1t,..1 s',",,Protk,:el :::7 74C: Pi',4.:.:iiVitt IfitAttitgAW'
D'A'R-cerlifled labOrattity 1 air awa",tt-a thee are`AliragkiiiilitifteftAPPAI:k/41141rtiforlyiefforj:jr;04i4,lkil'gsibility,:, fir105.,,,,r',ripr:. rorreN fol kiln.",ng vi41,;:::§ilAti71'. ';',14ttlitl'.;•;:404.gINteg,
C44t.i/P PAQ/e e,„ee 41.4„."„ge----- AOPPr
/- 4.., i— 1?-,/ ci/ c2,21
p.m..(or Authorized Agent)Name and Title-Please print or type Signature of Permitiee.(or Authorized Agent) ( ate)
GW-59 Rev.3-1-2016