WQ0033770_Monitoring - 01-2022_20220627

t
SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OFENVIR�4ENTAL QUALITY-DIV.OF WATER RESOLIRCEB
GROUNDWATER QUALITY MONITORING: and 1 copy to: INFORMATION PIS UI T
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 276se-1e17
FACILITY INFORMATION Please Pent Clearly orType PERMYT Number:w t70033770 Expiration Date: 12/31/2026
Facility Name: caroling Plantation Non-Discharge UIC
Permit Name(if different): NPDES Other infiltration system
Facility Address: Carolina Plantation Road TYPE OF PERMITTED OPERATION BEING MONITORED
7acksonville. NC ' 28540 County Onslow ❑ Lagoon ❑Remediation:Infiltration Gallery
,State,
0 Spray Field 0 Remediation: r.
Contact Person: Jeff Jarman Telephone#: [phone] 0 Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name:carol i na Plantation map No.of wells to be sampled: 6 0 Water Source Heat Pump El Other. Imderdrai ns
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): Date sample collected: //Z7/Z_Z FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1.25 in. pH 00400: units Temp.00010: °C DRY at
Depth to Water Level e254s:g, Z ft.below measuring point Screened Interval: 15 ft. to _ft. Spec.Cond.o0094: µMhos time of
sampling,
Measuring Point is 2 ft.above land surface Relative M.P.Elevation: ft. Odor 00386: check
Volume of water pumped/bailed before sampling: gallons Appearance here.ci
Samples for metals were collected unfiltered: II YES 0 NO and field acidified: I YES 0 NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Certification No.
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 0oel s mg/L Pb-Lead olo51 ug/L p P"!,mil r,
Coliform:MF Fecal 31616 /100mL Nitrate(NO3)as N 00620 mg/L Zn-Zinc wowwowmg/L C A 5 nt,t
Coliform:MF Total 31504 /100mL Phosphorus:Total as P 00665 mg/L }".IN 2 7
20;
(Note: Use MPN method for highy turbid eampbe) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 mg/L Al-Aluminum o1105 mg/LKH
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC ooe8o mg/L Ca-Calcium 00916 J($Q-2 8 2022
Chloride°o94o mg/L Cd-Cadmium 01027 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,GC/MS,HPLC)
Phenol 3273o ug/L Fe-Iron 01045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate ooaa5 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? 0 Yes(1) 0 No(0)
Specific Conductance 00085 µMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia ooeio mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen NH,ae N;Ammonia Nitrogen,Total) Mn-Manganese 01055 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%
I cert.fy that,to the best of my knowledge and belief,the information submitted in this report is true,accurate.and complete,and that the laboratory analytical data was produced using approved methods of analysis by a
_,'.P curt:fied trborator`y. I err.:,.;are that
there are significant penalties for submitting false information,including the possibility of fines and imprisonment for I:nowing violations \
P orAutho ed Anent)Name and Title-Pleaseprint or Signature of Pe ' (or Authorized t) t / ( l�
ermit�( Ae ) type y
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF EWY1ROl6ENTAL r1UALITy-DIV.OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: INFORMATION PROCESSING tAST
COMPLIANCE REPORT FORM ie17 MAIL SERVICE CENTER.RALEIGH.NC rmee-1aT
FACILITY INFORMATION Please Print Clearly or Type PERMT Number:
wa0033770 Expiration Date: 12/31/2026
Facility Name: carol i na Plantation Non-Discharge UIC
Permit Name(if different): NPDES Other Infiltration System
Facility Address: Carolina Plantation Road TYPE OF PERMITTED OPERATION BEING MONITORED
Jacksonville. NC 28540 County Onslow 0 Lagoon ❑Remediation:Infiltration Gallery
❑ Spray Field 0 Remediation: +sr
Contact Person: Jeff Jarman Telephone#: [phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name:carol i na Plantation WWTP No.of wells to be sampled: 6 CIWater Source Heat Pump ID Other: underdrai ns
(from Perri*
SAMPLING INFORMATION Q If WELL
WELL ID NUMBER(from Permit): r Z 5 Date sample collected: //L?f-Z. FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1.2 in. pH 00400: units Temp.00o10 °C DRY at
Depth to Water Level 62546: i i. ( ft.below measuring point Screened Interval: 15 ft. to ft. Spec.Cond.00094: µMhos time of
sampling,
Measuring Point is 2 ft.above land surface Relative M.P.Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: gallons Appearance here:0
Samples for metals were collected unfiltered: ®YES 0 NO and field acidified: II YES 0 NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: 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 -
Coliform:MF Fecal 31616 /100mL Nitrate(NO3)as N 00620 mg/L Zn-Zinc 01092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P 0066s mg/L
(Note: Uee MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(SpecifyComp
ounds and Concentration Units):
Dissolved Solids:Total 70300 mg/L Al-Aluminum o11os mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC ooeeo mg/L Ca-Calcium 00918 mg/L
Chloride 00940 mg/L Cd-Cadmium 01027 ug/L
Arsenic 01002 ug/L Chromium:Total 01034 ug/L
Grease and Oils o0s52 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 S.ATTACH LAB REPORT.)
Sulfate cows mg/L Hg-Mercury 71900 ug/L Lab Report Attached? 0 Yes(1) ❑ No(0)
Specific Conductance o0oe5 }Mhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia ooeio mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen;NH,as N;Ammonia Nitrogen,Tolal) Mn-Manganese 01055 ug/L ,method#
TKN as N 00625 mg/L Ni-Nickel 01067 ug/L ,method#
For Remedlation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I certi`,Cant to the best of my I. o,edge a d b,-I ef Vie information subrmtted In this report is true.accurate,and complete and that the laboratory analgticai data was produced using appro.ed methods of analysis eye
DWP-cerrined laboratory t am a.vare that there are significant penalties for submitting false information,including the possibility of fines and Imprisonment for knowing violations
\ \- . "Ai'^� A �_. ►�d" e- ..#) d -a Z.
Permittee(or Authorized Agent)Name and Title-Please p t or type II Signature raj''' Ittee or Authorized Agent) (e 1
GW59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENTOFI �AL PTY ROCESSING
WATER RESOURCES
COMPLIANCE REPORT FORM and 1 copy to: 1e17 MAIL SERVICE CENTER,RAi- oH,Hc27etls1617
FACIUTY INFORMATION Please Print Clearly or Type PERMT Number:w00033770 Expiration Date: 12/31/2026
Facility Name: carol i na Plantation Non-Discharge UIC
Permit Name(if different): NPDES Other Infiltration system
Facility Address: carol na Plantation Road TYPE OF PERMITTED OPERATION BEING MONITORED
Jacksonville. NC'- 28S40 County onslow 0 Lagoon 0 Remediation:Infiltration Gallery
❑ Spray Field 0 Remediation: yr
Contact Person: Jeff Jarman Telephone#: [phone] ❑ Rotary Distributor 0 Land App cation of Sludge
Well Location/Site Name:carol i na Plantation WWTP No.of wells to be sampled: 6 ❑ Water Source Heat Pump to Other underdrai ns
(from Peat)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): 70Z, -/ Date sample collected: /I 2.y//ZZ FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:2•25 in. pH 00403: units Temp.00010_ °C DRY at
Depth to Water Level 62546:/.5. 7 ft.below measuring point Screened Interval:15 ft. to_ft. Spec.Cond.00094: µMhos time ofsampling,
Measuring Point is 2 ft.above land surface Relative M.P.Elevation: ft. Odor 0ooe5: check
Volume of water pumped/bailed before sampling: gallons Appearance here:❑
Samples for metals were collected unfiltered: MI YES 0 NO and field acidified: Il YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Certification No.
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N cows mg/L Pb-Lead 01051 WA
-
Coliform:MF Fecal 31819 /100mL Nitrate(NO3)as N 00620 mg/L Zn-Zinc 01092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P 00665 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 mg/L Al-Aluminum o1105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC ooeeo mg/L Ca-Calcium o0916 mg/L
Chloride cow mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 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#.ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) 0 No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia tmei° mg/L Mg-Magnesium 00927 mg/L ,method#
(Anmonia Nitrogen;NH,reN;Ammonia Nitrogen.Total) Mn-Manganese 01055 ug/L ,method#
TKN as N o0625 mg/L Ni-Nickel 01087 ug/L ,method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
1 certify tart to the best of my I nciii.ledge and uehef the information submitted rn tiiis report is troe,eccLrate,and complete.and that the'aboratory-analytrcal data was produced using approved methods of analysis by a
MR-certified laboratory I am aware that there are significant penalties for submitting false information,including the possibility of fines and irrnrisonment for knowing violations.
rii
'1 ,:�,Thv = �. A n E'_ i/ /';
Permittee(or Authorized Agent)Name and Title-Please print or type Signature of P=r1'r'--(or Auth =•Agent) (a-te).
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUAUTY MONITORING: Mail original ME►rroFI u OF WATER
RESOURCES
NFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM and 1 copy to. 1817 MAIL SERVICE CENTER,RALEIGH,NC27889-1817
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number:wo0033770 Expiration Date: 12/31/2026
Facility Name: Carolina Plantation Non-Discharge UIC
Permit Name(if different): NPDES Other Infi 1 tration system
Facility Address: Carolina Plantation Road TYPE OF PERMITTED OPERATION BEING MONITORED
Jacksonville. NC-- 28540 County Onslow ❑ Lagoon ❑Remediation:Infiltration Gallery
m: 0 Spray Field 0 Remediation: lir
Contact;argon; Jeff Jarman Telephone#: [phone] 0 Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name:carol i na Plantation wwTP No.of wells to be sampled: 6 0 Water Source Heat Pump D Other underdrai ns
from Pemtit
SAMPLING INFORMATION Q 3 If WELL
WELL ID NUMBER(from Permit): i Z- Date sample collected: 2?l Z—Z FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1•25 in. pH 00400: units Temp.oomo: °C DRY at
Depth to Water Level 82548: i 2. •7 ft.below measuring point Screened Interval: 15 ft. to _ft. Spec.Cond.00094: ;Mhos time of
sampling,
Measuring Point is 2 ft.above land surface Relative M.P.Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: gallons Appearance tore:❑
Samples for metals were collected unfiltered: ON YES ❑ NO and field acidified: ®YES 0 NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Certification No.
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00336 mg/L Nitrite(NO2)as N owls mg/L Pb-Lead oiosi WA-
Coliform:MF Fecal 3181e /100mL Nitrate(NO3)as N 0092o mg/L Zn-Zinc 01092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P ooees mg/L
(Note Use MPN S tl10d"ot°o"ly turbid Pi68) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 mg/L Al-Aluminum 01105 mg/L
pH(Lab)ooaoa units Ba-Barium 01007 ug/L
TOC ooeeo mg/L Ca-Calcium ooale mg/L
Chloride 0o94o mg/L Cd-Cadmium 01027 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 o1045 ug/L (Specify test and method#.ATTACH LAB REPORT.)
Sulfate oos4s mg/L Hg-Mercury 71900 ug/L Lab Report Attached? 0 Yes(1) ❑ No(0)
Specific Conductance 00095 ;Mhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia ooeio mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammon®Nitrogen;NH3as N;Ammonia Nitrogen,Toth) Mn-Manganese 01055 ug/L ,method#
TKN as N oo825 mg/L Ni-Nickel 010e7 ug/L ,method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
-°cdge and belief.the informabori sutmitted in this report is true,accurate and complete,and that the laboratory analytical data was produced using approved methods of analysis by a
S\9`(sin a,�ccm that there are significant penalties for submitting false information iccl dine the possihddy c'fines and imcnsonment for knowing violations
e.
Pam 1(or Authorized Agent)Name and -Please PO pa,�c a - Si natu (or Authorized ant �/a a/.2�
A Agent) (dal
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original + A710NPROCESSNGUU r�wA7ER�
COMPLIANCE REPORT FORM and 1 copy to: 1817 MAIL SE 1/10ECENTE,RALEK I„Nc27119e-seiT
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number:wQ0033770 Expiration Date: 12/31/2026
Facility Name: Carolina Plantation Non-Discharge UIC
Permit Name(if different): NPDES Other Infiltration System
Facility Address: Carolina Plantation Road TYPE OF PERMITTED OPERATION BEING MONITORED
Jacksonville. NC` 28540 county Onslow 0 Lagoon 0 Remediation:Infiltration Gallery
tcmn
0 Spray Field 0 Remediation: gar
Contact Person: Jeff Jarman Telephone#: [phone] 0 Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name:Carol 1 na Plantation WWrP No.of wells to be sampled: 6 0 Water Source Heat Pump fl Other: tmderdrai ns
(Rom Pemi)
SAMPLING INFORMATION Q l If WELL
WELL ID NUMBER(from Permit): T Z 2__ Date sample collected:/! Z-�/Z-e—. FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1'25 in. pH 00400: units Temp.coos" °C DRY at
time of
Depth to Water Level 82546:/4, ft.below measuring point Screened Interval: 15 ft. to _ft. Spec.Cond.00094: IMF sampling,
Measuring Point is 2 ft.above land surface Relative M.P.Elevation: ft. Odor cocoas: check
Volume of water pumped/bailed before sampling: gallons Appearance here:0
Samples for metals were collected unfiltered: I♦YES ❑ NO and field acidified: ®YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Certification No.
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N oasts mg/L Pb-Lead oiosi uli/L
Coliform:MF Fecal 31818 /100mL Nitrate(NO3)as N wino mg/L Zn-Zinc wow mg/L
Coitform:MF Total 31504 /100mL Phosphorus:Total as P 00685 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 mg/L Al-Aluminum tit105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 00680 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 mg/L Cd-Cadmium 01027 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,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? 0 Yes(1) 0 No(0)
Specific Conductance 00095 Whoa K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia 0oe10 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 coins 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 best of my knowledge and belief the inforraton submitted in this report is true,accurate,and complete.and that the laboratory analytical data was produced using
DAP-certified laboratory I am aware that there are significant penalties for submitting false information including the possibility of fines and imorisonment for knowing violations
\iN_
Permittee(or Authorized Agent)Name and Title-Please print or ty•= Signature ofo P r=a(or Al •rized Agent) (e- -1
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original E�OFINFORMATION
n�AL DIV.PROCESSING OF WATER RE30t1RCES
COMPLIANCE REPORT FORM and 1 copy to: 1Bn MAIL SERVICE CENTER.RALElGH roc rev
FACILITY INFORMATION Pleese Print Clearly wType PERMIT Number:w00033770 Expiration Date: 12/31/2026
Facility Name: Carolina Plantation Non-Discharge UIC
Permit Name(if different): NPDES Other Infiltration system
Facility Address: carol i na Pl antati on Road TYPE OF PERMITTED OPERATION BEING MONITORED
Jacksonville. NC' 28540 County Onslow 0 Lagoon ❑Remediation:Infiltration Gallery
, 0 Spray Field 0 Remediation: -war
L
Contact Person: Jeff Jarman Telephone#: [phone] ❑ Rotary Distributor and Applicati Sl Application ofudge
Well Location/Site Name:Carolina P1 antati on ww-rP No.of wells to be sampled: 6 0 Water Source Heat Pump El Other. underdrai ns
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): //
/
Date sample collected: 2-7/2 FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1.25 in. pH 00400: units Temp.000io °C DRY at
Depth to Water Level 82548:9, 1 ft.below measuring point Screened Interval: 1S Mfg ft. to _ft. Spec.Cond.00094: µ time of
sampling,
Measuring Point is 2 ft.above land surface Relative M.P.Elevation: ft. Odor 00385: check
Volume of water pumped/bailed before sampling: gallons Appearance here:❑
Samples for metals were collected unfiltered: ®YES ❑ NO and field acidified: ®YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Certification No.
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD o0335 mg/L Nitrite(NO2)as N 00815 mg/L Pb-Lead oioei ug/L
Coliform:MF Fecal 31818 /100mL Nitrate(NO3)as N 00620 mg/L Zn-Zinc 01092 mg/L
Cofform:MF Total 31504 /10omL Phosphorus:Total as P 00685 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 00e80 mg/L Ca-Calcium 00918 mg/L
Chloride oos to mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 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#.ATTACH LAB REPORT.)
Sulfate 00s45 mg/L Fig-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) 0 No(0)
specific Conductance 000s5 µMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia 0oe10 mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen;NH,aa N:Ammonia Nitrogen,Total) Mn-Manganese 01055 ug/L ,method#
TKN as N coons mg/L Ni-Nickel 01087 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 best of my knowledge,and be'l.<' : ,-. -"-d in this report s true accurate.and complete.and that the laboratory analytical data was produced using approved methods of anal c s u,a
DVVR-certified laboratory I am a: -e that there are significant per. ':fitting false information,including the possibility of fines and imorisonment for knowing violations.
Vc\ \ \,-, >'tt(k c a '9 6 � -
Permittee(or Authorized Agent)Name and Title-Please print or t�pe Signatu • (thee(or Authorized Agent) (
GW-59 Rev.06-07-2018