WQ0033770_Monitoring - 03-2022_20220627 (2)

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF INFORMATION R OCESS�UNIT WATER RESOURCES
COMPLIANCE REPORT FORM and 1 copy to: 1e17 MAIL SERVICE CENTER,RALEIGH.NC 2T889-1617
FACILITY INFORMATION Please Print Clearly or Type 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: Carolina Plantation Road TYPE OF PERMITTED OPERATION BEING MONITORED
Jacksonville. NC 28540 County onslow 0 Lagoon 0 Remediation: Infiltration Gallery
0 Spray Field 0 Remediation: r
Contact Person: Jeff Jarman Telephone#: [phone] 0 Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name:Carolina Plantation wwrP No.of wells to be sampled: 6 0 Water Source Heat Pump ElOther: underdrai ns
(tom Pence)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): /6Z Date sample collected: 3)30/J 2-7--- FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1.25 in. pH 00400: units Temp.00010 °C DRY at
h to Water Level 82548: a ft. below measuringtime of
Dep
th point Screened Interval: 15 ft. to _ft. Spec.Cond.00094: 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:❑
Samples for metals were collected unfiltered: ®YES 0 NO and field acidified: IN 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 coals mg/L Pb-Lead oiosi WA-
Coliform:MF Fecal 31e1e /100mL Nitrate(NO3)as N 0062o mg/L Zn-Zinc o10a2 mg&
Collform:MF Total 31504 /100mL Phosphorus:Total as P 006as mg/L i,y --_._
(Note: Ur MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other S .k ` n f I t,,,�'`
g/ ( pet ary Compounds and Concentration UMW° ., f .P
Dissolved Solids:Total 70300 mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L JUN ��L� ���� 7 202�
TOC ooeeo mg/L Ca-Calcium ooaie mg/L .4
Chloride 0o94o 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? 0 Yes(1) ❑ No(0)
Specific Conductance cooe5 µMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia 00810 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 mg/L Ni-Nickel 01oe7 ug/L ,method#
For Remedlatlon 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 mformahon suomitted in bus report J complete,and that the laboratory analytcal data was produced using approved method of analysis by a
DWR-certified laboratory lam aware that there are significant penalties for submitting fals,: '"e possibility of fines and imprisonment for knowing violations
r c \�-- c c \NY ` \c e___ ? 67- - -7-z
Permittee(or Authorized Agent)Name and Title-Please print or Type Signature of P rm' (or Authorized Agent) (Date)
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENTAL QUAUTY-ON.OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1817 MAIL SE/WMCENTER.RALEIGH,NC27659-ten
FACILITY INFORMATION Please Print Cleeily or Type PERMII Number:w00033770 Expiration Date: 12/31/2026
Facility Name: carol i na P1 antati on 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 ❑ Lagoon 0 Remediation:Infiltration Gallery
❑ Spray Field ❑Remediation: �.
Contact Person: Jeff Jarman Telephone#: [phone] El Rotary Distributor El Land Application of Sludge
Well Location/Site Name:Carolina Pl antati on WWTP No.of wells to be sampled: 6 0 Water Source Heat Pump fl Other urrderdrai ns
(Rom Permit)
SAMPLING INFORMATION Q If WELL
WELL ID NUMBER(from Permit): T z S Date sample collected: 3/j0/Z-2 FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1.25 in. pH 00400: units Temp.°0o10: °C DRY at
time of
Depth to Water Level 82548: //• F.ft.below measuring point Screened Interval: 15 ft. to ft. Spec.Cond.00094: NMI sampling,
Measuring Point is 2 ft.above land surface Relative M.P.Elevation: ft. Odor 00065: check
Volume of water pumped/bailed before sampling: gallons Appearance here:❑
Samples for metals were collected unfiltered: II 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 00338 mg/L Nitrite(NO2)as N 00815 mg/L Pb-Lead 01051 ugh
Conform:MF Fecal 31818 /100mL Nitrate(NO3)as N 00820 mg/L Zn-Zinc 01092 mg/L
Conform:MF Total 31504 /100mL Phosphorus:Total as P otces 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 oiios mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC oosao mg/L Ca-Calcium 00918 mg/L
Chloride 00940 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1o02 ug/L Chromium:Total 01034 MR-
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 oosts mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance moos NMI K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia 00610 mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammons Nitrogen;NH,as N:Ammonia Nitrogen,Total) Mn-Manganese°loss ug/L ,method#
TKN as N 00e25 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 - r this e--ort is tr., accurate an J coma and _ne lab°at ,an. _u:ed using approved methods of analysis by a
DVVP-certified laboratory. lam aware that there are s:gnd ,se information in- ,as and - >
\\A N and Title-P 1nt or�� � Signature of Perm'•-- •-Authorized 1 �' (Date)
/01
Permittee( Anent) type p
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original OEPARTMENTOFEONM AL OF WATER RESOURCES
INFORMATION
COMPLIANCE REPORT FORM and 1 copy to: 1617 MAIL SERVICE CENTER,RALPgH,NC276a9-1617
FACILITY INFORMATION Please Print Clearly orType PERMT Number:w(10033770 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 onsiOW ❑ Lagoon 0 Remediation:Infiltration Gallery
0 Spray Rekf 0 Remediation: f-
Contact Person: Jeff Jarman Telephone#: [phone] ❑ Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name:Carolina Plantation TP No.of wells to be sampled: 6 El Source Heat Pump fl Other. Underdrai ns
W
tom Penney _
SAMPLING INFORMATION //�� !J If WELL
WELL ID NUMBER(from Permit): PL _l Date sample collected: 3 3v/7-I- FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1.25 in. pH o040o units Temp.cool() °C DRY at
Depth to Water Level e2548:18 ff�y r7 ft.below measuring point Screened Interval: 15 ft. to_ft. Spec.Cond.coml. µMtas 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
Samples for metals were collected unfiltered: [EYES 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 mom ug/L
Coliform:MF Fecal 31818 /100mL Nitrate(NO3)as N 00620 mg/L Zn-Zinc 01002 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P owes mg/L
(Note: Use MPN method for hilly turbid samples) Orthophosphate 70507 m L Other(Specify
g/ 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 owe mg/L
Chloride 00940 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 ug/L Chromium:Total 01034 ug/L
Grease and Oils ooss2 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 00945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? 0 Yes(1) ❑ No(0)
Specific Conductance 00095 Athos K-Potassium o0a37 mg/L VOC 7873 ,method#
Total Ammonia 00610 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 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 - - - . - - - -cr•,is true,accurate and complete,and that the laboratory analyticardata was produced using approved methods of analysis by a '
C...- . -. mere are s'r •_ant pera ties for subn.'mrg false information including the possibility of fines and imprisonment for knowing-'riolattons
G
Permutes(or Authorized Agent)Name and Title-Please print or • I' Signal! Ittee(or A •rized Agent) (Data)
GW-59 Rev.08-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF INFORMATION
UNIT WATER RESOURCES
COMPLIANCE REPORT FORM and 1 copy to: 1617 MAIL SERVICE CENTER,RAUDoH,Ncrmsss-1e17
FACILITY INFORMATION Pie se Print Clearly or Type 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: Carolina Plantation Road TYPE OF PERMITTED OPERATION BEING MONITORED
Jacksonville. NC'" ' 28540 County onslow 0 Lagoon ❑Remediatlon:Infiltration Gallery
0 Spray Field 0 Remediation: .
Contact Person: Jeff barman Telephone#: [phone] 0 Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name:Carolina Plantation WWTP No.of wells to be sampled: 6 0 Water Source Heat Pump ElOther: underdrai ns
mom Perms
SAMPLING INFORMATION f�z, / Z FIELD ANALYSES: If WELL
WELL ID NUMBER(from Permit): 7 3 Date sample collected: j ?j O Z WAS
Well Depth: 18 ft. Well Diameter:1.25 in. pH 00400: units Temp.00010 °C DRY at
Depth to Water Level 82546: f3•S. 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 00086: check
Volume of water pumped/bailed before sampling: gallons Appearance here:❑
Samples for metals were collected unfiltered: I♦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 00615 mg/L Pb-Lead oiosi ug/L
Coliform:MF Fecal 31818 /100mL Nitrate(NO3)as N 00820 mg/L Zn-Zinc 01092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P oases mg/L
(Note: Use MPN method for highly turbid eempbs) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 mg/L Al-Aluminum 01106 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 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 o0945 mg/L Hg-Mercury 7190o ug/L Lab Report Attached? 0 Yes(1) 0 No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7573 ,method IS
Total Ammonia ooelo mg/L Mg-Magnesium o0927 mg/L ,method#
(Ammonia Nitrogen;NH,es N;Ammonia Nitrogen,Total) Mn-Manganese Dios ug/L ,method#
TKN as N 00625 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 test cf m;_no.:leJge 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
DiNR•certified laboratory 1 am snare that there are significant penalties for submitting false information including the possibility of fines and imprisonment for knowing violations.
*\\NC ' (-- c-i nc _7 / as a�
Permlttee(or Authorized Agent)Name and Title-Please print or Signature o '- ittee(or Authorized Agent) (Date
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENToF u IN INFORMATION PROCESSING UNIT WATER RESOURCES
COMPLIANCE REPORT FORM and 1 copy to: 1817 MAIL SERVICE CENTERRALEIGH,NC2789`1817
FACILITY INFORMATION Please Print Clearly orType PERMT Number:wp0033770 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 ElLagoon ElRemediation:Infiltration Gallery
❑ Spray Field ❑Remediation: r.
Contact Person: Jeff Jarman Telephone#: [phone] 0 Rotary Distributor ❑land Application of Sludge
Well Location/Site Name:Carolina Plantation wWTP No.of wells to be sampled: 6 0 Water Source Heat Pump fl Other underdrai ns
Permit)
SAMPLING INFORMATION ) If WELL
WELL ID NUMBER(from Pemllt): Pz Z Date sample collected: /3c> 2.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 82548: time of
�•`� ft.below measuring point Screened Interval: 15 ft. to_ft. Spec.Cond.00094: 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:D
Samples for metals were collected unfiltered: Mil 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 00615 mg/L Pb-Lead°lost ug&
Coliform:MF Fecal 31818 /100mL Nitrate(NO3)as N 00620 mg/L Zn-Zinc 01092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P owes mg/L
(Note. Use MPN method for highly bawd samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 mg/L Al-Aluminum of 10s mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC ooeeo mg/L Ca-Calcium owe mg/L
Chloride oo940 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) ❑ No(0)
Specific Conductance 00095 NMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia oosio mg/L Mg-Magnesium 00927 mg/L ,method#
(Amnon®Nitrogen;NH,as N;Ammonia Nitrogen.Total) Mn-Manganese°loss ug/L ,method#
TKN as N 0o625 mg/L Ni-Nickel o1oe7 ug/L ,method#
For Remediatton Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
certify that.to the best of my knowledge and belief hie nfcrmation submitted in mie reycrt is true accurate and complete'and that the laboratory analytical data was produced using approved methods of analysts c,a
;rP-certified laboratory I am aware that there are significant penalties for submitting false information including the possibility of fines and imprisonment for Knowing n:iolations
arm' __(orAuthorized Agent)Name and Title-Please print or type Signature of Per ee .r Authorized Agent) (a<te)
GW 59 Rev.06-07-2018 (, '

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF RiJINFORMATI TAL OF WATER RESOURCES
ON PROCESSING UNIT
COMPLIANCE REPORT FORM and 1 copy to: 1617 MAIL.SERVICE CENTERwuEIGH,NC21ess-1et7
FACILITY INFORMATION Please Print Clearly or Type 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 na Plantation Road TYPE OF PERMITTED OPERATION BEING MONITORED
Jacksonville. we'. ' 28540 County onslow 0 Lagoon ElRemediation:Infiltration Gallery
iGry.
El Spray Field 0 Remediation: it
Contact Person: Jeff Jarman Telephone#: [phone] ❑ Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name:Carol i na Plantation wwrP No.of wells to be sampled: 6 CIWater Source Heat Pump fl Other: underdrai ns
(from Puna)
SAMPLING INFORMATION P.Z. f WELL
WELL ID NURSER(from Permit): T / /Date sample collected: 3 r 5 - - FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1.25 in. pH 00400: units Temp.coma. °C DRY at
Depth to Water Level 82546: /0•3 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:❑
Samples for metals were collected unfiltered: I®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 00335 mg/L Nitrite(NO2)as N oasis mg/L Pb-Lead 01051 ugh..
Conform: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 00665 mg/L
(Note. Use MPN method for highly turbid samples) Orthophosphate mg/L (Specify 70507 g/ Other Compounds and Concentration Units):
Dissolved Solids:Total 70300 mg/L Al-Aluminum oiios mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 0oseo mg/L Ca-Calcium 00918 mg/L
Chloride cow mg/L Cd-Cadmium 01027 ug/L
Arsenic oi002 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 N.ATTACH LAB REPORT.)
Sulfate coats mg/L Hg-Mercury 71900 ug/L Lab Report Attached? 0 Yes(1) 0 No(0)
Specific Conductance 00095 Athos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia ooeio mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen;NH3 as N;Ammonia Nitrogen,Total) Mn-Manganese Dross ug/L ,method#
TKN as N 0oe s 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 Rernoval%
I certify that,to the best of my knowledge and belief,the nferrraton submitted in this report is true accurate and cor^plate.and that the laboratory analytical data was produced using approved methods of analysis by a
DWR-cerrtrfred laboratory. I am awa-\re
there are si can:penaltiesimprisonment for submitting false information,including the possibility of fines and imprisonme'for knowing iriolations
Permittee(or Authorized Agent)Name and Title-Please print or type Signature of Per, ,.- . Authorized Agent) (Date
GW-59 Rev.06-07-2018