WQ0033770_Monitoring - 04-2022_20220627

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVA{ONMENTAL album-DIV.OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 27490-11117
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
iacksonville. NC`' 28540 County onslow ❑ Lagoon 0 Remedtation:Infiltration Gallery
Jeff Jarman 910-330 8167 0 Spray Field 0 Remediation:
Contact Person: r
Telephone#: 0 Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name:carol i na Plantation wwrP No.of wells to be sampled: 6 0 Water Source Heat Pump ID Other: Underdrai ns
(mom Parma)
SAMPLING INFORMATION f� / If WELL
WELL ID NUMBER(from Permit): 7 Z 4P Date sample collected: y43/Z'� FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1.25 in. pH 00400: units Temp.000to. °C DRY at
Depth to Water Level 82546: 15 time of
pt �, ft.below measuring point Screened Interval: ft. to _ft. Spec.Cond.00094: Mhos sampling,
Measuring Point is 2 ft.above land surface Relative M.P. Elevation: ft. Odor 000as: check
Volume of water pumped/bailed before sampling: gallons Appearance here:r-1
Samples for metals were collected unfiltered: I♦YES 0 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 ooet5 mg/L Pb-Lead o1os1 ug/L
Coliform:MF Fecal 31ete /100mL Nitrate(NO3)as N 00e20 mg/L Zn-Zinc 01092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P 00665 mg/L 'y/.(f k / _ -)
(Note. Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and ConcentrationUnits): -�
7issolved Solids:Total 70300 mg/L Al-Aluminum o1105 mg/L } 2 ,q 2.029
pH(Lab)00403 units Ba-Barium 01007 ug/L /
TOC 00880 mg/L Ca-Calcium owe mg/L
Chloride 0094o mg/L Cd-Cadmium 01027 ug/L
Arsenic ot0o2 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 oo945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? 0 Yes(1) 0 No(0)
Specific Conductance 00095 itMhos K-Potassium 00937 mg/L VOC 7873 ,method# KH
a
Total Ammonia ooeio mg/L Mg-Magnesium 00927 mg/L ,method#
(AmmoniaMtr
ogerK NH,as N;Ammonia Nitrogen,Total) 2
Mn-Manganese 01055 ug/L ,method# J[7N �[�%
TKN as N 00625 mg/L Ni-Nickel 01067 ug/L ,method#
For Remediatlon Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I cerhfy that.to the best of my knowledge and belief,the Information submitted in this report is true accurate,and complete,and that the ..:o-atory analytical data was produced using appro.ed methods of analysis by a
DWp'ce't fled laboratory I am aware that there are sigtificant penalties for submitting false information including the possibility of fines.a J imprisonment for knowing violations.
Pennittee(or Authorized Agent)Name and Title-Please print or pe t3 '
Signature of P- •--(or Authorized Agent) (per)
GW-59 Rev.06-07-2018 j
t--

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONM9(TALQUALITY-DN.OFWATERRESOURCES
GROUNDWATER QUALITY MONITORING:
and 1 copy to: INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1817 MAIL SERVICE CENTER,RALEIGH,NC 27699.1817
FACILITY INFORMATION Please Pnnt Clearly orType 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 D Lagoon 0 Remediation:Infiltration Gallery
i Stater
❑ Spray Field 0 Remediation: r.
Contact Person: Jeff Jarman Telephone#: [phone] El Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name:Carol i na P1 antati on min? No.of wells to be sampled: 6 El Water Source Heat Pump fl Other: underdrai nsmin?
(from Pwmi)
SAMPLING INFORMATION ,./ If WELL
WELL ID NUMBER(from Permit): S Date sample collected: 7/Z 3/2..7„. FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1.25 in. pH ooaoo: units Temp.00010. °C DRY at
Depth to Water Level a254e: /fir Coft.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 0 NO and field acidified: E 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 oio51
Coliform:MF Fecal 31616 /100mL Nitrate(NO3)as N 0062o mg/L Zn-Zinc 01092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P 00665 mg/L
(Note: Use MPN method for Nighty turbid samples) Orthophosphate 70507 mg/L Other(Sp
ecify 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 rng/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 uglL (Specify test and method#.ATTACH LAB REPORT.)
Sulfate o0945 mg/L Hg-Mercury 7190o uglL Lab Report Attached? 0 Yes(1) 0 No(0)
Specific Conductance 00095 µMhos 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 00625 mg/L Ni-Nickel o1oe7 uglL ,method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I certify that.to • - - -• • - UOe laboratory anatyticandata was produced using appro._d methods of anays,s by a
DNR-certified lab jro, ,am a,iare that
t, r-a ,i ;'hccaant pena<es tiiiii sS..' • - ' _ >. ". '' as and imprisonment for knowing violations
`
Permittee(or Authorized Agent)Name and Tide-Please print or type Signature of rm (or Authorized Agent) (Datel
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF ENvmottei emu.QUaury-b/.OFWATERRESOURCES
COMPLIANCE REPORT FORM and 1 copy to: 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617
FACILITY INFORMATION Please Print Creamy orType PERMIT Number:wQ0033770 Expiration Date: U/31/2026
Facility Name: Carolina Plantation Non-Discharge UIC
Permit Name(if different): NPDES Other Infiltration System
Facility Address: caroling Plantation Road TYPE OF PERMITTED OPERATION BEING MONITORED
iacksonvi11e. Nt`"fe`mt 28540 onslow
County 0 Lagoon ❑Remediation:Infiltration Gallery
(state)
❑ Spray Field 0 Remediation:
Contact Person: Jeff Jarman Telephone#: [phone] vosir
0 Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name:carol i na Plantation wrap No.of wells to be sampled: 6 0 Water Source Heat Pump 0 Other underdrai ns
(from Permr
SAMPLING INFORMATION /l If WELL
WELL ID NUMBER(from Permit): L
y Date sample collected: (l Zs Z Z FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:3.25 in. pH 00400: units Temp.00010: °C DRY at
Depth to Water Level 82548:(5• $ 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 avow: check
Volume of water pumped/bailed before sampling: gallons Appearance herein
Samples for metals were collected unfiltered: MI 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 00615 mg/L Pb-Lead oios1 ug/L
Coliform:MF Fecal 31618 /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 turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units).
dissolved Solids:Total 70300 mg/L Al-Aluminum o11o5 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC 00880 mg/L Ca-Calcium 00916 mg/L
Chloride 00940 mg/L Cd-Cadmium 01027 ug/L
Arsenic oieo2 ug/L Chromium:Total 01034 ug/L
Grease and Oils aos52 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 7190o ug/L Lab Report Attached? 0 Yes(1) 0 No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia 00610 mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen;NH,asN;Ammonia Nitrogen,Total) Mn-Manganese o1os5 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: m g/L Effluent Total VOCs: mg/L VOC Removal%
I certify that,to the best of my knowledge and belief,the infci n.-• • -ite and complete,and that the laboratory analytical data was produced using approved methods of analysis by a
DWR-certified laboratory. lam aware that there are significant per • -- - - .;ling the possibility of fines and imprisonment for knowing violations
• \Nr \ \ i ' 0-A- t► ��(..._ _A�� �a i
=ermittee(or Authorized Agent)Name and Title-Please print or •- MP Signature of Permittee(• Apen t (Date)
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF ENVIRONMENTAL QIJAUTt'-DIV.OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING: and 1 copy to: INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1817 MAIL SERVICE CENTER RALEJGH,NC 27689-1617
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number:w00033770 Expiration Date: J2/31/2026
Facility Name: Carolina 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
0 Spray Field 0 Remediation: .or
Contact Person: Jeff Jarman Telephone#: [phone] ❑ Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name:Carol ina Plantation WWTP No.of wells to be sampled: 6 0 Water Source Heat Pump El Other underdrai ns
(mom Penn)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): 1Z 3 Date sample collected: y/4.T /Z 2•• FIELD ANALYSES: WAS
Well Depth: 18 R. Well Diameter:1.25 in. pH 00400: units Temp.o001o. °C DRY at
time of
Depth to Water Level 82s46: j Z ft.below measuring point Screened Interval: 15 f. to _ft. Spec.Cond.00094: MMhos sampling,
pl g,
Measuring Point is 2 R.above land surface Relative M.P.Elevation: ft. Odor o0065 check
Volume of water pumped/bailed before sampling: gallons Appearance here❑
Samples for metals were collected unfiltered: ®YES ❑ NO and field acidified: MI 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 o1051 ug/L
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 00665 mg/L
(Note: Use MPN method tor highly turbid samplee) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 7030o mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 units Ba-Barium 01007 ug/L
TOC ooeeo mg/L Ca-Calcium 0091e mg/L
Chloride oo94o mg/L Cd-Cadmium 01027 ug/L
Arsenic 01002 ug/L Chromium:Total 01034 ug/L
Grease and Oils 0os52 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 00945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) 0 No(0)
Specific Conductance 00095 I+Mhos K-Potassium 00937 mg/L VOC 7873 .method# _
Total Ammonia ooeio mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nitrogen;NN,ae N;Ammonia Nitrogen.Total) Mn-Manganese close ug/L ,method#
TKN as N 0o62s mg/L Ni-Nickel 01067 ug/L ,method#
For Remedlatton Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
I certify that to:he best of my knowledge and belief the.information submitted ul this report is true accurate.and complete.and that the laboratory analytical data was produced using approved methods of analysis by a
DWP-certried laboratory I am aware that there are significant penalties for submitting false information including the possibility of fines and imprisonment for l.nowrng violations
Permittee(or Authorized Agent)Name and Title-Please print or type l, Signature of Perini (er uthonzed Age ) (a-
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF ENVIRONMENTAL OF WATER RESOURCES
COMPLIANCE REPORT FORM and 1 copy to: TION PROCESSING UNIT
1617 MAIL SERVICE CENTER.RALEIGM,NC27699-1617
FACILITY INFORMATION Please Print Clearly orType PERMIT Number:wo0033770 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 ❑ Lagoon C]Remediation:Infiltration Gallery
tCry) rz.rp,
0 Spray Field 0 Remediation: ____—,,-
Contact Person: Jeff Jarman Telephone#: [phone] 0 Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name:carol i na Plantation WTP No.of wells to be sampled: 6 0 Water Source Heat Pump Li Other: under drai ns
tom FL"'ul
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Perrnk►: 13Z Z Date sample collected: • Z3 /2 Z FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:l.25 in. pH 00400: units Temp.00010 °C DRY at
Depth to Water Level 82546: /Ga,( ft. below measuring point Screened Interval: 15 ft. to ft. Spec.Cond.00094: I M
hos time of
sampling,
Measuring Point is 2 ft.above land surface Relative M.P.Elevation: ft. Odor 000ee: check
Volume of water pumped/bailed before sampling: gallons Appearance here:0
Samples for metals were collected unfiltered: IIn 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 oo335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead oiosi uflit-
Cohfomt MF Fecal 31616 /100mL Nitrate(NO3)as N 00820 mg/L Zn-Zinc 01092 mg/L
Colform:MF Total 31504 /100mL Phosphorus:Total as P 00885 mg/L
(Note: Use MPN method for highly turbid eamplee) 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 oosie mg/L
Chloride 00940 rng/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 C0945 mg/L Hg-Mercury 71600 ug/L Lab Report Attached? 0 Yes(1) 0 No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 ,method#
Total Ammonia ooelo mg/L Mg-Magnesium 00927 mg/L ,method#
(Ammonia Nltroperr,NHses N:Ammonia Nitrogen,Total) Mn-Manganese o1055 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%
icertify that.:, •:st of my knowledge and be '•m submitted ur this report is true accurate,and complete.and that the laboratory analytical data was produced using approved methods of anal,sa b1
DWR-certified ;'rr; I am aware =t there are; enalfies for s:r'r'!' ''I','.' ,'1.•.'1'•"" ' .'',,the possibility of fines and imprisonment for knowing violations
r \C .— ) '` ``\—Nac\Q /-2
or AuthorizedAgent)Name and Title-Please print or t11pe Fe Signature of Perm or A orized Agent ( )
PermiNee(
GW-59 Rev.06-07-2018

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF ENVIRONMENTAL QUALITY-DIV.OF WATER RESOURCES
and 1 copy to: INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1817 MAIL SERVICE CENTER,RALEIGH,NC 278e9-1817
FACILITY INFORMATION Please Print Clearly or Type PERMIT 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''£" 28540 County 0ns1ow ❑ Lagoon 0 Remediation: Infiltration Gallery
0 Spray Field ❑Remediation:
Contact Person: Jeff Jarman 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 Other: underdrains
tram Prrri
SAMPLING INFORMATION If WELL
WELL ID NUMBER(fro Peit): `1/�
m mt L,- / Date sample collected: 3 Z FIELD ANALYSES: WAS
Well Depth: 18 ft. Well Diameter:1.25 in. pH 00400. units Temp.°polo °C DRY at
time of
Depth to Water Level e2548: f/ ft.below measuring point Screened Interval: 15 ft. to ft. Spec.Cond.00094: OA hossampling,
Measuring Point is 2 ft.above land surface Relative M.P.Elevation: ft. Odor tx 085 check
Volume of water pumped/bailed before sampling: gallons Appearance here:
Samples for metals were collected unfiltered: II 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 oiosi ug/L
Coliform:MF Fecal 31818 /100mL Nitrate(NO3)as N 00620 mg/L Zn-Zinc o1092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P oases mg/L
(Note: Use MPN method for highs turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 7030o mg/L Al-Aluminum 01105 mg/L
pH(Lab)00403 units Ba-Barium o1007 ug/L
TOC ooeeo mg/L Ca-Calcium°ogle mg/L
Chloride 00940 mg/L Cd-Cadmium 01027 ug/L
Arsenic olooz 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 o0095 µMhos 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,Total) Mn-Manganese°loss ug/L ,method#
TKN as N o0625 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./that :o the best of my knowledge and belief.the information submitted in this report is tire,accurate,and complete and that the laboratory analytical data was produced using approved methods of analysis by a
DVVP-certified laboratory I am ae.are that there are sign frcant penalties for subrm,tr::m f;is -formation including the possibility'of fines and imprisonment for knowing violations
;\;- .c\ �=(\ r ;r(--)L_\.c `. Lt V . : 4 Z. - a a.
Permittee(or Authorized Agent)Name and Title-Please print or ty.. Signature of P •-(or Authorized Agent) (• -1
GW-59 Rev.06-07-2018 /