WQ0007144_Monitoring - 03-2024_20240425 (2)

Monitoring Report Submittal
.....................................................
Permit Number#* WQ0007144
Name of Facility:* Camp Seafarer
Month: * March
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
G W-59
Confirmation Email Address: *
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2024
Upload Document*
Non Discharge Reports March 2024.pdf 202.35KB
PDF Only
Monitoring Well Reports March 2024.pdf 318KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Stanley Eudy
CStarl�%6 5;1 W%
4/25/2024
This will be filled in automatically

Reviewer: Wanda.Gerald
Is the project number correct?* WQ0007144
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Reviewer:
Review Date:

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: DEPARTMENT OF ENVIRONMENTAL QUALITY- DIV.OF WATER RESOURCES
INFORMATION 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: Camp Seafarer
Non -Discharge W00007144 UIC
Permit Name (if different): YMCA of the Triangle Area, INC. NPDES Other
Facility Address: 2744 Seafarer Rd Arapahoe NC 28510 TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe IstreegNC 28510
County Pamlico X Lagoon ❑Remediation: Infiltration Gallery
rcity; s,eto, Mip; ❑ Spray Field ❑ Remediation:
Contact Person: Mike Askew Telephone#: [phone] ❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Lagoon No. of wells to be sampled: 5 ❑ Water Source Heat Pump ❑ Other:
WELL ID NUMBER from Permit): Well 2
( ) Date sample collected: 3 �a �¢
Well Depth: 20 ft. Well Diameter: 2 in.
Depth to Water Level 82546: 7.,5 ft. below measuring point Screened Interval: 10
�_ 9 P ft. to 20 ft.
Measuring Point is 1.9 ft. above land surface Relative M.P. Elevation: 24.2 ft.
Volume of water pumped/bailed before sampling: 7-A.r gallons
Samples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
FIELD ANALYSES:
pH 00400: Temp. 000lo: 16, ac
Spec. Cond. 00094: � 3 � • �" µMhos
Odor 00085: NorE
Appearance
VVMLL
IT AS
WAS
DRY at
time of
sampling,
check
here:❑
LABORATORY INFORMATION
Date sample analyzed: 3/.ZD/.2
Laboratory Name: ►NR1'j�/�T
0%N1jLrTyc6t, Certification No. /G
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/L
Pb - Lead olos1 ug1L
Coliform: MF Feca 31616 < 1100mL
Nitrate (NO3) as N 00620 C 0, 0
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P omes O. / %
mg/L
(Note: -;a MPN method for h ghly turbid samples:
4 3o
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Sol ds:Total 70300 mg/L
Al - Aluminum oil o5
mg/L
pH Lab) 00403 . units
Ba - Barium oloo7
uglL
TOC oo6ao mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 31 ,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 uglL
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
uglL
Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00065 µMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia 000lo 0- 3 S mg/L
Mg - Magnesium oo927
mg/L
method #
(Ammonia Nitrogen; NH3as N: Ammons Nitrogen, Total)
Mn - Manganese moss
ug/L
, method #
TKN as N 00625 mg/L
Ni - Nickel 01067
ug/L
method #
ror Kemeaiatlon systems Unly (Attacn Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Mike Askew, Director of Facilities and Boating Operations ° y — � zL f
Perm:ttee (or Authorized Agent) Name and Title - Please print or type Signature of Permittee (or Authorized Agent) (Date;
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
• •
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
GROUNDWATER QUALITY MONITORING:
INFORMATION PROCESSING;UNIT
COMPLIANCE REPORT FORM
• • •
•
1617MAIL SERVICE CENTER, RALEIGH,NC,27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Crearty or Type
PERMIT Number: Expiration Date:
Facility Name: Camp Seafarer
Non -Discharge WQD007144 UIC
Permit Name (if different): YMCA of the Triange Area, INC.
NPDES Other
Facility Address: 2744 Seafarer Rd Arapahoe
NC 28510
TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe s'ree'} NC 28510
County Pamlico
❑ Lagoon ❑ Remediation: Infiltration Gallery
.city) (Stato) (Zip}
,ffi Spray Field El Remediation:
Contact Person: Mike Askew
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Spray Field 3
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
(from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): WELL 5
Date sample collected: G o� g`
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
We I Diameter: 2 in,
l �1
pH o0400:A¢units Temp. 00010:0 • / °C
DRY at
Depth to Water Level ersas: 3. 2- 1 ft. below measuring point Screened Interval: 10 ft. to
20
ft. Spec. Cond. 000sa: ,SG µMhos
time of
sampling,
Measuring Point is 2.2 ft, above land surface
Relative M.P. Elevation: 27.7 ft.
Odor oco85: A101-6f
check
Volume of water pumped/bailed before sampling: 10
gallons
Appearance CL G L-D /
here: ❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
3L2401 ��
w6re&lt- r 1 G
Date sample analyzed:
Laboratory Name: C-spiNre-- � C.
! 10"—AfrT/t/3(Certification No.
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead olo51 ug1L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO3) as N 00620 0, 0 4
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P oo665 <0. p l�.
mg/L
(Note i.seMPNmethod for highly turtodsamples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 -5`/ mg/L
AI - Aluminum oi105
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 ug1L
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
uglL Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 }IMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia 00610 D. O 9" mg/L
Mg - Magnesium 00927
mg/L method #
Ammonia Nitrogen; NH3 as N Ammonia Nitro,,-,,-. Tota
Mn - Manganese oloss
ug/L , method #
TKN as N 00625 mg/L
Ni - Nicke 01067
ug1L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
GW-54 Rev.05-02-201'

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV.OFWATERRESOURCES
am
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27599-1617 Phone: [phone]
FACILITY INFORMATION Please PrrnfClearlyorType
PERMIT Number: Expiration Date:.S .3 10 2
Facility Name: Camp Seafarer
Non -Discharge W00007144 UIC
Permit Name (if different): YMCA of the Triangle Area, INC.
NPDES Other
Facility Address: 2744 Seafarer Rd Arapahoe
NC 28510
TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe (street) NC 28510
County Pamlico
El Lagoon ❑Remediation: Infiltration Gallery
(City) (steto) Mp.'
.9 Spray Field ❑ Remediation:
Contact Person: Mike Askew
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Applicat'on of Sludge
Well Location/Site Name: Spray Field 3
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
(from Permit
SAMPLING INFORMATION
J
If WELL
WELL ID NUMBER (from Permit): Well 6
Date sample collected: ,�-r
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
_J
Well Diameter: 2 in.
pH 00400: S 43 units Temp. 000lo: /3 -3 oC
DRY at
Depth to Water Level 825a6: .sg ft. below measuring point Screened Interval: 10 ft. to
�- g P
20
ft. Spec. Cond. o0osa: ,3 7, � µMhos
time of
Measuring Point is 2.75 ft. above land surface
Relative M.P. Elevation: 20.2 ft.
^
Odor 00085: NoNt
sampling,
check
Volume of water pumped/bailed before sampling: 14
gallons
Appearance C L C-6-&
he re:
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION 1
Date sample analyzed: 3; J_d � t-
LaboratoryName: Enviroment 1,INC.WJKPO/N% jj L1']-ot 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 ug/L
Coliform: MF Fecal 31616 C /100mL
Nitrate (NO3) as N 00620 p. O
mg/L Zn - Zinc 01092 m9 /L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P ooms C O • D 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 ! ld mg/L
Al -Aluminum o11os
mg/L
pH (Lab) 00403 S. Z - units
Ba - Barium 01007
ug/L
TOC 00680 mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 3o mg/L
Cd - Cadmium oio27
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 ug1L
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 00095 }tMhos
K - Potassium 00937
mg/L VOC 7873 method #
Total Ammonia 00610 1 G mg/L
Mg - Magnesium D0927
mg/L method #
(Ammonia Nitrogen; NM3as N, Ammonia Nitrogen, Total)
Mn - Manganese oio55
ug/L
, method #
TKN as N 00625 mg/L
Ni - Nickel 01067
ug1L method #
1-or Remediation systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Mike Askew, Director of Facilities and Boating Operations
Permittee :or Authorized Agent: Name and Title- Please print or type
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
•
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER'RESOURCES
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please PffrttClearlyorType
PERMIT Number: Expiration Date:
Facility Name: Camp Seafarer
Non -Discharge WQ0007144 UIC
Permit flame (if different): YMCA OF THE Triangle Area, INC.
NPDES Other
Facility Address: 2744 Seafarer Rd Arapahoe
NC 28510
TYPE OF PERMITTED OPERATION BEING MONITORED
2744 Seafarer Rd Arapahoe (S1fee1) NC 28510
County Pamlico
❑ Lagoon ❑ Remediation: Infiltration Gallery
(city) (Stale) (Zip)
❑■ Spray Field ❑ Remediation:
Contact Person: Mike Askew
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Spray Field 2
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
(from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): WELL 7
Date sample collected: 3410 101
FIELD ANALYSES:
WAS
Well Depth: 12 ft.
Well Diameter: 2 in.
pH 0000:. #D, units Temp. 000lo: eC
DRY at
Depth to Water Level 82546: •% 1 ft. below measuring point Screened Interval: 2 ft. to
12
ft. Spec. Cond. 0oo94: 67.9 µMhos
time of
Measuring Point is 1 ft. above land surface
Relative M.P. Elevation: 25.8 ft.
Odor 00085: pw-6
sampling,
check
Volume of water pumped/bailed before sampling: .gallons
Appearance C L r-
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION 1
Date sample analyzed: 3laa 1 a�
Laboratory Name: Enviroment 1 jNc.Wr rf
6/&T &- ALrT1 Mt Certification No. /D
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N oo615
mg/L Pb - Lead o1 o51 ug/L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO3) as N oo62o p , 0
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P om65 0. O ¢
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70607
mg/L Other (Specify Compounds and Concentration Units):
is�otved Solids:Total 70300 ! $� mg/L
Al - Aluminum o11o5
mg/L
pH (Lab) 00403 ,�, Z units
Ba - Barium 01007
ug/L
TOC 0oseo mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 0 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug1L
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) ❑ No (0)
Specific Conductance 0009s µMhos
K - Potassium 00937
mg/L VOC 7673 method #
Total Ammonia 00610 Q• mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NHs as N: Ammonla Nitrogen, Total)
Mn -Manganese o1055
uglL
,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%
Mike Askew, Director of Facilities and Boating Operations
Permittee (or Authorized Agent) Name and Title - Please print or type
GW 59 Rev. 05-02-2017

SUBMIT FORM ON YFI I QW PAPER ONLY
norm
GROUNDWATER QUALITY MONITORING: �e �•
COMPLIANCE REPORT FORM
E9J ICY INFORMATION Please Print Clearly or Type
Facility Name: Camp Seafarer
Permit Name (if different): YMCA of the Triangle Area, INC.
Facility Address: 2744 Seafarer Rd
Arapahoe NC 28510 County Pamlico
Contact Person: Mike Askew Telephone#:[phone]
Well Location/Site Name: Spray Field 2 No. of wells to be sampled: 5
from Permit)
a
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
ISION OF WATER QUALITY4NFORMATION PROCESSING U141T
617 MAIL SERVICE CENTER, RAL'EIGH, NC 27699.1617 Phone: [phone]
PERMIT Number: Expiration Dates
g 1R/ d U 0 r% �q- UIC
Non-Dischar e Q
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:
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): Well 8
Date sample collected:.3 40 a I-
FIELD ANALYSES:
17' 6
IWAS
Well Depth: 12 ft.
Well Diameter: 2 in.
pH .S• O 3 units Temp. eC
DRY at
Depth to Water Level: .1 Y ft. below measur ng point
Screened Interval: 2 ft. to
12 ft. Spec. Cond. 3 T. 7 µ Mhos
time of
sampling,
Measuring Pant is 1 ft. above land surface
Relative M.P. Elevation: 15.3 ft.
Odor NU f-[
check
Volume of water pumped/bailed before sampling:
ga ions
Appearance CLa r, p
here: ❑
Samples for metals were collected unfiltered: DYES ❑
NO and fie d acidifed: ❑ YES ❑ NO
Lr4BORATORY INFORMATION
Date sample analyzed: 3/2-a1a �•
LaboratoryName: Etyirorm7Cf ,
Inc. Wi!y Polhr Certification No. G _
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/I
Co iform: MF Fecal /100m1
Nitrate (NO3) as N C O. Q mg/l
Zn - Zinc mg/I
Col form. MF Total /100ml
Phosphorus: Total as P _ < O • 0 4- mg/1
(Note. Use MPN method for highly turbid samplesi
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total / 7 mg/1
At - Aluminum
mg/I
pH (when analyzed) • 8 _units
Ba - Barium
mg/I
TOC mg/I
Ca - Calcium
mg/l
/ r-�
Chloride 1 ! mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/l
Grease and Oils mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/l
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate mg/I
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance uMhos
K - Potassium
mgll
VOC method #
Total Ammonia 0. d 7 mg/I
Mg - Magnesium
mg/1
method #
(Ammonia Nitrogen. NH�as N Ammonia Nitrogen. Total)
Mn - Manganese•
mg/I
,method #
TKN as N mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Mike Askew, Director of Facilities and Boating Operations
Permthee (or Authorized Agent) Name and Tifle - Please print or type
GW-59 Rev.112007

GW-59A COMPLIANCE REPORT FORM Permit # 1N 9 006 7/ 14
(Submit one each monitoring.period with GIV--59 forn+s.)
1
Enter date monitoring results were due. ( ) Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
2
Was any required information missing on the GW-59 report forms?
YES
1F the answer to question 1 or 2 is 'YES", list in the space provided below the well identification number(s) 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 Officefor guidance.
4
Are any monitored constituents equal to or above the established standards?
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:
3" 4.o I— PH 1-' 4 1-
M/►r l# G LaF- PH sf3
nil 04 PH 5.c 3
5
For the constituents identified in question 4 above, have standards been. exceeded previously for the
XE
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) re orted, n sample c llection date for each occurrence (for the last two years),
w ct Lc+rPH l� �3, �d31 1,2/.Z
l L # 6 Low- Pig 1.� 1.1 , ¢/�3 2/d2 7/a
>^-tt.c f� 7 Boa"• PH Iz113 � 1z��.z
H c>, Ptl /J/231 14Va.,
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
DK
If the answer is "YES", a groundwater qualityproblem 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
Nfl-
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 'WO" contact the Regional Office within 90 days: an evaluation may be
required to determine the Impact the waste 9is osal 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,
fines, andlor penalties. PEPG(� 7-t-1) Lot— J /— MGN / %ORC I A-G
wet-etToV I C �16 HrAb 1 a� tr7L wfjJ'N: �-Gro�
��r`G1at�i� oFFiCC
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.
-2" 1/13 -�+
Signature of Permittee (or Authorized Agent) Date
PEN
GW-59A 12/8/2003