WQ0007144_Monitoring - 07-2024_20240822 (2)

Monitoring Report Submittal
.....................................................
Permit Number#* WQ0007144
Name of Facility:* Camp Seafarer
Month: * July
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 July 2024.pdf 189.16KB
PDF Only
Monitoring Well Reports July 2024.pdf 354.55KB
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
8/22/2024
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: _anonymous
Review Date: 8/22/2024

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Print Cleady or
=acility Name: Camp Seafarer
permit Name (if different): YMCA of the Triangle Area, INC.
=agility Address: 2744 Seafarer Rd Arapahoe NC 28510
27" Seafarer Rd Arapahoe ssveegN C 28510 County Pamlico
(Stmo)
act Person: Mike Askew
Location/Site Name: Lagoon
Telephone#: [phone]
No. of wells to be sampled: 5
DEPARTMENT OF ENVIRONMENTAL QUALITY- DIV. OF WATER RESOURCES
INFORMATION PROCESSING UNIT
17 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
:RMIT Number: Expiration Date: / z
in -Discharge W00007144 UIC
)DES Other
'PE OF PERMITTED OPERATION BEING MONITORED
M Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
V11taT Vl1YV 9114 vr%wtM l 1%J tV n
WELL 1D NUMBER (from Permit): Well 2 Date sample collected: //Z� -Z `f -
ll Depth: 20 fL Well Diameter: 2 in.
Depth to Water Level 82546: ft. below measuring point Screened Interval: 10 ft. to 20 ft.
MeasuringPoint is 1.9 ft. above land surface Relative M.P. Elevation: 24.2 ft.
Volume of water pumped/bailed before sampling: -p%ZJ gallons
Samples for metals were collected unfiltered: ❑ YES ❑ NO and field acidified: ❑ YES ❑ NO
FIELD ANALYSES:
pH 004o0: 6 -Nnits Temp. 000lo: / 9' °C
Spec. Cond. 00094: /-2 7. 9 µMhos
r
Odor o0oa5: /Uo/ L-
Appearance C
if WELL
WAS
DRY at
time of
sampling,
check
here:❑
LABORATORY INFORMATION
Date sample analyzed: 7/2 ���.�
Rr D / _
Laboratory Name: W 1 Mj 19 N���%/ SIG% Certification No. 0
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N oom5
mg/L
Pb - Lead o1o51 ug1L
Coliform: MF Fecal 31616 < /100mL
Nitrate (NO3) as N 00620 a mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 O ..� 9
mg/L
(Note: use MPNmethodfor htghtyturbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total7030o T O mg/L
AI- Aluminum o11o5
nrl
pH (Lab) 00403 �. 7 units
Ba - Barium 01007
ug/L
TOC oo6e0 mg/L
Ca - Calcium oo916
mg/L
Chloride oo94o mg/L
Cd - Cadmium o1o27
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 oo945 -mg/L
Hg - Mercury 71soo
ug/L
Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 0009s i.tMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia ooslo C 0. D 2 mg/L
Mg - Magnesium oo927
mg/L
, method #
(Ammonia Nitrogen: NH3as N: An=nla Nilrcgen. Totai)
Mn - Manganese o1os5
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%
M ke Askew, Director of Facilities and Boating Operations ��
a�1
Permit ee or Authorized Agent) Name and Title - Please print or type Sijndlure of Permittee (or Authorized Agent) (Date) -
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
MEN
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: S 13
Facility Name: Camp Seafarer
Non -Discharge WQ0007144 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 El Remediation: Infiltration Gallery
(Cifyj (Slelu! (Zip)
Xf Spray Field ❑ 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:
horn Perm
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): WELL 5
Date sample collected: 7/2
!�
¢ oZ T
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH oo toolLI-Junits Temp. 000lo: -Z C
DRY at
Depth to Water Level 82546: C. 3 3 ft. below measuring point Screened Interval: 10 ft.
to 20 ft.
Spec. Cond. 000sa: � Mhos
14- 3 µ
time of
sampling,
Measuring Point is 2.2 ft. above land surfarcce
Relative M.P. Elevation: 27.7
ft.
Odor 00085: /✓ D 14--
check
Volume of water pumped/bailed before sampling: / - LA, gallons
Appearance LcD/SfI -_
here:❑
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
7/a �
v11' ' d
Date sample analyzed:
LaboratoryName: Ernvirerrtertf E,Ift-
Nr
1T-Certification No.
f
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N oo815
mg/L
Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 <z- i /100mL
Nitrate (NO3) as N 00620 - d 0 mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
�7
Phosphorus: Total as P 00665 V - r k mg/L
��
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 ._s mg/L
AI - Aluminum 01105
mg/L
pH (Lab) 00403 7 units
Ba - Barium 01007
ug/L
TOC oo6eo mg/L
Ca - Calcium oo916
mg/L
Chloride 00940 . 3 mg/L
Cd - Cadmium 01027
ug/L
Arsenic oloo2 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) ❑ No (0)
pecific Conductance 000gs µMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia 00610 <,- D . d z mg/L
Mg - Magnesium oo927
mg/L
method #
(Ammonia Nitrogen; NHyas N; Ammonia Nitrogen, T.w)
Mn - Manganese moss
ug/L
, method #
TKN as N 00625 mg/L
Ni - Nickel o1o67
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 jor Authorized Agent) Name and Title - Please print or type
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
t-AWLIIY INt-ORMATION. measernnrcteanyorType
Facility Name: Camp Seafarer
Permit Name (if different): YMCA of the Triangle Area, INC.
Facility Address: 2744 Seafarer Rd Arapahoe NC 28510
2744 Seafarer Rd Arapahoe (Sifom) NC 28510
County Pamlico
rarvi ­ 1
Contact Person: Mike Askew Telephone#: [phone]
Well Location/Site Name: Spray Field 3 No. of wells to be sampled: 5
DEPARTMENT OFENVIRONMENTAL QUALITY - DIV. OF WATERTRESOURCES
INFORMATION PROCESSING UNIT
1617 MAIL SERVICE'CENTER, RALEIGH, NC:27699-1617 Phone: 919 07=6306
PERMIT Number: Expiration Date: ,Z
Non -Discharge W00007144 UIC
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:
VIIYy 11YrVRlY1/'111V1Y
WELL ID NUMBER (from Permit): Well 6
Date sample 7 a
collected:
/
FIELD ANALYSES:
Well Depth: 20 ft.
Well Diameter: 2
in,
pH 00400: .76units Temp. 000lo: 23 •-/ °C
Depth to Water Level 82546: G.17ft. below measuring point Screened Interval: 10
ft. to 20 ft,
Spec. Cord. 00094: 3,S, 3 µMhos
Measuring Point is 2.75 ft. above land surface
Relative M.P. Elevation: 20.2
ft,
Odor 000as: O A- e
Volume of water pumped/bailed before sampling: I G
gallons
Appearance CL C' `'DY
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: q4o- � �'
Laboratory Name: �.
Wf�%�PD��`
_
Certification No. % G
PARAMETERS NOTE: Values should refl ct dissolved
and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N oo615
mg/L
Pb - Lead o1os1 ug/L
Coliform: MF Fecal 31616 &7 /100mL
Nitrate (NO3) as N 00620 0e D mg/L
Zn - Zinc 01092
mg/L
Coliform: MF Total 31504 1100mL
Phosphorus: Total as P oo6e5 Q .
3 mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total70300 IS& mg/L
Al - Aluminum oil o5
mg/L
pH (Lab) 00403 .0 units
Ba - Barium 01007
ug/L
TOC oo68o mg/L
Ca - Calcium oo916
mg/L
Chloride 00940! e mg/L
Cd - Cadmium olo27
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 uglL
Fe - Iron 01045
ug1L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
ug/L
Lab Report Attached? ❑ Yes(l) ❑ No(0)
Specific Conductance 0009s µMhos
Total Ammonia oo61a < 0.0 2-
K - Potassium 00937
mg/L
VOC 7873 method #
mg/L
(Ammonia Nitrogen; NH�as N: Ammonia Nitrogen, Total)
Mg - Magnesium oo927
mg/L
method #
Mn - Manganese olo5s
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%
129
M'ke Askew, Director of Faci.ities and Boating Operat'ons
Permittee :or Authorized Agent) Name and Tttie - Please print or type
a
S'gnature of Pemtittea (or Authorized Agent) ate)
GW-59 Rev.05-02-2017
DRY at
time of
here: El

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
DEPARTMENT OF ENVIRONMENTAL QUALITY - DIV. OF WATER RESOURCES
INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
i617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or7ype
PERMIT Number: Expiration Date: 3 13
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
❑Lagoon ❑Remediation: Irfiltration Gallery
(City) (Stale) (tip)
❑A Spray Field ❑Remediation:
Contact Person: Mike Askew
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Applicaton of Sludge
Well Location/Site Name: Spray Field 2
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other
(from Perm t)
SAMPLING INFORMATION
f
If WELL
WELL ID NUMBER (from Permit): WELL 7
d d
Date sample collected: 7 7 ! -z 1
FIELD ANALYSES:
WAS
Well Depth: 12 ft.
Well Diameter: 2 in.
pH o0400..5•Sgunits Temp. 000lo: 1 �• 6 °C
DRY at
Depth to Water Level 82546: 10, 5 ft. below measuring point Screened Interval: 2 ft. to
12 ft.
Spec. Cond. 00094: ,�(3. D µMhos
time of
Measuring Point is 1 ft. above land surface
Relative M.P. Elevation: 25.8 ft.
Odor 00085: /lam 0 NE
sampling,
check
Volume of water pumped/bailed before sampling: 3 — UR(Y gallons
Appearance CL t-?�
here:
Samples for metals were collected unfiltered: ❑ YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
7I2¢ f Q
I
p
WAl 7
Date sample analyzed: l f
Laboratory Name: ertvi�.
r0lt-�
Certification No. %d
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N oosi5
mg/L
Pb - Lead oio5i ug/L
Coliform: MF Fecal 31616 C /100mL
Nitrate (NO3) as N 00620 0. O SQ
mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P ooss5 d. 1 1
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
issolved Solids:Total 70300 22 O mg/L
Al -Aluminum oiios
mg/L
pH (Lab) 00403 -S• units
Be - Barium 01007
ug/L
TOC oo68o mg/L
Ca - Calcium oo91s
mg/L
Chloride 00940 371 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
Grease and Oils 00552 mgfL
Cu - Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron o1o4s
uglL
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mgfL
Hg - Mercury 71900
uglL
Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 FLMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia 00610 C 0. O Z mg,'L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; NHjas N; Ammonia Nitrogen, Total)
Mn - Manganese o1o55
ug1L
, method #
TKN as N 00625 mg/L
Ni - N eke] 01067
ug1L
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
Permlttee ;or Authorized Agent',. Name and Title- Please punt or type
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
t.DEPARTMENTOF ENVIRONMENT6. NATURAL RESOURCES GROUNDWATER QUALITY MONITORING: SION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 7 MAIL SERVICE CENTER, RALEIGH, NC 27699A617 Phone: [phone]
FACILITY INFORMATION Please Print C1eaAy or Type PERMIT Number: Expiration Dater 3
Facility Name: Camp Seafarer Non -Discharge WQ000 9/Q-A- UIC
Permit Name (if different): YMCA of the Triangle Area, INC. NPDES Other
Facility Address: 2744 Seafarer Rd TYPE OF PERMITTED OPERATION BEING MONITORED
Arapahoe NC 2a510 County Pamlico ❑ Lagoon © Remediation: Infiltration Gallery
y. u © Spray Field ❑ Remediation:
Contact Person: Mike Askew Telephone#: [phone] ❑ Rotary D'str'bt for ❑ Land Application of Sludge
Well Location/Site Name: Spray Field 2 No. of wells to be sampled: 5 ❑ Water Source Heat Pump ❑ Other:
SAMPLING INFORMATION ���1/
WELL ID NUMBER (from Permit): Well 8 Date sample collected: 244Z4-
Well Depth: 12 ft. Well Diameter: 2 in.
Depth to Water Level: ft. below measuring point Screened Interval: 2 ft. to 12 ft.
Measuring Point is 1 ft. above land surface Relative M.P. Elevation: 15.3 ft.
Volume of water pumped/bailed before sampling: 2 ` DP j gallons
Samples for metals were collected unfiltered: DYES ❑ NO and field acidified: ❑ YES ❑ NO
FIELD ANALYSES:
pH f e units Temp. z — DC
Spec, Cond, > 2 µMhos
Odor MO �L-LC
Appearance CL
If WELL
AS
rDRYat
e of
'sampling,
check
here:
LABORATORY INFORMATION
Date sample analyzed: 7zl¢��¢-
Laboratory Name:
C. YV r 1N% Certification No. 0
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mgll
Coliform: MF Fecal /100ml
Nitrate (NO3) as N O , {} O
mg/I
Zn - Zinc mgll
Coliform: MF Total C /100m1
is
Phosphorus: Total as P 0. is
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total 220 mg/I
Al - Aluminum
mgri
pH (when analyzed) S. units
Ba - Barium
mg/I
TOC mg/1
Ca - Calcium
mg/I
Chloride %.S. J mg/l
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/l
Grease and Oils mgli
Cu - Copper
mg/l
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
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 µMhos
K - Potassium
mg/1
VOC method #
Total Ammonia mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nirogen: NHjas N: Ammonia Nitrogen, Total)
Mn -Manganese•
mg/l
,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%
GW-59 Rev.1/2007

GW-59A COMPLIANCE REPORT FORM Permit # WQ O oa 7/44-
(Submit one each monitoring period with GIV--59 forms.)
Enter date monitoring results were due. ) Will this monitoring report (GIN-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 bW
IF 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 N
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional Qjfice for 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 B.
If the answer to question rf is "YES" list the affected wells individually with constituent(s) and concentrations)
exceeding standards in the s ace rovided below.
PF s 'J., v_ PW 9
� 6 ,� o — P/a 4 -
9
7 L LG Pal S,.74
+- T
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES NO
same constituent(s) In the same well(s) in the last two years?
If the answer to question 5 is `NO" skip to section B.
if the answer to question 5 Is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) report d, ands mple collec on date for each occurrence (for the last two years).
IN r c°�- N3 `t' ��.23 4-//131 12122
1
�^-I�- 6 ��F' � 3/j,4, J11 3 1
/►�-7�°wp� 3/It
�- g L-0-- PH 3 tz p3 12
Are the monitoring wells listed fn section 5 located at or beyond the review boundary?
YES
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 maV sub ect the permittee to a Notice of Violation
fines, and/or penalties. EPa fl Tto rij t0A
W�LI-S Tc, �,eAfyl^-C tc,r✓ 1--, C RL Uff/CF
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.
4 L4-t-� 61 5 /sb-�-
Signature of Permittee (or Authorized Agent) Date
GW-59A 12/&'2003