WQ0006254_Monitoring - 09-2016_20161101 (5)

DWATER QUALITY MONITORING:
IANCE REPORT FORM
TY INFORMATION Please Print Cleary or Type
Name: Corolla Light WWTP#1
Name (if different):
Address: 1102 Corolla Village Road
SUBMIT FORM ON YELLOW PAPER ONLY
County Currituck
Rct Person: Eddie Baldwin Telephone#: [phone]
Location/Site Name: South West of WWTP No. of wells to be sampled: 7
L ID NUMBER (from Permit): MW#1
Depth: 20 ft.
i to Water Level: 11.6 ft. below measuring point
luring Point is 2.0 ft. above land surface
ne of water, pumped/bailed before sampling: 5
)Ies for metals were collected unfiltered: DYES ❑
sample analyzed: 9/22/16
tAMETERS NOTE: Values shouldreflect dissoly
COD
mg/1
Coliform: MF Fecal
15 /100MI
Coliform: MF Total
/100ml
(Note;. Use MPN method for__ highly turbid samples)
mg/1
Dissolved Solids: Total
492 Mg/l
pH (when analyzed)
6.93 units
TOC
8.6 mgA
Chloride_
178 mg/1
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/I
Specific Conductance
µMhos
Total Ammonia
1.5 mg/l
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
TKN as N mg/l.
For Remediation Systems Only (Attach Lab Reports):
Danny Lassiter
Regional Manager
ittee(orAuthorizedAgenti [e-mail]
GW -59 Rev, 1/2007 800-525-7990
RENT 'OF ENVIRONMENT & NATURAL RESOURCES
OF WATERQUALITY4NFORMATION PROCESSING UNIT --
i sFRVicP'CENTER_ RIAL.E1Gl4Nc 2T699-im7 Phnnn•19191933-A229
°RMIT Number: Expiration Date: 9/30/2016
In -Discharge W00006254 UIC
'DES Other
IPE OF PERMITTED OPERATION BEING MONITORED
El Lagoon ❑ Remediation: Infiltration Gallery
® Spray Field ❑ Remediation:
FZ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source. Heat Pump N Other: LPP FIELD
Date sample collected: _9/22/16 FIELD ANALYSES: WAS
Well Diameter: 2 in. pH 6.93 units Temp. 22.1 °C DRY at
Screened Interval: 18 ft. to 20 ft. Spec. Cond. µMhos time of
sampling,
Relative M.P. Elevation: ft. Odor None check
s Appearance Clear here:.
-4 t: olA—irl7fiori- 17 V FC F-1 Nn
_ Laboratory Name: Environmental. Chemists,lna. Certification No. #3772.9
and colloidal concentrations.
Nitrite (NO2) as N 0.11 mg/I Pb - Lead mg/1
Nitrate (NO3) as N <0.02 mg/I Zn - Zinc mg/I
Phosphorus: Total as P 1.68 mg/i
Orthophosphate mg/I Other (Specify Compounds and -concentration Units):
Al - Aluminum mg/I I n 2016
Ba - Barium
mg/I
NOV 0 3 201Aa - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/1
Cu - Copper
mgll
Fe - Iron
mg/1
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
_ mg/I
Ni - Nickel
mg/l
1
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Report.Attached? ❑ Yes (1) ® No (0)
yOC method # 6200c
method #
method #
method #
Influent Total VOCs: mg/L Effluent Total VOCs:
Signature
VOC' Removal%

TER QUALITY MONITORING:
E REPORT FORM
Name: Corolla Light WWTP#1
Name (if different):
Address: 1102 Corolla Village Road
SUBMIT FORM ON YELLOW PAPER ONLY
County Currituck
act Person: Eddie Baldwin
Telephone#: [phone]
Location/Site Name: North West of WWTP
No. of wells to be sampled: 7
Spec. Cond. µMhos
from Permit
PLING INFORMATION.
sampling,check
L ID NUMBER (from Permit): MW#2
Date sample collected: '9/22/16.
Depth: 20 ft.
Well Diameter: 2 in.
i to Water Level: 12.0 ft. below measuring point
Screened Interval: 18ft. to 20 ft.
wring Point is 2-0 ft. above land surface
Relative M.P. Elevation: ft.
ne of water pumped/bailed before sampling: 5 gallons
aes ;
ING UNIT
oa,—. ruim
i'.RMIT Number: Expiration Date: 9/3U/ZU l b
m -Discharge WQ0006254 UIC
'DES Other
IPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
© Spray Field ❑ Remediation:
R1 Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ®Other: LPP FIELD
FIELD ANALYSES:
WAS
pH 6.64 units Temp. 23.3 °C
DRY at
Spec. Cond. µMhos
time of
COD
sampling,check
Odor None
<0,02 mg/l
Appearance Clear
here: ❑
sample analyzed: 9122/16
6.64 units
Laboratory Name: Environmental Chemists,inc. Certification No. #37729
IAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
Chloride
129 mg/l
COD
mg/I
Nitrite (NO2) as N
<0,02 mg/l
Pb - Lead mg/I
Coliform: MF Fecal
7 /100ml
Nitrate (NO3) as N
19.6 mg/l
Zn - Zinc mg/I
liuo tal
/100ml
Phosphorus: Total as P
7.06 mg/i
Ni - Nickel
(Note: MPMFe hor r highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds and C nation Units):
Dissolved Solids: Total
423 mg/l
AI - Aluminum
mall
pH (when analyzed)
6.64 units
TOC
4.1 mg/I
Chloride
129 mg/l
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/1
Sulfate
mg/I
Specific Conductance
µMhos
Total Ammonia
<0.2 mg/I
(Ammonia Nitrogen; NHsas N; Ammonia
Nitrogen, Total)
TKN as N mg/I
For Remediation Systems Only (Attach Lab
ittee (or Authorized Agent)1
OW -59 Rev. 1/2007
Ba - Barium
mg/l
Ca - Calcium
mg/l
Cd - Cadmium
mg/l
Chromium: Total
mg/l
Cu - Copper
mg/l
Fe - Iron
mg/l
Hg - Mercury
mg/I
K - Potassium
mgA
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
Ni - Nickel
mg/l
Influent Total VOCs:
Danny Lassiter
Regional Manager
[e-mail]
800-525-7990
NOV A �n
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Report Attached? ❑ Yes (1) ® No (0)
VOC _ , method # 6200c _
method #
Effluent Total VOCs:
method #
method #
VOC Removal%

.Y
TER QUALITY MONITORING:
E REPORT FORM
Name Corolla Light WVVTP#1
Name (if different):
Address: 1102 Corolla Village_ Road
County Currituck
act Person: 'Eddie Baldwin Telephone#: [phone]
Location/Site Name: Northeast of WWTP No. of wells to be sampled: 7
sas
NG UNIT
RMIT Number: Expiration Date: y --3U-1076
in -Discharge WQ0006254 UIC
IDES Other
PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
ONE Spray Field ❑ Remediation:
® Rotary Distributor ❑ Land Application of Sludge
Water Source Heat Pump R Other: LPP Field
L ID NUMBER (from Permit): MW#3 Date sample collected: 9/22/16 FIELD ANALYSES: IWAS
Depth: 20 ft.
Well Diameter: 2 in.
pH 6.40 units Temp. 26.7 eC
DRY at
i to Water Level: 2.2 ft. below measuring point
Screened Interval: 18 ft. to 20 ft.
--
Spec. Cond. µMhos
time ofampling,
miring Point is 2.0 fL above land surface.
Relative M.P. Elevation: _ _ ft.
Odor none
check
ne of water pumped/bailed before sampling:
5 gallons
Appearance Clear
here:
�
'i— f— -- .+nllen4vA ....TiLin.,nA• MVCe
n #V1 —A r—w .�nw;s—A•. n VCe r-1 kin
Mn - Manganese
mg/I
sample analyzed: 9
AMETERS NOTE:
COD mg/1
Coliform: MF Fecal 3 /1100ml
Coliform: MF Total /100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
447 mg/I
pH (when analyzed)
6.40 units
TOC _
3.9 mg/I
Chloride
162 _mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol mg/I
Sulfate mg/I
Specific Conductance pMhos
Total Ammonia <0.2 mg/1
(Ammonia Nitrogen; NHsas N; Ammonia Nitrogen, Total)
TKN as N- mg/I
For Remediation Systems Only (Attach Lab Reports):
GW -59 Rev. 1/2007
Laboratory Name: Environmental Chemists, Inc. Certification No. 37729
and colloidal concentrations.
Nitrite (NO2) as N <0.02 mg/1 Pb - Lead mg/I
Nitrate (NO3) as N. 1.09 mg/I Zn - Zinc mg/I
Phosphorus: Total as P 1.39 mg/I
Orthophosphate mg/I Other (Specify Compounds and ISO ntration Units):
AI Aluminum mg/I
Ba - Barium
mg/I
Ca -Calcium
mg/I
Cd - Cadmium
mg/I
'Chromium: Total
mg/I
C.0 - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
Ni - Nickel
mg/I
Influent Total VOCs:
Danny Lassiter
Regional Manager
[e-mail]
800-525-7990
wnv n.2-961
ORGANICS: (by GC; GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Report Attached? ❑ Yes {1) ❑ No (0)
VOC , method # 6200c
method #
method #
method #
Effluent Total
VOC Removal%

FORM ONYEL_ LOW. PAPER
ROUNDWATER QUALITY MONITORING:
OMPLIANCE'REPORT FORM
TY INFORMATION Please Print Cleady or Type
Name: Corolla Light WWTP#1
Name (if different):
Address: 1102 Corolla Village Road
la (Street) NC 27927 County Currituck
act Person: Eddie Baldwin 'Telephone#: [phone]
Location/Site Name: Northwest of VWVfP/East of LPP No. of wells to be sampled- 7
MAIL SERVIC
ICES
MING UNIT
7 Phone t919173342211
PERMIT Number: Expiration Date: U -30-2-U16
Non -Discharge WQ0006254 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
® Spray Field ❑ Remediation:
Rotary Distributor ❑ Land Application of Sludge
El Water Source Heat Pump N Other. LPP Field
L ID NUMBER (from Permit): MVV#4 Data sample collected: 9/22/16 FIELD ANALYSES: OAS
Depth: 20 ft.
Well Diameter: 2 in.
pH 6.78 units Temp. 23.1 oe
DRY at
R to Water Level: 2.1 ft. below measuring point
Screened Interval: 18 ft. to 20 ft.
Spec. Cond. µMhos
time
sampling,
curing Point is 2.0 ft. above land surface
Relative M.P. 'Elevation.- ft.
Odor none
check
vie of water pumped/bailed before sampling;
5 gallons
Appearance Clear
here:
1:1'
ales for metals were collected unfiltered: El YES
❑ NO and field acidified: ❑ YES ❑ NO
(Note: use MPN method for highly turtild samples)
Orthophosphate
sample analyzed: 9/22/16 _
Laboratory Name: Environmental Chemists, Inc. Certification No. 37729
AMETERS NOTE: Values should reflect dissolved and
colloidal concentrations
TOC
3.3 mg/I
COD mg/I
Nitrite (NO2) as N
<0.02 mg/I
Pb - Lead mg/I
Coliform: MF Fecal <1 /100ml
Nitrate (NO3) as N
<0,02 rrlgll
Zn -Zinc mg/I
Coliform: MF Total /100ml
Phosphorus: Total as P
1.71 mg/I
jiMhos
(Note: use MPN method for highly turtild samples)
Orthophosphate
mg/I
Other (Specify Compounds a d` - e tcentration Units):
Dissolved Solids: Total
580 mg/I
pH (when analyzed)
6.78units
TOC
3.3 mg/I
Chloride
165 mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg/I
Sulfate
mg/1
Specific Conductance
jiMhos
Total Ammonia
0.8 mg/1
(Ammonia Nitrogen; NH3as N; Ammonia
Nitrogen; Total)
TKN as N mg/I
For Remediation Systems Only (Attach Lab Reports):
ittee (or Authorized Agent) Name
GW -59 Rev. 1/2007
Al - Aluminum
mgn
Ba - Barium
mg/I
Ca - Calcium
mgA
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I.
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
Ni - Nickel
mg/I
Influent Total VOCs:
Danny Lassiter
Regional Manager
[e-mail]
800-525-7990
bi9vn s
416
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Report Attached? ❑ Yes (1) ®.No (0)
VOC method # 6200C
method
method #
method #
Effluent Total VOCs:
VOC Removal%

ROUNDWATER QUALITY MONITORING:
OMPLIANCE REPORT FORM
Clearly or Type
FORM ON YELLOW PAPER ONLY
ity Name: Corolla Light WWTP#1
iit Name (if different):
ty Address: 1102 Corolla_ Village Road
olla - (Street) NC 27927 County Currituck
(City) (Siete) (zip)
act Person: Eddie Baldwin Telephone#: [phone]
Location/Site Name: West of VWVEP/South west of LPP No. of wells to be sampled: 7
SOURCES
)CESSlNG UNIT
0617 Phone: [phone],3221
PERMIT Number: Expiration Date: 9-30-2016
Non -Discharge WQ0006254 UIC
NPDES Other
TYPE ,OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
1151 Spray Field ❑ Remediation:
R1 Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ••9 Other: LPP Field
L ID NUMBER (from Permit): MW#5 Date sample collected: 9/22/16_ FIELD ANALYSES: *AS
Depth: 20 ft.
Well Diameter: 2 in.
pH 7.77 units Temp. 24.6 °C
DRY at
I to Water Level: 4.2 ft. below measuring point
Screened Interval: 18 ft. to 20 ft.
—
Spec. Cond. µMhos
time of
sampling,
luring Point is 2.0 ft. above land surface
Relative M.P. Elevation: ft.
Odor none
check
ne of water pumped/bailed before sampling: .
5 gallons
Appearance Clear / Tan
here:
)les for metals were collected unfiltered': DYES
❑ NO and field acidified: ❑ YES ❑ NO
Grease and Oils
mg/I
sample analyzed: 9/22/16 Laboratory Name: 'Environmental Chemists, Inc. Certification No. 37729
AMETERS NOTE: Values should reflect dissolved and colloidal concentrations:
COD
mg/I
Coliform: MF Fecal
<1 /loom[
Coliform: MF Total
/loom[
(Note: Use MPN method for highly turbid samples)
mg/I
Dissolved Solids: Total
659 mg/I
pH (when analyzed)
7.77 units
TOC
8.6 mg/I
Chloride
110 mg/l.
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mg%I
Sulfate
mg/1
Specific Conductance
µMhos
Total Ammonia
0.6 mg/I
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
TKN as N mg/I
Nitrite (NO2) as N <0.02 mg/I Pb -'Lead mg/I
Nitrate (NO3) as N <0.02 rng/I Zn - Zine mg/l
Phosphorus: Total as P 2.93 mg/l.
Orthophosphate
mg/I
Al - Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mg/I
K - Potassium
mg/I
Mg = Magnesium
mg/I
Mn - Manganese
mg/I
Ni - Nickel
mg/I
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs:
. . Danny Lassiter ,
Regional Manager
Permittee (or Authorized Agent) NameandTi [e-mail]
GW -59 Rev. 112007 800-525-7990
Other (Specify Compounds and tration Units):
8.
IV Qjl a LUIb
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Report. Attached? ❑ Yes (1) 5d No (0)
VOC method # 6200c
method #
method #
method #
Effluent Total VOCs:
VOC Removal%

SUBMIT FORM
DWATER QUALITY MONITORING:
Please Print Clearly or
ity Name: Corolla Light W11Vf P#1
lit Name (if different):
ity Address: 1102 Corolla Village Road
olla (Street) NC 27927 County Currituck
(City) _ (state) (zip)
act` Person: Eddie Baldwin Telephone#: [phone]
Location/Site Name: West of WWTP/ Northwest of LPP No. of wells to be sampled: 7
L ID NUMBER (from Permit): MW#6 Date sample collected': 9/22/16
Depth: 20 ft. Well Diameter: 2 in.
to Water Level: 4.0 ft. below measuring point Screened Interval'. 18 ft. to 20 ft.
curing Point is 3.0 ft. above land surface Relative M.P. Elevation: _ ft.
ne of water pumped/bailed before sampling: 5 gallons
)les for metals were collected unfiltered: DYES ❑ NO and field acidified: El YES ❑ NO
sample
IAMETERS NOTE: Values should reflect dissolv
COD
mg/I
Coliform: MF Fecal
<1 /loom]
Coliform: MF Total
/loom)
(Note: Use MPN method for highly turbid,sampies)
Chromium: Total
Dissolved Solids: Total
864 mg/I
pH (when analyzed)
8.01 units
TOC
13.0 mg/I
Chloride
148 mgA
Arsenic
mg/l
Grease and Oils
mgll
Phenol
mg/I
Sulfate
mgll
Specific Conductance
µMhos
Total Ammonia
1.1 mg/I
(Ammonia Nitrogen: NHsas N; Ammonia Nitrogen, Total)
TKN as N mg/l
For Remediation Systems Only (Attach Lab Reports)
GW1 59 Rev. 112007
)UKGtS
ESSING UNIT
617 Phones 1919) 7333221`
Number: Expiration Date:
:harge WQ0006254 UIC
)DES Other
'PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation Infiltration Gallery
Spray Field ❑ Remediation:
R1 Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump Ili Other: LPI' Field
FIELD ANALYSES: WAS
pH 8.01 units Temp. 22.8 °C DRY at
Spec. Cond. µMhos time li
sampling,
Odor slight check
Appearance Tan / Green here: 11
Laboratory Name: Environmental Chemists, Inc. Certification No. 37729
colloidal concentrations.
Nitrite (NO2) as N <0.02 mg/I Pb - Lead mg/I
Nitrate (NO3) as N <0.02 mg/1 Zn -Zinc mg/I
Phosphorus: Total as P 3.51 mg/I
Orthophosphate mg/I Other (Specify Compounds and Concentration Units):
AI - Aluminum
mg/l
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mgA
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
mg/I
Hg - Mercury
mgA
K - Potassium
mg/I
Mg - Magnesium
mgt]
Mn - Manganese
mgA
Ni - Nickel
mgA
Influent Total VOCs:
Danny Lassiter
Regional Manager
[e-mail]
800-525-7990
mov 4) q 7119R
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Report Attached? ❑ Yes (1) 10 No (0)
VOC , method # 6200c
Effluent Total VOCs:
, method #
method #
method #
VOC Removal%

TER QUALITY MONITORING:
E REPORT FORM
Name: Corolla Light WWTP#1
Name (if different):
Address: 1102 Corolla Village Road
SUBMIT
County Currituck
PAPER ONLY
act Person: Eddie Baldwin Telephone#: [phone]
Location/Site Name: Southeast of WWTP No. of wells to be sampled: 7
NATURAL. RESOURCES
IMATION PROCESSING UNIT
PERMIT Number: Expiration Date:
Non -Discharge W00006254 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
El Lagoon ❑ Remediation: Infiltration Gallery
© Spray Field ❑ Remediation:.
R] Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump 91 Other: LPP Field
LID NUMBER (from Permit): MW#7 Date sample collected: 9/22/16 FIELD ANALYSES: OAS
Depth: 20 ft.
Well. Diameter: 2 in,
pH 7.06 units Temp. 25.0 °C
DRY at
h to Water Level: 4.2 ft. below measuring point
ScreenedInterval: 18 ft. to 20 ft.
- —
Spec. Cond. pMhos
time of
sampling,
wring Point is 2.0 ft. above land surface
Relative M.P. Elevation: ft,
Odor Slight
check
ne of water um dlballed before sam lin :
p pe sampling:
5 g
gallons
Appearance Clear
here:
El
Dies for metals were collected unfiltered: ❑YES
❑ NO and field acidified: ❑ YES ❑ NO
Grease and Oils
mg/I
sample analyzed: 9/22/16 Laboratory Name: Environmental Chemists, Inc. Certification No. 37728
AMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD
mg/1
Coliform: MF Fecal
<1 /100ml
Coliform: MF Total
/100ml
(Note: Use MPN method for highly turbid samples)
mg/I
Dissolved Solids: Total
257 mgti
pH (when analyzed)
7.06 units
TOC
8.4 mg/I
Chloride
74 mg/I
Arsenic
mg/I
Grease and Oils
mg/I
Phenol
mgll
Sulfate
mg/I
:Specific Conductance
µMhos
Total Ammonia
mg/I
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen; Total)
TKN as N mg/I
For Remediation Systems Only (Attach Lab Reports):
GW -59 Rev. 1/2007
Nitrite (NO2) as N <0.02 mg/I Pb - Lead mg/I
Nitrate (NO3) as N 0,08 mg/t Zn - Zinc mg/I
Phosphorus: Total as P 0.20 mg/I
Orthophosphate mg/I Other (Specify Compounds and Concentration Units):
A1- Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Fe - Iron
'mg/I
Hg - Mercury,
mg/I
K - Potassium
mg/I
Mg - Magnesium
mgA
Mn - Manganese
mg/I
Ni - Nickel
mg/1'
Influent Total VOCs:
Danny Lassiter
Regional Manager
[e-mail]
800-525-7990
NOV
ORGANICS: (by GC, GC/MS; HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Report Attached? ❑ Yes (1) IR No (0)
VOC method # 6200c
Effluent Total VOCs:
Agent)
, method #
method #
method #
VOC Removal%

GW -59A COMPLIANCE REPORT FORM Permit #vaaa7z,,29L1
(Submit One each monitoring period with GW 5'9 forms
1
Enter date monitoring results were due. (_4-31-16 1 Will this monitoring report (GW -59 and GW -59A)
YES
N
be submitted after the established due date?
2
Was any required information missing on the GW -59 reportforms?
YES
NO
IF the answer to question I 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
O
identification plate, area overgrown, etc.)? If the annver is "Yes", contact the Regional Office for guidance.
4
Are any monitored constituents equal to or above the established standards?
S
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 consfituent(s) and concentrations)
exceeding standards in the space provided below:
5
For the constituents identified in question 4 above, have standards been exceeded previously for theS
NO
same constituent(s) in the same well(s) in the last two years?
if the answer to question 5 is IVO" skip to section 8.
If the answer to question 5 is "YES', list in the space provided below, each well with constituents) exceeding
standards, concentrations) reported, and sample collection date for each occurrence (for the last two years).
w:z
14 ruz1 = R 1%4N4 b -' -lDs = 66y
I,nai4
-i'vc, 5,30
X15
ivs = 65
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
O
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
O
groundwater quality problem?
If the answer to question '7 is "YES", describe those actions in the space provided below.
Nthe answer to question 7 is "NO" contact the Regional Office within 90 days, an evaluation maybe.
reoired to determine the impact the waste disposal 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, and/or penalties.
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.
11 hereby acknowledge that the above information was evaluated and the information submitted In Oils ulI
�report.(Comphanc_e Rpport G1111, S9A)_ s true and complete to thebest,ef_my knowledge
Signature o nye"�y Lassiter
Danny
ooainnal Manager
dwiassiter@ uiwater.com
GW -59A 12/8/2003 800-525-7990