WQ0006254_Monitoring - 11-2016_20161219 (2)

DWATER QUALITY MONITORING:
IANCE REPORT FORM
or Type
SUBMIT FORM ON YELLOW ,PAPER ONLY
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: Southeast of WWTP No. of wells to be sampled: 7
AL ta�spu zc �s
)N PROCESSING UNIT
PERMIT Number: Expiration Dates
Non -Discharge W00006254 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
13 Lagoon ❑ Remediation: Infiltration Gallery
KSpray Field ❑ Remediation:
iJ Rotary Distributor ❑ Land Application of Sludge.
❑ Water Source Heat Pump X Other:'LPP Field
L ID NUMBER (from Permit) MW#7 Date sample collected: 11/10/16
Depth: 20 ft. Well Diameter: 2 in.
n to Water Level: 5.4 ft. below measuring point Screened Interval: 18 ft. 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
for
sample analyzed: 1.
COD
mg/l
Coliform: MF Fecal
<1 /100ml
Coliform: MF Total
/100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
223 mg/i
pH (when analyzed)
7.64 units.
TOC
8.2 mg/I
Chloride
56 mg/l
Arsenic
mg/I
Grease and Oils
mgll
Phenol
mg/I
Sulfate
mg/l
Specific Conductance
µMhos
Total Ammonia
<0•2 mg/I
(Ammonia Nitrogen; NHgas N; Ammonia Nitrogen, Total)
to
FIELD ANALYSES WAS
pH 7.64 units Temp. 19:8 °C DRY at
Spec. Cond. µMhos time of
sampling;
Odor Slight check
Appearance Light Tan here::
Laboratory Name:
Environmental Chemists, Inc. Certification No. 37729
colloidal concentrations.
7 11 I,—
u
Nitrite
Nitrite (NO2) as N
<0.02 mg/l'
Pb - Lead
Nitrate (NOs) as IN
c0,02 mg/I
Zn - Zinc Tngil' i®S�
Phosphorus: Total as P
0.34 mg/I
0 w
Orthophosphate
mg/l
Other (Spec'(Spec& mpounds and Conc?Stat
Al - Aluminum
mg/1
Ba - Barium
mg/I
Ca - Calcium
mg/I
I t L I U
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB' REPORT.)
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) IR No (0)
K - Potassium
mg/I
VOC method # 6200C
Mg - Magnesium
mg/1
, method #
Mn - Manganese
- mg/I
method #
TKN as N mg/I Ni - Nicker mg/I method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: _ mg/L
s - - -ME ahT---- e - - • - •- a •• -•
- Danny Lassiter le. possbrity of: finea and imprisonment for Knowing violations.
1 Regional Manager
Permittee (or Authorized Agent) Name and Title - Plea. [e-mail] Signature of Permitt r rized Agent) -
GW -59 Rev. 1/2007 1800-525-7990
VOC Removal%

SUBMIT FORM ONYELI.OW PAPER ONLY
For Remediation Systems Only - ._ •
I certify that, to the best of my knowledge and belief, the
D4PWQ-certified laboratory. f arra aware that there are signifi r Danny Lassiter
Regional Manager
ittee (or Authorized Apent) Name and Title- Please [e-mail]
GW -59 Rev. 112007 1800-525-7990
Effluent Total VOCs:
VOC Removal%
• •
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
• • •
IVISION OFWATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
=55
617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: (919)'7333221
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 10/31/2021
Facility Name: Corolla Light WWTP#1
Non -Discharge WQ0006254 UIC
Permit Name (if different):
NPDES Other
Facility Address: 1102 Corolla Village Road
TYPE OF PERMITTED OPERATION BEING MONITORED
(Street) Corolla NC 27927 County Currituek
11 Lagoon El Remediation: Infiltration Gallery
(city) (stalls) (zip)
K Spray Field ❑ Remediation:
Contact Person: Eddie Baldwin
Telephone#: [phone]
K Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: West of WW'TP/ Northwest of LPP No. of wells to be sampled: 7
-
❑ Water Source Heat Pump ® Other: LPP Field
_..
-
_
from Permit
_
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW06
Date sample collected: 11/10/16
FIELD ANALYSES:
WAS
Well Qepft 20 ft.
Well Diameter: 2 in.
pH7.92_ units Temp. 19.4 °C
DRY at
Depth 'to'Water Level 4.6 ft. below measuring point
Screened Interval: 18 ft. to 20 ft. Spec. Cond. µMhos
time
sampling,
Measuring Point is 3.0 ft. above land surface
Relative M.P. Elevation:
ft.
Odor slight
check
Volume of water pumped/bailed before sampling:
5 gallons
Appearance Clear / Light Green
here:
Samples for metals were collected unfiltered: DYES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMAT{ON
Date sample analyzed: 11/10/16
Laboratory Name: Environmental Chemists, Ino. Certification.No. 37729
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD mg/1
Nitrite (NO2) as N
<0.02 mg/I
Pb - Lead mg/I
Coliform: MF Fecal <1 /100ml
Nitrate (NO3) as N'
<0.02 mgll
r Zn - Zinc mg/I
Coliform; MF Total - %100ml
Phosphorus: Total as 'P
3..02 mg/I
(Note: Use MPN method for Nghly turbid samples)
Orthophosphate
mg/I
Other (Specify C finds and Concentration Units):
Dissolved Solids: Total 1010 mg/I
Al - Aluminum
mg/1
pH (when analyzed) 7.92 units
Ba - Barium
mg/I
LEE 2 0 201A
TOC 12.1 mg/l
Ca- Calcium
mg/I
Chloride 140 mg/I
Cd - Cadmium
mg/1
Arsenic mg/I
Chromium: Total
mg/l
Grease and Oils mg/I
Cu - Copper
mg/I
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
rng/I
Report Attached? ❑ Yes (1) 10 No (0)
Specific Conductance µMhos
K - Potassium
mg/l
VOC method # 6200c
Total Ammonia 1 5 mg/I
Mg - Magnesium
mg/i
method #
(Ammonia Nitrogen; NH�as N; Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
method #
TKN as N mg/I
Ni - Nicker
mg/I
method #
For Remediation Systems Only - ._ •
I certify that, to the best of my knowledge and belief, the
D4PWQ-certified laboratory. f arra aware that there are signifi r Danny Lassiter
Regional Manager
ittee (or Authorized Apent) Name and Title- Please [e-mail]
GW -59 Rev. 112007 1800-525-7990
Effluent Total VOCs:
VOC Removal%

UNDWATER QUALITY MONITORING:
PLIANCE REPORT FORM
or
acility Name: Corolla Light WWTP#1
SUBMIT FORM ON YEI I OW PAPER ONLY
'ermit Name (if different):
=acility Address: 1102 Corolla Village Road
Corolla (street) NC 27927 County Currituck
(city) (state) (Zip)
tact Person: Eddie Baldwin Telephone#: [phone]
1 Location/Site Name: West of WWTP/South west of LPP No. of wells to be sampled: 7
TENT OF ENVIRONMENT & NATURAL RESOURCES
OF WATER QUALITY -INFORMATION PROCESSING UNIT
_ SERVICE CENTER, RALEIGH, NC 27699.1617 Phone: [phone]
PERMIT Number:
Non -Discharge W00006254
L ID NUMBER (from Permit): MW#5 Date sample collected: 11/10/16
Depth: 20 ft. Well Diameter: 2 in.
n to Water Level: 4.1 ft. below measuring point Screened Interval: 18 ft. to 20 ft.
curing Point is 2.0 ft. above land surface Relative M.P. Elevation: ft.
ne of water pumped/bailed before sampling: 5 gallons
Dies for metals were collected unfiltered: OYES ❑ NO and field acidified: ❑ YES ❑ NO
Expiration Date:
UIC
Other
'PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
© Spray Field ❑ Remediation:
® Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ® Other: LPP Field
FIELD ANALYSES:
pH 7.61 units Temp. 21.2 °C
Spec. Cond. µMhos
Odor none
Appearance Clear
sample analyzed: 11/10/16 Laboratory Name: Environmental Chemists, Inc.
;AMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO2) as N <0.02 mg/I Pb - Lead
Coliform: MF Fecal <1 /100mi Nitrate (NO3) as N <0.02 mg/I Zn - Zinc
Coliform: MF Total /100ml Phosphorus: Total as P 3.05 mg/I
Certification No. 37729
mg/1
mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Other (Specify Compounds oncentration Units):
Dissolved Solids: Total
825 mg/I
Al - Aluminum
mg/I
pH (when analyzed)
7.61 units
Ba - Barium
mg/I_
_
TOC
13.2 mg/I
Ca -Calcium
mg/I
f to
�2 LU 10
Chloride
107 mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
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/1
Report Attached? ❑ Yes (1) ® No (0)
Specific Conductance
µMhos
K - Potassium
mg/I
VOC method # 6200C
Total Ammonia
1.0 mg/I
Mg - Magnesium
mg/I
method #
(Ammonia Nitrogen; NH3 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:
submittedI certif-V that to the best of my knowled tion
DWQ-cert1ffied laboratory. I am aware thatDanny Lassiter Mao
Regional Manager
Permittee (or Authorized Agent) Name and T [e-mail]
GW -59 Rev. 1/2007 800-525-7990
mg/L Effluent Total VOCs: mg/L VOC Removal%
WELL
at
of
UK

SUBMIT FORM ON
TER QUALITY MONITORING:
E REPORT FORM
Name: Corolla Light WWTP#1
Name (if different):
Address: 1102 Corolla Village Road
(street) County Currituck
la NC 27927
act Person: Eddie Baldwin Telephone#: [phone]
Location/Site Name: Northwest of WWTP/East of LPP No. of wells to be sampled: 7'
0
L ID NUMBER (from Permit): MW#4 Date sample collected: 11/10/16
Depth: 20 ft. Well Diameter: 2 in.
i to Water Level: 5.4 ft. below measuring point Screened interval: 18 ft. to 20 ft.
luring Point is 2.0 ft. above land surface Relative M.P. Elevation: ft.
ne of water pumped/balled before sampling; 5 gallons
)les for metals were collected unfiltered: DYES ❑ NO and field acidified: ❑ YES ❑ NO
s sample analyzed: 11/10/16
tAMETERS NOTE: Values should reflect dissoly
COD
mg/I
Coliform: MF Fecal
<1 /100ml
Coliform: MF Total
/100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
672 mg/1
pH (when analyzed)
7.55 units
TOC
4.7 mg/i
Chloride
160 mg/l
Arsenic
mg/1
Grease and Oils
mg/1
Phenol
mg/1
Sulfate
mg/l
Specific Conductance
µMhos
Total Ammonia
<0.02 mgll
(Ammonia Nitrogen; Nti3as N; Ammonia Nitrogen, Total)
TKN as N mg/1
TUKAI...KbbUUKGlh5
ATION PROCESSING UNIT
:RMIT Number: Expiration Date: 1 U/J 11ZUZ 1
In -Discharge WQ0006254 UIC
IDES Other
'PIE OF PERMITTED OPERATION BEING MONITORED
11 Lagoon ❑ Remediation: Infiltration Gallery
® Spray'Field ❑ Remediation:
Rotary Distributor ❑ Land Application of Sludge
Water Source Heat Pump E Other: LPP Field
FIELD ANALYSES:
WAS
pH 7.55_ units Temp. 20.2 °C
DRY at
Spec. Cond. µMhos
time of
AI - Aluminummg/l
sampling,
Odor none
check
Appearance Clear
here:
�
Laboratory Name: Environmental Chemists, Inc. Certification No. 37729
copoidal concentrations.
Nitrite (NO2) as N <0,02 _mg/I Pb - Lead mg/I
Nitrate (NO3) as N <0.02 mg/I Zn - Zinc mg/I
Phosphorus: Total as P
0.67 mg/I
Orthophosphate
mg/I
Other (Specify Compounds�a Concentration Units):
AI - Aluminummg/l
Ba - Barium
- mg/I
DEC 2 0 mg
Ca - Calcium
mg/I
Cd - Cadmium
mg/l
Chromium: Total
mg/I
Cu - Copper
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Fe - Iron
mg/1
(Specify test and method #, ATTACH LAB REPORT.)
Hg - Mercury
mg/1
Report Attached? ❑ Yes (1) IR No (0)
K - Potassium
mg/I
VOC method # 6200c
Mg - Magnesium
mg/1
method #
Mn - Manganese
mg/l
method #
Ni - Nickel
mg/I
method #
For Remedlation Systems Only (Attach Lab Reports): Influent Total VOCs:
Ep WON
Danny Lassiter
Regional Manager
Permittee (or Authorized Agent) Marne and Titl [e-mail]
GIN -59 Rev.1/2007
800-525-7990
Signature
Effluent Total VOCs:
mg/L VOC Removal%

NDWATER QUALITY MONITORING:
LIANCE REPORT FORM
or
SUBMIT FORM ON YELLOW PAPER ONLY
Name: Corolla Light WWTP#1
Name (if different).-
Address:
ifferent):Address: 1102 Corolla Village Road
la (Street) SIC 27927 county Currituck
act Person: Eddie Baldwin Telephone#: [phone]
Location/Site Name: Northeast of WWTP No. of wells to be sampled: 7 \
1RTMENT OF ENVIRONMENT& NATURAL RESOURCES
ZION OF WATER QUALITY -INFORMATION PROCESSING UNIT
MAIL SERVICE CENTER, RALEIGH, RIC 27699-1617 Phone: [phone]
PERMIT Number:. Expiration Date:
Non -Discharge W00006254 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
KX Spray Field ❑ Remediation:
® Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ®Other: LPP Field
_L ID NUMBER (from Permit): MW#3 Date sample collected: 11/10716 FIELD ANALYSES: IWAS
I Depth: 20 ft.
Well Diameter: 2 in.
pH 728 units Temp. 21.7 °C
DRY at
th to Water Level: 5.4 ft, below measuring point
Screened Interval: 18 ft: to 20 ft.
Spec. Cond. µMhos
time li
sampling,
isuring Point is 2.0 ft. above land surface
Relative M.P. Elevation: ft.
Odor none -
check
Ime of water pumped/bailed before sampling: 1
5 gallons
Appearance Clear
here:.
toles for metals were collected unfiltered: DYES
❑ NO and field acidified: ❑ YES ❑ NO
Total Ammonia
<0.2 mg/I
sample analyzed: 11/10/16
kMETERS NOTE: Values should reflect dissoly
COD mg/1
Coliform: MF Fecal c1 /100ml
Coliform: MF Total /loom]
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
411 mg/l
pH (when analyzed)
7.28 units
TOC
4.3 mg/i
Chloride
135 mg/1
Arsenic
mg/l
Grease and Oils
mg/l
Phenol
mg/1
Sulfate
mg/l
Specific Conductance
µMhos
Total Ammonia
<0.2 mg/I
(Ammonia Nitrogen; NH3 as N; Ammonia
Nitrogen, Total)
TKN as N
mg/l
_ Laboratory Name: Environmental Chemists, Inc. Certification No. 37729
and colloidal concentrations.
Nitrite (NO2) as'N <0.02 mg/i Pb Lead mg/l
Nitrate (NO3) as N 0.10 mg/l Zn - Zinc mg/I
Phosphorus: Total as P 1.12 mg/1
Orthophosphate
mg/l
Ai -Aluminum
mg/l
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/l
Chromium: Total
mg/I
Cu - Copper
mg/l
Fe - Iron
mg/l
Hg - Mercury
mg/l
K - Potassium
mg/l
Mg - Magnesium
mg/I
Mn - Manganese
mg/1
Ni - Nickel
mg/I
For Remediation Systems Only (Attach Lab Reports): Influent Total
DWQ-certified laboratory. I am aware thE Danny Lassiter
Regional Manager
Permittee (or Authorized Ascent) Name an [e-mail]
GW -59 Rev. 112007 800-525-7990
Of
Other (Specify Compounds and Concentration Units):
NC 2 0 2016
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Report Attached? ❑ Yes (1) IR No (0)
voc method # 6200C
method #
method #
Effluent Total VOCs:
method #
VOC Removal%

DWATER QUALITY MONITORING:
IANCE REPORT FORM
or
SUBMIT FORM ON YELLOW PAPER ONLY
Name: Corolla Light WWTP#1
Name (if different):
Address: 1102 Corolla Village Road
(sheat;
la NC 27927 County Currituck
act Person: Eddie Baldwin Telephone#: [phone]
Location/Site Name: North West of WWTP No. of wells to be sampled 7
F ENVIRONMENT & NATURAL RESOURCES
TER QUALITY -INFORMATION PROCESSING UNIT
PERMIT Number: Expiration bate: TU/31ILU17
Non -Discharge WQ0006254 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Kc Spray Field ❑ Remediation:
R Rotary Distributor ❑ Land Application of Sludge
El Water Source Heat Pump 'Z Other: LPP FIELD
L ID NUMBER (from Permit): MW#2 Date sample collected: 11/10/16 FIELD ANALYSES: IWAS
Depth: 20 ft:
Well Diameter: 2 in,
pH 7.71 units Temp. 19.8 °C
DRY at
i to Water Level: 12.5 ft. below measuring point
Screened- Interval: 18 ft. to 20 ft.
Spec. Cond. µMhos
time of
sampling,
;using 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
here:
)les for metals were collected unfiltered: ❑YES
❑ NO and field acidified: ❑ YES ❑ NO
Total Ammonia _
<0.2 mg/I
sample analyzed; 11/10/16 Laboratory Name: Environmental Chemists,lnc. Certification No. #37729
4METERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/l
Coliform: MF Fecal 1 /100ml
Coliform: MF Total /1'00ml
(Note_ Use MPN method for highly turbid samples)
Dissolved Solids: Total
423 mg/i
PH (when analyzed)
7.71 units
TOC
6.4 mg/I
Chloride
126 mg/I
Arsenic _
mg/I
Grease and Oils
mg/I
Phenol'
mg/I
Sulfate
mg/I
Specific Conductance
µMhos
Total Ammonia _
<0.2 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 0.65 mg/I Zn - Zinc mg/I
Phosphorus: Total as P 5.54 mg/I
Orthophosphate
mg/I
AI - Aluminum
mg/l
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd' - Cadmium
mg/1
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/1
Influent Total VOCs:
Danny Lassiter
Regional Manager
[e-mail]
800-525-7990
Of
Other (Specify CompQij-nd and Concentration Units):
UEU Y 0 LQ16
ORGANICS: (by GC, GC/MS, HPLC)
(Specify test and method #. ATTACH LAB REPORT.)
Report Attached? ❑ Yes (1) IR No (0)
VOC method # 6200:
method #
Effluent Total VOCs:
method #
method #
VOC Removal%o

SUBMIT FORM ON YELLOW PAPER ONLY
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs:
GW -59 Rev, 1/2007
Danny Lassiter
Regional Manager
[e-mail]
800-525-7990
mg/L Effluent Total VOCs:
Agent)
VOC Removal%a
ERARTAAI NY OF ENVIRONMENT S NATURAL RESOURCES
GROUNDWATER (QUALITY MONITORING:IVISION
�1647
of WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
MAIL SERVICE CENTER, RALEIGH, NC 2769977617 Phone: (919):733-3224
FACILITY INEORMATION Please Print Clearly or Type
PERMIT Number. Expiration Date: 10/31/2021
Facility Name: Corolla Light WWTP#1
Non -Discharge WQ0006254 UIC
Permit. Name .(if different):
NPDES Other
Facility Address: 1102 Corolla Village Road
TYPE OF PERMITTED OPERATION BEING MONITORED
Corolla (Street) NC 27927 County Currituck
❑ Lagoon ❑ Remediation: Infiltration Gallery,
(City) (state) (zip)
R Spray Field ❑ Remediation:
Contact Person: Eddie Baldwin
Telephone#: [phone]
l Rotary Distributor El Land Application of Sludge
Well Location/Site Name: South West of WWTP
No. of wells to be sampled: 7
❑ Water Source Heat Pump ® Other: LPP FIELD
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW#1
Date sample collected: 11/90/16
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH 7.91 units Temp.. 19.1 °C
DRY at
Depth to Water Levet;. 1..0:9 ft. below, measuring point
Screened Interval: 1.8 ft. to 20 ft. Spec. Cond. µMhos
time of sampling,
Measuring Point is 2.0 ft. above land surface
Relative M.P. Elevation:
ft.
Odor None
check
Volume of water pumped/baited before sampling:
5 gallons
Appearance Clear
here:
Sam les for metals were collected unfiltered: OYES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed: 1111'0/16
LaboratoryName: Environmental Chemists, Inc. Certification No. #37729
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
<0.02 mg/I
Pb - Lead mg/l
Coliform: MF Fecal <1 /100mt
Nitrate (NOs) as N
<0,02 mg/I
Zn - Zinc mg/I
Coliform: MF Total f900ml
Phosphorus: Total as P
1.21 mg/i
(Note: Use MPN method for highly turbid,samples)
Orthophosphate p __-
mg/l
Other (Specify Compounds and Concentration Units):
Dissolved Solids: Total 509 mg11
At - Aluminum
mg/l
M
pH (when analyzed) 7.91 units
Ba - Barium
mgA
TOC 7.3 mg/i
Ca - Calcium
mg/l
� 2016
Chloride 160 mg/I
Cd - Cadmium
mg/l
_n.
Arsenic_ mg/1
Chromium: Total
mglt
Grease and Oils mg/1
Cu - Copper
mg/l
ORGANICS-- (by GC, GC/MS, HPLC)
Phenol _ mg/i
Fe - Iron
mg/l
(Specify test and method #. ATTACH LAO REPORT.)
Sulfate mg/I
Hg - Mercury
mg/l
Report Attached? ❑ Yes (1) 10 No (0)
Specific Conductance µMhos
K - Potassium
mg/I
VOC method # 6200c
Total Ammonia 2.7 mg/l
Mg - Magnesium
mg/l
method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
method #
TKN as N mg/I
Ni - Nickel
mg/l
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs:
GW -59 Rev, 1/2007
Danny Lassiter
Regional Manager
[e-mail]
800-525-7990
mg/L Effluent Total VOCs:
Agent)
VOC Removal%a

KY
GW -59A COMPLIANCE REPORT FORM Permit #
(Subndt one each monitoring period with GW -59 forins.)
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?
a
Was any required information missing on the GW -59 report forms?
YES
'NO
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
NO
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional ice for guidance.
4
Are any monitored constituents equal to or above the established standards?
YES
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.
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 8.
If 'the answer to question 5 is "YES". list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
6
Are the monitoringwells listed in section S located at or beyond the review boundary?
YES
NO
If the answer is "YES". a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answerls '`WO' 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 hayjnp at the review and compliance
boundaries surroundino this facility, Failure to do so may subject the permittee to a Notice of Violation.
fines. andlor 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.
it hereby acknowledge that the above information was evaluated and the information''submiitted in this
irePort,(Compliance Report GW 59A) is true and _complete to the best gf my
Signature !6f7P" (or Autho Danny Lassiter ate
Regional Manager
u W 1db51 LeFLGU uiwater.com
800-525-7990
GLV -59A 12/8/2003