WQ0005849_Monitoring - 03-2020_20200701 (2)

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
o . e
" •
DEPARTMENT OF ENVIRONMENT a NATURAL RESOURCES
DIVISION OF WATER QUALITY4NFORMATION PROCESSING UNIT
1617 MAIL SERVICE CENTER
RALEIGH, NC 27699-1617 Phone. [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT No. W00005849 EXPIRATION DATE: 6-30-2020
Facility Name: Pluns LLc
Non -Discharge UIC
Permit Name (if different):
NPOES
Facility Address: 1095 HWY 210
Sneads Ferry Isn••q NC 28460
County onslow
TYPE OF PERMITTED OPERATION BEING MONITORED
(State) p
agoon Remediation: Inflitration Gallery
Contact Person: Randy Hoffer
Telephone#: [phone]
Spray Field Remediation:
ell Location/Site Name: g
No. of wells to be sampled: 4m,m1el
Rotary Distributor Land Application of Sludge
Water Source Heat Pump
Well Identification Number (from Permit): (
if WELL WAS DRY
Other:
Well Depth: +L7' ft. Well Diameter._ in.
at time of sampling, Check here
Screened interval: ft. to ft.
Sample is from system:
For Remediation System Influent/Effluent Only (Attach Lab Reports.)
Depth to Water Level: ft. below measuring point.
❑ Influent Dffluent
Influent mg/L (Total VOC Concentration)
Measuring Point isrA_ ft. above land surface.
Relative M.P. Elevation in ft.
Effluent mg1L (Total VOC Concentration)
Gallons of water pumped/bailed before sampling:_
Date sample collected: ' 2-0
VOC Removal
FIELD ANALYSIS: pH to- I Specific Conductance
uMhos
Date sample analyzed:
Temp.- °C Odor
Appearance lJJ�g2
Laboratory Name:
Certification No.
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified YES NO.)
NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO2) as N mg/I Ni - Nickel
Coliform: MF Fecal
/100ml
Coliform: MF Total
t /100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
pH (when analyzed)
units
TOC
�%_ I y mg/1
Chloride
-7 mg/I
Arsenic
mg/I
G d O'I1
m /I
Nitrate (NO3) as N �` L mg/I
Phosphorus: Total as P
mg/I
Orthophosphate
mg/I
A I- Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/1
Chromium: Total
mg/i
Cu - Copper
mg/I
Pb - Lead
Zn - Zinc
Other (Specify Compounds and Concentration Units)
mg/1
mg/I
mg/I
rease an s
Phenol
g
mg/I
Fe - Iron
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Sulfate
mg/I
Hg - Mercury
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Specific Conductance
uMhos
K - Potassium
mg/I
Report Attached? Yes (I) No-(®)
Total Ammonia
mg/I
Mg - Magnesium
mg/I
VOC : method #=
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
: method #=
TKN as N
mg/I
: method #=
method #=

SUBMIT FORM ON YELLOW PAPER ONLY
NDWATER QUALITY MONITORING:
M%141:71'i
Please Print Clearly or
Name: Pwris LLC
Name (if different):
Address: 1095 HWY 210
Sneads Ferry (s-'t) NC 2848.0 County Onslow
act Person: Randy Hoffer Telephone#: [phone]
Location/Site Name: No. of wells to be sampled: f
rom ermR)
Well Depth: U
Screened Interval:
Depth to Water Level: fe- _3"
Measuring Point ism'_
Gallons of water pumped/bai
ft. Well Diameter: in.
ft. to ft.
ft. below measuring point.
ft. above land surface.
td before sampling:
WELL WAS DRY
time of sampling, Check here
Date
Influent
EIGH, NC 27699-1617
MIT No. WQ0005849
MENT & NATURAL RESOURCES
Y•INFORMATION PROCESSING UNIT
Phone: [phone]
EXPIRATION DATE:
UIC
PE OF PERMITTED OPERATION BEING MONITORED
o�Lagoon Remediation: Inflitration Gallery
_Spray Field Remediation:
_ Rotary Distributor Land Application of Sludge
Water Source Heat Pump
Other
For Remediation System InfluentlEffluent Only (Aitaach Lab
nt Influent mglL (Total VOC Concentration)
Effluent mg/L (Total VOC Concentration)
3: VOC Removal
FIELD ANALYSIS: pH . `f Specific Conductance uMhos Fertification
ate sample analyzea:
Temp.fSZ °C Odor Appearance s Ss �rE� aboratory Name: No.
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified YES NO.)
NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO2) as N mg/I Ni - Nickel mg/I
Coliform: MF Fecal /100ml Nitrate (NO3) as N (),07 mg/I Pb - Lead mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
mg/I
Zn - Zinc mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total q
mg/I
Orthophosphate
A I- Aluminum
mg/I
mg/I
Other (Specify Compounds and Concentration Units)
pH (when analyzed)
units
Ba - Barium
mg/I
TOC
mg/I
Ca - Calcium
mg/I
Chloride f P. ��
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Sulfate
mg/I
Hg - Mercury
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Specific Conductance
uMhos
K - Potassium
mg/I
Report Attached? Yes (1) No (0)
Total Ammonia
mg/I
Mg - Magnesium
mg/I
VOC : method #=
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
: method #=
TKN as N
mg/I
: method #=
method #=
or
GW-59 Signature of Permittee (or Authorized Agent)
Rev. 11 /2005

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATERQUALITY MONITORING: . . . . . . •
.,COMPLIANCE REPORT FORM
INFORMATION Please Pnnt Clearly or
Facility Name: Pluds LLC
Permit Name (if different):
Facility Address: 1095 HWY 210
Sneads Ferry (street) NC 28460 County Onslow
act Person: Randy Hoffer Telephone#: [phone]
Location/Site Name: i=! :Jl c,� No. of wells to be sampled:
(from rmrt)
Well Depth: f W
Screened Interval:
Depth to Water Level: !�
Measuring Point is�'
Gallons of water pumped/ba
ft. Well Diameter:_-�.in.
ft. to ft.
ft. below measuring point.
ft. above land surface.
�d before sampling:
WELL WAS DRY
time of sampling, Check here
Influent
Date sample collected: -5 —
IIT No. WQ0005849 EXPIRATION DATE: 6-30-2020
scharge UIC
OF PERMITTED OPERATION BEING MONITORED
_ Lagoon Remediation: Inflitration Gallery
_Spray Field Remediation:
—Rotary Distributor Land Application of Sludge
Water Source Heat Pump
Other:
Remediation System InfluentlEffluent Only (Attach Lab Reports.)
ant mg/L (Total VOC Concentration)
ant mg/L (Total VOC Concentration)
Removal
FIELD ANALYSIS: pH c;: =j Specific Conductance uMh s Date sample analyzed:
Temp._°C Odor Appearance tjPlV- Laboratory Name:
Certification No.
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified YES NO.)
NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO2) as N mg/I Ni - Nickel
Coliform: MF Fecal /100ml Nitrate (NO3) as N , L� mg/1 Pb - Lead
Coliform: MF Total
/100m1
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
4/ mg/1
pH (when analyzed)
units
TOC
mg/i
Chloride
7" mg/I
Arsenic
mg/1
Grease and Oils
mg/I
Phosphorus: Total as P
mg/I
Orthophosphate
mg/1
A 1- Aluminum
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/1
Cd - Cadmium
mg/I
Chromium: Total
mg/I
Cu - Copper
mg/I
Zn - Zinc
Other (Specify Compounds and Concentration Units)
rng/I
mg/I
mg/I
Phenol
mg/I
Fe - Iron
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Sulfate
mg/I
Hg - Mercury
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Specific Conductance
uMhos
K - Potassium
mg/I
Report Attached? Yes (1) No (0)
Total Ammonia le, 0. a-
mg/I
Mg - Magnesium
mg/I
VOC : method #=
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
: method #=
TKN as N
mg/I
: method #=
method #=

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
0 0 .
° ° °
DEPARTMENT OF ENVIRONMENT $ NATURAL RESOURCES'
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
1617 MAI! SERVICE CENTER
RALEIGfi, NC 276994617 Phone: [phone]
FACILITY INFORMATION Please Print Clearly or Type
PERMIT No. W00005849 EXPIRATION DATE: 6-30-2020
Facility Name: Pluds LLc
Non -Discharge UIC
Permit Name (if different):
NPDES
Facility Address: 1095 HWY 210
Sneads Ferry (str°°t) NC 28460
County onslow
TYPE OF PERMITTED OPERATION BEING MONITORED
m 'P
Lagoon Remediation: Inflitration Gallery
erson: Randy Hoffer
Telephone#: [phone]
Spray Field Remediation:
LWetion/SiteName: gej,,L, ci • L v�y?
No. of wells to be sampled:
Rotary Distributor Land Application of Sludge
on ma
Water Source Heat Pump
Well Identification Number (from Permit):gq'
If WELL WAS DRY
Other:
Well Depth: ft. Well Diameter: in.
at time of sampling, Check here
Screened Interval: ft. to ft.
Sample is from system:
For Remediation System Influent/Effluent Only (Attach Lab Reports.)
Depth to Water Level: ft. below measuring point.
❑ Influent Dffluent
Influent mg/L (Total VOC Concentration)
Measuring Point is2 � ft. above land surface._
Relative M.P. Elevation in ft.
Effluent. mg/L (Total VOC Concentration)
Gallons of water pumped/bailed before sampling:
Date sample collected: 3
VOC Removal
FIELD ANALYSIS: pH Specific Conductance
uMhos
Date sample analyzed:
Temp. in oC Odor
Appearance C_1F..-Ar42
Laboratory Name:
Certification No.
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified YES NO.)
NOTE: Values should reflect dissolved and colloidal concentrations.
COD
mg/I
Nitrite (NO2) as N
mg/I
Ni - Nickel mg/I
Coliform: MF Fecal
/100ml
Nitrate (NO3) as N
D.Ci'a mg/1
Pb - Lead mg/I
Coliform: MF Total 41
1100ml
Phosphorus: Total as P
mg/I
Zn - Zinc mg/I
(Note: Use MPN method for highly turbid samples)
Orthophosphate
mg/I
Dissolved Solids: Total :��j
mg/I
A I- Aluminum
mg/I
Other (Specify Compounds and Concentration Units)
pH (when analyzed)
units
Ba - Barium
mg/I
TOC
mg/I
Ca - Calcium
mg/I
Chlorides
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Sulfate
mg/I
Hg - Mercury
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Specific Conductance
uMhos
K - Potassium
mg/I
Report Attached? Yes (1) No (0)
Total Ammonia
mg/I
Mg - Magnesium
mg/I
VOC : method #=
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
: method #=
TKN as N
mg/I
: method #=
method #=

SUBMIT FORM ON
PAPER ONLY
-
1i!GROUNDWATER QUALITY• • i'',I o fiY'OY��� s • r • • •
I ,COMPLIANCE REPORT
_
ii
ACILITY INFORMATION Please Print Clearly or Type
Facility Name: Pluds LLC
Permit Name (if different):
Facility Address: 1095 HWY 210
Sneads Ferry is«eetl NC 28460 County onslow
Contact Person: Randy Hoffer Telephone#: [phone]
Well Location/Site Name: gam, A 6 pZT" t�a,�6JS No. of wells to be sampled: t rom .—p r
Well Depth: J Y' ft. Well Diameter:_ in.
Screened Interval: ft. to ft.
Depth to Water Level: y' 9 ft. below measuring point.
Measuring Point ism_ ft. above land surface.
Gallons of water pumped/bailed before sampling:
FIELD ANALYSIS: pH Specific Conductan
Temp. _,2 0 °C Odor
If WELL WAS DRY
at time of sampling, Check here
Sample is from system:
❑ Influent [
Relative M.P. Elevation in
Date sample collected:
Appearance fzirs_fi
No. WQ0005849 EXPIRATION DATE:
arge UIC
'E OF PERMITTED OPERATION BEING MONITORED
----Lagoon Remediation: Inflitration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Water Source Heat Pump
Other:
For Remediation System InfluentlEffluent Only (Attach
Influent mglL (Total VOC Concentration)
Effluent mg/L (Total VOC Concentration)
VOC Removal
Date sample analyzed:
Laboratory Name:
Certification No.
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified YES NO.)
NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO2) as N
mg/I Ni - Nickel
mg/I
Coliform: MF Fecal
/100ml
Nitrate (NO3) as N �_ ^a
mg/I
Pb - Lead mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
mg/I
Zn -Zinc mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total
mg/I
Orthophosphate
A I- Aluminum
mg/I
mg/I
Other (Specify Compounds and Concentration Units)
pH (when analyzed)
units
Be - Barium
mg/I
TOC /,. L9
mgll
Ca - Calcium
mg/I
Chloride '3
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Sulfate
mg/I
Hg - Mercury
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Speck Conductance
uMhos
K - Potassium
mg/1
Report Attached? Yes (1) No (0)
Total Ammonia
mg/I
Mg - Magnesium
mg/I
VOC : method #=
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total) —
Mn - Manganese
mg/I
: method #=
TKN as N
mg/I
: method #=
method #_

SUBMIT FORM ON
HAHLK UNLY
TY INFORMATION Please Print Clearly or Type
Name: Pluris LLC
Name (if different):
Address: 1095 HWY 210
Sneads Ferry $tree) NC 28460 County onslow
act Person: Randy Hoffer Telephone#: [phone]
Location/Site Name: tki2'I— No. of wells to be sampled:
ro miq
Well Identification Number
Well Depth: 1 `7'
Screened Interval:
Depth to Water Level. !
Measuring Point isg;�_
Gallons of water pumped/bai
ft. Well Diameter: in.
ft. to ft.
ft. below measuring point.
ft. above land surface.
A before sampling:
time of sampling, Check here
Influent
Date sample collected:.
EPARTMENT OF ENVIRONMENT & NATURAL RESOURCES'
IVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
i17 MAIL SERVICE CENTER
RLEIGH. NC 27699-1617 Phone: [phone]
No. W00005849
EXPIRATION DATE:
UIC
PE ®F PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Inflitration Gallery
_Spray Field Remediation:
----.Rotary Distributor Land Application of Sludge
Water Source Heat Pump
Other:
For
mt mg/L (Total VOC Concentration)
�nq mg/L (Total VOC Concentration)
Removal %
FIELD ANALYSIS: pH = Specific Conductance uMh s Date sample analyzed:
Temp. °C Odor Appearance he,14-92- Laboratory Name:
Certification No.
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified YES NO.)
NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO2) as N mg/1 Ni - Nickel
Coliform: MF Fecal /100ml Nitrate (NO3) as N Lg �� mg/1 Pb - Lead
Lab Reports.)
mg/I
mg/I
Coliform: MF Total
1100ml
Phosphorus: Total as P
mg/1
Zn - Zinc mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total 339
mg/I
Orthophosphate
A I- Aluminum
mg/I
mg/I
Other (Specify Compounds and Concentration Units)
pH (when analyzed)
units
Ba - Barium
mg/I
TOC
mg/1
Ca - Calcium
mg/I
Chloride
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Sulfate
mg/I
Fig - Mercury
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Specific Conductance
uMhos
K - Potassium
mg/I
Report Attached? Yes (1) No (0)
Total Ammonia , -
mg/1
Mg - Magnesium
mg/I
VOC : method #=
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese
mg/I
: method #=
TKN as N
mg/I
: method #=
method #=

SUBMIT FORM ON YELLOW PAPER ONLY
DWATER QUALITY MONITORING:
IANCE REPORT FORM
Vid
ty Name; Pluds LLC
it Name (if different):
ty Address: 1095 HWY 210
Sneads Ferry (st a t> NC 28460 County Onslow
act Person: Randy Hoffer Telephone#: [phone]
Location/Site Name: 0,o. of wells to be sampled:
rom em q
Well Depth: — ft.
Screened Interval: ft.
Depth to Water Level: 15, cl ft.
Measuring Point is ,- - ­­ ft.
Gallons of water pumped/bailed
FIELD ANALYSIS: pH ,f.a . �
Temp. ;;I
Well Diameter: e�, in.
to ft.
below measuring point.
above land surface.
before sampling:_
Specific Conductar
°C Odor
WELL WAS DRY
time of sampling, Check here
ample is from system:
❑ Influent [
Date sample collected: 5- J 42 Sze
uMhos
Appearance
W00005849
EXPIRATION DATE:
UIC
PE OF PERMITTED OPERATION BEING MONITORED
a/ALagoon Remediation: Inflitration Gallery
_Spray Field Remediation:
—Rotary Distributor Land Application of Sludge
Water Source Heat Pump
Other:
Remediation System Influent/Effluent
ant mg/L (Total VOC Concentration)
.nt mg/L (Total VOC Concentration)
Removal %
Name:
I No.
PARAMETERS (Samples for metals were collected unfiltered YES NO and field acidified YES NO.)
NOTE: Values should reflect dissolved and colloidal concentrations.
COD
mg/I
Nitrite (NO2) as N
mg/I
Ni - Nickel mg/I
Coliform: MF Fecal
/100ml
Nitrate (NO3) as N
mg/I
Pb - Lead mg/I
Coliform: MF Total
/100m1
Phosphorus: Total
as P mg/I
Zn - Zinc mg/I
(Note: Use MPN method for highly turbid samples) l,
Orthophosphate
mg/I
Dissolved Solids: Total p�`'B LI
mg/I
A I- Aluminum
mg/I
Other (Specify Compounds and Concentration Units)
pH (when analyzed)
units
Ba - Barium
mg/I
TOC
mg/1
Ca - Calcium
mg/I
Chloride °3-
mg/I
Cd - Cadmium
mg/I
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/I
Phenol
mg/I
Fe - Iron
mg/I
ORGANICS: (by GC, GC/MS, HPLC)
Sulfate
mg/I
Hg - Mercury
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Specific Conductance
uMhos
K - Potassium
mg/I
Report Attached? Yes (9) No (0)
Total Ammonia
mg/I
Mg - Magnesium
mg/I
VOC : method #=
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese
mg/1
: method #=
TKN as N
mg/I
: method #=
method #=

GW-59A COMPLIANCE IRE PORT FORM
(Submit one each monitoringperiod irith GIV-59forms.)
1
Enter date monitoring results were due. {✓z;J>,j; ° ) Will this monitoring report (GW-59 and GW-59A)
YES
(NO `
be submitted after the established due date?
-- -
rNO
2
Was any required information missing on the GW-59 report forms?
YES(
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 Off ce for guidance.
i
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
YE
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, concentrations) reported, and sample collection date for each occurrence (for the last two years).
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
7NO
If the answer is "YES", a groundwater quality problem maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells maybe 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?
i
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 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 G W-59 forms for required wells to the address provided at the top of the current G W-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 comb[ a to the best of my knowledge.
Signature of Permittee (or AuthorWdd' g ) path
GIV-59A 12/8/2003

2017 2018 2019 2020
MARCH JULY NOV. MARCH JULY NOV. MARCH JULY NOV. MARCH JULY NOV.