WQ0004972_Monitoring - 08-2020_20200831

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0004972
Name of Facility:* Forest Lake ELS
Month:* August
Report Information
Type *
GW-59
Confirmation Email Address:*
Name of Submitter:*
Signature:*
Date of submittal:
Initial Review
Year:* 2020
Upload Document*
Forest Lakes August 2.1 MB
Groundwater Results.pdf
FDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Arnie Ferguson
McOVkOW&W
Reviewer: Williams, Kendall
8/28/2020
This will be filled in automatically

Is the project number correct?* WQ0004972
Is the monitoring report t: Yes r No
accepted?*
Regional Office* Winston-Salem
Accepted Date: 8/31/2020

RESEARCh & ANAtyTICAL
LAbORATORIES, INC.
For: Forest Lake Preserve
192 Thousand Trails Drive
Advance, NC 27006
Attn: John Keen
Client Sample ID: MW-1
Site: Forest Lakes
Parameter —
Fec Coli-MF
Total Organic Carbon
Report of Analysis
8/26/2020
�fs��era+i��t�
��
4 4
M
4 d.f UC w d7 NC #34
NC #37701
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! PIED MO`ti
Lab Sample ID: 86130-01
Collection Date: 8/13/2020 7:25
Method Result Units Rep Limit Anal st Analysis DatelTime
SM 9222 D-2006 383 c011100 ml 1 BJ 8/13/2020 1315
SM 5310 N-2011 <1.0 mg/L 1 MG 8/24/2020
Client Sample ID: MW-2
Site: Forest Lakes
Parameter Method
Fec Coli-MF SM 9222 D-2006
Total Organic Carbon SM 5310 N-2011
Client Sample ID: MW-3
Site: Forest Lakes
} Parameter Method
Fec Cali-MF SM 9222 D-2006
Total Organic Carbon SM 5310 N-2011
Lab Sample ID: 86130-02
Collection Date: 8/13/2020 7:39
Result Units Rep Limit Analyst Analysis Date/Time
<1 co11100 ml 1 BJ 8/13/2020 1323
5.63 mg/L 1 MG 8/24/2020
Lab Sample ID: 86130-03
Collection Date: 8/13/2020 7:50
Result Units Rep Limit Analyst Analysis DatetTime
740 col/100 ml 1 BJ 8/13/2020 1327
2.56 mg/L 1 MG 8/24/2020
Client Sample ID: MW-4 Lab Sample ID: 86130-04
Site: Forest Lakes Collection Date: 8/13/2020 8:06
Parameter Method Result Units Rep Limit Analyst Analysis DatelTime
Fec Coli-MF SM 9222 D-2006 394 c011100 ml 1 BJ 8/13/2020 1331
Total Organic Carbon SM 5310 N-2011 <1.0 mg/L 1 MG 8/24/2020
NA = not onciyzed
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] wvvw.randalabs.com Page 1

RESEARCh & ANALYTICA[
ptp LAbORAToRIES, INC. g°` NO#34
0 Analytical/Process Consultations yySk+°jaecreR
Chemical Analysis for Selected Parameters and Sampling Location Identified as Groundwater
(A Forest Lake Preserve Pro)ect, collected 13 AR ast 2020)
L Volatile Organics Quantitation MW-1 MW-2 MW-3 MW4
EPA Method 8260 D Limit
Parameter {ppbi (Dnbl tnnbl (Dob) IRLb1
Acetone 25 BQL BQL BQL BQL
Acrolein 100 BQL BQL BQL BQL
Acrylonitrile 100 BQL BQL BQL BQL
Benzene 0.5 BQL BQL BQL BQL
Bromobenzene 0.5 BQL BQL BQL BQL
Bromoehloromethane 0.5 BQL BQL BQL BQL
Bromodichlorome0rene 0.5 BQL BQL BQL BQL
Bromoform 1.0 BQL BQL BQL BQL
Bramomethane 1.0 BQL BQL BQL BQL
2-Butanone 25 BQL BQL BQL BQL
Carbon Disulfide 5.0 BQL BQL BQL BQL
Carbon Tetrachloride 0.5 BQL BQL BQL BQL
Chlorobenzene 0.5 BQL BQL BQL BQL
Chloroethane 1.0 BQL BQL BQL BQL
2-Chloroethyl vinyl ether 5.0 BQL BQL BQL BQL
Chlorofo0.5 BQL BQL BQL BQL
Chlorm rometbane I.0 BQL BQL BQL BQL
2-Chlorotoluene 0.5 BQL BQL BQL BQL
4-Chlorotoluene 0.5 BQL BQL BQL BQL
Cis-1,2-Diehloroethene 0.5 BQL BQL BQL BQL
Cis-1,3-Dichloropropene 0.5 BQL BQL BQL BQL
1,2-Lhbromo-3-Chloropropene(DBCP) 5.0 BQL BQL BQL BQL
1,2-Dibromoethane (EDB) 0.5 BQL BQL BQL BQL
Dibromochloromethane 0.5 BQL BQL BQL BQL
Dibromomcdme 0.5 BQL BQL BQL BQL
1,2-Dichlorobenzene 0.5 BQL BQL BQL BQL
1,3-Dichlorobenzene 0.5 BQL BQL BQL BQL
1,4-Dichlorobenzene 0.5 BQL BQL BQL BQL
],I-Dichlomethane 0.5 BQL BQL BQL BQL
1,2-Dichlomethane 0.5 BQL BQL BQL BQL
],I-Dichloroethene 0.5 BQL BQL BQL BQL
Diehlorotlouromethane 0.5 BQL BQL BQL BQL
1,2-Dichlompropane 0.5 BQL BQL BQL BQL
1,3-Dichlompropane 0.5 SQL BQL BQL BQL
2,2-Dichlomprepane 0.5 BQL BQL BQL BQL
),I-Dichloropropene 0.5 BQL BQL BQL BQL
Ethyl Benzene 0.5 BQL BQL BQL BQL
2-Hesanone 5.0 BQL BQL BQL BQL
IPE 0.5 BQL BQL BQL BQL
I-Propylbenzene 0.5 BQL BQL BQL BQL
4-Methyl-2-Pentmtone 5.0 BQL BQL BQL BQL
Methyl Iodide 1.0 BQL BQL BQL BQL
Methylene Chloride 5.0 BQL BQL BQL BQL
MIKE 0.5 BQL BQL BQL BQL
Naphthalene 0,5 BQL BQL BQL BQL
N-Butylbenzene 0.5 BQL BQL BQL BQL
N-Propylbenzene 0.5 BQL BQL BQL BQL
p-Lsopropyltoluene 0.5 BQL BQL BQL BQL
Sec-Butylbenrene 0.5 BQL BQL BQL BQL
Styrene 0.5 BQL BQL BQL BQL
Tert-Butylbenzene 0.5 BQL BQL BQL BQL
1,1,1,2-Tehachloroethane 0.5 BQL BQL BQL BQL
1,1,2,2-Tehachloroethane 0.5 BQL BQL BQL BQL
Tetrachloroethene 0.5 BQL BQL BQL BQL
Toluene 0.5 SQL BQL BQL BQL
Trans-1,2-Dichlomethene 0.5 BQL BQL BQL BQL
Trans-1,3-Dichloropropene 0.5 BQL BQL BQL BQL
Trans-1,4-Dichloro-2-butene 5.0 BQL BQL BQL BQL
1,2,3-Trichlombenzene 0.5 BQL BQL BQL BQL
1,2,4-Trichlombenzene 0.5 BQL BQL BQL BQL
1,1,1-Trichloroethane 0.5 SQL BQL BQL BQL
I11,2-Triehloroethane 0 5 BQL BQL BQL BQL
Trichloroethene 0.5 BQL BQL BQL BQL
Trichlorofluoromethane 0.5 BQL BQL BQL BQL
IA3-Trichloeopropanc 0.5 BQL BQL BQL BQL
IA4-Trimethylbenzene 0.5 BQL BQL BQL BQL
I,3,5-Trimethylbenzene 0.5 BQL BQL BQL BQL
Vinyl Acetate 1.0 BQL BQL BQL BQL
Vinyl Chloride 0.5 BQL BQL BQL BQL
Total Xytenes 1.0 BQL BQL BQL BQL
Dilution Factor 1 I I 1
Sample Number 86130-01 86130-02 86130-03 86130-04
Sample Date 08/13/20 09/13/20 08/13/20 08/13/20
Sample Time (his) 0725 0739 0750 0806
Date Analyzed 08/20/20 09/20/20 09/20/20 08/20/20
Time Analyzed 2118 2150 2221 2253
Surrogate Recovery Range
DBFM (70-130%) 110% 114% 114% 117%
Toluene-d& (70-130%) 100% 98% 103% 99%
4-BFB (70-130%) 100% 104% 97% 100%
BQL - Below QuInthation Limit! J - Patimntod Commae7ieo. P-re but below gaautitntion limit. ppb part per billion

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
and 1 copy to:
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phona: j919) 733.3221
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: W00004972 Expiration Date:
Facility Name: Forest Lake ELS
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: 192 Thousand Trails Drive
TYPE OF PERMITTED OPERATION BEING MONITORED
Advance NC
27006
County Davie
❑ Lagoon ❑ Remediat'son: Infiltration Gallery
© Spray Field ❑ Remediation:
Contact Person: Barbara Stanze
Telephone#:
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:
No. of wells to be sampled: 4
❑ Water Source Heat Pump ❑ Other:
(from Parmd)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-1
Date sample collected:
8/13/2020 FIELD ANALYSES:
WAS
Well Depth: 90.00 ft.
Well Diameter:
2 in. pH 004011 units Temp. 00010: eC
DRY at
Dept to Water Level 64.92 ft. below measuring point
Screened Interval
Pt. to ft Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is ft. above land
surface
Relative M.P. Elevation:
ft. Odor 00i
check
Volume of water pumpedlbailed before sampling:
6.50-Dry
gallons
Appearance
here:❑
Samples for metals were collected unfiltered:
❑ YES ❑
NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 08113 & 08/24/2020
Laboratory Name: Research & Analytical Laboratories, Inc Certification No. 34
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mglL
Nitrite (NO2) as N OD615
ri Pb - Lead otosl ug/L
Coliform: MF Fecal 31616 383
I100ml-
Nitrate (NO3) as N OD620
ni Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
1100mL Phosphorus:
Total as P cosss
mglL
(Note, Lise MPN method tor highly turbid samples)
Orthophosphate 70507
11 Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300
ri
Al -Aluminum olim
mg/L
PH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC ooflm <1.0
mg1L
Ca - Calcium oog16
mg1L
Chloride 00940
mglL
Cd - Cadmium 01027
ug1L
Arsenic 01002
ug1L
Chromium: Total 01034
ug1L
Grease and Oils 00552
mg1L
Cu - Copper 01042
mg1L ORGANICS: (by GC, GCIMS, HPLC)
Phenol 32730
1
Fe - Iron 01045
ug1L (Specify test and method #. CyyTACH LAB REPORT.)
Sulfate 00945
mg1L
Hg - Mercury 71900
ug1L Lab Report Attached? LN!�] Yes (1) ❑ No (0)
Specific Conductance 00095
µMhos
K - Potassium 00937
mglL VOC 78732: method # 8260
Total Ammonia 00610
ni
Mg - Magnesium 00927
mglL method #
(Ammonia Nitrogen, Ni as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug1L , method #
TKN as N 00625
mg/L
Ni - Nickel 011067
11 method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mglL Effluent Total VOCs: mglL VOC Removal%
I certify that, to the best of my knowledge and belief, the information submitted in this report is true, accurate, and complete, and that the laboratory analytical data was produced using approved methods of analysis by a
DWQ-certified laboratory. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
/\Ji . f m r1JU0
Permittee (or Authorized Aeent) Name and Title -Please print or type
Sionatu*'16TPermitiee (or Authorized Acent)
(Date)
GW-59 Rev. 2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original
DEPARTMENT OF ENVIRONMENT & NATURAL. RESOURCES
GROUNDWATER QUALITY MONITORING:
and 1 Copy to:
DIVISION OF WATER QUALITY•INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: I919I 733-3221
FACILITY INFORMATION
Please Print CleanyorType
PERMIT Number: W00004972 Expiration Date:
Facility Name: Forest Lake ELS
Non -Discharge UIC
NPDES Other
Permit Name (if different):
Facility Address: 192 Thousand Trails Drive
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Advance NC 27006 County Davie
Spray Field ❑ Remediation:
Contact Person: Barbara Stanze
Telephone#:
❑ Rotary Distributor ❑ Land Application of Sludge
Well LocationlSite Name:
No. of wells to be sampled: 4
❑ Water Source Heat Pump ❑ Other:
(from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-2
Date sample collected:
811312020 FIELD ANALYSES:
WAS
Well Depth: 39.00 ft.
Well Diameter:
2 in. pH 00400- units Temp. 000lo aC
DRY at
Dept to Water Level 35.67 ft. below measuring point
Screened Interval:
ft. to ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is ft. above land surface
Relative M.P. Elevation:
ft. Odor 00085:
check
Volume of water pumped/bailed before sampling:
1.25-Dry
gallons
Appearance
here: ❑
Samples for metals were collected unfiltered:
❑ YES ❑
NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 08113 & 08/24/2020
Laboratory Name: Research & Analytical Laboratories, Inc Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mglL
Nitrite (NO2) as N oos15
mglL Pb - Lead o1o5i uglL
Coliform: MF Fecal 31616 <1
1100mL
Nitrate (NO3) as N 0062D
mg1L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
1100mL Phosphorus: Total as P 00665
mglL
{Note: use MPN method for highly lurUd samples)
Orthophosphate 70507
mglL Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300
ni
Al - Aluminum o1105
mglL
pH (Lab) 00403
units
Ba - Barium 01007
uglL
TOC oo660 5.63
mg/L
Ca - Calcium 00916
mglL
Chloride 00940
mglL
Cd - Cadmium 01027
uglL
Arsenic 01002
uglL
Chromium: Total 01034
uglL
Grease and Oils 00552
mglL
Cu - Copper 01042
mglL ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
11
Fe - Iron 01045
uglL (Specify test and method #. FTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
uglL Lab Report Attached? E' Yes (1) F-] No (0)
Specific Conductance 00095
µMhos
K - Potassium 00937
mglL VOC 71 method # 8260
Total Ammonia ool to
mglL
Mg - Magnesium C0927
mglL method #
(Ammonia Nitragen: NH3 as N: Ammonia Nitrogen, Total)
Mn -Manganese 01 Ds5
uglL ,method #
TKN as N 00625
mglL
Ni - Nickel CID67
uglL method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOC& mglL Effluent Total VCl
mglL VOC Removal%
I certify that, to the best of my knowledge and belief, the information submitted in this report is true, accurate, and complete, and that the laboratory analytical data was produced using approved methods of analysis by a
DWO-certified laboratory. I am aware that there are sigrifirant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Permittee (or Authorized Aqent) Name and Title -Please print or type Signature of Permittee (or Authorized Agent) (Date)
GW-59 Rev.212010

SUBMIT FORM ON YELLOW PAPER ONLY
Mail Original
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
and 1 Copy to:
DIVISION OF WATER QUALITY -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: WQ0004972 Expiration Date:
Facility Name: Forest Lake ELS
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: 192 Thousand Trails Drive
TYPE OF PERMITTED OPERATION BEING MONITORED
Advance NC
27006 County Davie
❑ Lagoon ❑ Remediation: Infiltration Gallery
© Spray Field ❑ Remediation:
Contact Person: Barbara Stanze
Telephone#:
❑ Rotary Distributor ❑ Land Application of Sludge
Well LocationlSite Name:
No. of wells to be sampled: 4
❑ Water Source Heat Pump ❑ Other:
(from Permit)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-3
Date sample collected:
8/13/2020 FIELD ANALYSES:
WAS
Well Depth: 1910 ft.
Well Diameter:
2 in. pH 00400: units Temp. o00101 °C
DRY at
Dept to Water Level 88 33 ft. below measuring point
Screened Interval:
ft. to _ft Spec. Cond. 00094: NMhos
time of
sampling,
Measuring Point is ft. above land surface
Relative M.P Elevation:
ft. Odor 00095:
check
Volume of water pumped/bailed before sampling:
5.25
gallons
Appearance
here: ❑
Samples for metals were collected unfiltered: [--]YES
❑ NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 08113 & 08/24/2020
Laboratory Name: Research & Analytical Laboratories, Inc Certification No. 34
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD o11335
mglL
Nitrite (NO2) as N 00615
mglL Pb - Lead o1o51 ug1L
Coliform: MF Fecal 31616 740
1100mL
Nitrate (NO,) as N 00620
mglL Zn - Zinc 01092 mg1L
Coliform: MF Total 31504
1100ml-
Phosphorus: Total as P o06m
mglL
(Note Use MPNmethod for highiyturbid samples)
Orthophosphate 705t17
mglL Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300
mg1L
Al -Aluminum of lo5
mglL
pH (Lab) 00403
units
Bat - Barium o1co7
uglL
TOC owo 2-56
mg1L
Ca - Calcium 00916
mglL
Chloride 00940
mg1L
Cd - Cadmium 01027
ug1L
Arsenic 01002
ug1L
Chromium: Total 01034
uglL
Grease and Oils 00552
mg1L
Cu - Copper 01042
mglL ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug1L
Fe - Iron 01045
uglL (Specify test and method #. g TACH LAB REPORT.)
Sulfate 00945
mglL
Hg - Mercury 71900
uglL Lab Report Attached? u Yes (1) =No (0)
Specific Conductance o0095
NMhos
K - Potassium 00937
mg1L VOC 78732: method # 8260
Total Ammonia 00610
mglL
Mg - Magnesium 00927
mglL method #
(Ammonia Nilrogem, NHSas N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
uglL , method #
TKN as N 00625
mglL
Ni - Nickel 01067
uglL method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mglL Effluent Total VOCs:
mg1L VOC Removal%
I certify that, to the best of my knowledge and belief, the information submitted in this report is true, accurate, and complete, and that the laboratory analytical data was produced using approved methods of analysis by a
DWQ-cerlified laboratory. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
�. ^ - ( G" V1.1 �l_
Permittee (or Authorized Actent) Name and Title - Please orint or type
Z�_ _--�7
Signature of Permidee (or Authorized Agent)
-� -7 4;7G
(Date)
GW-59 Rev.212010

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original
DEPARTMENT OF ENVIRONMENT 8 NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
and 1 copy to:
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: [phone]
FACILITY INFORMATION
Please Print Cleady
or Type
PERMIT Number: WQ0004972 Expiration Date:
Facility Name: Forest Lake ELS
Non -Discharge UIC
NPDES Other
Permit Name (if different):
Facility Address: 192 Thousand Trails Drive
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Advance NC 27006 County Davie
"
© Spray Field ❑ Remediation:
Contact Person: Barbara Stanze
Telephone#:
❑ Rotary Distributor ❑ Land Application of Sludge
Well LocationlSite Narri
No. of wells to be sampled: 4
❑ Water Source Heat Pump ❑ Other:
(from Fermis)
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): li
Date sample collected:
8/13/2020 FIELD ANALYSES:
WAS
Well Depth: 46.00 ft.
Well Diameter:
2 in. pH 00400: units Temp. 000lo °C
DRY at
Dept to Water Level 39.99 ft. below measuring point
Screened Interval:
ft. to ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is ft. above land surface
Relative M.P. Elevation:
ft. Odor o0085
check
Volume of water pumpedlbaited before sampling:
2.00-Dry
gallons
Appearance
here: ❑
Samples for metals were collected unfiltered: ❑ YES ❑
NO and field acidified: ❑ YES ❑ NO
LABORATORY INFORMATION
Date sample analyzed: 08113 & 08/2412020
Laboratory Name: Research & Analytical Laboratories, Inc Certification No. 34
PARAMETERS NOTE: Values should reflect
dissolved and
colloidal concentrations.
COO 00335
mg1L
Nitrite (NO2) as N 00615
mglL Pb - Lead 01051 uglL
Coliform: MF Fecal 31616 394
1100mL
Nitrate (NO3) as N 0015520
mglL Zn - Zinc 01092 mglL
Coliform: MF Total 31504
1100ni Phosphorus: Total as P 00665
mglL
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mglL Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
uglL
TOC 00680 c1.0
mglL
Ca - Calcium oo91s
mglL
Chloride 00940
mglL
Cd - Cadmium 01027
11
Arsenic 01002
ug1L
Chromium: Total 01034
uglL
Grease and Oils 00552
ni
Cu - Copper 01042
mglL ORGANICS: (by GC, GCIMS, Hi
Phenol 32730
11
Fe - Iron C1045
uli (Specify test and method #. ATTFACH LAB REPORT.)
Sulfate 00945
mglL
Hg - Mercury 71goo
i Lab Report Attached? 0 Yes (1) ❑ No (0)
Specific Conductance 00095
µMhos
K - Potassium C0937
mglL VOC 78732: method # 8260
Total Ammonia 00610
ni
Mg - Magnesium C0927
mg1L method #
(Ammonia Nitrogen; NH3 as N. Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug1L method #
Ti as N 00625
li
Ni - Nickel 01067
uglL method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mglL Effluent Total VOCs:
ni VOC Removal%
I certify that, to the best of my knowledge and belief, the information submitted in this report is true, accurate, and complete, and that the laboratory analytical data was produced using approved methods of analysis by a
DWQ-Certified laboratory, I am aware that there are significant penaltiesforsubmitting false information, including the possibility of fines and imprisonment for knowing violations,
Permittee for Authorized Agent) Name and Title - Please print crtvpe Signature of Permittee {or Authorized Agent) (Date;
7e
GW-59 Rev. 2/2010