NC0000507_AROHistoricGroundwaterA_02052019

_JNA DEPARTMENT OF NATURAL k ;8 AND COMMUNITY DEVELOPMENT
VISION OF ENVIRONMENTAL MANAGED. GROUNDWATER SECTION
P.O. BOX 27867 - RALEIGH,N.C. 27011. PHONE [phone]
WELL CONSTRUCTION RECORD
FOR OFFICE USE ONLY
Quad. No. d :-Serial No. � I
Lat. 35"1to ' 2 a Long. SVZ4z 'sz Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent.
DRILLING CONTRACTOR Z22.4 t TifTF TF.STi tJl�
STATE WELL CONSTRUCTION
DRILLER REGISTRATION NUMBER e 6 8 PERMIT NUMBER: d2l' DD id GJ.tq DO S
1. WELL LOCATION: (Show sketch of the location below)
Nearest Town: g4r1$ 71 >L R o1 A1- County:
Depth DRILLING LOG
(Road, Community, or Subdivision and Lot No.)
From To Formation Description
2. O W N E R ,4's' // r.� Z �ICG76?-7G (­2
ADDRESS��
r eet or Rout No.
City or Town State Zip Code 0 f Or30/
3. DATE DRILLED ' �%��6 USE OF WELL
4. TOTAL DEPTH I3,e CUTTINGS COLLECTED
/ Yes ❑ No / gig S�1�r0 i C
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes U No
6. STATIC WATER LEVEL: .S� 6 FT. ❑ above TOP OF CASING,
'below
TOP OF CASING IS 3, FT. ABOVE LAND SURFACE.
7. YIELD (gpm): !V41 METHOD OF TEST di✓//rr 4
S. WATER ZONES (depth): St rO 1fLLe " 5. 6
9. CHLORINATION: Type �� Amount
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft. Materri/alp
From 3 To f_ Ft. 2- h yv Pvc,
From To Ft.
From To Ft.
11. GROUT:
Depth Material Method
From To-3,5'Ft. L 04 '
From -1, 5- To 6•�Ft. -Ilee& 7c�rC
12. SCREEN:
Depth Diameter Slot Size Material
From 9, ? To /3, 2 Ft. .2 N in. o coo in. Svc
Fr3m To Ft. in. in.
From To Ft. in, in.
13. GRAVEL PACK:
Depth SizeMaterial
From ti,s To /J� S Ft. OT7,&L ,0aC S'Awa
From To Ft.�
14. REMARKS:
If additional space is needed useu k Bf fo
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
- t�al�
+� SITE
�� .('.` I�*�.\�
•�. / '
/��T fir:
I DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD AS BEEN PROV =TEL OWNER.
/e1i3f86 .
SIGNATURE OF CONTRACTOR OR AGENT DATE
Ruhmit oriainal to Divisinn of Fnvi-mnmantai Mananamant nnr4 rrnnv to wall nw Ior

..1one5- .
,'� �'t„ ICI �' �• � • ,: �•
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w4 r . ti;pn ti.ho,,j _ "�`� P �J r Upwas
arc
T26
4-
the w« at r N C �>
Camp Fa�rKr tinds.N .f
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.Grounds;-' ,�! • ��\ F1,
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o,
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J4 _�'74000m E.
L
m1,
t ��, ROD `:LA.`i`,1F�C;AT1nN

GENERAL ELECTRIC COMPANY COUNTY: HENDERSON
DATE SAMPLED
ALKALINITY,TO pH 4.5
ALKALINITY,TO pH 8.3
ALUMINUM
/.
0•.20
C, 0
0.�70
6.33'
ARSENIC
o. 0 00
0.
0. 0(?
< 0.00,
v 0.005'
BARIUM
BERYLLIUM
BICARBONATE
CADMIUM
CALCIUM
CARBONATE
CHLORIDE
q, `T
i 1
r!
tj
/' 0
CHROMIUM,TOTAL
< o .00s,
a 0. oos
0.00.6,
Oe 040s
COBALT
COD
COLIFORM, FECAL
COLIFORM, TOTAL
COPPER
0. 0.21
0. 016
0. 110 7!s'
Oro _ 0,21
0. 007
CYANIDE
DISSOLVED SOLIDS
7,90
26.0
FLUORIDE
HARDNESS CaCo3
HARDNESS, NON CARB
IRON
LEAD
< 0, 003
0. 00-4
< 0. 0 OJ
0.00 33,4
er, 00.3
LITHIUM
M BAS
MAGNESIUM
MANGANESE
MERCURY
c0.0001
c o, coo i
t G. 000)
c 0. c)oo
.4 0. 0001
NICKEL
NITROGEN, AMMONIA
NITROGEN, KJELDAHL
NITRATE & NITRITE
ORGANIC SCAN
ORTHOPHOSPHATE
PHENOLS
<0. 0io
<0,0j0
a 0.9ta
0.0f0
eQr.0.40
PHOSPHORUS, TOTAL
POTASSIUM
-
SELENIUM
SILVER
SODIUM
SPECIF. CONDUCTANCE
SULFATE
cp7'
/00
TOC (UNFILTERED)
y3
3.
, , 7
�, S
TOX
TSS
VOC
ZINC
0.0.20
o.;to
acz,c� f3eo.c�,;2oe0.
�0
STATIC WATER LEVEL
-1. 6,9 ' 1
4 - 1
6 , :3 d "
4. v
Red Ink=Sample taken by facility

COUNTY: /YEIVD6 R5 ® Al
!a- vo /!- 30�-00
DATE SAMPLED
� `iq
�'1-G
ALKALINITY, TO pH 4.5
ALKALINITY, TO pH 8.3
ALUMINUM
0.
o • 01
4 0- !0
ARSENIC
0. 00%;
c 0 o0.
: oo av3'
t ae�o5
BARIUM
BERYLLIUM
BICARBONATE
CADMIUM
CALCIUM
CARBONATE
CHLORIDE
CHROMIUM, TOTAL
D 5
< 04 00S,
0 •
COBALT
COD
COLI FORM, FECAL
COLI FORM, TOTAL
COPPER
0. v 10
a 0. o iv
a 0. 4> I
CYANIDE
DISSOLVED SOLIDS
i % d
3 a
Q
FLUORIDE
HARDNESS CaCo3
HARDNESS, NON CARB
IRON
LEAD
U, vv3
Z 0, 0 03
0. Ga3
.4 0. 009
LITHIUM

WELL NO. P /off COUNTY: REAIDEW SOAI
DATE SAMPLED %-ro-oc► ri-30- 0
®
MBAS
MAGNESIUM
MANGANESE
MERCURY
t o. v�oa
o, ado
NICKEL
NITROGEN, AMMONIA
NITROGEN, KJELDAHL
NITRATE& NITRITE
ORGANIC SCAN
PH
6.0
( O
&. 0
PHENOLS
c [?. c�>d
�'O• oro
�. veo
L o. ago
PHOSPHORUS, TOTAL
POTASSIUM
SELENIUM
SILVER
SODIUM
SPECIF. CONDUCTANCE
SULFATE
% S a
/'jo
130
f�
TOC (UNFILTERED)
TOX
TSS
VOC
ZINC
t (7 �?�7,
G D• Off-
0. V ,A
0,037
STATIC WATER LEVEL

WELL NO.y1 S/ P/ COUNTY: P e N o L 2 S O 1y
DATE SAMPLED
�, _ 97
-3- G $
7- -10 -79
ALKALINITY, TO pH 4.5
ALKALINITY, TO pH 8.3
ALUMINUM
0. ;1'7 7
0. 140
0. 1,77
0 . & 73
ARSENIC
e, ta. 0�rsc,
< ca ®�g o
< 0, o S
- ©. Oa
< O. Da S'
BARIUM
BERYLLIUM
BICARBONATE
CADMIUM
CALCIUM
CARBONATE
CHLORIDE
3A .6
1.2. 3
CHROMIUM, TOTAL
< 0. a i 00
e 0. of ©o
4 0.01
t p , cy /
� 0.01
4 0. O f
COBALT
COD
COLIFORM, FECAL
COLIFOR.M, TOTAL
COPPER
0. vX?a
ca.v® o�
0. 00.6
t c�. 00-i'
0. v'.28
0, c -ai
CYANIDE
DISSOLVED SOLIDS
3 o �f-
,330,0
2 g,5'
3,20
.3/6
g
FLUORIDE
HARDNESS CaCo3
HARDNESS, NON CARB
IRON
LEAD
0. 0&77r
0, 00&'IA
LITHIUM
Red Ink = Sample taken by facility

f
COUNTY:
DATE SAMPLED
MBAS
MAGNESIUM
MANGANESE
MERCURY
0. ao3'�2 ou
t tl owe 2 ®©
4 CU. 00+7.4
c o. v av
o. 000�
t 0. 000';„
NICKEL
NITROGEN, AMMONIA
NITROGEN, KJELDAHL
NITRATE & NITRITE
ORGANIC SCAN
pH
S. "7 3
6, v K
-6': 33
.3 . 9 !
PHENOLS
!�. voN�4�
0. 00U
< o, v v.
.4 O. 00.6
0. oa.'
.t O, 0 !
PHOSPHORUS, TOTAL
POTASSIUM
SELENIUM
SILVER
SODIUM
SPECIE. CONDUCTANCE
SULFATE
js
1�
l o� Q
/2
TOC (UNFILTERED)
%
'r9
'4 / ®
7
%.
TOX
TSS
VOC
ZINC
d, o7 o
o•oa7®
o o 2 o
o.ois-9
0.02
O. o3y
STATIC WATER LEVEL
j
3
�°j,77�
e
q 0
W a
Iced Ink = Sample taken by facility

COUNTY r1N✓� i'� 5 ��'a/
DATE SAMPLED
ff - 30 -- 16
3" Q ' `/ fo
%-
`I%
%- q - l
ALKALINITY, TO pH 4.5
ALKALINITY, TO pH 8.3
ALUMINUM
f< . ` .5y
Z) �+~�
.e. f' . o to
0.,2 70
o
ARSENIC
c 0 .050
o. 0-2 3
< 0.o,;?Y
, 0- 0,260
0.03 SO
BARIUM
BERYLLIUM
BICARBONATE
CADMIUM
CALCIUM
CARBONATE
CHLORIDE
f�
CHROMIUM, TOTAL
0. 0066
4 (?
4 0. 010
< O. fJl��iJ
e 0• o/00
COBALT
COD
COLIFORM, FECAL
COLIFORM, TOTAL
COPPER
® of-1
0. 00(1
l2 • %a ®
o. 00
CYANIDE
DISSOLVED SOLIDS
/
a 0C,
30
.3 / j
FLUORIDE
HARDNESS CaCa,
HARDNESS, NON -CARBONATE
IRON
LEAD
G !e. 00yo
4 0°. ©0 ,�F
0 . 0 ®
0. 00d igf
Z.0. 00 i o
C 0, 0 a 00
LITHIUM
Red Ink = Sample taken by facility'

COUNTY 171Ely AC-S,'7) At
DATE SAMPLED
%%' .0 ` P
'" -
- / U'" l�
/f ;7'
%- /i - 9 7
MBAS
MAGNESIUM
MANGANESE
MERCURY
NICKEL
NITROGEN, AMMONIA
NITROGEN, KJELDAHL
NITRATE & NITRITE
ORGANIC SCAN
_
pH
PHENOLS
4 ®• 045043
ac'ob-2
t 0- acpoy.j
^C Q .;o'l?'s /
4 0, v.s 15
O. O la 010
PHOSPHORUS, TOTAL
POTASSIUM
SELENIUM
SILVER
SODIUM
SPECIFIC CONDUCTANCE
SULFATE
7;Z
1 0
/ a -
< *O. o
TOC (UNFILTERED)
(
/
C�
�`
g o
7
TOE:
TSS
VOC
ZINC
(� , d � �
0. 0,2 -3
0.010
U. 010
®. 0 `go
0. 0
STATIC WATER LEVEL
r
� � �E
3 • G &
3 , l 0 '
2. G 0'
it 1 l r

COUNTY I-1 C-N 0 zF2 .S c5N
DATE SAMPLED
/% �� � �_
� ��
` /-
r/ - `l
3 3
ALiALINITY, TO pH 4.5
ALI:ALINITY, TO pH 8.3
ALUMINUM
/t 0
01 `� &7 �
�% ��
0 v `% /
4 0• 05(.
G 0. C)3-6
ARSENIC
0, C).550
4 to, �,�
!�. c7 w
.� 0.: 0.5,C)
e p, ®SO
.t 0.().6 0
BARIUM
BERYLLIUM
BICARBONATE
CADMIUM
CALCIUM
CARBONATE
CHLORIDE
/JP. �?
613
`'t '�'
/•
..Z
CHROMIUM, TOTAL
f�, 19�
C3. 0.
r�, tit�ti"
0'005'2'
cj0"
""0"
COBALT
COI)
COLIFORM, FECAL
COLIFORM, TOTAL
COPPER
, 3
�. L%07d
c7. v3v
4 0.00v0
0. 006 %
U. 0043
CYANIDE
DISSOLVED SOLIDS
:z -3
z
70
/ 70
/ (0 0
FLUORIDE
HARDNESS CaCo,
HARDNESS, NON -CARBONATE
IRON
LEAD
c (;>. ®
c Q•
O. '!
G d , 011
O > 00'td
Z 0- 0 0 4
LITHIUM
Red Ink = Sample taken by facility
X

NO. f
COUNTY
DATE SAMPLED
MBAS
MCNESIUM
MANGANESE
MERCURY
NICKEL
NITROGEN, AMMONIA
NITROGEN, KJELDAHL
NITRATE & NITRITE
ORGANIC SCAN
S
PH
PHENOLS
L 0.-Gt7053
0. 00/
ov
O. D®/6
e 0,0;1
PHOSPHORUS, TOTAL
POTASSIU"i
SEL UNIUM
SILVER
SOD IiT. 1
SPECIFIC CONDUCTANCE
SUL,F-ATE
'%(
74
``
v S-
63
% 7
TOC ( UNFILTERED)
'' s"
To
� l
� ° �
/ ° !
j
TO:ti
TSS
VOC
ZINC7
. L�r.i 13
0, 0° 0
Z c>>03S"
40. Cad0
STATIC WATER LEVEL

I
DATE SAMPLED
// / ,.
3 - /6 - �j,;4
I/ -16 VA
.3- /®., r3
-7-
0. 0-,6'0
ALI:ALINITY, TO pH 4.5
ALI:ALINITY, TO pH 8.3
ALUMINUM
�. l3 d �
0. OS-
0, 3
ARSENIC
0. UUj
G 0.
t 0.,
0. (7Y0
BARIUM
BERYLLIUM
BICARBONATE
CADMIUM
CALCIUM
CARBONATE
CHLORIDE
4
4
1,2
2 0
CHROMIUM, TOTAL
G D • A0 `
z ®• 00-6
4 a- C»b
4
< 0, 00Sm
% 0-
COBALT
COD
COLIFORM, FECAL
COLIFORM, TOTAL
COPPER
( f�,,:�
C l� . U
�. ©. 0
C). C, 0 TO
t 0. 00'70
0 - 0 0
CYANIDE
DISSOLVED SOLIDS
/ 170
/ ,g o
/ 6-0
/ -/- 0
/ 7 0
FLUORIDE
HARDNESS CaCo.
HARDNESS. NON -CARBONATE
IRON
LEAD
00��
� U. f Uj
G D, O c�!
A
4 C). 0
LITHIUM
Red Ink = Sample taken by facility

.'ELL NO.
COUNTY /-/ 6!-,lJ0-` ,P.5"
DATE SAMPLED
3 - / (,-IA
7 - / " Y
3 J- /0 "- 93
2 --?v- 93
MBAS
MAGNESIUM
MANGANESE
MERCURY
NICKEL
NITROGEN, AMMONIA
NITROGEN. KJELDAIIL
NITRATE & NITRITE
ORGANIC SCAN
PH
• 3
�j' .53
7• �
�
-j : 1�0
r
3 f�
PHENOLS
Q` O t
L 0_ 0S
1 m- �JS
L, !3• /i50
0.. 0 0
U, C�c�z�S3
PHOSPHORUS, TOTAL
POTASSIUM
SELENIUM
SILVER
SODIUM
SPECIFIC CONDUCTANCE
SULFATE
6-5
7, Go
7 7
/ j,
0
�� p
TOC ( UNFILTERED)
`% • 6,
`% , 1
Y, 3
/ (a
3
ZINC
,G U .• v A
< O • 0.33
o _ if) 1A
o .y '
STATIC WATER LEVEL
•
3, -�f
`J 0

RATE SAIPLEn
7,�
3-6..57©
ALKALINITY TO PH 4. 5-
ALKALINITY, TO PH 8.3
ALUMINUM
..A/ D
IV D
ARSENIC
/Y
f�
ND
N 4
N 0
< 0 aa.S
J , Off
(BARIUM
,BICARBONATE
CADMIUM
CALCIUM
CARBONATE
CHLORIDE
Jam,
r
CHROMIUM, TOTAL
/U iJ
✓ v /�•
AfD
14:0.
ov°
.0 0- 0 0�
COD
^OLIFORMr FECAL
COLIFORM, TOTAL
COPPER
I'U,<�/
/`%ji
%VCi
fJO
(). oa
� f.G��
�C�</�.>�
CYANIDE
I
DISSOLVED SOLIDS
% 36
g
160
o
FLUORIDE
ARDNESS, CaCO
1
riARDNESS NON -CARBONATE_
IRON
f
_
4BAS
1AGNESIUM(
WGANESE
I
_
1ERCURY
_
JI GKLE

(Continued) �.
CIO i I
DATE SAIPLEn
., 2$
%�%$`1'
//-r - `1
3-f .arc
9-/9-90
NITRO GEN; AMMONIA
NITROGEN,KJELDAHL_
NITRATE & NITRITE
ORGANIC SCAN
I
pH
PHENOLS
IU
1 Al o
0
/V D
AID
L 0 • 0-5-
� �
PHOSPHORUS, TOTAL
POTASSIUM
SELENIUM
SILVER
SODIUM
-
SPECIFIC CONDUCTANCE
SULFATE
t
�
4-7
� b 5�
f N �
[9 �
� � �
�� 1J
POC (UNFILTERED)
'� �- 40
lJ
i 30
,INC
lv
/v
/V o
10-01-7
lVG
0 03
0. O
I
I
i
t �
1

I
DATE. SA11PLEn
3
S!
3092
ALKALINITY CaCO3)
To pNf . 8.3
To pH4.5
-/
Aluminum _
Gd .0
4
t
°l. , 0
Arsenic
Q MK
I -A Q,5'
4
4-, 01
A/4P
Bicarbonate
;� S
Cadmium
Go. o /
Calcium
g
Carbonate
Chloride
Chlorinated Hydrocarbon
Chromium, Hexavalent
Chromium, Total
LO.OiS�
jjr 4�`j�d.�u�
G
COD
`
Coliform, Fecal
Co 1 i fo rm, To to 1
Cyanide
Dissolved Solids 1
l 30
/.S+
1
%jo
/ 80
Fluoride
c 0.1
}
Hardness as CaCO
Hardness, Non -carbonate
70
Iron
Lead
ZV-05-
0. 3g
40"O r
< D.
L tdl
S�.asc
D.D z
Lithium
WAS
Magnesium
Z
Manganese
0, !r
�rcury
�o.000Z

-,4L n
3 8
$
*/'?'3
.2
A tvogen,. Ammonia
a0 It-
Vi trogen, Kjel dahl
b
-
Nitrate & Nitrite-
. 0
Drgani c Scan3t
Phenols
�o,00Z.
�o os^ 1
L11, DS
Cd, a©
�.. ao
:.�1�
/1
Phosphorus, Total
e-0.01
-
?otassi um
-
Wed um
o c S
ca
-
Alver
Sodi um =_
Specific .Conductance6
Sulfate
�g
/�i
/.
.S
G %
SG 3,6
Sul fi t*
Zinc
«0/l
D. D
b�0
. 0/g
3arium
LD.S"
`opPer
Ie 0.0 1
.0�5
�D.D S
f).0
A q
41010
A)
Nn
Gteese a- AA
i z � rcr(-c �,eoP,eaPi+�r�
ajkv&- a E(-
3.
.$2

.2
.7"
rELL NO. `7_ oS COUNTY
DATE SAMPLED
g-a
11- 30 o 1
/f',? 6 "96 1
?1' a _ `7
L
IL
�-
L
r e>/N/T/Ltti/®/f`C-NFL
*0
40 f Nd OR 0 eHC ny- L
®. 0076
Y
c /ij- t->A 0 01-1jFAI 4
1

SUBMIT FORM ON YELLOW PAPER ONLY
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: 1�► �"") `S'FS'+``S '•Jt" ___
Permit Name (if different): �wA,f
rt 1 n-Cr4.La.� : �r Cn In
Well Location/ Site Name:
County 1942wvPlf'a -
Telephone #: a
No. of Wells to be Sampled:,r
Well Identification Number (from PermI0:.AAt —4 -4 PI G, For Groundwater Treatment Systems
',Veil Depth: I r � 5 ft. Well Diameter: L in. Check One:
Screened Interval: l f r L it. to ft. ❑ Influent (98)
Depth to Water Level: a % ft. below measuring point. ❑ Effluent (99)
Measuring Point is Z+ 7 ft. above land surface.
Gallons of water pumped/bailed before sampling: �+
Field analysis: pH (r)-0 , , Specific Conductance uMhos
Temp. —I b -C, Odor A& ­p— Appearance 1A0J ef,1, ',
PERMIT M EXPIRATION DATE:
Non-Dischar e _ UIC
NPDeS o c� Uc3 S tl
TYPE PE PERMITTED OPERATION BEING MONITORED
Lagoon Remedialion: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of S t�lge +.t
Other: U3 '©
NOTE: Values should reflect dissolved and /f 'C7
colloidal concentratio s. 7` ``�'-�'GL —
7 f(. /0), -! 77/ZZ 1,
Date sample collected: Date sample"ahalya�,
Laboratory Name: fie t,by
Certification No. 32c E
for metals were collected unfiltered_)L<,.YES NO and field acidified
PARAMETERS_ (Samples
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal
/100MI
Nitrate (NO3) as N
P
mg/I
mg/I
Coliform: MF Total
/100MI
Phosphorus: Total as
(Note: Use MPN method for highly turbid_ samples)
Dissolved Solids: Total '360
mg/I
Orthophosphate
Al - Aluminum �`
m9
pH (when analyzed) �2= �15
units
Ba - Barium
mg
g/
TOC W a h
mgll
Ca - Calcium
mg/
mg/mg/
chloride i0
-Arsenic �-VIVO s
mg/I
mgll
Cd - Cadmium
Chromium: Total '� d�
mg/11
Grease and Oils
mg/I
Cu - Copper 01001
mg/IL
Phenol %rQ d
Sulfate � b
mg/I
mg/l
Fe - Iron
Hg - Mercury _ t;�UCJ
mg/I
mg/I
Specific Conductance
uMhos
K - Potassium
mg/I
mg/I
Total Ammonia
mg/I
Mg - Magnesium
m /l
Mn - Manganese
mg/I
A_ YES NO)
Ni - Nickel mg/I
Pb - Lead 01 0 0 mg/I
Z - " +_0 mg/l
X1nig 4tr r'er� � ` mg/I
ooun and Concentration Units)
ON
(Specify test and method #. Attach lab re(0)
Report Attached? Yes (1) No
VOC : method # =
TKN as N g : method # s
method #
lies 4, AQMAW/��l , Sr, V"Ceps-c
e�� Authorized Agent) Name and Tiye - Pie se print or type
�lB1M�vf
,v. 4/98

SUBMIT FORM ON YELLOW PAPER ONLY
Please Print Clearly or Type
Facility Name:
Permit Name (if different):
Fa ility Address: C iU S '¢� '''� 'N' 7( � ant ct•�JT {,lP rvG 2_ 7'Wc/ County -I �( G� ✓
Contact Person: L-2eTelephone #:'�' 253�
Well Location/ Site Name: ER s-t ElLst !' No. of Wells to be Sampled: e
Well Identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: ' 1L-3-5 ft. Well Diameter: _Z in. Check One:
reened interval: 11 r'L ft. to I b • 3 s -ft. ❑ Influent (98)
`Depth to Water Level: 'f, 0 ft. below measuring point. ❑ Effluent (99)
Measuring Point is Z: -1 ft. above land surface.
Gallons of water pumped/bailed before sampling: IS 3
Field analysis: pH 3 0 , Specific Conductance � uMhos
Temp. 1:3 °C, Odor .Iv-dwe Appearance
PARAMETERS (Samples for metals were collected
COD
mg/I
Coliform: MF Fecal
/100m1
Coliform: MF Total
/100m1
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total mg/I
pH (when analyzed) 2
units
TOC i-t p 5
mg/l
f— 7hioride to
mg/I
,arsenic G 0, 00 5
mg/I
Grease and Oils
g
Phenol �p ` I?
mll
g
Sulfate £� I
mg/I
Specific Conductance
uMhos
Total Ammonia
mg/I
TKN as N
mg/i
PERMIT #: EXPIRATION DATE: -3 OU
Non -Discharge UIC
NPDES I - dO Gl -L' 5-CJ°"7 C44 .
TYPE OF PERMITTED OPERATION BEING MONITORED
_ Lagoon Remediation: Infiltration Gallery is
Spray Field Remediation:
Rotary Distributor Land Application of Sludge C
Other
NOTE: Values should reflect dissolved and 3 .2-yki
colloidal concentrations.
Date sample collected: Date sample analyzed:
Laboratory Name:
Certification No. Z'
tered__�&YES NO and field acidified
Nitrite (NO2) as N
mg/I
Nitrate (NO3) as N
mg/I
Phosphorus: Total as P
mg/I
Orthophosphate
mg/I
Al - Aluminum G Q o LfJ
mg/I
Ba - Barium
m
Ca - Calcium
m
Cd - Cadmium �� ,�
Chromium: Total
m
Cu - Copper 0, 0 "2,3
m
Fe - Iron
mg
I
Hg - Mercury I 0i�f9f
mg
K - Potassium
mg
I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
A YES NO)
Ni - Nickel mg/I
Pb - Lear1 0 . n ©33 mg/I
Zn -Zinc �. a , 02. mg/I
Ammonia Nitrogen mg/I
Other (Soe its u r� adsTnd Cm'aentl`Rtion Units)
VOC
FR
t-,
MS, PLt Cn
�d #. ttaob latQe .)
,s (17.. ort
N2 � (0)
method # =
method # =
method # =

SUBMIT FORM ON ff PAPER ONLY
Please Print Clearly or Type
Facility Name: �E ' �F
J G S S 'a
Permit Name (if different):�,�
IFcllit Address: S� 2-9'7 County "Erg
d� n _ Telephone #:
Contact Person: '�`'� ' ' ' 1 {Lc�k No. of Wells to be Sampled:
torn "'MI
Well Location/ Site Name: torn orm
F'IL Y
' Identification Number (from Permit): �`'iw' - For Groundwater Treatment Systems
t (� ft. Well Diameter: �- in. Check one:
_ee Depth: i , ti, ft. ❑ Influent (98)
Screened Interval: _�---- point. Depth to Water Level: b,3( ft. below measuring p ❑ Effluent (99)
Measuring Point Is = ft. above land surface.
Gallons of water pumpedibailed before sampling: 7a uMhos
Field analysis: pH
Specific Conductance
jL_°C, Odor ✓Uo "/C Appearance
PERMIT#: EXPIRATION DATE: 3G
Non -Discharge
NPDES 1V 00 0 V
TYPE OF PERMITTEQ OPERATION BEING MONITORED
�G Lagoon Remedialion: Infiltration Gallery
— Spray Field Remedlation:
CID
Rotary Distributor Land Application of Sludge
— Other:
NOTE values should reflect dissolved and 1 f' (7 `� � _
colloidal concentrations. II 2 9 i
t i ) �) Date sample analyzed:
Date sample collected:
LaboratoryName: .
Certification No. -
Temp.
_NO and field acidified
��g,S (Samples for metals were collected unfiltered —YES mg/I
mgll Nitrite (NO2) as N mg/I
COD /100MI Nitrate (NO3) as N mg/I
Coliform: MF Fecal
/1
Coliform: MF Total mi Phosphorus: as P mg/I
(Note: Use MPN method for highly turbid samples) G 4 L (� mgll
Dissolved Solids: Total -� j �___---- mg/I Al -Aluminum mg/l
units � � 6 � - nBa -Barium
pH (when analyzed) 5 nits Ca mgll
Calcium mg/i
C t ! mg/I Cd - Cadmium 4L mg/I
% loride ,c p �� mg/I Chromium: Total
mg
Arsenic mg/I Cu - Copper /I
Grease and Oils G l _ mg/I Fe - Iron
H9 - mgll mg/l
Phenol — Mercury
Q mgll
Sulfate uMhos K - Potassium mg/I
Specific Conductance mg/I Mg - Magnesium mg/I
Total Ammonia mgll Mn - Manganese
TKN as N
YES NO)
Ni Nickel J mg/l
Pb -Lea IV, mgll
Zn - Zinc �c , a, _- mg/l
(Specify test and method #. Atiacn tau 1up— ••i
Report Attached? Yes 0) No _X, (0)
VOC : method # _
method # _
method # _
ertify that, to the oebt ui 11,y r: ;
g approved rnethori of ar�a,�us by a Noah C:.tra�lna D`�ti'C� (1onn�r y � c . � ��' � " �.
fr 4novring viol
ing the possibility, of fines and imprisonment aations. - Please print
or type

SUBMIT FORM ON YELLOW PAPER ONLY
Facility Name: , V'
Permit Name (if different): -t--;
Fact ity res0. tl
Co act Person:
C. ee. I s�el
Well Location/ Site Name:
Please Print Clearly or Type
M-�' 3,JC.
M! w -
County
Telephone #: -' _
No. of Wells to be Sampled:,
Well Identification Number (from Permit): M'%'-`j (-Ui$ 4r"J For Groundwater Treatment Systems
"'ell Depth: kt,3S ft. Well Diameter. 2 in. Check One:
_,eened Interval:. i,ft. to l '3� -ft. El Influent (98)
,1
Depth to Water Level: —eQQ�ft. below measuring point. ❑ Effluent (99)
Measuring Point is 2 7 ft. above land surface.
Gallons of water pumped/balled before sampling:7_� �'�-�'
Field analysis: pH 716 , Specific Conductance `4 ,5-'U-_ uMhos
Temp. - Iq—°C, Odor IV-Oeje- Appearance
PARAMETERS (Samples for metals were collected unfit
COD mg/I
Coliform: MF Fecal /t 00ml
Coliform: MF Total /I00ml
(Note: Use MPN method for highly turbid samples)
310
Dissolved Solids: Total
mg/I
pH (when analyzed) b= C Z
units
TOC 3 = 7
mg/I
)loride I 1
mg/I
^ r"senic C.p = 6 0-5
mg/I
Grease and Oils
mg/I
Phenol G.(? ©1 Q
Sulfate
mg/I
mg/I
Specific Conductance uMhos
Total Ammonia
mg/I
TKN as N
mg!I
PERMIT #: EXPIRATION DATE: =3CIO 0
Non -Discharge UIC
NPDES IV'G O C C d 57-02 p--p
Zy OF PERMii•TED OPERATION BEING MONITgPEDc)_
J Lagoon Remediation:Intiltratioggalle"T',�
Spray Field Remediation: z'a'
Rotary Distributor Land Application of Sic e
Other:
"
NOTE: Values should reflect dissolved and E
colloidal concentrations. 7%0l
z
Date sample collected: LPC Date sample analyzed:
Laboratory Name: S— kT �� i/`�'Yi�� • '`e-�i"'r' Sep �!`�'�i /c
Certification No. 3 LJ
lered_,X._YES NO and field acidified
Nitrite (NO2) as N
mg/I
Nitrate (NO3) as N
mg/I
Phosphorus: Total as P
mg/I
Orthophosphate
mg/I
Al - Aluminum Z
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
Chromium: Total 4L d©S
mg/I
mg/I
Cu - Copper C'� at91
mg/I
Fe - Iron
Hg - Mercury = (� r GHQ t
mg/I
mg/I
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mg/I
O m /i
Zn - Zinc Gf3r V mg/I
(Specify test and method #. Attach lab report.)
Report Attached? Yes 0) No (0)
VOC method # =
method # =
: method # =

SUBMIT FORM ON YELLOW PAPER ONLY
Facility Name: C o
Permit Name (if differerrn�t):SJO
IN
► p� .1
Contact Person:=1
Well Location/ Site Name:
Please Print Clearly or Type
w G Z,9-737 County
i ILPI Telephone #: g '�b `/3 2`532
No. of Wells to be Sampled:,�
Well Identificati° Number (from Permit): AA"/—`/l y!51V (zJ For Groundwater Treatment Systems
r 'III Depth: I to s 5 ft. Well Diameter: Z in. Check One:
,eenedlnterval ft. to i�3� ft. ❑Influent (98)
Depth to Water Level: 3 , 62 ft. below measuring point. ❑ Effluent (99)
Measuring Point is 2 7 ft. above land surface.
Gallons of water pumped/bailed before sampling: 2--1 S 6
Field analysis: pH 2, C , Specific CorLductance 3 uMhos
Temp. —_`C, Odor �61-- e Appearance A,2 c i(�' t7�'^�d`
PERMIT #:,AI ( 06)C) )5-V % EXPIRATION DATE:
Non -Discharge UIC
NPDES
OF pERMITTE OPERATION BEING MONITGOEDp
Lagoon Remedialion: Infiltratior*alle►%
rn
Spray Field Remediatlon: ��'—C2 --
Rotary Distributor Land Application of Sludge o
O :Z- r-n
Other: 1'
�6c
NOTE: Values should reflect dissolved and _ tn� ,`
colloidal concentrations. `` U —
z�/Ui -/l -7/0l
Date sample collected:Date sample an lyzA
S .
Laboratory Name: .f
Certification No. 1 L2
for metals were collected unfiltered_ K YES NO and field acidified
PARAMETERS (Samples
COD
mg/I
Nitrite (NO2) as N
mg/I
mg/I
Coliform: MF Fecal
/100m1
Nitrate (NO3) as N
P
mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as
mg/I
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total 2"30 mg/I
Orthophosphate
Al - Aluminum / • L
mg/i
pH (when analyzed) 5-1 1�5
units
Ba - Barium
mg/I
mg/I
TOC ��3.11
mg/I
Ca - Calcium
mg/I
loride V 1 7
H senic 6' o f b
mg/I
mg/I
Cd - Cadmium
Chromium: Total . U d s
mg/I
Grease and Oils
mg/l
Cu - Copper - 2 I
mg/I
mg/I
Phenol 0,010
Sulfate J '7
mg/I
mg/I
Fe - Iron
Hg - Mercury G Q 1 0f
mg/I
Specific Conductance
uMhos
K - Potassium
mg/I
mg/I
Total Ammonia
TKN as N
mg/I
mg/I
Mg - Magnesium
Mn - Manganese
mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lead Z_ U , U rJ 3 mg/I
Zn - Zinc 01 U 20 mg/I
Ammonia Nitrogen mg/I
numar &RnAr vA;rnnnxa1ndm 3M oncentration Units)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No _,>�` (0)
VOC method # =
method # =
method # =

SUBMIT FORM ON YELLOW PAPER ONLY
t Z'E ,
Gf O NbWATER ,Y:QUAL tMONiTdh1NG:' ` ` }
rf r,
COMPLIANCE'REP00 FORMi
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: �' (� }j�-j' ^l (� S YS ^'S� ✓ C,
Permit Name (if difffeerent)-
S Ur
F cility dress:
real n1 G Z 7:1 —,✓ ct
County
Contact Person: e- v'� I�� p Telephone #:
Well Location/ Site Name: i2017 pta If- W l "f C No. of Wells to be Sampled:
(from Perm)_I
Well identification Number (from Permit): For Groundwater Treatment Systems
Well Depth: ) �0 3 it. Well Diameter: Z In. Check One:
Screened Interval: I!. L ft. to) ft. ❑ Influent (98)
Depth to Water Level 13 7 ft. below measuring point. ❑ Effluent (99)
Measuring Point is Z - ft. above land surface.��
Gallons of water pumped/bailed before sampling: "
Field analysis: pH , Specific Conductance uMhos
Temp. t q °C, Odor 1VV ^ 6 Appearance L L-e Q '?-
PERMIT M EXPIRATION DATE: 7/J
Non-Dischar a UIC
NPDES L 00 UU .'0 -7
TYPE F PERMITTED OPERATION BEING MONITORED
Lagoon Remediallon: Infiltration Gallery
Spray Field Remediation: v
Rotary Distributor Land Application of Sae
n`
Other:
00
NOTE: Values should reflect dissolved and cif am
colloidal concentrations. ijql /Uv
Date sample collected: �I 61vo Date samplefn.�al, : —Jq 7)00
Laboratory Name: C, -f' L'``
Certification No. 3 i �o 0
PARAMETERS (Samples for metals were collected unfiltered. 2�,_YES NO and field acidified
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal
/100ml
Nitrate (NO3) as N
mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly turbid sam�pfes)
Dissolved Solids: Total 3 /D
mg/l
Orthophosphate
At - Aluminum G 0 / 0
mg/I
mg/I
pH (when analyzed) S. f5
units
Ba - Barium
mg/I
TOC i
mg/I
Ca - Calcium
mg/I
Chloride 13
mg/I
Cd - Cadmium
mg/I
Arsenic <. 0 0 0 S
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper "Lo r U 1
mg/I
Phenol G-a U 10
mg/I
Fe - Iron
mg/I
YES NO)
Ni - Nickel mg/I
Pb - Lead G • �" Ci 3 mg/I
Zn - Zinc 0 r 0 3 —7 mg/I
Am o en mg/I
Oth 1�peaiyrao*opn(t—waro Cprflibation Units)
IC
Sulfate 130
mg/I
Hg - Mercury
G 0 r 000 L mg/I (Specify test and method #. Attach lab re o .)
Specific Conductance
uMtlos
K - Potassium
mg/I Report Attached? Yes (1) No(0)
Total Ammonia
mg/I
Mg - Magnesium
mg/I VOC method # _
TKN as N
mg/I
Mn - Manganese
mg/I method # =
: method # =

SUBMIT FORM ON YELLOW PAPER ONLY
(rUMI'VIHIVLc;',rsGrvn a :.e v� please Print Clearly or Type
FACILUI-M-0-g—MATIM
�
Facility Name:
Permit Name (if different):
Facility Address: 1fBe,t `� 4 y F n G(a ��
I ,J;!'� Li J- Count
jCeyt L�� v Al a tat ail Telephone #: �ii--�R4�-�
Contact Person:
Well Location/ Site Name: 4-c-" : 'J C- No. of Wells to be Sampled:
Well Identification Number (from Permit): 414-9N Wiy
For Groundwater Treatment Systems
-yell Depth: .I ' ft. Well Diameter: 2- In. Check One:
screened Interval: %L —ft. to - Influent (98)
Depth to Water Level: b- b ft. below measuring point. ❑ Effluent (99)
Measuring Point is ­2t_�ft. above land surface.
Gallons of water pumped/bailed before sampling: ✓: 5—
Field analysis: pH
h'O Specific Conductance L4 2 uMhos `
� P
Temp. --7 °C, Odor N V' Appearance SL% 1�1L 'ty/- '
EXPIRATION DATE:
PERMIT M
Non -Discharge UIC
NPDES IV h Q 0 C GI
TYPE OF PERMITTED OPERATION BEING MONITORED,._
Lagoon Remediation: IntiltratiorMallerK
Spray Field Remediation: �-—
Rotary Distributor Land Application of Slue
N
Other:
NOTE: Values should reflect dissolved and"
colloidal concentrations.
Date sample collected: Date sample naled
-SL La
Laboratory Name: f
Certification No.
were collected unfiltered -YES NO and field acnhdgi�led
PARAMETE$S_ (Samples for
metals
mg/l
Nitrite (NO2) as N
COD
Coliform: MF Fecal
/100ml
/100ml
Nitrate (NO3) as N
Phosphorus: Total as P
mg/I
mg
Coliform: MF Total
Orthophosphate
/I
(Note: Use MPN method for highly
Dissolved Solids: Total
turbid samples)
3 20 mgll
.
Al - Aluminum
mg/I
mg/I
pH (when analyzed)
� units
Ba - Barium
mg/I
TOC
mg/ l
! 1 mgll
Ca - Calcium
Cd - Cadmium
mg/I
,hloride
Arsenic
mg/I
0 a 0 �
Chromium: Total , 0 f 0
m /I
mg/I
Grease and Oils
mg/l
4-0� Q I!3 /l
m g
Cu -Copper
Fe - Iron
mg/I
Phenol
o mg/l
Hg - Mercury G 0 . Q c, t?
— mg/I
Sulfate
Specific Conductance
uMhos
mg/I
K - Potassium
Mg - Magnesium
mg/I
mg/I
Total Ammonia
TKN as N
mg/l
. Mn - Manganese
YES NO)
-Nickel mg/I
Ni
N-Lead G 0.3 mg/l
Pb Zn -Zinc � � d 2 mg/l
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concentration Units)
ORGANICS: (GC,
(Specify test and m
Report Attached?
VOC
0MS,HPL l ,
thod #. Attach lab 'reRoyt.)(0)
Yes 0) No Mom__
method # =
method # =
: method # =

R ONLY
Facility Name:
Permit Name (if different): 1
Foy A ress: -3 U) d
11 S
asap 7--y
(GAY) �.
Contact Person: F-us�- �,
Well Location/Site Name: s
Please
County 11 " rVtl `' V
Telephone #: $ 1-9 b 93 Z`s33
No. of Wells to be Sampled: LT
ur—M-17
Well Identification Numbe�rlfrom Permit): U ir4 -p )4 For Groundwater Treatment Systems
f­Ve11 Depth: . I b• 3b ft. Well Diameter: Z- In. Check One:
Screened Interval: �I L_ ft. to _I � 3 ft. ❑ Influent (98)
Depth to Water Level: y • ft. below measuring point. ❑ Effluent (99)
Measuring Point Is Z �� ft. above land surface.
Gallons of water pumpe balled before sampling: 31 S
Field analysis: pH 6• ® , Specific Conductance uMhos
Temp. 2e °C, Odor /VcJe/e- Appearance Sf
PERMIT #: EXPIRATION DATE:
Non -Discharge UIC
NPDES ✓C0 0 0Q S7J%
TY
PE OMITTED OPERATION BEING MONITORED
Lagoon Remedialion: Infiltration Gallery
Spray Field
Rotary Distributor
Other:
Remediation:
Land Application of Sludge
22
NOTE: Values should reflect dissolved and
colloidal concentrations. , ly i/
Date sample collected: SL% Date sa ple analyzed/
0 ;
Laboratory Name: ''—"—xt
Certification No. 3 Ot
_ (Samples for metals were collected unfiltered YES NO and field a/led YES NO)
mg Ni -Nickel mg/I
PARAMETERSmg/l
COD
Coliform: MF Fecal
mgll
/100ml
Nitrite (NO2) as N
Nitrate (NO3) as N
mg
mg/l
Pb - Lead ��' mg/I
o
Zn -Zinc CfJ° p moo Q mg/l
Coliform: MF Total _/100m1
Phosphorus: Total as P
Orthophosphate
mg/l
Ammonia Nitrogen mg/I
(Note: use MPN method for highly
Solids: Total
turbid samples)
O mg/I
Al - Aluminum ®•
m9�i
Other (Specify Compounds and Cceni'on Units)
Dissolved
pH (when analyzed)
• 0 units
.L�
Ba - Barium
mg/l
g
c a<
TOC
mgll
Ca -Calcium
mg/I
-Ra
j�hloride
"Arsenic
R• m ll
00 - mg/l
'e, g
Cd - Cadmium
Chromium: Total < O.00S
Chromium:
mg/l
$�
r --
Grease and Oils
mg/ I
Cu - Copper GD.O l
pp
m /I
9
m /l
g
ORGANICS: (GC,GC/MS,HP@
Phenol
G(3 r 0113 mg/l
(ate W 0 In /l
Fe - Iron
Hg -Mercury �Q. 0�? ( L, mg/I
(Specify test and method #. Attach IZ r ort.)
Specific Conductance
uMhos
K - Potassium
mg/I
mg/I
Report Attached? Yes (# No (0)
VOC :method # _
Total Ammonia
m /l
g
mg/l
Mg - Magnesium
Mn -Manganese
mg/I
: method # _
TKN as N
: method # _
20-111 Ilia
Permitt (or Authorized A ent) ame and Title -
ase print or type
> / /
`• AIQR
onature o ermitlee (or Authorized Agent)
(Date)

SUBMIT FORM ON YELLOW PAPER ONLY
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: . - .' CP "J Sly S �i° ns,„J C.
Permit Name (if different): S �� �
Facility A dress: ,
a 1 s, v1"S r.► s ; lac "aaN 5739 County ' -
Contact Person: L--f"s
Well Location/ Site Name:
Izrol L. 3
Telephone #: ?L8 VL0
IIAVC No. of Wells to be Sampled: r
Well Identification Number (from Permity M--Lt L $`��N1 Y For Groundwater Treatment Systems
- Well Depth. • 16, �E ft. Well Diameter: in. Check One:
Screened Interval:_LT Z _ ft. to ! bo ft. ❑ Influent (98)
Depth to Water Level: Lip I S ft. below measuring point. ❑ Effluent (99)
Measuring Point is 2 ft. above land surface.
Gallons of water pumped/bailed before sampling: 3 �� V^J uMhos
Field analysis: pH-6-0, Specific Conductance s
Temp. . 13—°C, Odor �' �� Appearance
pAgAMETE$S_ (Samples for metals were collected unfit
COD
mg/I
Coliform: MF Fecal
/1OOml
Coliform: MF Total
/100m1
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total '5 30
mg/l
pH (when analyzed)
units
TOC ��
mg/l
_
"hloride I l� 3
0, 005'
mg/I
mg/I
Arsenic
Grease and Oils
mg/I
Phenol C
Sulfate t�,1
mg
g/I
Specific Conductance
uMhos
Total Ammonia
mg/I
mg/I
TKN as N
PERMIT #: EXPIRATION DATE: `t /
Non -Discharge UIC
NPDES /V 0 0 0 5 0-7
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
12�z'►��z� f9`
i AZq 9 Date sample anal zed:
Date sample collected. �cc ��r �.%✓C,
Laboratory Name: 31
Certification No.
tered—'`YES NO and field acidinea
Nitrite (NO2) as N mg/I
Nitrate (NO3) as N m9/I
Phosphorus: Total as P mg/I
Orthophosphate mg/I
Al - Aluminum 0*2, mg/I
Ba - Barium mg/I
Ca - Calcium
Cd - Cadmium C ®. � O �" mg/l
Chromium: Total
Cu - Copper 0,01 mg/I
Fe - Iron mg/l
Hg - Mercury < O. 00 O mg/I
K - Potassium mg/I
Mg - Magnesium mg/I
Mn - Manganese mg/I
,X,YES NO) a
Ni -Nickel �O.Oe7� c� mg/1
Pb - Lea r,
Zn -Zinc < O� mg/I
Ammonia Nitrogen ca ILI, mg/I
Other (Specify Compounds and d-ooncedMon Units)
M;V
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab re)(0)
Report Attached? Yes (1) No
VOC method # =
method # =
method #
,X,YES NO) a
Ni -Nickel �O.Oe7� c� mg/1
Pb - Lea r,
Zn -Zinc < O� mg/I
Ammonia Nitrogen ca ILI, mg/I
Other (Specify Compounds and d-ooncedMon Units)
M;V
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab re)(0)
Report Attached? Yes (1) No
VOC method # =
method # =
method #
ORGANICS: (GC,GC/MS,HPLC)
(Specify test and method #. Attach lab re)(0)
Report Attached? Yes (1) No
VOC method # =
method # =
method #

SUBMIT FORM ON YELLOW PAPER ONLY
FACILITY INFORMATION Please Print Clearly or Type
Facility Name:—(51
Permit Name (if different):
" 1✓'r Z County
Contact Person: carat t �r Telephone #:
Well Location/ Site Name:.'" No. of Wells to be Sampled: yam
Well Identification, Number (from Permit): �',_►'^�� f `�`f Pi For Groundwater Treatment Systems
dell Depth: L 169 33S- ft. WellDiameter: 2- In. Check One:
"Screened Interval: „
ft. to El Influent (98)
Depth to Water Level- .��ft. below measuring point. ❑ Effluent (99)
Measuring Point Is Z e % - ft. above land surface.
Gallons of water pumped/bailed before sampling: (w1�t{�'JS
+S_ Specific Conductanc
Temp. 1.e uMhos
Field analysis: — 7 oC, Odor �'e' Appearance
Temp. __.-_-
eARAMETE$S_ (Samples for metals were collected i
COD
Coliform: MF Fecal
/100m1
Coliform: MF Total
/100MI
(Note: Use MPN method for highly turbid sam les)
6
mg/)
Dissolved Solids: Total � �
analyzed) units
pH (when
TOC
�.,hloride 1 Z, 5'
mg/l
mg/I
Arsenic BLS'
mg/I
Grease and Oils
mg/I
r
Phenol s y
mg/I
mg/I
Sulfate
Specific Conductance
uMhos
Total Ammonia
mg/I
g
TKN as N
YES NO
PERMIT #: EXPIRATION DATE: __�LL
Non -Discharge UIC
NPDES 'V 1))
TYPE OF PERMITTED OPERATION BEING MONITORED
_ x Lagoon Remedialion: Infiltration Gallery
Spray Field Remedialion:
Rotary Distributor Land Application of Sludgy v
Other:
^ti c
NOTE: Values should reflect dissolved and t
colloidal concentrations.
ry
Date sample collected: k —o 7 Date sample anatl%zedr� t
Laboratory Name:
Certification No. 2 % {
c� CD
and field acidified
Nitrite (NO2) as N
mg,�
Nitrate (NO3) as N
Phosphorus: Total as P
m9/I
Orthophosphate
mg/I
Al - Aluminum ` 7,�
mg/
D
Ba - Barium
Ca - Calcium
mg
Cd - Cadmium
Chromium: Total c - a 1
mg/
Cu - Copper U a 0 2-1 S
mgl
Fe - Iron
Hg - Mercury
mg/
mg/
K - Potassium
mg/I
mg/I
Mg - Magnesium
Mn - Manganese
YES NO)
Ni - Nickel mg/I
Pb - Lead 04 mg/I
Zn - Zinc 0104 mg/I
Ammonia Nitrogen mg/I
per u, nre3oo and Concentration Units)
(Specify test and method #. Attach lab report.)
Report Attached? Yes —(I) No X (0)
VOC : method # =
method # =
method # =
e- e 4 � y S �`, �,j tl, � 0�
rmittee (or Authorizgd Agent) N_c�all__ Title - Please print or type t i / Q �/
A Inn

19AY 19 1999 10:29 FFI„BLS EHS-FAGIL ENG e286952130 TO 8282516452
P.06i14
ENVIRONMENTAL NATIONAL LABORATORIES
LAW
TEST DATA REPORT
04/14/99
--- Project Information ---
Page 1
Mr. Paul Johnstone
Project Name:
GELS
Law Eng. & Env. Svcs., Inc-
Gels 30200-5-2739.03.901
4 Interchange Blvd.
Greenville, SG 29607
--- Sample Information —
Date Sampled:
03/24/99
Station ID: MW-4
Time Sampled:
11:15
Lab ID: AB67851
Log In Date:
03/25/99
Collector: K. VOYLE5
Log 1n Time:
15:52
Analysis
--- Test Information ---
Units Method
Rt�t Lim Rey tilt
Date I�gh-
Parameter
mg/L SW9060
1.00 9.14
03/29/99
AP
10621-�9060 Total OrganiC Cazbon
03/31/99
JR
10610-6010 ICP Metals N mg/L
m9/L SW6010B
0.127
03/31/99
JR
mg/L SW6010B
0.100
Alnmin=
mg/L SW60109
0.0250 Not net
03/31149
pracYtic
mg/L SW6010B
0.0100 Not net
03/31/99
JR
Cbromitua hromi
mg1L SW6010B
0.00500 0.0128
03/31/99
JR
cDpper
mg/L SW6010B
0.0100 0.0244
03/31/99
Jt
zinc
mg/L SW7421
0.40500 Not net
03/30199
Me
10610-7421 Lead Water mq/L
0.000200 Not Det
03/29/99
JE
10610-7470 Mercury Water Mg/L
Mg/L SW7470A
03/26/99
M6
10621-300.0 Anions Water m4/L
mg/L EPA 300.0
03/26199
MG
MqfL EPA 300.0
4.00 18.4
Chloride
mg/L EPA 300.0
4.00 153
03/26/99
MG
sulfate
EPA 150.1
2.5-12,0 5.71
03125/99
ST
SQ610-150.1 pH
mq/L EPA 160.1
10.0 316
03/26/99
MC
10610-160.1 Total Digs solids
Done
03/26/99
DB
10610-3030C ICP Digestion Water
ASTM 3030C
03/25/99
DB
10610-F3030C Furnace Dig
sm3030C
Done
Remarks:
Signed:
Carl B. Causey
Technical Services Director

r'19 1999 10:30 FP r-'S EHS-FACIL ENG 8286932130 TOi �2282516452 P.08/14
SQUTHEMN ANALYTICAL LASORATOR1ES511NC-
1 1 O BAYVIEW COULEV �t�D. Ol-BEM^
P.
April 13, 1999
Law Engineering and Environmental Services, Inc. Project No 16280
3355 McLemore Drive Page 1 of 2
Pensacola, Florida 32514
LABORATORY REPORT
project Description: Law Project - Gels
sample Description: 01 - Water, Law ID A867850, sampled 3/24/99, 1020
02 - Water, Law ID AB67851, sampled 3124/99, 1115
03 - Water, Law ID Aft67852, sampled 3124/99. 1130
04 - Water, Law iD AB67853, sampled 3124/99, 1200
Date Received: 3/30199, 1015
(01)
(02)
(03)
(04)
Method
Units
.
AB67850
AB67851
AB67852
A367853
Blank
Parameter
Phenols - EPA Method 604
4-Chloro-3-methylphenol
ug/1
10 U
10 U
10 U
10 U
10 U
2-Chlorophenol
hg/I
5 U
5U
5U
5U
5U
2,4-Dichlorophenol
ugll
10 U
10 U
10 U
10 U
10 U
0
2,4-Dimethylphenol
Pg/I
5 U
5 U
SU
5U
U
14-Dinitrophenol
ugll
20 U
20U
20U
20U
20U20
2-Methyl-4,6-dinitrophenol
Pg/I
20 U
20 U
20 U
20 U
U
2-Nitrophenol
ug/l
10 U
10 U
10 U
10 U
10 U
4-Nitrophenol
µg/l
20 U
20 U
20 U
20 U
20 U
Pentachlorophenoi
ugh
20 U
20 U
20 U
20 U
20 U
Phenol
lig/I
5 U
5 U
5U
5U
5U
2,4,6-Trichlorophenol
Ng11
10 U
10 U
10 U
10 U
10 U
U - Analyte was not detected; indicated concentration is method detection limit.
FDOH Environmental Lab No. E84129
FDOH Drinking Water Lab No. 84269
Comprehensive QA Plan No. 870317
Francis I. Daniels
Laboratory Director

,HY 19 1999 10:30 FR`­ ,LS EHS-FACIL ENG 8286932130 TO-7118282516452 P.09/14
April 13, 1999
Law Engineering and Environmental Services, Inc. Project No. 16280
3355 McLemore Drive Page 2 of 2
Pensacola, Florida 32514
LABORATORYREPO-
Project Description: Law Project - Gels
Parameter
Method Detection Limit Analysis Date
5-20 ►fig/l Ext. 3/31199
Phenols EPA 604 Ana. 4/8199
Francis I. Daniels
Laboratory Director
Southern Analytical Laboratories, Inc.

SUBMIT FORM ON YELLOW PAPER ONLY
FACILITY INFORMATION Please Print Clearly or Type
Facility Name:
Permit Name (if different):
tcar, County
Contact Person:' IZro) Telephone #:
Well Location/ Site Name. F—,&1* Et"' - lei, !'jC, No. of Wells to be Sampled: Qom erm�
Well Identification Number (from Permit): m6)- 0t P r For Groundwater Treatment Systems
Well Depth: �J� ft. Well Diameter: in. Check One:
-reened Interval: Pic. L ft. to 116' 3y ft. ❑ Influent (98)
�Uepth to Water Level: ft. below measuring point.
❑ Effluent (99)
Measuring Point Is 2 = 7 ft. above land surface. .
Gallons of water pumped/balled before sampling: 2- 7s -' `` ry 4:t'' 2� 7 '
Field analysis: pH b' , Specific Conductance uMhos
Temp. l �'S °C, Odor N> -"✓ Appearance ``' w �"�'�� `
PERMIT M EXPIRATION DATE: �l / 3 t'100
Non -Discharge UIC
NPDES �G 0 00 6-7
T OF PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery,
Spray Field Remedialion: `
Rotary Distributor Land Application of Sludge �-
Other:
NOTE: Values should reflect dissolved and a
colloidal concentrations.
1 '
Date sample collected:- l Date sample anal �
�{ L
Laboratory Name: L� �' ► "�� �'N �`�
Certification No. 2-K
PMAMETERS (Samples for metals were'collected unfiltered '/',, YES NO
and field acidified __X YES NO)
COD
Coliform: MF Fecal
mg/I
/100ml
Nitrite (NO2) as N
Nitrate (NO3) as N
mg/I
mg/I
Ni - Nickel _
Pb - Lea <0 0L"
mg/I
mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
mg/I
Zn - Zinc 0, 0 2.
mg/l
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total 3 I b mg/I
Orthophosphate
Al - Aluminum 00
mg/I
mg/I
Ammonia Nitrogen mg/I
Other (Specify Compounds and Concent(ation Units)
pH (when analyzed) 25a 7
units
Ba - Barium
mg/I
Lo
TOC 91/
mg/I
Ca - Calcium
mg/I
Chloride
mg/I
Cd - Cadmium
mg
t:
senic
mg/I
Chromium: Total G�
I mg/I
d rill
'I
m /I
Cu - Co or 0, 0 / Z8 mg/I
=
Urease an I s
Phenol n . G&,-
I g
mg/I
pp
Fe - Iron
mg/I
ORGANICS: (GC,GC/MS,HPLQj T 1
Sulfate ► 53
mg/I
Hg - Mercury '<01 0 0 G 2-
mg/I
(Specify test and method #. Attjeh lad brt.)
Specific Conductance
uMhos
K - Potassium
mg/I
Report Attached? Yes � Nlj,'X (0)
Total Ammonia
mg/I
Mg - Magnesium
mg/I
VOC method-#=
TKN as N --
mg/I
Mn - Manganese
mg/I
method # = _=
method # =
4/98
QM
Permittee (or Authorized Agent) Name a d I file - Please print or type
��0 =� 11Kt dL^ , '/ in

SUBMIT FORM ON YELLOW PAPER ONLY
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: G'' �' �' l �s_�e �4�C
Permit Name (if different):1JN IL A a r, -1 . �Vj 4 L-J e- 7
,✓Jwvt(Street) G County
ac .M (its) a�► Telephone #: L8-,b Y?
Contact Person:
Well Location/ Site Name:r-S " L"l- ' c No. of Wells to be Sampled:
Well Identification Number (from Permit): 45- H t Q 51 'J For Groundwater Treatment Systems
Well Depth: -3 -- ft.
Well Diameter: 2 _ in. Check One:
;Greened Interval a I• to I - ft. ❑ Influent (98)
Depth to Water Level: L -C ft. below measuring point.
p ❑Effluent (99)
Measuring Point Is ft. above land surfaces 2-�7 64 L
Gallons of water pumpedibailed before sampling:
Field analysis: pH--�� �' , Specific Conductance �� uM os
Temp. + Li -C, Odor ^' Appearance m d 4 7WA ')
PERMIT M EXPIRATION DATE: `L l;
Non -Discharge UIC
NPDES A"CG 0 0 Svc
TYPEf P R TTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentrations.
Date sample collected: Date sample analyzed:
Laboratory Name: VA't"f i�,��,N�~`�""t✓
Certification No. 2IL
(Samples for metals were collected unfiltered__�-4YES NO
and field acidified _7s, YES NO)COD
PARAMETERS_
m /I
/100MI
Nitrite (NO2) as N
Nitrate (NO3) as N
mg/I
mg/I
Ni - Nickel mg/I
Pb - Lead 0 Q mg/I
Cool orm: MF Fecal
Coliform: MF Total
/100m1
Phosphorus: Total as P
mg/I
mgll
Zn - Zinc d , 0 i 5'8 mg/I
Ammonia Nitrogen mg/I
(Note: Use MPN method for highly turbid sampl s)
Dissolved Solids: Total -3 -
mg/l
Orthophosphate
Al - Aluminum p s
y s ® mg/I
Other (Specify Co
pH (when analyzed) S• IJ units
Ba - Barium
mg/l
TOC F L
mg/I
Ca - Calcium
mg/I
mg/l
All
ADD
chloride 2- : %4
(' L
mg/I
mg/I
Cd - Cadmium
Chromium: Total
_ / mg/I
�_ _arsenic
Grease and Oils
`
mg/I
Cu - Copper < d ,
0 0 5mg/I
mg/I
ORGANICS: (G
y , ER SECTION
,GC/k#I i GiONAL OFFICE
Phenol ' S
Sulfate t 1-
mg/I
mg/I
Fe - Iron
Hg - Mercury
D .0 U 2 - mg/I
(Specify test and method act lail
(0)
Specific Conductance
uMhos
K - Potassium
mg/
mg/
Report Attached? Yemethod #)= No
VO
Total Ammonia
mg/I
mg/I
Mg - Magnesium
Mn - Manganese
mg/I
method # =
TKN as N
method # =
M
Permittee (or Authorize Agent) Name and 1te - He print or type 3 2,Y 9
v. 4/98 gnature o ermiltee (or Authorized ent) (Date)
a

SUBMIT FORM ON YELLOW PAPER ONLY
Facility Name:_
Per
mit it Name (if
F��Address
Contact Person:-&=
Well Location/ Site
Please Print Clearly or Type
1)C
�..� 3 County
e +i (/� (� `die 7 (zip)
Telephone
C -avi-- F-W+ ✓'T� No. of Wells to be Sampled:
Well identificatio Number (from Permit): fAk (6K"/ PIL,- For Groundwater Treatment Systems
Well Depth: 5 e ft. Well Diameter: ItIn. Check One:
screened Interval: 1 o'L ft. to Ib►3S ft. ❑ Influent (98)
Depth to Water Level:b�_ ft. below measuring point. ❑ Effluent (99)
Measuring Point is _In _ ft. above land surface.
Gallons of water pumps bailed before sampling: s+ ©�
Field analysis: pH b' 0 , Specific Conductance —uMhos fib`'
Temp. �_°C, Odor �-V- Appearance - �"� '' nn
PERMIT #: EXPIRATION DATE, -14
Non -Discharge UIC
NPDES Al C 0 d is - �
Ty�p� PERMITTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
Rotary Distributor Land Application of Sludge
Other:
NOTE: Values should reflect dissolved and
colloidal concentr ons.
�ed: �/ ? K Date sample analyzed: g�fo
Date sample collected: ��
Laboratory Name: 2 8 �
Certification No.
eAAAMETEM (Samples for metals were collected unfiltered E NO and field acidified
Ni - Nickel NO)
mg/i
COD mgll
Coliform: MF Fecal /100m1
NY as N
Nitrite ( 2)
Nitrate (NO3) as N
m /I
9
mg/I
Pb - Lead 0' 00 f 1
-Zinc 000210
mg/l
mg%II
Coliform: MF Total /100m)
Phosphorus: Total as P
Orthophosphate
mgll
onia Nitro en
Ammonia
its
(Note: Use MPN method for highly turbid so pies)0
Solids: Total Z S mgll
Al - Aluminum ! Z -7 q
mg/I
Other (Specify
TO a� Qpnp#ntrati
L5 lu1 VV I155
Dissolved
H (when analyzed) _� = 3 units
pHy
Ba - Barium
Ca
mg/l
mg/I
_ mg/l
-Calcium
mg/l
Chloride 12 a $ mgll
C 0' o ZS mgll
Cd - Cadmium
Chromium: Total
QO
'Arsenic
Grease and Oils mgll
Cu - Copper ��
mg/l
rng/I
ORGANICS:
t
I AL OFFICE
Phenol 0 rJ 5�
f
mg/l
mg/l
Fe - ron
Hg - Mercury 0. 000,21
mg/i
(Specify test and method #. Attach lab reRort.)(0)
No ��__
Sulfate
s
uMhos
K -Potassium
K -
mg/l
Report . Attached? Yes (1)
Specific Conductance
m g
- Magnesium
mg/l
VOC : method # =
Total Ammonia
mg/I
Mn - Manganese
mg/l
method # =
TKN as N
method # _
.. ... -.
zed gent) Narny d Title - Please print or type' !„
`ev. 4/98

Type or Use a ball-point pen and press firmly. PERMIT NUMBER: (REQUIRED)
Facility Name E (--Non-Discharge
NPDES
3D t> ✓ ✓f w 4 _., r— QC Sol
Address TYPE OF DISPOSAL OPERATION BEING MONITORED
to-. -rL✓s ns✓ �e �.1G '1Z 7 9-1m County tale ✓s4PAI (REQUIRED)
Well Location C- 1 Lagoon Septic Tank/Drain Field
Well Identification Number A4141— `/ (Qf N4 p/2-) Well Depth �6� 3 S Ft. Spray Field Subsurface Low -Pressure
Well Diameter 2 Sample (Screened) Interval 1A z Ft. To lb-3 Ft. Piping (LPP)
Depth to Water Level 3, I ft. below measuring point (before sampling) Land Application of Sludge
Other
Measuring point is 'X,, 7 ft. above land surface Rotary Distributor
'allons of water pumped/bailed before sampling
=field Analysis: pH 1. 0 S eci is Conductance 300 uMhos Temp. 5 ° 3 3 or Naac Appearance S �'
Date Sample Collected 3 9� Date Lab Sample Analyzed a
Laboratory NameZcpn 1-1 i[/�®"'¢_ 11 s _ Certification No. 2 �7
SAMPLES FOR METALS WERE COLLECTED UNFILTERED AND FIELD ACIDIFIED _YES NO
COD
Coliform: MF Fecal
Coliform: MF Total
_ mg/I
/100ml
/100ml
(Note: Use MPN method for highly turbid samples)
Dissolved Solids: Total "330. O
mg/I
pH (when analyzed) ® $
units
TOC 6.7a
mg/I
Chloride l I.
mg/I
Arsenic < 0. o 5 0
mg/I
-Grease and Oils
mg/I
,hardness: Total
mg/I
Phenol 0. 0 0 5 25
mg/I
Sulfate I y 2
mg/I
Specific Conductance
uMhos
T 1 A ;a
mg/I
Nitrite (NO2) as N
mg/I
Nitrate (NO3) as N
mg/I
Phosphorus: Total as P
mg/I
Al - Aluminum / 0.7
mg/I
Ba - Barium
mg/I
Ca - Calcium
mg/I
Cd - Cadmium
mg/I
Chromium: Total < 0. 0100
mg/I
Cu - Copper L o o0 5fl0
mg/I
Fe - Iron
mg/I
Hg - Mercury < D 800-za2
mg/l
K - Potassium
mg/I
Mg - Magnesium
mg/I
Mn - Manganese
mg/I
Na - Sodium
mg/I
Ni - Nickel
mg/I
Pb - Lead �• O[76'7�
mg/I
Zn - Zinc c� pz7 0
mg/I
Pesticides/Herbicides
(Specify Compounds)
ug/I
ug/I
' ug/I
Other (Specify Compounds and �
Concentration units)
ota mmonl
TKN as N mg/I MIR - 191998
I CERTIFY THAT THIS REPORT IS TRUE AND ACCURATE. Note: Values should reflect dissolved and
colloidal concentrations. (see #3 on back)
* See back for instructions.
�ture of Permittee (or uthorized Agent*) Date ** Submit blue and yellow copies only to address above.
iiture of Perrm�ittee ((o�ruthorized Agent*)
'EV. 8/96

Facility Name
Address
or,Use a ball-point pen and press firmly.
Cou
.�soa✓
Well Location i:_-= r_ c 1CN L--
Weil Identification Number M k/— `' -4 9 fz Well Depth 16.35 Ft.
Well Diameter 2-" Sample (Screened) Interval / /. 2— Ft. To I 35 Ft.
Depth to Water Level 431 ft. below measuring point (before sampling)
Measuring point is 2. 2 ft. above land surface
allons of water pumped/bailed before sampling 6
. field Analysis: pH 6.0 Specific Conductance 3 b 0 uMhos Temp. 13. O
Date Sample Collected J'zg1 R i Date Lab Sample Analyzed f 2 $
Laboratory Name 1.4ti/ ,V i'ROM wK<w44.1 /VA'Bwo.( [r.4-6s
SAMPLES FOR METALS WERE COLLECTED UNFILTERED AND FIELD ACIDIFIED
PERMIT NUMBER: (REQUIRED)
Non -Discharge
NPDES //G I,OCJOSO%
TYPE OF DISPOSAL OPERATION BEING MONITORED
(REQUIRED) /
r/ Lagoon Septic Tank/Drain Field
Spray Field Subsurface Low -Pressure
Piping (LPP)
Land Application of Sludge
Rotary Distributor
° C Odor ,vo�vc Appearance 5 % T''z y'
'7 - 030hi?
_ Certification No.
ZYES
m
COD
mg/I
Nitrite (NO2) as N
mg/I
Coliform: MF Fecal
/100ml
Nitrate (NO3) as N
mg/I
Coliform: MF Total
/100ml
Phosphorus: Total as P
mg/I
(Note: Use MPN method for highly
turbid samples)
Al - Aluminum / 0, 1
mg/1
Dissolved Solids: Total
'3o y
mg/I
Ba -Barium
mg/I
pH (when analyzed)
S.9 3
units
Ca - Calcium
mg/I
TOC
1,44
mg/I
Cd - Cadmium
Chloride 3
2 1 6
mg/I
Chromium: Total L ®, o / Da
mg/1
Arsenic L 0. L'>.250
mg/I
Cu - Copper o. o z20
mg/I
Grease and Oils
mg/I
Fe - Iron
mg/I
hardness: Total
mg/I
Hg - Mercury >. 00 o z oo
mg/I
Phenol 0.
oo`t 96
mg/I
K - Potassium
mg/I
Sulfate 1 -6
5
mg/I
Mg - Magnesium
mg/I
Specific Conductance
uMhos
Mn - Manganese
mg/I
Total Ammonia
mg/I
Na - Sodium
mg/I
TKN as N
mg/I
_
I CERTIFY THAT THIS REPORT IS TRUE AND ACC FRME1 1998
ure of "Permittee Z(or thorized Agent*) Da e
`V. 8/96
2. 97
Other
Ni - Nickel
mg/I
Pb - Lead 0. o o 777
mg/I
Zn - Zinc 0.0390 40
Z-11 mg/I
Pesticides/Herbicides
(Specify Compounds) r� t
g/I
mug/I
g�fg/I
Other (Specify Compounds and
m'
Concentration units)
Note: Values should reflect dissolved and
colloidal concentrations. (see #3 on back)
* See back for instructions.
** Submit blue and yellow copies only to address above.

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NORTH CARO \ DEPARTMENT OFNATURAL RESOURCES &" COM `ITY DEVELOPMENT
WELL RECORD DIVI3_ N OF ENVIRONMENTAL MANAGEMENT, GROUNDWA; SECTION
R.O. BOX 27687 = RALEIGH, N.C. '27611 $
DRILLING CONTRACTOR Q %� / C E REG. NO. WELL CONSTRUCTION PERMIT N0.
1. WELL LOCATION: (Show sketch df the location below
Nearest Town: QA County: %
Quadrangle No. —4
(Road,Community or qubdivision nd eLot No.)
2. OWNER:a DRILLING LOG
3. ADDRESS: 3t ,. 1- DEPTH
FROM TO FROM DESCRIPTION,
4. TOPOGRAPHY: draw,vall4 lope hilltop,flat(circle one)
5. USE OF WELL: j )a DATE:
' t
6. DOES THIS ELL REPLACE AN EXISTING WELL? j
7. TOTAL DEPTH i RIG TYPE OR METHOD: Airr
8. FORMATION SAMPLES COLLECTED: YES NO 9i�A
9. CASING: Depth Inside Wall thick. type
41
Dia. or weight/ft. a
t� d'�vc, Lh x
Fr�m�to�ft� � ..��"� ` t
Method
10. GROUT Depth MaterialN4.
Fro mtoft
r# m- i, ,
If a4aitional ace is nee e , use ac o
11. SCREEN: Depth Dia. Type & 4-penig
From toft S ti ° = LOCATION SKETCH
(Show distance to numbered roads, or other map reference
V Cl
a� `a
12. GRAVEL: Depth Size Material
From-t j`y ft
13. WATER ZONES (depth)
above
14. STATIC WATER LE17EL:`CiJ+�ft• :eLoe op of casing
Casing is .. ft. above land surface ELEV:
15. YIELD(gpm): METHOD OF TESTING:_
16. PUMPING WATER LEVEL: ft.
after hours at gpm•
17. CHLORINATION: Type Amount
18. WATER QUALITY: TEMPERATURE(OF)
19. PERMANENT PUMP: Date Installed
Type Capacity (gPm)HP`
Make Intake Depthw"a
Airline Depth
20. HAS THE OWNER BEEN PROVIDED A COPY OF THIS RECORD AND INFORMED OF THE DEPARTMENTS 1y'
RECOMMENDATIONS?
21. REMARKS
—
I do hereby certify that this well was constructed in accordance with N.C. Well Cop
,
Regulations and Standards and that this well record is true and exact.
SIGNATURE OF CONTRACTOR OF AGENT DATE
Form GW-1 Revised 11/3/77 Submit original to Groundwater Section and cc
.--...-...._.„..-.--.�,.. __.,. i..-;.,,<..... nu..am v ,3: .0 .ri.F ;�.,P .a. . +, v.mx � T'. ...:+- x .. r.>.. ..,::- -• - .... _

WELL DATA TABULATION
POLLUTION SOURCE MONITORING SITE
Facility Name: ,� c Count jj
y: /"�P�dr►�5/�,�t
Pollution Source (lagoon, landfill, etc. v� Latitude: 3S /6 add
Permit No: el' ° -11
K
Longitude: 9 y YJ
Non -Discharge 1711A NPDES: ,/j & 40660,j207
Well Connt.: f/ DHS:6 —
Quad No: io gy
e
Sampled By:
Well No.
Date
Installed
Total
Depth
(ft)
Diam.
(in)
Screen(S)/
Open hole
(OH)
(ft-ft)
Grout
Interval
(ft-ft)
Gravel/Sand
Pack
Interval
(ft-ft)
Remarks
.
. yr
o»1
i.
_PM- A0
D /3ir
6 1:3
yo
Draw a diagram on the reverse side of this form showing map location of the site and the
location (direction and distance) of each well with respect to the pollution source and to
each other. Indicate sampling schedule, parameters and any changes to schedule.
GW-51
Revised 8/20/84

We- s I
✓ {a

r SAMPLED 71244* 3
,,ALINITY (CaCO3
To pH 8.3
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PAGi 2
;Continued)
,AT1PLEDRZ21171g
•iitrogen, Ammonia
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VAUL I
GATE SAMPLED
ALKALINITY (CaCO3)
To pH 8.3
To pH_4.5
Aluminum
*®
Arsenic
Bicarbonate
Cadmium
Calcium
I
Carbonate
Chloride
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COD
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Cyanide.
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Mercurya_'
Nickel.
}
C .Q
0, 0
L45' i�0
6 0 0,

PAGL 2
,4(Continued)°
. SAMPLES!
'Nitrogen, Ammonia
A
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A hA®
:EW3
03
---------------------
131
O•Os-
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pH
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Q
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Test Well
Late of
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Zn I Ni C 1
Cr Cd Fe
w
Depth
f
Y 3
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TEST rat LL DATA
`'est Well pate of
Collection PH 2n *li C��,11 'Cr Cd Fe p Den'th
�6
9 ; 4' 9 l
2 -� 10
20!., i
r 0'A a .
3-101
10
20' _.
20°
40,

,-WENTRAL Ia\BUfAZO���� � B2�O
.�/ Y �
Serial Number
�d I Time By
�
/
, Date Collecte
.. �
Location or site _ �
Description of Sampling Point.
Remarks
Alto
(pumping Time A��)Temperature,, etc.)
FIELD KNALYSIS
PH
Odor
Spec. Coad.
Appearance
Temp. OC
Taste
PLEASE TEST FOR COZ45TITUENTS
OR PROPERTIES AS
111MICATED. REPORT ANALYSIS
TO.:. CHIEF,
GROUb-DWATER SECTION, RALEIGH,
N.C.
F--� Alkalinity (As CaCO o)
Nitrogen '
to PH 8,3.~....,
/1
DjmIdzbI.,~......
/I
[---1 to PH 4.5,......,
/l-
Nitrate & Nitrite.
/l
1>�1
1 |Alumiuum.^........^..
ug/l
p8 Value (When analyzed
[--�
F--�
Arsenic ..............
u�/l
PbeomI..,°..,....,,.
-��---�
g/l
! | Bicazbooate~.,~...°.
/l
'Pbompbozus» Total ....
F--1
( | BOD" 5-Day.-.........
l
Pmtaouium,,~.,.,°,..
F---1
[ | Cazbonace.....,...~^
/l
--
Specific Conductance
-
F---}
Carbon Diuxide.,.,...
mg/l
(micromhos at 25~C) ~^
[--�
CbIorida..............
l
Silica...,.
,. . ..
`^ ` '
/ �
| |
[--� _
CoIiform (~mcal ���..
/lD�ol
Sodium `~^^^^`^^^^~^^
/l
'
�--1 ~,,-_�,�,.,,.°
Copper
u�/l
5olfata.~-.~~.~~^`...
��//
/ |
[--�Cyanide,_,_,^,,,,,.~
/l
%ioc~^~~~`^~~^^^^~~~
/l
F--���s�n���I �oli�a.~,.
l
CaIcium`^~^~`~�~^^~~
/l
�--lFIuoride..,.....-.~,
I
Magnesium .~.~.^^....
l
| |
F--�Bazdoee� �� �O ...
C C
�--� 3 '
' l
` D��ac�o^
Hardness,
| � Non Carbmoate.....
�/l
D
Iron..'.,....,.^.....
oQ/l
| }Lead..,......^.,..^..
> �Lithium.-............
/l
| {Mtangaaeom..,.,.......
/l
Mercury ..............
/l
FOR IN7
Samples I /x(} \'}'
Log uuc. c� ________� '_____
'
Date Repor�ed ----- --
uata ont , � ck^
[JJ 5 4

Ground:rater Sectioza count Q
A�
J _�D U "'t RAL LABO?ATORY
REPORT Crid Location
r
Serial, Number
1
Date Collected 1 Time
E E o.
Location or site
biescription of Sampling Point
Remarks
(Pumping Time, Air Temperature, etc.) -
FIELD ANALYSIS
Odor.
Spec. Cond. ApPearaace,,
Temp. OC Taste
PLEASE TEST FQR CONST = ► OR PWPERT32S A5 MICATED REPORT ANALYSIS TO."
CHIEF,
• GROMWIAXER SECT TT RALEIGH N. G.
baliaity (As CaCO3)
'to
Nltrageu
pH 8.3........... _rag/I
to p$ 4.5.......... �Ot M.
Ki e7 �ahh .
Nitrate &Nitrite.
mg f
Aluminura....�._.,.a...' ug/1
pH Value (When analyzed 3
Ar enie....ae:....... ug/I
j]:j.:B1
Phenol... ..,...
u g/I
carbonate-. ....-.•-• C.
Phosphorus, Total..r.cofi
cy
BflD, 5-bay, , y , , ..... tng/l
Potassium...... , .....
roof 1
Q
[�]Caarbcnate_.�.�•!
Specrfc Conductance
_
Carbon�_ �.
Carbon. %1�.G2a...:s.;.::�>. r r a . • Ro��.
Cmicromhos at 250C) ..
Chloride- _
Silica...
ilica.•e...
M6y
EColifor,. (> � }..v' 1100mi
Sodium .........-..:...
ng/1El
Copper...., u/1
Sulfate......,........
as/j
0
tag/1
o .....a....>..
ZinCyanide.....,}........ . ..
Uofl
s
Dissolved
MID
Calcium ..............
Mg/1�
Fluoride.ea....... m�®Z
Magnesium -
....... ..
� •
IIo /1
t, r
fl�Hardness
a!:- Cs-CO3 ....
a
t , . rig/ I
Reaarks:
`;rduess,
Non Car;bonate..... mg/1
EIIron............ ug/I
Lead.. ....„ . ug/1
LithiL. a .. • •
�i3P�dII23?.. .... Lo/1
a7
fifercu y... ... ug/1

Date Collected
Location or site
OMkL LUO'-�-A-TORY REPORr c
T I C il Location
LT
Serial Number
6 Time
description of Sampling Point
D. Lk*
(Pumping Time, Air Temperature, etc.)
FTELD AWN.YSIS
PH odor
Spec. Cond.
Tem0p. C Taste
PLEASE TEST MR CC'iST=U=S OR PROPERTIES AS M' ICA-TZD RF-PORT,ANALYSIS TO-. CHIEF,
MOUNDWATER SEM(Mr, RAUIC-H, N. C
AlkaJAairy (As Cac t-rog
03) NiC11en
EDto PR 8.3 ....... 6 .-�- . Kj e Idahl. .
tc�PH4.5......... Mc,/1 - -
Nitrate & Nitrite. Us, L
........1
C ugh
Arsenic ........ I ......
E:l Bicarbonate. .......
BOB, 5-Day.— .......
E::] Carbon D ic,- x�-
C'
P P er
< jig./ i
ElCyaaide—.7 .... #... -----------------------------
Dissolved S:, 1
FZ::Iluoride ..........
llarene3s as
3
Hardness,
Non Carbj=ata .....
................
e-a d ..... ........
Li t: ..............
Ug/1
pH Value Men analyzed
Phenol.... ..
EJ
Phosphorus, Total....
Potassium.... ..♦..
Tag
concluctanc!a
(Tdcromhog at 250C)-._.
Silica,.......
Sodium......_.._....- -------
sulfate..... ......
IF-1
Zinc.................
Calcium ..............
, Cr
F —1
Remarks:'
FOR 1JIT M-E 12,11 USE
ck.— Rcporr.ed

NORTH CAROLINA D'ARTMENT OF NATURAL RESOURCES & COMMUNITY DEVELOPMENT
RECORD DIVISION` ENVIRONMENTAL MANAGEMENT, GROUNDWATER(
,LION
"O. BOX 27687 - 'RALEIGH, N.C. 27611
DRILLING CONTRACTOR( FtEG. NO. WELL CONSTRUCTION PERMIT NO.
1. WELL LOCATION: (Show sketchf the location below
{( 1 unty: e NJA e f°"'�^S�}
Nearest Town:Co
_ is 5� t ,
Quadrangle No.
(Road,Community or ubdivision and Lot No.)2. OWNER:Ir-L" f O� DRILLING LOG
may' ( e _ : DEPTH
3. ADDRESS: -" e FROM TO FORMATION DESCRIPTION
4. TOPOGRAPHY: draw,valleylope , hilltop,flat(circle one)
S. USE OF WELL: 6) 11) EE i € ,DATE:
6. DOES THIS WELL REPLACE AN EXISTING WELL?- g
7. TOTAL DEFTH.\ RIG TYPE OR METHOD:
U
8. FORMATIONS SAMPLES COLLECTED YES NO �
9. CASING: Cepth Inside Wail thick. type
Dia. or weight/ft-
P c-
From co ft " �
r
LIZE
10. GROUT: Depth Material Method �'
From to ft �.�; `fig r'� .i3
ray
I a itiona space is nee e , usebacko orm
11. SCREEN Depth Dia. Type & Openi g b
Frtoft LOCATION SKETCH
erence points)
• :(Show distance to numbered roads,. or other map ref
om .
C�D J
12. GRAVELt Depth Size Material
From
13. WATER ZONES(depth): -�-
above
14. STATIC 'WATER LEVEL:�l "below
of casing
Casing isft. above land surface ELEV:
15. YIELD(gpm;; METHOD OF TESTING:_
16. PUMPING WATER LEVEL: ft
after hours at gPm•
17. CHLORINATION: Type Amount
18. WATER QUALITY: TEMPERATURE(°F)
19. PERMANENT PUMP: Date Installed
Type Capacity (gPm)HP.
Make Intake Depth
Airline Depth
20. HAS THE OWNER BEEN PROVIDED A COPY OF THIS RECORD AND INFORMED OF THE DEPARTMENTS REQUIREMENTS AND
RECOMMENDATIONS?
21. REMARKS
I do hereby certify that this well was constructed in accordance with N.C. Well Construction
Regulations and Standards and that this well record is true and exact.
SIGNATURE OF CONTRACTOR OF AGENT DATE
Forid GW-1 Revised 11/3/77 Submit original to Groundwater Sectionandcopy to well owner.

WELL DATA TABULATION
POLLUTION SOURCE MONITORING SITE
Facility Name: County:
Pollution Source (lagoon, landfill, etc. Lat-itude:
4
Permit No: Longitude:
Non -Discharge: 1111h NPDES: ffi� 4=27
Well Const.: DHS:— Quad No: /0 gil
Sampled By:
Well No.
Date
Installed
Total
Depth
(ft)
Diam.
(in)
Screen(S)/
Open hole
(OH)
(ft-ft)
Grout TGravel/Sand
Interval Pack
(ft-ft) Interval
(ft-ft)
Remarks
?
5/3ir-XQ
37
if
61
?
Tllfd 7
44
21
3
Draw a diagram on the reverse side of this form showing map location of the site and the
location (direction and distance) of each well with respect to the pollution source and to
each other. Indicate sampling schedule, parameters and any changes to schedule. -
r1w- � I

C'I,V.: P O4 .
-,ATE SAMPLED 712
_KALINITY (CaCO3)
To pH 8.3 -
To pH 4.5
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PAGE 2
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TEST WELL DATA
.__ Wiest Well � Date of
# lCollection PH Zn Ni GU„ Cr � Ca � Fel P Depth
1 10'
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2
401
3 - 10'
20'
-----------------
40
IL
10,
2
_ _
L-
y---- -- -r-

EST WELL
DATA
,
le11
Date of
�
�
Collection
PH
� Zn
Ni;
C
'Cr
Cd
Fe
p
Denth
:202
}
l
,.
2 .. 10,
®
40'Alb
3 - '101
2011
�
400
209
401
c
I w 10'
20'
J
40
2 - 10°
209�
-
401
3 - 10°
20*
401
jo
2 0.'
401

OQGroundwater Section .aunty )j K -a Q sty
ALIABO'ERATORY REPORT sGrid Location , Serial Number L &
Date CollectedA
Location or site
Description of Sand
Remarks
(Pumping Time, Air Temperature, etc.)
FIELD ANALYSIS
pq___
Spec. Cond.
Temp.
Odor
Appearance
0
C Taste
PLUSE TEST FOR CONSTITUENTS OR PROPERTIES AS INDICATED. REPORT ANALYSIS TO: CHIEF,
GROUli-DWATER SECTION, RJUEICH, N.C.
Alkalimity (As CaCO3) Nitrogen
to pH 8.3......... mg/1 Kj eldahl .......... mg/1
to p4 4.5........ MCP/l Nitrate & Nitrite. mg/1
.
[:/2-11uminum ............. ug/1 pH Value (When analyzed
El
Arsenic .............. cy/1 U. Phenol......... , .... ug/l F-1
Bicarbonate......... . Phosphorus, Total... mg/1
BOB, 5--Day.......... M&11 Potassium,...........
Carbonate............ mg/1 Specific Conductance
(micromhos at 250Q., jo
Carbon Diaxlde ....... g
Chloride.... ........ Mgil Silica ............... mg/1 Ell
Sodium..... .......... 0 1
CQlifo—.a jTozal UP).. I 00MIM" /
Sulfate..... ......... M-/1
Copper...._. _: ...... ug/1UAI­j
Cyanide mg/l Zinc........... ...U.g/ i FE�K
Dissolved mg/1 Calcium ............... Mg/1
mg/1
Magnesium............ Mg/1
Hardness as CaCO3... 1 Remarks'
Hardness,
Non Carbonate..... Mg/1
i:o............. I...
zl�2 �2 _21 9
mod ................. ugh /M0
Lithium ..............
J-Man ariese ............ yg/1 J V I
A
7
rcury .............. Igh I-) exc
FOR INTERI-kB USE �STT -,215-T�To
Samples In
Log ent.- ck.--- Date Reported
Data
M4 54

Groundwater Section
ENTRAL LABORATORY IEPDBZ\�V)
Date Collected
Location Or sit '
Description of Sampling Poiat__Remarks
___
. \`
p
By:
County
bl Location
Serial Number
[B | �b� �ur `.�
`
` moy��� m� eza e° �tzFIELD kXALYSIS
PH m
:~
SpecCondAppearance
Temp. C Taste
PLEASE TEST FOR CONSTITUENTS OR PROPERTIES AS IMIOACED. REPORT ANALYSIS TO:
GROUNDWATER_
CHIEF,,
Alkalinity (&s CaCO 3^ �
Nitrogen
�--1 to PH 8.3,-..~..^
/l
Kj eI4ahl,.,.,....
/l
�--1 to DB 4~5.......°
�_.
~ l�
����a�e � �l�r��e /l
~
F--1 1QLuminum,-...~....°..
ug/l
PH Value (When analyzed
[--T
[---\ Arsenic
m ,.^.,.,..,....
^ u�.l
/
Phenol ...............
8/1
El
Bicarbooate..~^,.,..
/l
Phosphorus, Ibtal.,.
/l
F--1
i� } BUD, S-Da�...,..~.,.
l
Yotassium.,.... ,°,.~
r--1
a� �ace.�..^...^..
Carbonate
/l
��c c
Specific Conductance
[--�
Carbon Dioxida......
�/I
(o��c�o�bu� a� 2�`C\
^^`
F--1
L_J
F--� -
Cblozi�e.....,,,,,,,
—�
/l
Silica ^^^~~^~~~~~^`^
/l
[--1
L__]
[---1 Culiform (Total ��),
/100mi
Sudiu�`^^^^',,~~`~'^
/l
F--1 Copper '
- ^~-~.,.^~...^.
/l
Sulfate ^^^'°`~~^^~~^
L__� ~-^^^ ^^`~~^^
El,
--
- /�
%inz^~^^^^^^`'^~~~^^
- /l
F--|
L_]
r--lDissolved Solids^,,^
_ l
.
Calcium`^^^~^',``^^^
/l
[--1
L_�
[--�Fluoride ^.... ...
^^^`
/l
8agoeaium^^~^^^~^`^~
�------'
F--�
Hurdoeam ae CaCO_...
/l
Remarks:
Hardness,
F--1
-
Non Carbonate ..,.
/lED
----
_ Icoo........,.,.....
/I
-~]
=
| /Laa6...,.'....^...,.
/l
Lithium � '~~~^^~,~.'~`^
o�/l
`
�-��----------
Mao8aoeue^^....
'
/l
8e [---!
ccuz�....~.....,~~
!--- -- '
/l
'

Groundwater Section County
_
'CENTRAL_LABOREATORY
REPORT Grid Location
Serial Number`
Date Collected .� Time
4 By: . 1k
or
Location or site
e k.
Description of Sampling Point
Remarks
(Pumping Time, Air Temperature, etc.) -
FIELD &NALYSIS
PH
Odor
Spec. Cond.
Appearance
Temp. OC
Taste
PLEASE TEST FOR CONSTITUENTS OR; PROPERTIES AS DMICATM1. REPORT ANALYSIS TO: CHIEF,
GROUNDWATER SECTION1, RALEIGH N.C..
kalinity (As CaCO}
Nitrogen
to pH 8.3..........
mg/1
mg/1
to Of 4>5.>..... mg/1 .
Nitrate '& Nitrite.
Cr
a
Aluminum..............
ug/1
pH Value (When analyzeds�
Arsenic.,............
U.
Phenol..........
icarbonate..........
mg/1
Phosphorus, Total....
mg/1
0
BOD, 5-Day...,,........
rig/1
Potassium ......
mg/1
P-C.-arbonate
...... .... 1
mg/l
Specific Corductanc
-,:. -
Carbon l�.:.er �,.:z.t:;�`s.... > .
Mg/1
0
(m:icromhos at 25 _ C) ..
Q
Ch3oride '..at=q,>. r►.s.
Ti7 g/1
r
Silica........ ...•,
mg/1
F
..ice--.!
ElColiform (Tot-alICE') ..
II OCmi
Sodium........... ...
ng/1
Copper .. ro. 9 Y. >. 1 f
*. I ♦{
g L
Sulfate...... .. • ..
mof 1
Cyanide.
Mg/1.
zinc .................
ug%1
,� issolved So:��.w,:...f.. �� mg/1
_
Calcium ..............
mg/1
Fiuoride...�........,:
mg/I
Magnesium............
mg/1
A' ardness ai, CaCO3....
mg/1
Remarks:
Hardness,
Non Carbomate....
rig/1
0 Iron...... ..........
ug/F
Lead..................
ug/1
. .. . ..
dl i
n) t'Ta ngaae3e.........
1a
j
i i..7 Hercury... a ... • .. • ....
Ug/

NORTH CAROLINA*,;.,EPARTMENT OF NATURAL RESOURCES & COMMUNITY DEVELOPMENT
WELL RECORD Y} DIVISION "ENVIRONMENTAL MANAGEMENT, GROUNDWATER' CTION *
y.0. BOX 27687 - RALEIGH, N.C. 276I1 �.
DRILLING CONTRACTOR I L �+� `Ctry Ed. NO. WELL CONSTRUCTION PERMIT NO.
1. WELL LOCATION: (Show sketch �f the location below
Nearest Town:_ r7<
(Road,Community or
2. OWNER:_&&_ �J
County: / f WlL-�' fir"".. _:50,,///
Quadrangle No.
Lot No.)
,y
DRILLING LOG
3.
ADDRESS: L'All i o �'� _ � r .: DEPTH
4.
0 FROM TO FORMATION DESCRIPTION
lope hilltop,flat(circle one)
TOPOGRAPHY: draw,vall Y.,
5.
USE OF WELL: tj DATE:
6.
DOES THIS WELL REPLACE AN EXISTING WELL?
7.
TOTAL DEPTH.\ RIGTYPE OR METHOD:
.
`
8.
FORMATION SAMPLES COLLECTED: YES NO L/ ,
9.
a
CASING:.. Oacicn Inside Wail thick. type Lon. �_.,.
Dia. or weight/ft.)
From to ft i"V C'
10.
GROUT: Depth Material Method
tsnm'
�
L"$
If Additional space is nee e , use back Bf toF5
11.
SCREEN: Depth Dia. = Type & O eniiAg
Fromta ft
LOCATION SKETCH
(Show distance to numbered roads, or other map reference points)
a
12.
GRAVRL. Depth Size Material
Fromto ft
13.
WATER ZONTS(depth): p "
14.
STATIC WATER' LEVEL)25 ft.aYxo p of casing
Casing i4 ; ft. above land surface ELEV:
15.
YIELD(gpm),. METHOD OF TESTING:
16.
PUMPING WATER LEVEL: ft..
after hours at gpm.;,
17.'
CHLORINATION: Type Amount
18.
WATER QUALITY: TEMPERATURE(OF)
19.
PERMANENT PUMP: Date Installed
Type Capacity (gpm)HP'
_Make Intake Depth
Airline Depth ;
20.
HAS THE OWNER BEEN PROVIDED A COPY OF THIS RECORD AND INFORMED OF THE DEPARTMENTS REQUIREMENTS AND
RECOMMENDATIONS?
21.
REMARKS
I do hereby certify that this well was constructed in accordance with N.C. Well Construction
Regulations and Standards and that this well record is true and exact.
SIGNATURE OF CONTRACTOR OF AGENT DATE
Form=GW-1 Revised 11/3/77 Submit original to Groundwater Section and copy to well owner.

i
SAMPLED
g-g
-
17 30
5 3 3 f KY
,cINITY (CaCO3)
To pH 8.3
To pH 4.5
s-
3
i umi num
,arsenic
Bicarbonate
��'
Cadmium
G
p
aG0.0
G0.00Z
Calcium
" ___�°_=
/Z 7.9
Carbonate
Chloride
"
Chlorinated Hydrocarbon
�
s
G.Q,QS
G
UJ`�
^I
d '� OX
.110-Q L OrOf�)
Chromium,Hexavalent
Chromium, Total
COD
t
Col i f orm, Fecal
Coliform, Total
Cyanide
Dissolved Solids
fJD
�a
0
�3
q
73 !�
Fluoride
f� 1
3
Sj
43
47 37
Hardness as CaCO3
Hardness, Non Carbonate
G
L�
Iron
L D, I
GD,
�%
<
Z®as0
40,05- zo,or
Lead
Z A 0 w.©/
Lithium
AQ
Q
MBAS
J. o�
3.�j'
A %
2 • Z . 9
Magnesium
'langanese
d. 3b�
,Z %
Mercury
Nickel
A0.000Z '40.0002
LO�O'� GO.4

PAGt 2
'(Continued) L,I,(
SA.PIPLE�
-
31077 8
3 1rpg
rogen, Ammonia
jj,03
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2-
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49.01
trogen, Kjel dahl
o l /-
� � $
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LO. 1
jtrate & Nitrite
rganic Scan
>H
�.7
Phenols
L• S
Phosphorus, Total
�. D
j}.
a, �l
d /
©•OZ
0.0�
Potassium
Selenium
G0.AD
Silica
Silver
, �j`
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Sodium
%�
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Specific Conductance
Sulfate
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Zinc
0.0�
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IC40
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i COIJIIi'Y(
-c :' SNIPLED
10474,
`INITY (CaCO3) To pH 8.3
To pH 4.5
S7
kluminum
Irsenic _
D_
3icarbonate
f
,admium
<p►C1
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--
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;hromium, Total
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:ol i farm, Total
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i2 -
1i�o
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lardness as CaC080,7
lardness, Non Carbcnate
ron►�
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IBAS
lagnesi um
s
langanese
lercury
ickel

PAG€ 2
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9/717164&X
�Jitrogen, Ammonia
Nitrogen,Kjeldahl
__._
Nitrate Nitrite
47
Organic Scan
pH
Phenols
Phosphorus , Total
15,00oQrtJ
0
06
_1,
._
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j
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4401
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T' Jt Well
Date of
1
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Collection
PH
Zn
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Cd
Fe n
I Denth
401
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Groundwater Section
TRAL LkBORATORY REPORT
Date Collected ZZ;2 J_Z
Location or site
Description of Sampling Loin.
Remarks
umpiag Time, Air Temperature, etc.)
FIELD ANALYSIS
Count
10Grid Location
Serial Number:!
11
pH Odor
Spec. Cond. Appearance
Temp. OC Taste
PLEASE TEST FOR CONSTITUENTS OR PROPERTIES AS INDICATED. REPORT ANALYSIS TO: CHIEF,
GROMNDWATER SECTION, RALEICH, N.C.
Alkalinity (As CaCO3)
to pH 8.3.........
mg/1
to pa 4.5........
C'mg/1
FZJ-Pff-=" inum ..... .......
--Ug/1
F Z:1-Araenic
..............
ug/1
Bicarbonate.........
. mg/1
BOD, 5-Day ...........
Carbonate...........
mgil
Carbon Dl.oxida .......
--mg/1
Chloride.........
I
Colifor= (Total NF)..
/100mi
E�opper. ...........
ug/1
Cyanide... i ........
mg/1
Dissolved Solids.....
mg/1
E2-rlfuoride .............
Hardness as CaCO 3 ....
mgrl
Hardness,
EI Non Carbonate .....
mg/l
1roa .................
ug/1
.end ....... I .........
</00 U0'/j
Lithium........ ....
u.-/1
EK�Kangaue3e ... -
[ZaKercury .............. —u g
FOR INTEMAB USE
Samples ln'� - ��- �'� q 0
Log eftt.--. ck.
Nitrogen
Kj eldahl .......... mg/1
Nitrate & Nitrite. Mg/1
pH Value (When analyzed
Phenol....... ..'... ug/1
Phosphorus, Total..... mg/1
Potassium....... mg/1
Specific Conductance
(Micromho5 at 25 0 C)..
Silica ............... mg/1
Sodium....... .... 21 Man
U==T
Sulfate....: ..... /6 mojl
Zinc.... ..... ... 2C) ug/1
Calcium ...... mg/1
Magnesium...........
Remarks:
CA
-<Ire
Date Reported
Data ent, -�e
Mi 54

Groundwater Section IrCounty eNkf eww-fiy*pj
-ENTRAL LABO?LATORY REPORT Grid Location
( 2_ Serial Number
Date Collected 9
Location Or site L:72�� C�,
Description of Sampling Point
Remarks
(Pumping Time, Air Temperature, etc.)
FIELD AVALYSIS
PH
Odor
Spec. Cond.
Appearance
Temp •C
Taste
-
PLEASE TEST F08 CMgSTIT`MTS OR PROPERTIES AS MICATED. REPORT ANALYSIS TO;
CHIEF,
GROnDWATER SECTIC-U RALEIGH N.C. .
Al-kalinity {As GaCOS)
Nitrogen
to pH $,5..,...,..
mg/1
Kjeldahl,,.,......
mg/1
Q
to pH 4. 5.........
mg/I '
Nitrate -& Nitrite.
Aluminum.............
ug/1
pH Value (When analyzedd,
..
epic...... ....
��Bircarbonate..
ug/l
Phenol.... .w.. ,..
+Tota
ug/1
....... 8 Mal
�.________ �
Phosphorus,. �...
d
BOD, 5-Day,w$..`....,.
/l
w,......«..
Potassiumg/1
m
Carlio*za* ; > .... LMmgll
Spectfic Conductance
Carbon Dior° :: „.. . > .
mg/I
(micromhos at 250C) .
Q
hloride.....,_,....w
Silica...............
m g/1
Coliform -ta w ,
/ltlt?ml
Sodium... .......,.
moll
ED Copper.
uag/ 1
Sulfate... .......
agJl
Q
F]Cyanide..
/I
Zinc.................
ug/I
Tssolved -cq-: ,ds.. ..
Calcium ....,w..,....
mg/1
Fluoride...— .......
_mg/I
mg/l
Magnesium............
mg
ardness as.. c:1C.03... n$/I
Remarks:
F dness,
� `
Nort Carbonate. ....
ng/l
Iron ...... >..........
ug/I
Lead. .....�.. ........
ug/I
Lithe , .. ......
uv fi
_
�lariga �:.i ............
Mercury.. .. .,
ug/I
FOR ZNTE2UB USE
Samples In
Log ent. ck.
Date Reported
Data ent. ck,
__ _ _
M4
54

Groundwater Section County -
ENTRAL LABORA.TO�Y REPORT Grid Location
Serial Number
r �
Date Collected Time
Location or site
Description of Sam;
Remarks
(Pumping T:
FIELD ANALYSIS
int
, Air Temperature, etc.)
PH Odor
Spec. Cond. A earacace
Temp._ OC
Taste
PLEASE TEST FOR CONSTITUENTS
OR PROPERTIES AS
INDICATED. REPORT ANALYSIS TO: CHIEF,
GROU1°+W&TER SECTION RALEIGH
N.C.
Alkali aityr (As CaCO3)
Nitrogen
to pH 8.3.........
mg/l
Kjeld.ahl..,,.....
mg/1
to pH 4.5........
mg/1'
Nitrate &Nitrite.
Aluminum .............
ug/1
pH Value (When analyzed
Arsenic ....., ....
,.
ug/1
Phenol .............•
u /l
g
ElBicarbonata.........
_ ,mg/I
Phosphorus, Total....
BOD, 5-Uay..........
mg/1
Potassium......,..... -
'ngll
Carbonate...........
mg/l
Specific Conductance
� Carbon D.a:«xide, . , .. ,
mg/1
(micromhos at 250C)..
Chloride ...........
hlorid:........... , 6.g
Silica.......... • • ..
mg/l
El
(TQtal pY)•
ILL----
/100ml
Sodium. a. r••s r•as•rColifoim
g/1
Q.
Co er........:..Pp •,.
.
Sulfate..... •.,,..
ma/jug/i
Q
cyanide—.. .......
mg/l
Zinc .................
ugh
Dissolved Solids....
mg/1
Calcium... .,.....
mg/l
El
Fluoride...._...... . _
Mg/1
Magnesium.r.•.••,..•
rag/1
Hardness as CaCO3...
mg/1
Remarks:
Hardness,
Nora Carbonate.. ,,
mg f l
° _
- $ :i ; J t 4 sP
t t" ,.,r*''`d
r
�rU•J
Iron ................
ug/1
Lead.— ............
ugll
Lithium.. .........
ud/1
Manganese............
ug/1
EDMercury.. ........
ug/]
FOR INTERLAB USE
Samples In �L,1,3 5 C .
Log eat. _ ck,
Date Reported
Data ent.— � ck..
GW 5 4

i
NORTH CAROLINA DEPARTMENT OF NATURAL RESOURCES b COMMUNITY DEVELOPMENT
DIVISIC` �'F ENVIRONMENTAL MANAGEMENT, GROUNDWATF ',,ECTION
_ RECORD � I
O. BOX 27687 - RALEIGH, N.C.` 27611 F
tILLING CONTRACTOR i a r� �` YCC i^1.1 REG go WELL CONSTRUCTION PERMIT NO.
1. WELL LOCATION: (Show sketch
sIf. the location
���Jbelow
Nearest Town: Qs f EIS l tor-- county:
Quadrangle No. /
(Road,Community or ubdivision and Lot No.)
2. OWNER:'U � �f # � DRILLING LOG
3. ADDRESS: C (' I . DEPTH
a FROM TO FORMATION DESCRIPTION
4. TOPOGRAPHY: draw,vall elope hilltop,flat(circle one)
5. USE OF WELT.
T7� DATE:
S. DOES THIS WELL REPLACE AN EXISTING WELL?_ri:e?
7. TOTAL. DEPTH RIG TYPE OR METHOD:
a.. FORMATION SAQXPL��E'C$COOLI,ECTED: YES. NO
9. CASING: Depth Inside Wall thick. type
Dia. or weightiest.
10. GROUT: Depth Material Method Y
410141�0�
If i tional space is needed, use back of lorm
11. SCREENS Depth Dia. Type 6 Openi g
Fromtoft Aj LOCATION SKETCH
(Show distance to numbered roads,_ or other map reference Eoints)
rt ,,pp c
12. GRAVE ,: L`ept`t Size Material
From Laft
13. WATER ZO-faS(demth2: •j '7
r 1
I4. STATIC Wr LEVEL. ft.abovetoo of casing
below
Casing ft. above-la-d surface ELEV:
15. YIELD (y^sA METHOD OF TESTING:
16. PUMPING WATER LEVEL: ft.
after hours at gon.
17. CHLORINATION: Type Amount
18. WATER QGALITY: TE24PER.ATURE(oF)
19. PER_MAN✓::T PI,?tP: Date Installed
Tyo� '' Capacity (gpm)HP
Make Intake Depth
Airline Depth \
p
20. HAS THE OWNER BEEN PROVIDED A COPY OF THIS RECORD AND INFORMED OF THE DEPARTMENTS REQUIREMENTS AND 1'}
RECOM."t-N RATIONS?
21. REMA_Rx.3
I do hereby certify that this well was constructed in accordance with N:C_ Well Construction
,
Regulations and Standards and that this well record is true and exact.
SIGNATURE OF CONT CTOR OF AGENT UATL
Form GW-1 Revised 11/3/77 Submit original to Groundwater Section and copy to wall -owner

coil ii t I
.1 fE SMIPLED
<LINITY (CaCO3)
To pH 8.3
To pH 4.5
—
--,
12
3
Z
Aluminum
L. R
G®o4
D`Og
i Arsenic
Bicarbonate
Cadmium
Calcium
�.
�% $rg
04
.3
Carbonate
Chloride
t3
- VL
Chlorinated Hydrocarbon
Chromium,Hexavalent
Chromium, Total
LO,OZ
LD.OZS
COD
Coliform, Fecal
Col i forr!, Total
Cyanide
Dissolved Solids
Fluoride®,
Hardness as CaCO3
Hardness, Non Carbonate
Iron
G.D,
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�. _._____ _._____
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L

PAGt 2
i�Continued)
',,,,,'(Conti
COUNT
SAMPLEn
3 S
0
23
3 8°
1 $1
Nitrogen, Ammonia
b2
A a
.V)-
O.Of
0.0(
Nitrogen, Kjeldahl
�
�
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Nitrate & Nitrite
Organic Scan
pH
5.3
S.Q
Phenols
DD
Phosphorus, Total
Potassium
°761
Selenium
-
GD.QOS
Silica
Si 1'ver
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LU.oZ'�
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a,
.$'°g
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Zinc
D ��S`
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29.9
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2 7s

i (E SAMPLED
1
-:ALINITY (CaCO3)
To pH 8.3
To pH 4.5
Aluminum'
ArsenicQ,
Bicarbonate
Cadmium
(%r�1
40.0 f
0100
6,00
0.60
0
< 0: .
Calcium
(�
Carbonate
Chloride,
Chlorinated Hydrocarbon
Chromi-um,Hexavalent
Chromium, Total.ttt,
..,
COD
.Coliform, Fecal
Coliform, Total
Cyanide
'
Dissolved Solids
°
Fluoride
Hardness as CaC08
Hardness, Non Carbonate
Iron
epe
Lead
<c. %
C1
Lithium
_
MBAS
Magnesium
Manganese
+�. N20 •�`
Mercury
0,0 0 1-:3' A 0iacxa��

PAGI 2
Continued)
ONN
8c
;1i trogen, Ammonia
.
_
10,
a
<010-5 p,
Nitrogen, KjeldahT
-
-
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,
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'
Phenols`
;
Phosphorus, Total
C3. 7 %}T�4Y
y_°+ t�i
,
�,
e
�.5
Potassium
Selenium
-
Silica
Silver
..
.OTO
Sodium
3,91
Specific Conductance
_
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Sulfite
Zinc.
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� �
lCollection PH I Zn Ni I Ct Cr Cd Fe P Depth
1 - 10'
t I
-
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<716
00
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lzlz/h
f
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TEST WELL DATA
Test Well Date of
# `Collection I PH Zn Ni Ctt,, Cr I Cd I Fe P Depth
02
401
20'
20'
r'
+f 4 0
Pf_1
3 _ lop
20'

1 i
TEST WELL DATA
ii
Test well Date of
tion PH Zn Ni C_ Cr Cd Fel P Depth
oil e _c 44
I
10,
2 02
IF7r7
`
.Y�J_
{
2 — 10
'3 — 10'
20'
-
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ol
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201
3-io'
20'
s
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s

TEST WELL DATA
a t well
s
gate of
Collection
PH
Zn
*Iz
C Cr
Cd Fe v
c
Benth
i 1 v •
2. - 10 -
-
-
20,
17,
40
3 -- 10•
Ab
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2019
400
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3 CJ
07
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^ 10'
20'
40'
•
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20°
40'
3 -- 10'
20'
401
:f • - 10'
40'

Date Collected
Location br site
Description of Samp
Remarks �1 tx ,ur,
(Pumping
WGroundwater Section County C,__, �' L ; r;�`f
ENTRAL LABORATORY REPORT Grid Location _
Serial. Number/__
ag oxnt if^
l�txFD
Air Temperature etc )
FIELD kNALYSIS
PH
Odor
Spec. Cond.
Appearance f
Temp. OC
Taste
�1
PLEASE TEST FOR CONSTITUENTS
OR PROPERTIES AS
MICATED. REPORT ANALYSIS TO:'CHIEF,
GROUN-DWATER SECTION RALEIGH
N.C.
Alkalinity- (As CaCO3)
Nitrogen
to PH 8.3.........
mg/1
Kjeldahl.......... G7<
mg/1
E� to pH 4.5........
xngil
Nitrate &Nitrite._ �S .. /
-g/1
Aluminum.........«
ug/1
pH Value (When analyzedEl
Arsenic ..............
ug/l
Phenol..............
ug/�
El
ElBicarbonate.........
mg/1
Phosphorus, Total.«., n
mg/1
E] BOD, 5-Day...........
mg/1
Potassium...., . ♦ Y P • ♦ •
r
mg / l
�—d
Carbonate ............
_ mg/1
Specific Conductance
Carbon Dioxide .......
mg/l
(micromhos at 250C).._
(-
_
Ch?oride.............
mgll
Silica ..............
mg/1
EJ
E]
6c.
Coliform (7al MF�EJ
n
/1001
Sodium....«.,.......
r,/1
g
Copper .............. _
ug/1
Sulfate... ..,..
mgli
Cyanide ..............
mall
Zinc w ..............
ug/l
Dissolved Solids ....
mg/1
Calcium ....... P.....
mg/1
Q
Fluoride .............
-_ — mg/I
Mag�aesium...........
mg/1
= Hardness as CaCO3' mg/1
"- rdness,.
EjNon Carbonate.....
Iron». ......
Lead... .. .....
Lithium .............
Manganese...........
Mercury............ » .
ugh
Remarks:*
FOR ItrrE LAB USE
Samples In
Lag eret. Ck' Date Reported
Data GS3 54

_�-... Groundwater Section County o
CENTRAL LABORATORY REPORT 4 Grid location
Serial Number
Date Collected T e By•
Location ar site C _w@
Description of Sampling Point
td,J -0 11 Its-
4✓
Remarks
(Pumping Time, Air Temperature, etc.)
FIELD ANALYSIS
PH
Odom
Spec. Cond.
Appearance
Temp. PC
Taste
PLEASE TEST. FOR CONSTITUENTS
OR PROPERTIES AS
INDICATED. REPORT ANALYSIS
TO CHIEF,
GROUNDWATER SECTION. RALEIGH,
N.C.
kalinity (As CaCO)
to pH 8.3>.....,.
mg/1
Nitrogen
Rjeldahl,.........
mg11
Q
ff to pH 4.5......,,. mg/1'
Nitrate & Nitrite.
ng/l
Aluminum .............
ug/1
pH Value (When analyzed Lie
EDArsenic ..............
ug/1
Phenol...............
ug/1
j i��carbonate... ......
off- mg/1
Phosphorus, Total,...
mg/1
BOD, 5-Dam .......,,.
mg/l
Potassium,,.......,..
mg/l
Q
Carbonate.....,.........
mg/1
Specific Conductance
Carbon Dios da.......
mg/1
°
(micrombos at 25C)..
FC�h&rida.
mg/1
Silica ...............
mgJL
Q Coliforn ;rota]. MF)..
/100m1
Sodium.
mg/1
ED Copper...�,.�..........
ug/1
Sulfate.- .............
mg/1
0
CF-lyanide...-...........
_mg/i
Zinc.................
ug/1
Q
issolved >So$ids....,
� mg/1
Calcium.............g/l
Q
Fluoride.4...........
meo/1
Magnesium............
mg/1
ardnesa as--CaCO3.... mg/1
Remarks:
H,apdness,
Non Cart ovate..... 0 mg/1
DIron .................
ug/1
aLead..,..:............
u9/1
Lithium..............
uo/1
QManganese............
ug/1
DMercury ..............
ug/1
FOR INTERLAB USE
.Samples In
Log ent. ck.
Date Reported
Data ent. w ck.
GW 54

Groundwater Section
WRAL LABORATORY REPORT
Date Collected
2A44L-
Location or site
Description of Sampling Point
it m e -arks
(Pumping Time, Air Temperature, etc.)
FIELD A'XULYSIS
PU Odor
Spec. Cond. Appearance
Temp. OC Taste
eCounty -141(*
Grid Location 7
Serial Number
I
PLEASE TEST FOR CONSTITUENTS OR PROPERTIES AS DMICATED. REPORT ANALYSIS TO: CHIEF)
GROUNDWATER SECTION, RALEIGH, N.C.
Alkalinity (As CaCO
3)
to pH 8.3 ..........
mg/1
to PH 4.5.........
mg/1
F:�--��.iuminum ............. ZO-12—u
g
—1,q
1-
Asenic* ..............
Ug/1
EDBicarbonata ..........
rag/1
BOD, 5-Day..........
Carbonate.. ........
Carbon Diowida,,.
Mg/l
Chlorida,. ............
I
lifo=t (7.:)!:al MY)..
/100m1
uCpper........:..... Ug/l
EDCyanide..............
Dissolved Solids,....
mg/1
u o r i d e .............
mg/1
11ardaess as Caco 3***'—
Mg/1
Nitrogen
Kj eldahl ..........
Nitrate & Nitrite.
mg/l
Mg/1
pH Value (When analyzed
Phenol ............... ug/1
Phosphorus, Total.... mg/1
Potassium........... -7' 1
Specific Conductance
(micromhos at 25 0 C).. L/
Silica..,...... ....
Mg/1
Sodium ............... rag/1
Sulfate..... .... mg/1
Zinc ................. U19: / I
Calcium .............. mg/1
Magnesium ............. mg/1
Remarks:
Hardness,
E1Nora.
Carbonate.....
mg/
r o a ..................
-
LI
.................
0
�) 11 -elo 0
Lithium.. . .4 ......
11c,
[1:;-,I-anganeSa ........ *
ED-4 �er cury ..............
1,3 Ugh
FOR INTERTIAB USE
Samples
Log ent. ck.
Date Reported
Data
M4 54

NORTH CARE -NA DEPARTMENT OF NATURAL RESOURCES & COMMUNITY DEVELOPMENT x�
WELL RECORD DID` ON OF ENVIRONMENTAL MANAGEMENTS GROUND' :R SECTION
0. BOX 27687 "- RALEIGH, N.C. 27L
DRILLING CONTRACTOR ( - ra " IREG. N0. WELL .Gf,STRUCTION PERMIT NO.
1. WELL LOCATION: (Show sketch If the location belowl 4
9
Nearest Town: Cs County:
Quadrangle No.
19
(Road,Community ubdivision and Lot No.)
2. OWNERor DRILLING LOG
3. ADDRESS: '°—r' F DEPTH
6 m x FROM TO FORMATION DESCRIPTION
4. TOPOGRAPHY: draw,valley, lope hilltop,flat(circle one)
S. USE OF WE'LL. PJ.'.j-ry } �Tt � ")a DATE:
6.'DOES THIS WELL REPLACE AN EXISTING .WELL. � ....�
�
7. TOTAL DEPTH: RIG TYPE OR METHOD:
8. FORMATION SAMPLES COLLECTED: YES NO ;w�
7
9. CASING: Dez)th Inside wall chick. type
Dia. or weight/ft. _
From z ft `-+�- P*• i 5 r »�'i�1..
10. GROUT: Depth Material 3 Method S`
I ..R c
Fro. 3 �! `d r
I additional space isneeded, use back ot rorm
11. SCREEN: Depth Dia. Type
{j& Openin
From ?o ft t-1 mbLOCATION SKETCH
(Show distance to numbered roads, or other map reference points)
12. GRAVEL: Depth SizeMaterial
From'-, o_Q2 ft
r� yJ��
13. WATER ZONES ',depth) i
14. STATIC WATER LEVEL: ftabove . o top of casing
Casing is ft. above land surface ELEV:
15. YIELD(gpm) METHOD OF, TESTING:
16. PUMPING WATER LEVEL: ft.
after hours at gpm.
17. CHLO.RINATION: Type Amount
18. WATER QUALITY: TEMPERATURE(oF)
19. PERMANENT PUMP: Date Installed
Type Capacity (gpm)HP`
Make Intake Depth
Airline Depth
;+A
20. HAS THE OWNER BEEN PROVIDED A COPY OF THIS RECORD AND INFORMED OF THE DEPARTMENTS REQUIREMENTS AlgbL',�
RECOMMENDATIONS? jfl
21. REMARKS
I do hereby certify that this well was constructed in accordance with N.C. Well Construction
Regulations and Standards and that this well record is true and exact.
SIGNATURE OF CONTRACTOR OF AGENT DATE
Form GW-1 Revised 11/3/77 Submit original to Groundwater Section and copy to welli

t"E SAMPLED-
CITY (CaCO3)
7T``
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,minum
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�E SAMPLED
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Aluminum
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PAGE 2
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❑Q PN d'
El

Test Well Date of
# Collection PH Zn Ni CFI Cr Ca rel P Depth
� � I I �
1 - 10,
1
8O,,7'`rl
a1
;of
.off
�'
2o•
o 01
�v
40'
4,0t
(4
r L�
V•�
t
14.01
3 _ 10'
201
401
07
-�
e f- 10
.�
20'
fr
1 - 101
1
-
i'2,
.�v1
11.0 1
-,.,-«off
Oax
2 _ 10'
'
._.._
201
O (k Oa k a
1 Z CY
1010 1
i
0
.09
<
3 — 10'
i
20'
-,
of
-_�/,2_1/17 5i
�D
e�
t
a
_J_
1
!
i

10,
9
p
dJ
p
of
,3 — 10
201
,=
t
' 0'--
✓
C/
1 - 10°
_" 2 0'
ct4�3'
2 — 10'
20`
3 10'
20'
e.•r
4t ... Z0,
401
i
,-

EST WELL DATA
Test. Well Date of IL
Collection PH Zn Ni C- Cr � Cd � Fe P Depth
ol
< - 10'
40
♦
r�
'3 - 10`
2 CJ
Re f
10'
20.'
40:
✓y
r
d
1 10,
„ 2 0 °
•�
2 10'
20'
i
10'
2 W '
�....A..�� � 0
� fJ //J`r J/`/I'/7�Ly' %% �
p /)
ti �.m..W",e
,
1,. 9:
y � ��
� �
�
¢ .-r.
..e..,..�,«...d.<

`: st Well Date of
Ca13.ectirsa�
PH un Ydi
�Cr
C� Fe P [3enh
1 101
°
I ! V
Sty '1a?
►
1^ fyas
4 0
s
�,O0
-1,01
2 _ 10°
Qj�p�4 0
An 017
.12
-L0-
3 - 1@°
Q
%
I
,
,,.0.9..
>Ief. 2ro
40°
t�'�
��
a
4 Coo
w 10,
20°
401
1
.
2 - 10°
209
40°
3 - 10°

Groundwater Section
� W rRAL LA30RATORY REPORT
County_ ,ia__ f
Grid Location
Serial. Number:!
l
Date Collected .Y '" Time By* -.t ,.. P 3
Location or site
Description. of Sampling Point__ l"
_ .. 17
Rcmarks
(Pumping Time, Air Temperature, etc.)
FIELD ANALYSIS 'n V
p
Spec. Cond. Appearance
Temp. ��0C Taste
PLEASE TEST FOR CONSTITUENTS OR PROPERTIES AS Ia�ICL.TED. REPORT ANALYSIS TO: CHIEF,.
GROUN-T}WKrER SECTION, RA,LEIGH, N.C.
A11mlinl.ty (As CaCO3)
to pH S.B..........
mg/l
to DH 4.5........
Clc InuM.............
/00 ugh
12;-
rsenie.. .. • ....
1'd uojl
Bicarbonate.......
mg/1
BOD, rj"Day...........
�Mg/ 1
Carbonate ............
Carboni Dioxide.......
mg/1
Chloride.... .......
mg/l
Col:iform (Total 12)
/100rnl
EaCapper•
... ......
—
`, ll� ug/1
Cyanide... ......,.
mg/l
Dissolved Solids.....
mg/1
F' Luori.de........... •
-<D-
Hardness as CaCOB ♦ ..
mg/ 1
Hardness,
Non Carbonate.....
mg/l
Iron:.. .........
"< 160 ugrl
ea d................
l ug/l
Lithium .............
uQrl
,tan -anew ........ ....
/QD ug/1
j���Iercury...........•,.
ilb �� g/l.
Nitrogen,
Kjeldahl.......... mg/l
Nitrate & Nitrite. �g/1 LJ
pH Value (When analyzed _ EJ
Phenol, .......... ug/l
Phosphorus, Total:...._ mg/1
Potassi.um.......
Specific Conductance
(zaicromhos at 250C).. �
Silica...........,.. mg/1
Sodium...... .. .. /' mg
Sulfate..... .. .. S' mg/l
Zinc ............ ..i u'g / I'"
Calcium.......... .. .L') mg/l EJ
Magnesium....... ... mgflL
Remarks
ti
r� tt t
FOR INTERLAB USE
Samples In L-&)
Log ent. ck. Date Reported
Data eat.`' ck.,s._z Goa S.
r�

Groundwater Section County --tea
r I .'Aj
WENTRAI. LA.BORAXORY REPO.,-- > Grid Location
Serial Number
Date Collected ime 14
BY:
Location or site 9a rift
Description of Samptxiln Point
k Remar
(PumpingTime, Air Temperature, etc.)
FIELD ANALYSIS
PH Odor
Spec. Cond. Appearance
Temp._ OC Taste
PLEASE TEST FOR CONSTITUENTS OR PROPERTIES AS INDICATED. REPORT ANALYSIS TO: CHIEF$
GROUNDWATER SECTION, RALEIGHZ N.C.
Alkalinity (As CaCO3)
to PH 8.3 ..........
to PH 4.5 .........
Aluminum .............
Arsenic............
Bicarbonate.........
DOD, 5-Day..........
mg/1
EDCarbonate.. ........
Mg/1
Carbon Dioxide......
mg/1
Chloride... .........
Colifor-"I (Tbtal MF)..
Copper....... .. : ......
Cyanide ...............
Dissolved Solids.....
mg/1
Fluoride.......... ..
mg/1
Hardaess as Caco
3*"*mgll
Hardness,
F-1 Non Carbonate.....
Iron .................
Lead .................
Lithium......... ..
1-fanganes e.
Hercury ...............
mg/1
ugh
Nitrogen
Kj eldahl .......... mall Et�ne
Nitrate & Nitrite. mg/1 Ea
PH Value (When analyzed
Phenol...............
Phosphorus, Total.... mg
Potassium...... .... mg/1
Specific Conductance
(m.icromhos.at 250C).. 0
Silica ...............
mg/1
F�
Sodium ...............
C'/j
0
Sulfate..... ...
-c,/!
0
F
Zinc .................
ugli
0
Calcium........'. I .-
-g/1
El
Magnesium ............
mg/1
E]
Remarks:
\j

Groundwater Section F County_.M1J
CENTRAL
LABORATORY REPORT Grid Location
Serial Number
Date` Collected
Time
$y; r
Location or site
Description of Sampling Point
Remarks
(Pumping Time, Air Temperature, etc.)
FIELD AXALYSIS
PH
Odor
Spec. Cond.
Appearance
Temp. OC
Taste
PLEASE TEST FOR CONSTITUENTS
OR. PROPERTIES AS
IMICATED. REPORT ANALYSIS TO:
CHIEF,
GROUNDWATER SECTION, RALEIGH,
N.C.
Alkalinity.(As CaCO3)
Nitrogen
to pH $.3.. ....,..
mg/1
Rjeldahl..........
mg/1
to pH 4.5...........
mg/1''
Nitrata & Nitrite.
mg/1
F
Aluminum .............
ug/1
pH Value (When analyzed
'.
Arsenic....... ......
Phenol...............
ug/1
mg/1
Phosphorus, Total....
mg/1
SOD, 5-Day-.......,..Potassium,,,.........mgll
MA/1 1
�' arbonat ............ �, mg/1
Specific Conductance
Carbon Dioxide.......
mg/l
(micromhos at 25oC)..
o
Chloride
g/1
Silica.......... ..
mg/1
Q
Coliform T tal. MF)..
/100m1
sodium ...............
ng/1
1:1.
Copper....,—, .......
u 1
g/
Sulfate ..............
mg/].
F
F-lCyanide.
mg/1
Zinc.................
ug/1
issolved
mg/1
Calcium .......:......
mg/1
Fluoride....,>....»...
mg/1
Magnesium..®......,.,
mgll
ardness as CaCO3.... mg/ 1
Remarks;
Ha ness,
Non Carbonate....-.
mg/1
QIron.......... ....
ugh
s.►.s............
ug/1.
Lithium..............
ugjl
Manga.ies e............
ug/1
Mercury................
ug/1
FOR INTERLAB USE
Samples In
Log ent. ck.
Date Reported
Data ent.ck.
614 54

,"' division of Environmental k; nagement
GROUNDWATER SEC,01\1
CHAIN OF CUSTODY RECORD
;.
I
or Inv.estiga,iaEof
Incident No.
4 SamplIfected and GW-54 forms completed b
Lab Only Quad No of
LatNo. No. Location
Date
96
JA
R lin(auishr�j�q by, Pignature)
I
ceived by(Signature)-
Rel. U Rec. by
Rel. Rec. by
Rel. Rec. by
Method of Shipment:
Seal by:�5���;.;�t�� Broken by
Security Type and Condition: Lock by: Open by:
I A rl 1 1( r
Time
Container,.,
�v
U
ate/Time
Lab
No.
o.
Received by
Date t T,m
From
Through
Containers
Analysis
Relinquished by
OhJll
n
3-l7-8-S
(J
3-1 7--E�S
a
! 18g

F lision of Environmental ME' 'gement
GROUNDWATER SECTION
CHAIN OF CUSTODY RECORD
dl
For Investigation of F f9�, '.%t� F :-r.?�.v, incident No.
Samples collected and ,GW-54 forms completed
by:
Lab Only
Quad
No. of
Lab No.
No.
Location
Date
Time
Containers
} `yF..ILL
Re'linguis)j,p,d .bX(Srignature):.
Received
by(Signature):
Date/Time
Rel.
R
Rec. by
ReJ.
Rec. by
/
Rel.
Rec. by
j
Method of
f
Shipment: t
Seal by.'..
,.{'.F:
Broken by:
Security Type and Condition: Lock by:
Open by:
Lab No.
From Through
N o. -
Containers
Analysis
V I V L 1
Relinquished by
Received by
Date / Time
/
/
/
vv LC. lJl lyllial built WILF] 5fllpffle nI
GW-63 Copy retained by collector 2/86

GENERAL* ELECTRIC
LIGHTING SYSTEMS DEPARTMENT
GENERAL ELECTRIC COMPANY•HENDERSONVILLE, NORTH CAROLINA 28739
November 10, 1987
NC Dept. of Natural Resources
and Community Development
P.O. Box 370
Asheville, NC 28802-0370
Subject: Groundwater Monitoring Results for July 1987
Dear Ms. Dechant:
I regret to inform your office that we were not able to perform the complete
July sampling and analysis of the groundwater monitoring wells at our site.
This situation came to my attention during a recent review of the status of
our groundwater monitoring program. There was a misunderstanding between GE
and the contract firm conducting the sampling and analysis. Samples were
collected for Well #1, the suspect contaminated well, and screened for
Volatile Organics. However none;,of the other wells were sampled and none of
the other parameters were analyzed for.
On Monday the November set of samples were collected for analyses. Vie have
also performed the first sampling of the most recently installed set of
monitoring wells and expect the results soon.
I apologize for any problems this may have caused. We will continue to make
all attempts to keep your office informed of the status of the groundwater
monitoring program at the plant.
T
ehin,
Mfg. Support Eng'r.
[phone]
''BRINGING NEW IDEAS TO LIGHT''

DIVISION OF ENVIRONMENTAL MANAGEMENT
ASHEVILLE REGIONAL OFFICE
GROUNDWATER SECTION
April 10, 1987
MEMORANDUM
TO: Bob Cheek
Permits,& Compliance Unit Supervisor
Groundwater Section i
THROUGH: Don Link, Hydrogeological Regional Supervisor __%
Groundwater Section �C
FROM: Diane Eskenasy, Hydrogeological Technician
Groundwater Section
SUBJECT: Additions To The Water Quality Monitoring Network
Four new pollution monitor wells (Well Numbers Q84p9, Q84p10, Q84pll,
and Q84p12) located at General Electric Company, Henderson County, should
be added to the water quality monitoring network. These wells were con-
structed to comply with NPDES Permit No. NC0000507. Data on the new
monitor wells is enclosed.
Also, Mike Wall (Town of Alexnder Mills, Well Numbers Q78ul and
Q78u2) was concerned about getting his compliance monitoring results to
us late because his TOC results take several months to return to him.
I told him to send us the early results first and make note that TOC
has been taken on time and results will be forwarded as soon as
possible. M
DE/ar l 4-A
Enclosures
r3r
SW L TDs - bob. Vb f�l -50`Y k

WELL DATA TABULATION
POLLUTION SOURCE MONITORING SITE
Facility Name: � � �jj _ County:
Pollution Source (lagoon, landfill, etc.) Latitude: v?S 6/1,
Permit No: Longitude:
Non -Discharge: A/_/At NPDES: w c. cDa�d
Well Const.: /V//g- DHS: Quad No: a
Sampled By:
Well No.
Date
Installed
Total
Depth
(ft)
Diam.
(in)
Screen(S)/
Open hole
(OH)
(ft-ft)
Grout
Interval
(ft-ft)
Gravel/Sand
Pack
Interval
(ft-ft)
Remarks
-
R.4
31*0/6 Ix ''
02
Z� '#44
s f'°/l• rZs
$7
® ZSL
r�',tZlAi�
123-15'
pZ
S la.s-zz.
Q -,5"
s -23.5-
350/6 `za
0ze! f
3sr'l
%Z
to117h4p
13.9
;;L
S $ -1 . dZ.
0 - 3.5-
S . -13 . g
a s3'
3 s° 16 '20
Szaz.q
3 z'
Draw a diagram on the reverse side of this form showing map location of the site and the
location (direction and distance) of each well with respect to the pollution source and to
each other. Indicate sampling schedule, parameters and any changes to schedule.
GW-51
Revised 8/20/84

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24 000
— ROAPD CLA;SIFiCATVON
FT Heavy-dta[v _ _ r�00�' ,no*o, Arai

JNA DEPARTMENT OF NATURAL RE :_ ' S AND COMMUNITY DEVELOPMENT
JIV1310N OF ENVIRONMENTAL MANAGEMENT GROUNDWATER SECTION
P.O. BOX 27687 - RALEIGH.N.C. 27611. PHONE [phone]
WELL CONSTRUCTION RECORD
FOR OFFICE USE ONLY Ne
Quad. No. _ �_ Serial No.
Lat. long. Pc
Minor Basin
Basin Code
Header Ent. GW-1 Ent.
DRILLING CONTRACTOR % 2; cT,f72r TFsi iitJi.� /fir '° - . {`
DRILLER REGISTRATION NUMBER 6 STATE WELL CONSTRUCTION
8 PERMIT NUMBER: 1 ,v DD Za !. W OD:
WELL LOCATION: (Show sketch of the location below)
Nearest Town: �Ttc1F�/d 7L le "Ce-419
County: / -0 rSD17
(Road, Community, or Subdivision and lot No.)
Depth
2. OWNER /'S'/i lend Ci'7j/�/G �� From To
ADDRESS
/ t or Routef No.
City or Town State Zip Code 2
3. DATE DRILLED 16 -11 'e 4 USE OF WELL
4. TOTAL DEPTH •z & 61' " " CUTTINGS COLLECTED
/ Yes ❑ No
5. DOES WELL REPLACE EXISTING WELL? ❑ Yes LJ No
6. STATIC WATER LEVEL: 2q, ( FT. 0Above TOP OF CASING,
IG below
TOP OF CASING IS 3_� FT. ABOVE LAND SURFACE..
7. YIELD (gpm): //O METHOD OF TEST 01 11"
8. WATER ZONES (depth): .Sawa Z 2S
9. CHLORINATION: Type -�� Amount
10. CASING:
Wall Thickness
Depth Diameter or Weight/Ft.
Material
From _ To _ Ft._2- ,ICAI—v F�/G
From To Ft.
From To Ft.
11. GROUT:
Depth Material Method
From 6' To .ZO' Ft. ee we o, 1 /
From 2d" To22 Ft.�Gd70AlAr a6aeneol-
12.. SCREEN: p�
Depth Diameter Slot Size Material
From 7_ To.2j?_ Ft. !l in. O, G1/O in. Pvc
From To Ft. in in.
From To Ft. in. in.
13. GRAVEL PACK
Depth SizeMaterial
FromTo z67"/Ft. 07
47'
1,sA&
From To Ft.,
14. REMARKS
DRILLING LOG
ormation Description
l Z 2 >�y Ssrvra/i1�'
x / 2 ,?
- - d Ad
If additional space is needed use back of form.
LOCATION SKETCH
(Show direction and distance from at least two State Roads,
or other map reference points)
1 DO HEREBY CERTIFY THAT THIS WELL WAS CONSTRUCTED IN ACCORDANCE WITH 15 NCAC 2C, WELL CONSTRUCTION
STANDARDS, AND THAT A COPY OF THIS RECORD AS BEEN PROVIDED TO THE WELL OWNER.
. CEk Gl,
SIGNATURE OF CONTRPCTOR OR AGENT DATE
r_w_, Qo, ;.OA Sub_mit orioi-namomto. Divisio nwmntal Map, mErng pnrulnr�,pr v #kit