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SUBMIT FORM ON YELLOW PAPER ONLY
Number -(fro.m.Permilt): M W
I F-jr I . !As-10
Facp#, N.am CApg F_,ry,4tL 17 6 L Pj4 .. ; e.
Permit Name (if ciff erent): A PR
Facility Address:
m f-, j e -4 L 0 T,!!�' L `bounty 4 a r 69 6� 7—
fW (Z". ,
_G&A-acLP_e=m_,..__ TejepWr 2 - 3 r13 - �' 22i
.�eened irtom
Depth to Water -
Gallons -of. water.
Held anarysis. j
Fr G4,iitimW_ We T "eat-ent
-Check-One.-_
"T,it below measuring Foini.Efflueni '(99)
ti above fang su�aqe-
�ed before sampling:..
-�*%%rpne!jq _,_ - - 7 Cetus
T� --- ArW
1— P
PFRMIT V. EXPIWON DATV"//:2)7
Non-Disc*pargekjYx-g—G—O—.4,-7'��-�-' Uiic_
NPDES
i YPE OF PERMrr TED OPERATION BEING MONITOPED
Lagoon Remedatiorr Infiltration Gallery
.ReawfiWick
Rotary Land AP�iCaiion of Sludge
other,
colloidal concentra tions-
PARAM911EMS (Samplet for melds were collected unfiltered V YES NO
d Held acidiffed-
lP
YES NO)
GOD
--mg/l
Nitrite (NO2) as N
mg/l
Ni - Nickel
MgA
-F
Wr -0(WI.- ecal
-0ml -----
tO
- Nitrate--(NO3-)-as-N----
_MC
a
Coliforim: IMF TotaL
J100ml
Phosphorus: Total as P
m9A
Zn - Zinc.,.!!
_m9A
•m
QBa th- opand.ousffipllhatte
mg1l
AmoniaNitrogen'
Dissolv--dSolids- Tbtal�--..-
.-
�Mgj
Al - lminum
gl
i
1(Specifyopunia)&p6`s
Urs
Bu
n
_
hid
mgfil
Chloride
mgri
Cd - Cadmium
r
Arsenic
mg/!
Chromium:--1 otal
Its
r"g/1
Grease and Oils
mg,/t
Cu - Copper
Mrill
F"931 n^
Fe
mrvn
411.zvs
it A N11C a (GC,GQ-MS,HPLG)
a iffal
S us. te
m 9p,
Hig rcury
- Me,
I
Mgp
(Specify test and method #. Attach lab report)
4c�
__a zL___
UIVIub
` - - -!-.—
"
-
mg
- ___ --`__ -
0-1e
ALtaCU7 YesL—'
—(Un
-Notal PAU-31monia
mg1i
Ma - Magnesium
mgfl
VOC : method# -
TKN as N
mg/l
Mn - Manganese
mg/l
: method# -
: method fl=
Pnv WAR
!� ® SUBM! i FOHM UN I Li-i_Vyy riAr cr\ vevL- t
flF
�:1� 1-.'^d ;�biy � :.: ' i ,X � r ' », {, .• t n a. • t� n^�) / r �C 'u�.
v�Vla�7'.?.. _ ..,,_..aa ' .„• _ �, '''i,�: .Q�Zih,�� ."' c' .Yc..'°^+-''s;3�...c c.'.-
�� i.J ■.■`..>A��� ..��, n.. �r:. .'2-� s 7 � � ^ur- y ,. i;,: ca. ... ti• �y�. "� �, "�a.+
�OR9:3918 -� -- - A E n z P e r / 0, 0 5Dc�2U C F`
G�.tity N�mn ANC
�n-�i��Se
P�asit i tC3711ei dtierar.�)
L� fl=®!it
FatSrr-k3[eSS' » h
:-) ' •. - �;�e - - - Co!!nt)( _ r, I' I _ emedia2T`orc lnfiitiaibn Gallery
- .'_a "i �i� Ili �� _ - �_/.... !-e��1...�-M "- •^-,-^^_'. .{ 1:.� tl -r'1 - ��)�i�r r.f�1 f L �O. ��� .h:.'y✓w--�. Y.
tE
ue 1`�arr�
�-
Wefis-to`b
T 4
_ �"- `from Permlij � � - 7 � ::: for Giaunciwatet?nea�l.Systems er ,�
11��,, �•7l ,a,,,,,♦ter- r •, �, ...,,
1.9 eH .t�6r.W�at'Qi%.,.i`��':iei
_ L'516iel .. � ns :� T ;t,c' w�.:.'�' .- .� � _• .,. .
aloes shootdxrefiecidlssoivedtand �.
e� rs °`" ��_.- ., .. ._; A ♦ - a, - t _ 1-t-[��t. wt-. l■i.,ar ;r -a.+-x e-'o:';°"r ram,_. =� .r_,.
-
'", •+ � YY' IeaSisi� Oi2t:e iQiiS-� �. `,. c
-
a._ as�a!
nxs !e coile%t"Y yl�
lvteastlrrn_g Datesa� f
_�_... ,�_,�,. _ .,:::...- �>_- _ �_ _-_. - •4� � - �abocaiorY.��g'"`-'�N-U �c
r, — --
Germ
"Cs'�Ow2DA _f�S>�Satrp_lews_
e.� (N0Y2E} Sas N_ NO tq44spit, aimcd9i�fier d
Ni ifi�iiCdsc✓e: !!tv
m
glt
u
--.... - -Lead
►o O
.= koi
CoiIfocm;>MF ai _ - _ _
— - Ammonialittogen
--+T--
D ss�ired•Soitcis �otai- - =-- mgtf A -77
f mo w
.;j um
c/nit
l
p
m eT-�SPeci
` 1
"Gttromoum -eta; m.
=' a �nnp!
t11ea anal v�:S aaty t r .
... �.�-;, _ :..:. ti;�r"`'
tJllPtlni
_ ......
..�R�,.,�. is P ��� __"'- - tnbn._ Prf niched? Yes
I!lannacii,ri molt VOC_:_.__
trtl" No
raiSGi TjC3:7 a.V°'�aG$ 73 l7Ubt . �. . `„j-: ••.. �.. ...
ethod"�#
TKN as N ' mg/i Mn - Manganese _
.. .. . . -.
_ . c _ _ _ _ _ c _-ir�sc::frr_s�rrnr..r_�nz�-rz.�T�,:S3rTST..•.i+'s:�.raar:ral5�►arofas.-� - � ! _ ( )ir( ,
er Afdhoriz le - Please � or �YPe
cm-59 Rev_ 4/98 nattsrw nl Pc3rmrttP.R fnr Authorized Oer-ll (PaeX,
(�C t_LVYY r'NrLR�L��
Facility Narpe-_
t�IT/1Qlf�tl'�.� r
County -V Q
Telephone #:
Wew',;enu;ication Number (from rermii): NRmY-X_�_ For Groundwater TreatmentSystems
Well Depth ' r,�O_! ( n K ft won Diarneter F1- "n..,.
S.,Iai:•ev;:,�ec-v ' sr. to ►� - ® fluent /98 -
- Sje�3h to Vllater i o._._ - - ._ -ft.- :' m a.c . , ` )
iii...GJ..i •:L iiv:iiL i
c! : IT' r-iitRsar3=
Measuring Point is ft above land surface. �
Gallons of.water pum i ed_before_sam - - --
P�9=-
Field analysis: pH ' .Specific C�ir4nrjoahos
Temp. -C, Odor Appearance
RARAMEEEFBS (Sam-ples !or metals were -Wilected
COLS mg/I
Coliiorm: MF Fecal /i 00ml
(Note. the MPH method for highly turbid s j
Dissolved. Solids: a oral rng/I
pi-f (vinen analyzed)
o ;its
T�
mai_i
J:::i71 i'Liv
gA
Arsen.;G
mgA
itease and mils
ing/l
Phenol
mgn
Specific Condt [clam
• ��
uivn IVJ
I vial rii o :: not iia
r?gf.
TL'N n- Oki
Vt
iiig/I
ieredy SYE$ t40
Nitrite (NO2) as N
Nitrate (NO,) as N
Phosphorus: Total as P
10 V v ; n9p,
Orthophosphate
mg/!
Al - Aiuminurn
mg/I
�a - Liar LI
mg/i
Ca - Calcium
mg/1
Cd - Cadmium
mg/I
Chr.cm.u::;: Total
Iil`y '
Cu - Copper
mg/I
.�v ri vfe
,�'i lt�l
f ig - IvIercui-Y
_ mg/I
K - Potassium
mG/I
agnes" ti i
mg/1
ivi i - IVianganese
mg/I
Ycs NVI
PERMIT EXPIRATION DAT[t;ela 714
NPDES
TYPE OF PEPKAITT;:70 OPERATt^,N BEING MONITORED
Lagoon Remedlatlon: infiltration Gallery
Dish Wor Land App katbn of sludge
Other:
Va.iues_sfioutdeeffectiiii�s—ofvea and --
collo:dal concentrations_ f._ /
Laboratory Name: _
Certification No. _
..I
�saU
a •YIIIQLI
mg/I Ni - Nickel Tig/i
h - I_Part - - -- - - rnnA
Zia - Zinc _ mg/I
Ammonia Nitrogen 4 rtg/l
Other (S ,eGili Cons pounds and Concenira?lon i-fnRs)
:.�: :".irAaiiiw: (ar7v V%C/MJIni'�Lkj
li
(Specify test rinad rIthori:. Attach lab repon.i
nemr! At"a -h,0A9 vex
VOC method # -
: method # a
: method #