WQ0007283_Monitoring - 07-2020_20200908 (2)

GW-59A COMPLIANCE REPORT FORM Permit
(Submit one each monitoring period with GW-59 forms.)
,10:� — - n
1
Enter date monitoring results were due. ( — ill this monitoring report (GW-59 and GW-59A)
be submitted after the established due date?
2
Was any required information missing on the GW-59 report forms?
YES
O
IF the answer to question 1 or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3
Are any of the monitor Hells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
O
identification plate, area overgrown, etc.)? If the answer is "Yes", contact the Regional Office for guidance.
4
Are any monitored constituents equal to or above the established standards?
YES
ew
If the answer to question 4 is "NO", skip to section 8.
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentrations)
exceeding standards in the space provided below:
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
YES
NO
same constituent(s) in the same well(s) in the last two years?
If the answer to question 5 is "NO", skip to section 8.
If the answer to question 5 is "YES", list in the�space provid"below, each well with constituent(s) exceeding
standards, concentration(s) reported, and samp�collectie dd or each occurrence (for the last two years).
z
ri
CD rr
o r.
rn_
6
Are the monitoring wells listed in section 5 lo6iWd at* befind the review boundary?
YES
NO
1 M
If the answer is "YES", a groundwater qualitygrroblem may a occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If th"nswer is "NO", monitoring wells may be improperly
located, contact the Regional Office.
7
Is the permittee implementing previously approved actions required by the Division involving this
YES
NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the Regional Office within 90 days: an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surrounding this facility, Failure to do so may sub'ect the a=ittee to a Notice of Violation
fines, and/or penalties.
g
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW-59A) is true and complete to the best of my knowledge.
-2G-Z v
ignature of Permittee (or Auth ized Agent) Date
GW-59A 12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
0
W
RESOURCES
COMPLIANCE REPORT FORM
. � �
�
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: _ 7/31/2021
Facility Name: TOWN OF
POLLOCKSVILLE
Non-Dischar( WQ0007283 UIC
NPDES Other
Permit Name (if differe
Facility Addres: 488 Goshen road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
mir Name (it a rreren .ING County Jones
(city) (State)
X Spray Field ElRemediatic
Contact Persor JOHNNIE CHADWICK
elephone#: 252-224-9831
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Ni: # 1 Upgradient West Lagoon
D. of wells to be sampled: Six
(from Permit)
❑ Water Source Heat PuQ Other
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Perr MW-1
Date sample collected: 7/28/2020 FIELD ANALYSES:
WAS
Well Depth: 21 ft.
Well Diameter: 2 in.
pH 004( 7.1 units Temp. 00 27 °C
DRY at
Depth to Water Level E 13.02
Screened Interval: ft. to
_ft. Spec. Cond. 00094: µMhos
time of
Measuring Point is 2 ft, above land surface
Relative M.P. Elevation: ft.
Odor 00085:
samplin
Volume of water pumped/bailed before so 1.5
gallons
Appearance _
g, c�
Samples for metals were collected unfi[S
NO id field acidified: S NO
❑ ❑ El
her
LABORATORY INFORMATION
Date sample analy; 7/28/2020
Laboratory Nam ENVIRONMENT 1, INC. Certification No. 10 _
PARAMETER; NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/LPb - Lead 01051 ug/L
iform: MF Fecal 31616 <1 /100mNitrate
(NO3) as N 00620 0.62
mg/L Zn - Zinc 01092 mg/L
liform: MF Total 31504 /100oohorus: Total as P 00665 3.16
mg/L
(Note: Use MPN method for highly turbid sanphosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
ed Solids:Total 70300 124 mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L
TOC 00680 1.24 mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 6 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
rease and Oils 00552 mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
ug/L Lab Report AttacheC] Yes (1) ❑ No (0)
is Conductance 00095 µMhos
K - Potassium 00937
mg/L method;
Total Ammonia 00610 mg/L
Mg - Magnesium 00927
mg/L method;
(Ammonia Nitrogen, NH3 as N; Ammonia NitINIgerlba4drese 01055
ug/L method;
TKN as N 00625 <0.04 mg/L
Ni - Nickel 01067
ug/L method;
For Remediation Systems Only (Attach Lab Rdp6vWt Total VOCs: mg/Effluent Total VOCs: mg/LVOC Removal%
Dnrmiffnn /nr Ai ithnri�cA Anon+\ nlmmn �nrl Tifln - Dlnnco nrint nr tvnn
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
�1617
RESOURCES
COMPLIANCE REPORT FORM
MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 7/31 /2021
Facility Name: TOWN OF
POLLOCKSVILLE
Non-Dischar( WO0007283 UIC
NPDES Other
Permit Name (if differe
Facility Addres: 488 Goshen Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
,rmit Name (it different): County Jones
(City)
❑ Spray Field ❑ Remediatic_
Contact Persor JOHNNIE CHADWICK
elephone#: 252-224-9831
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Nt # 2 EAST SIDE REAR Lagoon
D. of wells to be sampled: Six
❑ Water Source Heat Puq Other
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Perr MW-2
Date sample collected: 7/28/2020 FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH 004( 7 units Temp. 00 22 °C
DRY at
Depth to Water Level E 9.5
Screened Interval: ft. to
ft. Spec. Cond. 00094: µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085:
samplin
Volume of water pumped/bailed before sa 2.5
gallons
Appearance _
g, c
Samples for metals were collected unfiD S
❑ NO id field acidified: ❑ S ❑ NO
her2
LABORATORY INFORMATMN
Date sample analy. 7/28/2020
Laboratory Nam ENVIRONMENT 1, INC. Certification No. 10
PARAMETER; NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/LPb - Lead 01051 ug/L
iform: MF Fecal 31616 <1 /100mNitrate (NO3) as N 00620 0.1
mg/L Zn -Zinc 01092 mg/L
liform: MF Total 31504 /100udphorus: Total as P 00665 0.2
mg/L
(Note: Use MPN method for highly turbid sang phosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
ed Solids:Total 70300 452 mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L
TOC 00680 6.79 mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 40 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
rease and Oils 00552 mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
ug/L Lab Report Attache(D Yes (1) ❑ No (0)
is Conductance 00095 µMhos
K - Potassium 00937
mg/L method;
Total Ammonia 00610 mg/L
Mg - Magnesium 00927
mg/L method;
(Ammonia Nitrogen; NH3 as N; Ammonia NitINIgeri�%o4d)nese 01055
ug/L method;
TKN as N 00625 5.47 mg/L
Ni - Nickel 01067
ug/L method;
For Remediation Systems Only (Attach Lab Rdp6uWt Total VOCs: mg/Effluent Total VOCs: mg/LVOC Removal /e
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
�1617
RESOURCES
COMPLIANCE REPORT FORM
MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 7/31/2021
Facility Name: TOWN OF POLLOCKSVILLE
Non-Dischar( WQ0007283 UIC
NPDES Other
Permit Name (if differe
Facility Address 488 Goshen Road
TYPE OF PERMITTED OPERATION BEING MONITORED
mit Name (it ditferen : NC 20 County Jones
❑ Lagoon ❑ Remediation: Infiltration Gallery
(state) (zip)
❑ Spray Field ❑ Remediatic_
Contact Persor JOHNNIE CHADWICK elephone#: 252-224-9831
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Nii # 3 EAST SIDE Lagoon of wells to be sampled: Six
(from Permit)
❑ Water Source Heat PuQ Other
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Perr MW-3 Date sample collected: 7/28/2020 FIELD ANALYSES:
WAS
Well Depth: 25 ft. Well Diameter: 2 in.
pH 004( 5.1 units Temp. 00 24 °C
DRY at
Depth to Water Level E 12.3 Screened Interval: ft. to
_ft. Spec. Cond. 00094: µMhos
time of
Measuring Point is 2 ft. above land surface Relative M.P. Elevation: ft.
Odor 00085:
samplin
Volume of water pumped/bailed before se 2.5 gallons
Appearance
g, c
Samples for metals were collected unfiD S ❑ NO id field acidified: [:IS ElNO
her2
LABORATORY INFORMATMW
Date sample analy; 3/23/2020 Laboratory Nam ENVIRONMENT 1, INC. Certification No. 10
PARAMETER: NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N 00615
mg/LPb - Lead 01051 ug/L
iform: MF Fecal 31616 <1 /100mblitrate (NO3) as N 00620 11.06
mg/L Zn - Zinc 01092 mg/L
liform: MF Total 31504 /100r phorus: Total as P 00665 0.07
mg/L
(Note: Use MPN method for highly turbid sarQotbophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
ed Solids:Total 70300 118 mg/L Al - Aluminum 01105
mg/L
pH (Lab) 00403 units Ba - Barium 01007
ug/L
TOC 00680 1.02 mg/L Ca - Calcium 00916
mg/L
Chloride 00940 20 mg/L Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L Chromium: Total 01034
ug/L
rease and Oils 00552 mg/L Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L Hg - Mercury 71900
ug/L Lab Report AttacheC1 Yes (1) ❑ No (0)
is Conductance 00095 tLMhos K - Potassium 00937
mg/L method;
Total Ammonia 00610 mg/L Mg - Magnesium 00927
mg/L method;
(Ammonia Nitrogen; NH3 as N, Ammonia NitiNIgedv%o4dl ese 01055
ug/L method;
TKN as N 00625 <0.04 mg/L Ni - Nickel 01067
ug/L method;
For Remediation Systems Only (Attach Lab Rdpbats)t Total VOCs: mg/Effluent Total VOCs: mg/LVOC Removal%
JOHNNIE J. CHADWICK, ORC
Dmrmiffno Inr Ai ifhnri�oA Anon+\ nlomn onr♦ Tiflo - Dlcoco print nr hinn
nn-nfi irn of Dorrq(;yffcc Inr Ai ithnri�cA Ancn"K /rlofo\
8/26/2020
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Facility Name:
Permit Name (if differe
Facility Addres:
-rnnit Name (it ditteren
(City)
IContact Persor
Well Location/Site N<
Please Print Clearly or Type
TOWN OF POLLOCKSVILLE
488 Goshen road
County
Jones
JOHNNIE CHADWICK elephone#: 252-224-9831
# 4UP GRADIENT EAST SPRAY D. of wells to be sampled
Six
RESOURCES
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
PERMIT Number: Expiration Date: 7/31/2021
Non-Dischar( WQ0007283 UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration GaIIE
❑ Spray Field ❑ Remediatic
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat PuQ Other
SAMPLING INI-UKMA I IUN
If WELL
WELL ID NUMBER (from Perr MW-4
Date sample collected:
7/28/2020
FIELD ANALYSES:
WAS
Well Depth: 22 ft.
Well Diameter:
2 in.
pH 004( 6.9 units Temp. 00 22 °C
DRY at
Depth to Water Level E 14.89
Screened Interval:
ft. to _ft.
Spec. Cond. 00094: µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 00085:
samplin
Volume of water pumped/bailed before sa 1.5
gallons
Appearance
g, c
Samples for metals were collected unfi❑ S
❑ NO id field acidified: ❑ S
ElNO
her
Date sample analy: 7/28/2020 Laboratory Nam ENVIRONMENT 1, INC. Certification No. 10
PARAMETER: NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite (NO2) as N 00615 mg/LPb - Lead 01051 ug/L
iform: MF Fecal 31616 <1.0 /100mNitrate (NO3) as N 00620 0.52 mg/L Zn - Zinc 01092 mg/L
liform: MF Total 31504 /100u#horus: Total as P 00665 0.13 mg/L
(Note: Use MPN method for highly turbid sart ifsphosphate 70507 mg/L Other (Specify Compounds and Concentration Units):
led Solids:Total 70300
72 mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680
<1.0 mg/L
Ca - Calcium 00916
mg/L
Chloride 00940
8 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01034
ug/L
rease and Oils 00552
mg/L
Cu - Copper 01042
mg/L
ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg/L
Hg - Mercury 71900
ug/L
Lab Report Attache(D Yes (1) ❑ No (0)
is Conductance 00095
µMhos
K - Potassium 00937
mg/L
method;
Total Ammonia 00610
mg/L
Mg - Magnesium 00927
mg/L
method ;
(Ammonia Nitrogen, NH3 as N, Ammonia NitltalgerM'5c dd ese 01055
ug/L
method;
TKN as N 00625
<0.04 mg/L
Ni - Nickel 01067
ug/L
method;
For Remediation Systems Only (Attach Lab Rdp6uts)t Total VOCs: mg/Effluent Total VOCs: mg/LVOC Removal%
JOHNNIE J. CHADWICK, ORC
Dnrmiffnn /nr Ai tthnri�nrl Annni• Plomn onri Ti4ln _ Dlnocn nrint nr hinn
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
RESOURCES
COMPLIANCE REPORT FORM
• • •
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 7/31 /2021
Facility Name: TOWN OF
POLLOCKSVILLE
Non-Dischar( WQ0007283 UIC
NPDES Other
Permit Name (if differe
Facility Address 488 Goshen Road
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
crmrt Name (it different). County Jones
(City)
❑ Spray Field ❑ Remediatic
Contact Persor JOHNNIE CHADWICK
elephone#: 252-224-9831
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site NJ/ 5 DOWN GRADIENT EAST SPRA'o. of wells to be sampled: Six
(from Permit)
❑ Water Source Heat Pudgy Other
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Perr MW-5
Date sample collected: 7/28/2020 FIELD ANALYSES:
WAS
Well Depth: 21 ft.
Well Diameter: 2 in.
pH 004( 7.3 units Temp. 00 20 °C
DRY at
Depth to Water Level E 8.08
Screened Interval: ft. to
_ft. Spec. Cond. 00094: µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085:
samplin
Volume of water pumped/bailed before se 2.5
gallons
Appearance
g, c
Samples for metals were collected unfip S
❑ NO id field acidified: ❑ S ElNO
her
LABORATORY INFORMATION
Date sample analy. 7/28/2020
Laboratory Nam ENVIRONMENT 1, INC. Certification No. 10
PARAMETER: NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/LPb - Lead 01051 ug/L
iform: MF Fecal 31616 <1.0 /100mNitrate (NO3) as N 00620 <0.04
mg/L Zn - Zinc 01092 mg/L
liform: MF Total 31504 /100u phorus: Total as P 00665 0.04
mg/L
(Note: Use MPN method for highly turbid sanphosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
ed Solids:Total 70300 204 mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L
TOC 00680 1.55 mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 8 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
rease and Oils 00552 mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
ug/L Lab Report Attache(] Yes (1) ❑ No (0)
is Conductance 00095 µMhos
K - Potassium 00937
mg/L method;
Total Ammonia 00610 mg/L
Mg - Magnesium 00927
mg/L method;
(Ammonia Nitrogen; NH3 as N; Ammonia NitMgerV1iotg3d)nese 01055
ug/L method;
TKN as N 00625 <0.04 mg/L
Ni - Nickel 01067
uglL method;
For Remediation Systems Only (Attach Lab RdpbcWt Total VOC& mg/L=ffluent Total VOCs: mg/LVOC Removal%
JOHNNIE J. CHADWICK, ORC
Dormiffoc (nr Ai ifhnri�nrl Annnf\ Kimmn onrl Tifin _ Dlcoen nrinf nr+Nino
Qinn ofi irn of DanrAiffmo /nr Ai rfhnri�nrl -Anonf\ inofo\
8/26/2020
GW-59 Rev.8/2013

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
RESOURCES
COMPLIANCE REPORT FORM
• •
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617
FACILITY INFORMATION Please Print Clearly or Type
PERMIT Number: Expiration Date: 7/31/2021
Facility Name: TOWN OF
POLLOCKSVILLE
Non-Discharc W00007283 UIC
NPDES Other
Permit Name (if differe
Facility Address 488 Goshen Road
TYPE OF PERMITTED OPERATION BEING MONITORED
rrmit Name (it ditteren :
County Jones
❑ Lagoon ❑ Remediation: Infiltration Gallery
(City)
❑ Spray Field ❑ Remediatic
Contact Persor JOHNNIE CHADWICK
elephone#: 252-224-9831
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Nit 6 DOWN GRADIENT WEST SPRAb. of wells to be sampled: Six
❑ Water Source Heat PLIQ Other
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Perr MW-6
Date sample collected: 7/28/2020 FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH 004( 6 units Temp. 00 21 °C
DRY at
Depth to Water Level E 6.39
Screened Interval: ft. to
ft. Spec. Cond. 00094: µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085:
samplin
Volume of water pumped/bailed before sa 3
gallons
Appearance
g, c
Samples for metals were collected unfiD S
❑ NO id field acidified: ElS ❑ NO
her2
LABORATORY INFORMATION
Date sample analy; 7/28/2020
Laboratory Nam ENVIRONMENT 1, INC. Certification No. 10
PARAMETER; NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N 00615
mg/LPb - Lead 01051 ug/L
iform: MF Fecal 31616 <1.0 /100mNitrate (NO3) as N 00620 0.45
mg/L Zn - Zinc 01092 mg/L
liform: MF Total 31504 /100uAphorus: Total as P 00665 0.19
mg/L
(Note: Use MPN method for highly turbid sar>phosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
ed Solids:Total 70300 221 mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403 units
Ba - Barium 01007
ug/L
TOC 00680 <1.0 mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 15 mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
rease and Oils 00552 mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730 ug/L
Fe - Iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945 mg/L
Hg - Mercury 71900
ug/L Lab Report AttacheCl Yes (1) ❑ No (0)
is Conductance 00095 ttMhos
K - Potassium 00937
mg/L method;
Total Ammonia 00610 mg/L
Mg - Magnesium 00927
mg/L method ;
(Ammonia Nitrogen, NH3 as N; Ammonia NitlhdgerWa4dese 01055
ug/L method;
TKN as N 00625 <0.04 mg/L
Ni - Nickel 01067
ug/L method;
For Remediation Systems Only (Attach Lab Rdp6vWt Total VOCs: mg/Effluent Total VOCs: mg/LVOC Removal%

GW-59A COMPLIANCE REPORT FORM Permit #bd-a-_-b D 1 ;Z� 3
(Submit one each monitoring period with GW 59 forts.)
j
Enter date monitoring results were due. ( — ill this monitoring report (GW-59 and GIN-59A)
be submitted after the established due date?
NO
2
'Vas any required informationmissing on the GW-59 report forms?
IF the answer to question i or 2 is "YES", list in the space provided below the well identification number(s) and
explain the problems encountered in obtaining the required information.
YES
O
3
Are any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
identification plate, area overgrown, etc.)? if the answer is "Yes", contact the Regional Offrce
YES
'O
for guidance.
4
Are any monitored constituents equal to or above the established standards?
If the answer to question 4 is "NO", skip to section 8.
YES
NO
If the answer to question 4 is "YES" list the affected wells individually with constituent(s) and concentration(s)
exceeding standards in the space provided below:
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
same constituent(s) in the same well(s) in the last two
YES
NO
years?
if the answer to question 5 is WO" skin to .cartinn R
1t the answer to question 5 is "YES", list in the space provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
6 Are the monitoring wells listed in section 5 located at or beyond the review boundary? YES NO
If the answer is "YES", a groundwater quality problem may be occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells may be improperly
located; contact the Regional Office.
7 Is the permittee implementing previously approved actions required by the Division involving this YES NO
groundwater quality problem?
If the answer to question 7 is "YES", describe those actions in the space provided below.
If the answer to question 7 is "NO", contact the Regional Office within 90 days • an evaluation may be
required to determine the impact the waste disposal system is having at the review and compliance
boundaries surroundingthis facilit . Failure to do so ma subject the ermittee to a Notice of Violation
fines, and/or penalties
8
The person completing this portion (GW-59A) of the monitoring report should sign below and submit this
form with GW-59 forms for required wells to the address provided at the top of the current GW-59 form.
t hereby at:ktibwtodge that the above information was evaluated and the information submitted in this
reportt dompill 64;Report GW-69A) is true and complete to the _best ofmy knowledge.
of Permittee (or �
Agent)
1? -_2 2- v
Date
I
G W-59A 12/8/2003