WQ0004230_Monitoring - 07-2020_20200915

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMATION Please Pririt Clearly or Type i
Facility Name:���.�c��_P
Permit Name (if different):
Facility Address: V-7nCl\- 11v�-
C-1,Y) .iPRt-.L_ �p S eetl
�L� County- Q Cx_ f--� —
ty ...
C •o act Persofi�lc- e State ° Telephone #: �LSJ 3 S y - 5ln��t
Well Location/ Site Name: :�, No. of Wells to be Sampled: _
(fromye dq
'Vlell Identification Number (from Permit): _ For Groundwater Treatment systems
Well Depth:., ft. Well Diameter. --I_ in. Check One: ❑ Influent (98)
Screened Interval: ft. to _ ft, ❑ Effluent (99)
Depth to Water Level: Lft. below measuring point.
Measuring Point (M.P.) !s: ft. above land surface. Relative M.P. Elevation in ft - _
Gallons of water pumped/bailed before sampling: 1 : S Date sample collected.�-a
Field analysis: pH --'DJ, , Specific Conductance _uMhos
Temp. S_°C, Odor _ Appearance
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: EXPIRATION DATE:
Non -Discharge. A�CCQ42L '01_._..UIC__
NPDES
TYPE OF PERMITTED OPERATION 13EING 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 analyzed. SEP 1 5 20201�
Laboratory Name: �����������
Certification No. !) — JIM SECTION
PARAMETERS (Samples for metals were collected unfiltered__._YES NO
and field acidified
GOD
_ mg/I
/100ml
Nitrite 0102) as ': - mg/I
Nitrate {NO3) as N -_;� f�, mg/I
Coliform: MF Fecal - Rt
Coliform: MF Total _
/100ml
Phosphorus: Total as P_
_
mg/I
(Note: Use MPN method for highly h;:.id samples)
Dissolved Solids: Total L!
mg/I
Orthophospha+P ._ _
Al -Aluminum
m l
pH (when analyzed)
_
_units
Ba - Barium
mg/I
g
g/I
TOC �;
_ mg/I
Ca - Calcium
mg/I
Chloride
_ mg/I
Cd - Cadmium
mg/I
Arsenic
_ mg/I
Chromium: Total
ti/I
Grease and Oils _
_ m9/1
Cu - Copper
mg/l
Phenol
_ mg/I
Fe - Iron
mg/I
Sulfate
_ mg/I
Hg - Mercury
mg/I
Specific Conductance
uMhos
K - Potassium
mg/I
Total Ammonia
_ mg/I
Mg - Magnesium
mg/l
TKN as N
_ mg/I
Mn - Manganese
mg/I
YES _ _. N01
Ni - Nickel
_ mg/1
Pb - Lead
_ mg/I
Zn - Zinc
— mg/l
Ammonia fir. _..�
. �:::: n—�i--tr=--
�mg/1
Other (Specify Compounds a.;nd Concentration
Units)
ORGANICS: (G(,,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC : method # =
(or Authorize Atgent) f" and Title - Please print or type
method # =
- ..
GIN-59 ._Lt`�Llii r_j'?nk q/
Rev. 03/2000 Signature of Permitte or Authorized Agent (D

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORA?
FACILITY INFORMATION Please Print Clearly or Type
Facility Name:(N3
Fermit Name (if different): --
Facility. Address:--VflC"'�- TT\r&c L-,r
County k
l Y) Swte)
contact PersoI5-1>an_ t TelephoneWell Location/ Site Name: No. of Wells to be Sampled: {
''0 ell Identification Nut lber (from Permit): For Groundwater Treatment Systems
Well Depth: —_ ft. Well Diameter: �_ in. Check One: El Influent (�$
Screened Interval: ft. to _ ft. ❑Effluent (9�l)
Depth to Water Level: - I l p ft. below measuring point. _
Measuring Point (M.P.) !s: ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pumped iled before sampling: 1,C) Date sample collected:±,
Field analysis: pH_ Specific Conductance -—.uMhos
Temp. ']I.iG2-1C, Odor — Appearance _
DEPARTMENT OF ENVIR,JNMENT L NATURAL RESOURCES
WATER QUALITY DIVISION, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
PERMIT #: EXPIRATION DATE:
Nan-Discharge.-1.__ C-Qy.2%1__UIC_.,._.._
NPDES _
TYPE OF PERi,41TTED OPERATION 13EING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
!t:!:1Rotary Distributor Land A-pplication of Sludge
-- Other.
NOTE: Values :should reflect dissolved and
colloidal concentrations.
Date sample analyzed:
Laboratory Name: A
Certification No.
P-ARAMETER�j (Samples for metals were collected unfiltered --YES NO
and field acidified
COD
_ mg/l
Nitrite 0102) a.. ' -
mg/I
—
Coliform: MF Fecal __S'
/100ml
Nitrate ,NO3) as N n,
lv 6 mg/I
C•oliform: MF Total _
/100mi
Phosphorus: Total as P_
mg/I
(Note: Use MPN method for highly tt;+::id samples)
Orthophosphatp ._ _ _ _
mg/I
Dissolved Solids: Total ��mg/I
AlAI -Aluminum
mg/I
pH (when analyzed)
_units
Ba - Barium
mg/I
TOC °z 14?_ mg/1
Ca - Calcium
mgll
Chloride ISM
_ mg/I
Cd - Cadmium
mg/I
Arsenic
_ mg/I
Chromium: Total
mg/I
Grease and Oils _
_ mg/l
Cu - Copper
mg/I
Phenol
_ mg/I
Fe - Iron
mg/I
Sulfate
_ mg/I
Hg - Mercury
mg/I
Specific Conductance
uMhos
K - Potassium
mg/I
Total Ammonia
_ mg/I
Mg - Magnesium
mg/I
TKN as N
_ mg/I
Mn - Manganese
mg/I
YES _ _ Nol
Ni - Nickel
— mg/1
Pb - Lead_____
— mg/I
Zn - Zinc
_ mg/I
Ammonia ::m
�L — mg/I
Other (Specify Compounds and Concentration
Units)
ORGANICS: (G(,,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No (0)
VOC _: method # =
method # =
method#=
1 —Ch, 41n4 4,- K...

SUBMIT FORM ON YELLOlN PAPER ONLY
GROUNDWATER QUALITY MONITORING:
OMPLIANCE REPORT FORM
FACILITY INFORMATION Please Print Clearly or Type
Facility Name: �� "& r__0,�i�e.0 L^_
Fermit Name (if different): _
FacilityA�ddress:�fl�'� �( ,Nr•
I .1—k A�/`(l�C�P CLCS eel atec Countyw _
Contact Perso5-7t>ZC. cS1fy&; Telephone #:.�i�
Well Location/ Site Name: J 0 No. of Wells to be Sampled: 'L`-
'� tlrom Pe ,it)
Vleli Identification Nurturer (from Permit): For Groundwater Treatment Systems
Well Depth: �t S ft. Well Diameter: k in. Check One: ❑ Influent (�.8)
Screened Interval: ft. to _ ft. ❑ Effluent (99)
Depth to Water Level: ft. below measuring point. _
Measuring Point (M.P.) s: ft. above land surface. Relative M.P. Elevation in ft.:
Gallons of water pum /bailed before sampling: Date sample collected:
Field analysis: pH _ RI- , Specific Conductance _uMhos
Temp. IS:—*C, Odor ___ Appearance -
PERMIT #:
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
WATER OUALITY DIVIS101, GROUNDWATER SECTION
1636 MAIL SERVICE CENTER
EXPIRATION DATE:
Non -Discharge., kJ�C�41L 1.__UIC_
NPDES _
TYPE OF PER1J11TTED OPERATION BEING MONITORED
Lagoon Remediation: Infiltration Gallery
Spray Field Remediation:
�Rotary C)istributor _Land L and Application of Sludge
Other:
NOTE: Values :should reflect dissolved and .
colloidal concentrations.
Date sample analyzed:
Laboratory Name: A
Certification No.
PARAMETERS (Samples for metals were collected unfiltered_____YES NO
and field acidified
COD
_ mg/l
Nitrite 0102) aS ' -
mg/l
Coliform: MF Fecal _ l
/100ml
Nitrate ,NO3) as N—��-(P-"17 mg/1
Coliform: MF Total _
/100ml
Phosphorus: Total as P_
mg/l
(Note: Use MPN method for highly tur,.id samples)
Orthophospha+p ..,_
mg/l
Dissolved Solids: Total 77']—� _ mg/1
Al - Alurninum
mg/l
pH (when analyzed)
_units
Ba - Barium
mg/l
TOC �.
_ mg/1
Ca - Calcium
mg/1
Chloride ao"� _ mg/l
Cd - Cadmium
mg/I
Arsenic
_ mg/l
Chromium: Total
mg/1
Grease and Oils
_ mg/l
Cu - Copper
mg/l
Phenol
_ mg/1
Fe - Iron
mg/l
Sulfate
_ mg/l
Hg - Mercury
mg/1
Specific Conductance
uMhos
K - Potassium
mg/l
Total Ammonia
_ mg/l
Mg - Magnesium
mg/l
TKN as N
_ mg/1
Mn - Manganese
mg/l
n
YES _ _ N01
Ni - Nickel
— mg/1
Pb - LeacL____
_. mg/l
Zn - Zinc
_ mg/l
Ammon�, _
ia . �:: _.. �n .. r
— mg/I
Other (Specify Compounds and Concentration Units)
ORGANICS: (G(,-,GC/MS,HPLC)
(Specify test and method #. Attach lab report.)
Report Attached? Yes (1) No�(0)
VOC _: method # =
method # =
r
method#=
�I„uuce tv, mu,nunzea agent) arse and 71tte - Pie•ase Print or type
G'N-59 t�Cp
5i nature of Permit or Authorized Ag nt (Date)
Rev. 03/2-00© _ v — ..__ ___ _ ___ _ .. _