WQ0023310_Monitoring - 11-2020_20210122

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
01110ARTMINT OF ENVIRONMENTAL QUALITY » olV. OF WATER RESOURCES
INFONMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
160MAIL $1111101 R CENTER, RAL010H, NO 27800,1617
FACILITY INFORMATION cPlease 1Print Clearly orType (,1
1
PERMIT Number: 3�F�Cpiration Date: - Q -�
uu
Facility Name: C(SQ W Sail l'C
1C> n Tom, \P.(' W(�S�
r+
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Address: $ U1
FaM0J'-SC'W
TYPE OF PERMITTED OPERATION BEING MONITORED
" ',AJQ
County Q u rik I r,
❑ Lagoon ❑ Remediation: Infiltration Gallery
,, 1r, �
Contact Person: QS Q ( ,QQ
Telephone#-%1 - 3,13--343 'j
P-5p ay Field ❑Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name:
5 No. of wells to be sampled:
El water Source Heat Pump ❑Other:
from Permit
SAMPLING INFORMATION (�
WELL ID NUMBER (from Permit): ` \`
Date sample collected:�.,��' o
FIELD ANALYSES:
If WELL
WAS
Well Depth: ) S ft.
10
Well Diameter: in.
pH 00400: units Temp. 000i o: d, °C
DRY at
-&-
Depth to Water Level e2546: % a.. ft. below measuring point Screened Interval: ft. to
_�il_
ft. Spec. Cond. 000ga: µMhos
time ofsampling,
Measuring Point is ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085:
check
Volume of water pumped/bailed before sampling: , -5
_gallons
Appearance Q-f\
here:❑
Samples for metals were collected unfiltered: X YES
❑ NO and field acidified: N YES ❑ NO
LABORATORY INFORMATION - - 1 - - a0 ` _t_
Date sample analyzed: - - - S ao 1[- 6- of O Laboratory Name: �'U\ (� �,(V�
Certification No.
PARAMETERS NOTE: Values s ould reflec dissolved and colloidal concentrations.
_
COD 0033s mg/L
Nitrite (NO2) as N 00615 mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 �' /100mL
Nitrate (NO3) as N 00620 t mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL
Phosphorus: Total as P 00665 C) S mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentration Units):
issoived Solids:Total 70300 p�l mg/L
Al -Aluminum olim mg/L
pH (Lab) 0040 units
Ba - Barium 01007 t. ug/L
TOC ooseo mg/L
Ca - Calcium 00916 mg/L
Chloride 00940 mg/L
Cd - Cadmium 01027_
Arsenic 01002 ug/L
Chromium: Total 01034 Gy ug/L
Grease 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 Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 µMhos
K - Potassium 00937 mg/L
VOC 7873 method #
Total Ammonia 00610 �, Q y O� mg/L
Mg - Magnesium 00927 mg/L
method #
(Ammonia Nitrogen; NH,as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055 ug/L
, method #
TKN as N 00625 mg/L
Ni - Nickel 01067 ug/L
method #
t-or Kemealatlon Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:(
NUllr NM,,¢►� llAf.ITv�fuopwAT�tzraouraa�s
ray4* P , titlV ilta
COMPLIANCE REPORT FORM
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FACILITY INFORMATION, Please Print Clearly or Type j 1 _
�q_SgW �r
PERMIT Number rExpiration Date: - — Q
U
Facility Name:
q\ UV Q� t�\
Non -Discharge UIC
Permit Name (If dlff rent):
NPDES Other
Facillt Address:
TYPE OF PERMITTED OPERATION BEING MONITORED
County
❑ Lagoon ❑ Remediatlon: Infiltration Gallery
�ay Field ❑ Remediatlon:
Contact Person: ( (
qJ� l�J�
Telephone#%G - Q L- 3 T�
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: ' `
No. of wells to be sampled:_
❑ Water Source Heat Pump ❑ Other:
from Penult
SAMPLING INFORMATION ^
WELL ID NUMBER (from Permit): " d.�
Date sample collected: 1l Q�o
FIELD AMLYSES:
ltt,%
if WELL
WAS
Well Depth: Laft.
Well DIametec'el, in.
pH 00400: units Temp. 000lo °C
DRY at
Depth to Water Level e2546: ,eft. below measuring point Screened Interval: ft. to
Spec. Cond. 00094: µMhos
time of
Measuring Point Is ft. above land surface
Volume before �S_
_ft.
Relative M.P. Elevation: ft.
Odor 000e5:
sampling,
check
of water pumped/balled sampling:
gallons
Appearance 5_Q� 1— t? ems-
here:
Samples for metals were collected unfiltered: ® YES
❑ NO and field acidified: ® YES ❑ NO
LABORATORY INFORMATION \ — - 0) - -
Date sample analyzed:
Laboratory Name: Q\\ �M MC� P
n Certification No.
PARAMETERS NOTE: Values §hould refle t dissolved
aild colloidal concentrations.
COD 00335 mg/L
Nitrite (NO2) as N oo615 mg/L
Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 L' Cal , /100mL
Nitrate (NO3) as N 00620 C j mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100ml-
Phosphorus: Total as P 00665 Q mg/L
(Note: Use MPN method for highly turbid samples)
(ssolvedSollds:Total70300�3
Orthophosphate 70507 mg/L
Other (Specify Compounds and Concentration Units):
mg/L
AI- Aluminum oil o5 mg/L
pH (Lab) 00403 units
Ba - Barium 01007 ug/L
TOC 006e0_ mg/L
Ca - Calcium 00916 mg/L
Chloride 00940 S mg/L
Cd - Cadmium 01027 ug/L
Arsenic 01002 ug/L
Chromium: Total 01034 uglL
Grease 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 Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 _ µMhos
K - Potassium 00937 mg/L
VOC 7873 method #
Total Ammonia ooelo c)� mg/L
Mg - Magnesium 00927 mg/L
method #
(Ammonia Nitrogen; NH3 as N; Ammonia Nitrogen, Total)
Mn - Manganese o1o55 ug/L
method #
TKN as N 00625 mg/L
NI - Nickel 01067 ug/L
method #
certify that„todhebesto(in'yknowledge anti belief, the informationsubnutted in this report is true acc
W� 9a iheFhfahoialol;y' I,aill awa(,e that the,ie aie significant peRelliies (or.siibmdting false info,fmatioi
EMST2M
: r .= -
7'ermittee (or Authori ed A ent) Name and Tltle - Please print or type
GW-59 Rev.06-07-2018
mg/L Effluent Total VOCs:
Signature
mg/L VOC Removal%
O - D-O
(Date)

SUBMIT FORM ON
PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
Facility Name:
Permit Name (If
Facili,)y Address:
Contact Person:
Well Location/Site Name:
earty or r'ype
County
Telephone#:1 1 0 — 3
No. of wells to be sampled:
+eee.�d�y
PERMIT NumberWN 013SFxpiration Date: 11-30— oAD,
Non -Discharge UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Z-3p7ay Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
�r ivirL_unu wirymunm1 rVro
WELL ID NUMBER (from`Permit): ""3 Date sample collected: "^ pl�
Well Depth: 1� s ft. Well Diameter: in.
Depth to Water Level 82546:�kt %_ft. below measuring point Screened Interval: ft. to ft.
Measuring Point is ft. above land surface Relative M.P. Elevation: ft.
Volume of water pumped/balled before sampling: S gallons
Samples for metals were collected unfiltered: 0 YES ❑ NO and field acidified: N YES ❑ NO
FIELD AN LY ES:
pH ooaoo:units Temp. 00010:0�� °C
Spec. Cond. 00094: µMhos
Odor o0065:
Appearance (\
if WELL
WAS
DRY at
time of
sampling,check
here:
LABORATORY INFORMATION N\— — OA— 0
Date sample analyzed: — D —S^ —(;—
)) Laboratory Name:y\ �6
Certification No.
PARAMETERS NOTE: Values should reflect dissolved and
Colloidal concentrations.
_
COD 00335 mg/L
Nitrite (NO2) as N oo615
mg/L
Pb - Lead o1o51 ug/L
Coliform: MF Fecal 31616 /100mL
Nitrate (NO3) as N 00620 mg/L
Zn - Zinc 01092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus: Total as P 00665 3 S
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L
Other (Specify Compounds and Concentration Units):
Dissolved Sollds:Total 70300 mg/L
Al -Aluminum 01105
mg/L
pH (Lab) 00403 units
Be - Barium 01007
ug/L
TOC omm mg/L
Ca - Calcium oog16
mg/L
Chloride 00940 21" mg/L
Cd - Cadmium 01027
u9 /L
Arsenic 01002 ug/L
Chromium: Total 01034
ug/L
Grease 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 Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095 _ µMhos
K - Potassium 00937
mg/L
VOC 7873 method #
Total Ammonia oo610 mg/L
Mg - Magnesium 00927
mg/L
method #
(Ammonia Nitrogen; N%as N; Ammonia Nltrogen, To al)
Mn -Manganese o1o55
ug/L
TKN as N 00625 mg/L
NI - Nickel 01067
ug/L
,method #
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L
Effluent Total VOCs: mg/L VOC Removal%
Permittee (o Auth Ized Agent) Name and Title - Please print or type
GW-59 Rev.06-07-2018
a - a/ -
nature of.PerryAt fe uthorized Agent) (Date)

Fermi H a3310
(Submit one each ;monitoring period with Gl- 59 forms.)
1
Enter date monitoring results were due. Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
2
Was any required information missing on the GW-59 report forms?
YES
NO
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 wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
YES
NO
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
NO
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 concentration(s)
exceeding standards in the space rovide below:
a,�
l 30L �s.3
5
For the constituenti identified in question 4 above, have standards been'Weeded previously for the
YE
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 provided below, each well with constituent(s) exceeding
standards concentration(s) reported, and sample collection date for each occurrence (for the last two years).
�
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q
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Are the monitoring we s listed illsectioAF loc at or beyond the review boundary?
YES
NO
If the answer is "YES", a groundwater quality problem maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO", monitoring wells maybe 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 subject the permittee 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.
t hereby acknowledge that the above information was evaluated and the information submitted in this
report (Compliance Report GW 69A) is e a complete to the best of my knowledge.
Signature of Pe ittee (or Authorized Agent) Date
GW-59A 12/8/2003

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