HomeMy WebLinkAboutWQ0003271_Monitoring - 03-2021_20210429Monitoring Report Submittal
...........................................................................................................................................
Permit Number #* WQ0003271
Name of Facility:*
Month:* March
Report Information
Type *
GW-59
Hestron Park WWTP
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
Hestron GW-59.pdf 1.25MB
FDF Cnly
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
stacy.goff@carolinawaterservicenc.com
Stacy A. Goff
6S, ..ff
Reviewer: Williams, Kendall N
4/29/2021
This will be filled in autorratically
Is the project number correct? * WQ0003271
Is the monitoring report r Yes r No
accepted?*
Regional Office * Wilmington
Accepted Date: 4/29/2021
G W-59A COMPLIANCE REPORT FORM Permit 4 wQ 0 0 0 3 2 71
(Submit one each monitoring period with GIV-59 forms.)
1
Enter date monitoring results were due.( March ) Will this monitoring report (GW-59 and GW-59A)
YES
NO
be submitted after the established due date?
X
2
Was any required information missing on the GW-59 report forms?
YES
NO
x
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
identification plate, area overgrown, etc.)? If the ans-wer is "Yes ", contact the Regional Office for guidance.
YES
NO
X
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 provided below:
See Attachment
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 years?
YES
x
NO
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).
See Attachment
6
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
NO
x
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 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?
x
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.
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.
Signature of Permittee (or Authorized Agent) Date
GW-59A 12/8/2003
SUBMIT FORM ON YELLOW PAPER ONLY
, •..•
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
:
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
•
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: (919) 733-3221
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 12-31-2023
Facility Name: Hestron Park
Non -Discharge WQ0003271 UIC
Permit Name (if different):
NPDES Other
Facility Address: 5058 Hwy 70 Westridge Center Unit N2
TYPE OF PERMITTED OPERATION BEING MONITORED
Morehead City rstreetl NC
28557 CountyCarteret
El Lagoon El Remediation: Infiltration Gallery
City)
❑ Spray Field ❑ Remediation:
Contact Person: Stacy A Goff
Telephone#: 252-808-5955
❑■ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: WWTP
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-1
Date sample collected: 3/2/21
FIELD ANALYSES:
WAS
Well Depth: 21.5 ft.
Well Diameter: 2 in.
pH 00400: 7.0 units Temp. 000to: 17 °C
DRY at
Depth to Water Level 82546:5.33 ft. below measuring point Screened Interval: 5 ft. to
21.5 ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is 1.5 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: none
check
Volume of water pumped/bailed before sampling:
3.5
gallons
Appearance clear
here:
Samples for metals were collected unfiltered: El YES
El NO and field acidified: El YES El NO
LABORATORY INFORMATION
Date sample analyzed:3/2/21 to 3/11/21
Laboratory Name: Environment 1
Certification No. 10
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: IMF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 .11
mg/L Zn - Zinc 01092 mg/L
Coliform: IMF Total 31504
/100mL
Phosphorus: Total as P 00665 <.04
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 170
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680 11.5
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 18
mg/L
Cd - Cadmium 01027
ug/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 78732: method #
Total Ammonia 00610 <.04
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Dana Hill, Regional Manager
Permittee (or Authorized Agent) Name and Title - Please print or type
Dana Hill
mm
Signature of Permittee (or Authorized Agent) (Date)
GW-59 Rev.2/2010
SUBMIT FORM ON YELLOW PAPER ONLY
, •..•
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
:
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
•
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: (919) 733-3221
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 12-31-2023
Facility Name: Hestron Park
Non -Discharge WQ0003271 UIC
Permit Name (if different):
NPDES Other
Facility Address: 5058 Hwy 70 Westridge Center Unit N2
TYPE OF PERMITTED OPERATION BEING MONITORED
Morehead City rstreetl NC
28557 CountyCarteret
El Lagoon El Remediation: Infiltration Gallery
City)
❑ Spray Field ❑ Remediation:
Contact Person: Stacy A Goff
Telephone#: 252-808-5955
❑■ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: WWTP
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-2
Date sample collected: 3/2/21
FIELD ANALYSES:
WAS
Well Depth: 19.95 ft.
Well Diameter: 2 in.
pH 00400: 6.9 units Temp. 000lo: 16 °C
DRY at
Depth to Water Level 82546:6.79 ft. below measuring point Screened Interval: 5 ft. to
19.95 ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is 1.5 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: none
check
Volume of water pumped/bailed before sampling:
2.5
gallons
Appearance clear
here:
Samples for metals were collected unfiltered: El YES
ElNO and field acidified: El YES El NO
LABORATORY INFORMATION
Date sample analyzed:3/2/21 to 3/11/21
Laboratory Name: Environment 1
Certification No. 10
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: IMF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 2.58
mg/L Zn - Zinc 01092 mg/L
Coliform: IMF Total 31504
/100mL
Phosphorus: Total as P 00665 <.04
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 7030o 330
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680 10.68
mg/L
Ca - Calcium 00916
mg/L
Chloride 0094o 73
mg/L
Cd - Cadmium 01027
ug/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 78732: method #
Total Ammonia 00610 <.04
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Dana Hill, Regional Manager
Permittee (or Authorized Agent) Name and Title - Please print or type
Dana Hill
Signature of Permittee (or Authorized Agent)
(Date)
GW-59 Rev.2/2010
SUBMIT FORM ON YELLOW PAPER ONLY
, •..•
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
:
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
•
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: (919) 733-3221
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 12-31-2023
Facility Name: Hestron Park
Non -Discharge WQ0003271 UIC
Permit Name (if different):
NPDES Other
Facility Address: 5058 Hwy 70 Westridge Center Unit N2
TYPE OF PERMITTED OPERATION BEING MONITORED
Morehead City rstreetl NC
28557 CountyCarteret
El Lagoon El Remediation: Infiltration Gallery
City)
❑ Spray Field ❑ Remediation:
Contact Person: Stacy A Goff
Telephone#: 252-808-5955
❑■ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: WWTP
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-3
Date sample collected: 3/2/21
FIELD ANALYSES:
WAS
Well Depth: 24.44 ft.
Well Diameter: 2 in.
pH 00400: 7.3 units Temp. 000to: 17 °C
DRY at
Depth to Water Level 82546:3.4 ft. below measuring point Screened Interval: 5 ft. tC)
24.44 ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is 1.5 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: none
check
Volume of water pumped/bailed before sampling:
3.5
gallons
Appearance clear
here:
Samples for metals were collected unfiltered: El YES
El NO and field acidified: El YES El NO
LABORATORY INFORMATION
Date sample analyzed:3/2/21 to 3/11/21
Laboratory Name: Environment 1
Certification No. 10
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: IMF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 .06
mg/L Zn - Zinc 01092 mg/L
Coliform: IMF Total 31504
/100mL
Phosphorus: Total as P 00665 .13
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 7030o 850
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 0068o 5.41
mg/L
Ca - Calcium 00916
mg/L
Chloride 0094o 217
mg/L
Cd - Cadmium 01027
ug/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 78732: method #
Total Ammonia 00610 .22
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Dana Hill, Regional Manager
Permittee (or Authorized Agent) Name and Title - Please print or type
Dana Hill
Signature of Permittee (or Authorized Agent)
(Date)
GW-59 Rev.2/2010
SUBMIT FORM ON YELLOW PAPER ONLY
, •..•
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
:
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
•
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: (919) 733-3221
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 12-31-2023
Facility Name: Hestron Park
Non -Discharge WQ0003271 UIC
Permit Name (if different):
NPDES Other
Facility Address: 5058 Hwy 70 Westridge Center Unit N2
TYPE OF PERMITTED OPERATION BEING MONITORED
Morehead City rstreetl NC
28557 CountyCarteret
El Lagoon El Remediation: Infiltration Gallery
City)
❑ Spray Field ❑ Remediation:
Contact Person: Stacy A Goff
Telephone#: 252-808-5955
❑■ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: WWTP
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-4
Date sample collected: 3/2/21
FIELD ANALYSES:
WAS
Well Depth: 19.81 ft.
Well Diameter: 2 in.
pH 00400: 6.9 units Temp. 000lo: 17 °C
DRY at
Depth to Water Level 82546:6.12 ft. below measuring point Screened Interval: 5 ft. to
19.81 ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is 1.5 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: none
check
Volume of water pumped/bailed before sampling:
2.5
gallons
Appearance clear
here:
Samples for metals were collected unfiltered: El YES
ElNO and field acidified: El YES El NO
LABORATORY INFORMATION
Date sample analyzed:3/2/21 to 3/11/21
Laboratory Name: Environment 1
Certification No. 10
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: IMF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 13.37
mg/L Zn - Zinc 01092 mg/L
Coliform: IMF Total 31504
/100mL
Phosphorus: Total as P 00665 .14
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 960
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680 9.88
mg/L
Ca - Calcium 00916
mg/L
Chloride 0094o 301
mg/L
Cd - Cadmium 01027
ug/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 78732: method #
Total Ammonia 00610 <.04
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Dana Hill, Regional Manager
Permittee (or Authorized Agent) Name and Title - Please print or type
11 = 77 - h1,=erv�m
Dana Hill
Signature of Permittee (or Authorized Agent) (Date)
GW-59 Rev.2/2010
SUBMIT FORM ON YELLOW PAPER ONLY
, •..•
DEPARTMENT OF ENVIRONMENT & NATURAL RESOURCES
GROUNDWATER QUALITY MONITORING:
:
DIVISION OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
•
1617 MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone: (919) 733-3221
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: Expiration Date: 12-31-2023
Facility Name: Hestron Park
Non -Discharge WQ0003271 UIC
Permit Name (if different):
NPDES Other
Facility Address: 5058 Hwy 70 Westridge Center Unit N2
TYPE OF PERMITTED OPERATION BEING MONITORED
Morehead City rstreetl NC
28557 CountyCarteret
El Lagoon El Remediation: Infiltration Gallery
City)
❑ Spray Field ❑ Remediation:
Contact Person: Stacy A Goff
Telephone#: 252-808-5955
❑■ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: WWTP
No. of wells to be sampled: 5
❑ Water Source Heat Pump ❑ Other:
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW-5
Date sample collected: 3/2/21
FIELD ANALYSES:
WAS
Well Depth: 20 ft.
Well Diameter: 2 in.
pH 00400: 6.8 units Temp. 000to: 16 °C
DRY at
Depth to Water Level 82546:4.25 ft. below measuring point Screened Interval: 5 ft. to
20
ft. Spec. Cond. 00094: µMhos
time of
sampling,
Measuring Point is 1.5 ft. above land surface
Relative M.P. Elevation: ft.
Odor 00085: none
check
Volume of water pumped/bailed before sampling:
3
gallons
Appearance clear
here:
Samples for metals were collected unfiltered: El YES
ElNO and field acidified: El YES El NO
LABORATORY INFORMATION
Date sample analyzed:3/2/21 to 3/11/21
Laboratory Name: Environment 1
Certification No. 10
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615
mg/L Pb - Lead 01051 ug/L
Coliform: IMF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 9.64
mg/L Zn - Zinc 01092 mg/L
Coliform: IMF Total 31504
/100mL
Phosphorus: Total as P 00665 <.04
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
Dissolved Solids:Total 7030o 610
mg/L
Al - Aluminum 01105
mg/L
pH (Lab) 00403
units
Ba - Barium 01007
ug/L
TOC 00680 16.92
mg/L
Ca - Calcium 00916
mg/L
Chloride 0094o 237
mg/L
Cd - Cadmium 01027
ug/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 78732: method #
Total Ammonia 00610 <.04
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese 01055
ug/L method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Dana Hill, Regional Manager
Permittee (or Authorized Agent) Name and Title - Please print or type
Dana Hill
Signature of Permittee (or Authorized Agent)
(Date)
GW-59 Rev.2/2010