HomeMy WebLinkAbout640001_Monitoring (Report)_20210503GW-S°)A COMPLIANCE REPORT PoRj (
(Submit one each monitoring + Perm 1 t Wlp(� y
period with Get =S9 finny.)
Enter date monitor ng were due. (
lished due date? �~) Win this monitoring report (GW-59 and GW-59A) YES
be submitted after he estab
Was any required into rmation missing on the GW-59 report forms?
IF the answer to
explain the problems»encountered in obtaining the requireeprovided
Information.below the well identification number(s) and
Are any of the monit
identification plate, a
r wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
a overgrown, etc.)? If the answer is "Yes", contact the Regional °Like for guidance.
Are any monitored onstituents equal to or above the established standards?
If the answer to ques ion 4 Is WO"
section 8.
If the answer to queptlon 4 is "YEskip
" list the affected wells individually with constituent(s) and concentration (s)
exceeding standards i» the space provided below:
For the constituen • 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?
. If the answer to ques on 5 Is "NO", skip to section 8.
If the answer to qu ffon 5 /s "YES", list in the space provided below, each well with constituent(s)
standards, concentra an(s) reported, and sample collection date for each occurrence (for the last two exding
yeas).
C....,
Z•
to
40
Are the monitoring Wells listed In section 5 lo d at or beyond the review boundary?
If the answer is "YE ; a groundwater call
ty problem OFFICE IMMEDIATE YFOR GUIDANCE Ift a answer is may be
monitoroccurrining wells maybeimproperly
located; contact the egional Office.
If the answer to quest!
If the answer to que
I.: d to determin
oun arias surroun
amanceustaght
The person complete
form with GW-59 fo
I hereby acknowledg
report (Compliance Re complete to the best of my knowledge.
menting previously approved actions required by the Division involving this
robiem?
n 7 is "YES'; describe those actions in the space provided below.
Ithe 1mon 7 Is "NO`, c ntac the a lona/ O ce within 90 da • evaluate n ma be
n • this,act facil! a waFailure to do s o ma sub ect the • e I e to a Notice of
at � � rev : and com.11ance
Violation
gnature d i
g this portion (GW-59A) of the monitoringrepo f
s for required wells to the address provided at the topou/of d he current GW-59 form, n below and submit is
that the above information was evaluated and the information submitted in this
port GW-69A) is true and
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