WQ0002838_Monitoring - 03-2021_20210325

SUBMIT FORM ON Y OW PAPER ONLY
ROUNDWATER QUALITY MONITORING:
OMPLIANCE REPORT FORM
WILITY INFORMATION Please PrintClearly or
acility Name: ,,) pPr hi, rs-+ m
ermit Name (if different): Zs- ham+
acility Address: (005bo Pr,� qe-j4e,
it l NC
CountyWCL MCP_
ontact Person: Late M Telephone#:Qtq • �1 ` (oro(o
fell Location/Site Name: t- 14 G No. of wells to be sampled:
PARTMENT OF ENVIRONMENT 3 NATURAL R"OURCES
rISION OF;WATER QUALITY -INFORMATION PROGESSING.UNIT
17 MAIL SERVICE CENTER, RALEIGH, NC 97599-1517 Phone: [phone]
PERMIT Number- W& p�L MZfi_2*piration Date:
Non -Discharge UIC
NPDES Other
TELL ID NUMBER (from Permit): M, 3-!ii Date sample collectedZV3 21
tell Depth: alp ft. Well Diameter: Q in.
epth to Water Level: t ( ft. below measuring point Screened Interval: ft, to
easuring Point is nu above land surface Relative M.P. Elevation: ft.
plume of water pumped/bailed before sampling: __gallons
fmples for.metalswere colfecfedunfiltdted--RYES - - -❑ Nb and field acidified: AYES NO
'PE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
If WELL
FIELD ANALYSES:
WAS
pH 4-3-unit Temp. VS' -A °C
4-3-unit
DRY at
Spec. Cond. µMhos
time of
Odor N Ott,
sampling,
Appearance C C/ W V C>DO R
check
here:
late sample analyzed: 21- 3 n,?_j Laboratory Name: 0_e(_JtCh MY..
ARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO2) as N mg/I Pb - Lead
Coliform: MF Fecal !� ( Cv ( /100ml Nitrate (NO3) as N tl , mg/I Zn - Zinc
Coliform: MF Total /100ml Phosphorus: Total as P A D. D610 mg/l
(Note: Use MPN method for highly turbid samples)
Certification No. 1 (05
mg/I
mg/I
Dissolved Solids: Total
3
Orthophosphate mg/1
Other (Specify Compounds and Concentration Units):
pH (when analyzed)
5 O�
mg/l
units
Al -Aluminum mg/1
Q �� 1� AC In
TOC
D
mg/l
Ba -Barium mg/I
Ca - Calcium mg/I
MAP' 2 5 v 1,
Chloride
mg/I
Cd - Cadmium mg/1
Arsenic
mg/I
Chromium: Total mg/I
IMP W; I ION
Grease and Oils
mg/l
Cu - Copper mg/I
ORGANICS: Y
Phenol
mg/I
Fe - Iron fd +9/1
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate
Specific Conductance
mg/I
µMhos
Hg - Mercury mg/I
Report Attached? 21 Yes (1) El No (0)
K- Potassium K (} jmR'21
tit �
VOC .method #
Total Ammonia _ �.1 mg/I Mg - Magnesium mg/I
(Ammonia Nitrogen, NH3 as N; Ammonia Nitrogen, Total)
Mn -Manganese mg/l _
TKN as N mg/I Ni - Nickel mg/I
For Remediation Systems Only (Attach Lab Reports):
Permittee (or
G W-59
Rev. 1/2007
Infuent Total VOCs:
mg/L Effluent Total VOCs:
method #
method #
method #
VOC Removal%

G,W-59A C'ONIPLI,ANCE' Ri�,P(?K'i' 141EL�`i
rcrinif 6\jQ0M0Q KN
L.in6ntii one c,, . h nrnritotm nrrrnd ,i !tr G16-?) ir!nrn. j
1
Enter date monitoring results were due. III this monitoring report (GW-59 and GW-59A)
be submitted after the established due date?
YES
)
2 Was any required information missing on the GW-59 report forms?
YES
IF the answer to question 1 or 2 is "YE "', fist in the spac= f,rovideu below the well identification number(s) and
explain the problems encountered in obtaining the required intormation
3 :\re any of the monitor wells in need of repair or maintenance (damage(I casing, unlocked or missing cap, missing
identification plate, area overgrown, etc.)." ifthe answer is "Yes", centaci the Regional Q!TceJbi- paidunce.
ITS
O
4 Are any monitored constituents equal to or above the estahiished standards?
tYES
O
li 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.
I
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 "NO", skip to section 8.
If the "YES",
—I
answer to question 5 is 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.
Is the penrnittee implementing previously approved
actions required by the Division involving this
groundwater quality problem?
--+If
YES
NO
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 ma sub
fines, and/or penalties. "ecf the permittee to a Notice of Violation
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 a knowledge that the above information was evaluated and the information submitted in this
repo o pliance Report GW-59A) is true and complete to the best of my knowledge.
. t aalzl
,3Date
S gnature of Permittee (or Authorized Agent)
12/8/2003

SUBMIT FORM ON YFl I OW PAPER ONLY
ROUNDWATER QUALITY MONITORING:
OMPLIANCE REPORT FORM
Print
cility Name: hU(-_
rmit Name (if different): f^
-ility Address: Coson Pf-',
�P 1 NC
f ,JIDEPARTMENT.OF ENVIRONMENT d, NATURAL RESOURCES
VISION OF,WATER QUALITY-INFORMAT10N,PROCESSING.UNT'
617 MAIL SERVICE,CENTER, RALEIGH, NC'�7699 1617 Phoney t919) 733-9221
or type [NPDES
ERMIT N
` ,��QI���•��8 Expiration Date: I) �l �j
on -Disc arge tJ UIC
ZMP Other
County
act Person: ,�� .�.�5 Telephone#:g14-(A I- kI5�)
Location/Site Name: Q(• E1l�rs+ t'tl NG No. of wells to be sampled: L+
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon ❑ Remediation: Infiltration Gallery
56 Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
LL ID NUMBER (from Permit): C J�*?— 3 3
Date sample collected: ZI I
If WELL
II Depth: �p � FIELD ANALYSES:
Well
WAS
_ft. Diameter: in, pH 15.8 units Temp. IL $ oC
lth to Water Level: below measuring
DRY at
_�ft. point Screened Interval: ft. to ft. Spec. Cond. 3$a µMhos
isuring Point is 3 ft. above land
time of
surface Relative M.P. Elevation: ft, Odor N�%t�iQ
sampling,
ime of water pumped/bailed before sampling: J� gallons C�BGr' Appearance
check
iples for. metals -were -collected unfiltere : — - - — --
YES ---. n��---�nr1 fclr7 or;.hCe.A. I—Tv7c. -t:T.T<•. --- — ------ _- _------- -
ere:
�-
to sample analyzed:- ZI - 31 17 I Z I Laboratory Name: LYWI } -C k -
RAMETERS NOTE: slues should reflect dissolved and colloidal concentrations.
COD mg/I Nitrite (NO,) as N mg/I Pb - Lead
Coliform: MF Fecal C, /100ml Nitrate (NO3) as N
�-I Oy m9/I Zn -Zinc
Coliform: MF Total /100ml Phosphorus: Total as P D► IZ mg/1
(Note: Use MPN method for highly turbid samples)
Certification No. i Los
mg/I
mg/I
Dissolved Solids: Total �_mg/l
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
_
Al -Aluminum
mg/I
pH (when analyzed)
M.
units
Ba - Barium
mg/I
TOC
bZ •O
mg/I
Ca - Calcium
mg/I
Chloride
Ld 1.15
mg/1
Cd - Cadmium
mg/1
Arsenic
mg/I
Chromium: Total
mg/I
Grease and Oils
mg/I
Cu - Copper
mg/1
ORGANICS: (by GC, GC/MS, HPLC)
Phenol
Sulfate
mg/I
Fe -Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Specific Conductance
mg/I
µMhos
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Total Ammo
Ze O I
K - Potassium
mg/I
VOC , method #
nla mg/I Mg - Magnesium mg/I
(Ammonia Nitrogen; NH, as N; Ammonia Nitrogen, Total)
Mn -Manganese mg/I
TKN as N mg/I Ni - Nickel mg/I
For Remediation Systems Only (Attach Lab Reports)
Permitlee (or
GW-59
.r — nycml rvania arts I we - Please print Or type
Rev. 1/2007
Influent Total VOCs:
mg/L Effluent Total VOCs:
..r r....r r..rr�cc nHclltl
method #
method #
method #
VOC Removal%
Iualel

CNV-59A ('QNIPLIANE-'1 RV,-11010' P';lIL1'iJr�DD�2��
.Submit o I I e e�. - h mu Iit( rrirr to rtori m 11r G16-?9 ju; un'.l
1
Enter date monitoring results were due. (ZJ Will this monitoring report (GIN-59 and GW-59A)
YES
r O
be submitted after the established due date?
2
Was any required information missing on the GW-59 repotrt forms?
YES
IF the answer to question 1 or 2 is "YE", list in the spac , i,rovidev below the well iden6fica"ion number(s) and
explain the problems encountered in obtaining the reomr-ed information.
3 kre any of the monitor wells in need of repair or maintenance (damaged casing, unlocked or missing cap, missing
identification "yes",
V S
`o
plate, area overgrown, etc.)? ifthe answer is contaci the Regional 0 rice lbrgaidance.
Are any monitored constituents equal to or above the established standards?
YES
rIf the answer to question 4 is 'NO", skip tc 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:
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 provided below, each well with constituent(s) exceeding
standards, concentration(s) reported, and sample collection date for each occurrence (for the last two years).
i
I
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.
Is the permittee implementing previously approved actions
required by the Division involving this
groundwater quality problem?
YES
NO
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 malt 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 here nowledge that the above information was evaluated and the information submitted in this
repo (Co pliance Report GW-59A) is true and complete to the best of my knowledge.
�O- mokuo
t�5a
3130 zi
Signature of Permittee (or Authorized Agent) Date
C;W-59A 12/812003

SUBMIT FORM ON YFI I OW PAPER ONLY
ROUNDWATER QUALITY MONITORING:
DMPLIANCE REPORT FORM
,CI LITY INFORMATION Please Print Clearty or Type
cility Name: )I11UCWz'
rmit Name (if different): e('b, ip
cilityAddress: (OS00 1Pr jP44e_ j d
NC Countyv')aKtr
act Person: \P_ (� S Telephone#: CtP- LIP (' I oc�_(p
Location/Site Name: pP.l°Y- hu�S (`n I✓ No. of wells to be sampled: L-%—
MENT OF ENVIRONMENT & NATURAL RESOURCES
I OF;INATER QUALITY-INFORMATION;PROCESSING,UNIT
IL SERVICE CENTER, MILEIGH, NC`97699-1617 Phone: [phone]
PERMIT Number:
Non- a6qg QAFO0'%'J$
No
Expiration Date:
UIC
Other
TYPE OF PERMITTED OPERATION BEING MONITORED
Lagoon ❑ Remediation: Infiltration Gallery
50 Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
L ID NUMBER (from Permit): m W 3
Date sample collected: 313�a (
LL
Depth: ft.
a
FIELD ANALYSES:
WAS
t to Water Level: 43c�ft. below measuring
Well Diameter: in.
pH !Sl�units Temp, 5 °C
DRY at
point
Point
Screened Interval: ft. to
_ft. Spec. Cond. 410 µMhos
time of
uring is ft. above land surface
Relative M.P. Elevation: ft.
Odor
samplinc
ie of water pumped/bailed before sampling: eJ gallons
check
_
lesfoT metals -were collecfedunfilfered�Y6�---f-1-a7i�—
��a feia .,�:;i:F�.�.�—rr���----r_-� �-------
Appearance Dr M3
----- — �4-_ _-----------------------__
here:
to sample analyzed:_ I.- 3I I1 N
Laboratory Name: Mer
-Jie h x6c-
- Certification No. I LOS
RAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD mg/I
Nitrite (NO2) as N
mg/I
Pb - Lead mg/l
Coliform: MF Fecal 4 Cv I /100ml
Nitrate (NO3) as N
mg/I
Zn - Zinc mg/I
Coliform: MF Total 2100ml
Phosphorus: Total as P Q+ 13 mg/I
(Nola: Use MPN method for highly turbid samples)
Dissolved Solids: Total aSj mg/I
Orthophosphate
mg/I
Other (Specify Compounds and Concentration Units):
Al -Aluminum
mg/I
pH (when analyzed) (D • units
Ba - Barium
mg/I
TOC o^i .?I mg/I
Ca - Calcium
mg/I
Chloride ag •$ mg/I
Cd - Cadmium
mg/1
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils mg/I
Cu - Copper
mg/1
ORGANICS: (by GC, GC/MS, HPLC)
Phenol mg/I
Sulfate
Fe - Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
mg/I
Specific Conductance µMhos
Hg - Mercury
mg/I
Report Attached? ❑ Yes (1) ❑ No (0)
Total Ammonia D. l mg/I
K - Potassium
Mg
mg/I
VOC method .#
(Ammonia Nitrogen; NH3as N; Ammonia Nitrogen, Total)
- Magnesium
mg/I
, method #
TKN as N
Mn -Manganese
mg/I
, method #
mg/I
Ni - Nickel
mg/1
method #
For Remediation Systems Only (Attach Lab Reports)
-bale rn0ftbeAZs 1){2('
Permittee (or Authorized Agent) Name and Title - Please Print or tvpe
GW-59 Rev.1/2007
Influent Total VOCs: mg/L
Effluent Total VOCs: mg/L
VOC Removal%

G.W-59A f'ONIPLIANCE' RKPOWF FOR'NI
,Srdmuit one et,­h multitruinw hrr1n4 ;1Wlr Gtf-i<) iurrr�c.j
l
Enter date monitoring results were due. �—) Will this monitoring report (GW-59 and GW-59A)
YES
be submitted after the established due date?
2
Was any required information missing on the GW-59 report forms? --
YES
n
IF the answer to question 1 or 2 is "YES", list in the spac I,rovi,jea below the well identification number(s) and
explain the problems encountered in obtaining the required information.
3 Ire any of the monitor wells in need of repair or mainteninte (damaged casing, unlocked or missing cap, missing
identification plate, area overgrown, etc.)? ij the answer is yes",
Y1 5
car laci the Regional Office Jor 2uidunce.
Are any monitored constituents equal to or above the established standards?
tYES
NO
li 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
exceeding standards rn the space provided below: t) and concentration(s)
S
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
___ _
NO
If the answer to question 5 is "NO", skip to section 8.
If the "YES",
answer to question 5 is 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?
If the answer is "YES", a groundwater quality problem maybe occurring. CONTACT THE REGIONAL
OFFICE IMMEDIATELY FOR GUIDANCE. If the answer is "NO",
YES
NO
monitoring wells maybe improperly
located, contact the Regional Office.
Is the permittee implementing previously approved actions
required by the Division involving this
groundwater quality problem?
YES
NO
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 ma 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 maV subiect 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 G W-59 forms for required wells to the address
provided at the top of the current G W-59 form.
I hereby owledge that the above information was evaluated and the information submitted in this
report /Como lance Report GW-59A) is true and complete to the best of my knowledge.
Mova&*q
t�5a �O, --�) 0Z I ZI
Signature of Permittee (or Authorized Agent) bate
(AV-50A 12/8/21103

SUBMIT FORM ON YE1 I OW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
COMPLIANCE REPORT FORM
FACILITY INFORMAUDI.QhN
Please Print Clearly or
Facility Name: hVw-rs+ rmr �G
Permit Name (if different):�-h���
Facility Address: (n P` l oc 4.-.
IdG NC County
ntact Person: Z)ale MohP s Telephone#..a 1-oG1- Qb56
tll Location/Site Name: I
D=hUC75A M HC, No. of wells to be sampled: _y
DEPARTMENT OF ENVIRONMENT d NATURAL RESOURCES
DIVISION OF SKATER QUALIT1Y INFDRYATIoN;PROCESSING,UNIT
1617 MAIL SERVICE CENTER, RALEIGH, NC 47699-1617 Phone:'[phone]
PIW��� Expiration Date:
Non- isc arge UIC
NPDES Other
TYPE OF PERMITTED OPERATION BEING MONITORED
❑ Lagoon ❑ Remediation: Infiltration Gallery
Q� Spray Field ❑ Remediation:
❑ Rotary Distributor ❑ Land Application of Sludge
❑ Water Source Heat Pump ❑ Other:
-L ID NUMBER (from Permit): 44 Date sample collected: EA3IW
I Depth: S ft. Well Diameter: in.
th to Water Level: -25 ft. below measuring point Screened Interval: ft, to ft.
suring Point is 4'�I4 ft. above land surface Relative M.P. Elevation: ft.
me of water pumped/bailed before sampling: 1 gallons
If WELL
FIELD ANALYSES:
WAS
pH 5-4
units Temp. °C
DRY at
Spec. Cond.
393 µMhos
time of
Odor
N�
sampling,
Appearance
dear
check
here: —�
late sample analyzed: 3 21 - 3' nIZ4 Laboratory Name: zfNG
ARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
CCD_ mg/I Nitrite (NO2) as N mg/I Pb - Lead
Coliform: MF Fecal C, � /100ml Nitrate (NO3) as N
Q.qD mgll Zn -Zinc
Coliform: MF Total /100ml Phosphorus: Total as P Iti • D'jD mg/I
(Note: Use MPN method for highly turbid samples)
O
Certification No. k(p5
mg/I
mg/I
Dissolved Solids: Total I Los mg/I
rthophosphate
mg/I Other (Specify Compounds and Concentration Units):
pH (when analyzed) units
Al -Aluminum
mg/1
Ba -Barium
mgll
TOC , (_p mg/I
Ca - Calcium
mg/I
Chloride mg/I
Cd - Cadmium
mg/I
Arsenic mg/I
Chromium: Total
mg/I
Grease and Oils m /1
Phenol
g
CU - Copper
mg/1
ORGANICS: (by GC, GC/MS, HPLC)
Sulfate
mg/I
Fe -Iron
mg/I
(Specify test and method #. ATTACH LAB REPORT.)
Specific Conductance
mg/I
µMhos
Hg - Mercury
mg/I
Report Attached? ❑ Yes 1) ElNo 0
( )
Total Ammonia 0 11
K - Potassium
mg/I
VOC method #
(Ammonia Nitrogen; NH, as N; Ammonia Nitrogen, Total)
mg/I
Mg - Magnesium
m /I
g
, method #
TKN as N
Mn -Manganese
mg/I
,method #
mg/I
Ni - Nickel
mg/I
method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs:
iittee (or Authorized Aqent) Name and Title
GW-59 Rev.1/2007
Print or type
EMOMMM
Nraaf at fltQ.laboretmq analytical data
ility r f fines and imprisonment for kni
VOC Removal%
2z IZ1
;Date)

G1V-59A ( OA/1}'L1ANC Ri1:110k (' ai0R,,1i rcrinit [W_Q ,a3q
r.iuhrair one avid tttu:,itrrri w hrrrnri th (:IV-j9 io;n�y,j
1
Enter date monitoring results were due. WIII this monitoring report (GW-59 and GW-59A)
YES
T
be submitted after the established due date?
2 Was any required information missing on the GW-59 report forms? -
YES
IF the answer to question 1 or 2 is "YE ", list in the spec � provided below the welt identification number(s) and
explain the problems encountered in obtaining the regmrnd intormation.
3 .-1re any of the monitor wells in need of repair or maintenance (dawaged casing, unlocked or missing cap, missing
YES
identification plate, area overgrown, etc.)? if the ansiver is "Yes", contact the Regional Q! ice jbr pairlunce.
i 4 — Are any monitored constituents equal to or above the established standards?
rIf the answer to question 4 is 'NO", skip to section 8. — ---- -- --- —
If the answer to question 4 is "YES" list the affected wells indivViially with constituent(s) and concentration(s)
exceeding standards in the space provided below:
I
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 "YES",
answer to question 5 is 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).
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.
Is the e_ ittee implementing previously approved actions required by
the Division involving this
groundwater quality problem?
YES
NO
!
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 the
provided at top of the current GW-59 form.
I hereby acknowledge that the above information was evaluated and the information submitted in this
repo5,4CMp pllance Report GW-59A) is true and complete to the best of my knowledge.
41A A� mobK" 3 u�z1
nature of Permittee (or Authorized Agent) Date
( *W-i9,-\ 13/8/2003