WQ0000185_Monitoring - 04-2021_20210531

Monitoring Report Submittal
............................................................................................................................................
Permit Number #* WQ0000185
Name of Facility:*
Month:* April
Report Information
Type *
GW-59
Ocean Sands WWTP
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
Ocean Sands Signed 714.38KB
GW59.pdf
IPDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Rod Holley
Reviewer: Williams, Kendall N
5/31 /2021
This will be filled in automatically

Is the project number correct?* WQ0000185
Is the monitoring report t: Yes r No
accepted?*
Regional Office* Washington
Accepted Date: 6/3/2021

GW-59A COMPLIANCE REPORT FORM Permit # t,+p► Q 17 o L) o ) ,y S
(Submit one each monitoring period with GW-59 forms)
1
Enter date monitoring results were due. (il - 3 D - 24 Will this monitoring report (GW-59 and GW-59A)
YES
O
be submitted after the established due date?
2
Was any required information missing on the GW-59 report forms?
1F 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, mussing
YES
NO
identification plate, area overgrown, etc.)? If the answer is "Yes ", contact the Regional Officefor 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 6.
If the answer to question 4 is "YES" list the affected wells individually with constituents) and concentration(s)
exceeding standards in the space provided below.
MW -LI
*r t) s - (9
5
For the constituents identified in question 4 above, have standards been exceeded previously for the
ES
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 B.
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).
W` q 1 6 S 0-4 CO) lf-d 0A! AS Z
Are the monitoring wells listed in section 5 located at or beyond the review boundary?
YES
O
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.
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 rosy subiect the permittee to a Notice of Violatio&
fines, and/or penalties.
rn0,4; OP- m ��� �� fs,t,,. 14T J4,14it
c4j
�ow41 � it ��S�r Cr,a�S�+tuk�rt•S Aid
Q rE pk t� �So 1V{ , N C nJLfC. rl� Q ! �Sld �t r
8
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.
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.
L.0 5 ? i - Z /
Signature of Permittee (or Aulhorized Agent) Date
GW-59A 12/8/2003

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
DEPAFITMENT,GF ENVIRONMENT & NATURAL RESOURCES
E51VI51gN OF WATER QUALRY41SIFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
a
AIL SERVlcECENTER, RAlE[GH,Nc276s8-1si7 Phane'(999)7334221
FACILITY INFORMATION
Please PrintOaarfyorType
PERMIT Number: WQ0000185 Expiration Date: 6/30/2024
Facility Name: Ocean Sands
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
Corolla ""`" NC
27927 County Currituck
El Lagoon ❑Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: Rod Holley
Telephone#: [phone]
ElRotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Ocean Sands
No. of wells to be sampled: 5
❑ Water Source Heat Pump ® Other: Infiltration
from Perms
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW4
Date sample collected: 4/8/21
FIELD ANALYSES:
WAS
Weil Depth: 17.6 ft.
Well Diameter: 3 in.
pH 0040o: 6.82 units Temp. 000lo: 18.0 °C
DRY at
Depth to Water Level a2546:9.2 ft. below measuring point Screened Interval: 12 ft.
to 17 ft. Spec. Cond. 00094: µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation:
ft. Odor 000m: sulfur
sampling,
check
Volume of water pumped/bailed before sampling:
5.0
gallons
Appearance clear
here:❑
Samples for metals were collected unfiltered: ® YES
❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:4/8/21
Laboratory Name: Enviro Chem
Certification No. 94
PARAMETERS NOTE: Values should reflect
dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0,02
mg/L Pb - Lead 01051 ug/L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO$) as N 00620 0.41
mg/L Zn - Zinc olo92 mg/L
Coliform: MF Total 31504
/100mL
Phosphorus: Total as P 00665 4.83
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 7030o 644
mg/L
Al - Aluminum oil o5
mg/L
PH (Lab) 00403 6.82
units
Ba - Barium o10o7
ug1L
TOC 0068o 4.7
mg/L
Ca - Calcium 00916
mg/L
Chloride 0094o 182
mg/L
Cd - Cadmium of o27
ug/L
Arsenic 01002
ug/L
Chromium: Total olo34
ug1L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GCIMS, HPLC)
Phenol 32730
ug1L
Fe - Iron o1045
ug1L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate oo945
mg/L
Hg - Mercury 71900
ug1L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095
p Mhos
K - Potassium 00937
mg/L VOC 78732: , method #
Total Ammonia 00610 0.9
mg/L
Mg - Magnesium 00927
mg/L , method #
(Ammonia Nitrogen; NH4 as N; Ammonia Nitrogen, Total)
Mn -Manganese o1055
ug1L ,method #
TKN as N 00625
mg1L
Ni - Nickel 01067
ug1L , method #
For Remedlation Systems Only (Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
Rod Holley Wastewater Superintendent Trainee
Permittee (or Authorized Agent) Name and Tithe - Please print or type
(Date)
GW-59 Rev.212010

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
a
DEPARTMENT OF. ENVIRONMENT.$ NATURAL RESOURCES
DIVIS[oN OF WATER QUALITYdNFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
a
16W MAIL SERVICE CENTER, RALEIGH, NC 27699-1617 Phone; (919)733 M.I
FACILITY INFORMATION
Please PrintClearfyorType
PERMIT Number: WQ0000185 Expiration Date: 6/30/2024
Facility Name: Ocean Sands
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: 741 Ocean Trail
'TYPE OF PERMITTED OPERATION BEING MONITORED
Corolla' `"'' NC
27927
County Currituck
❑Lagoon ❑ Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: Rod Holley
Telephone#: [phone]
ElRotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Ocean Sands
No, of wells to be sampled: 5
❑ Water Source Heat Pump ® Other: Infiltration
rmm Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW5
Date sample collected: 4/8/21
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft,
Well Diameter: 3 in.
H 0040o: 6.57
p units Temp. 00010: 18.1 C
DRY at
Depth to Water Level 82546:5.0
p ft. below measuring point
1
Screened Interval: 2 ft.
to 17 ft. Spec. Cond. o0as4: It Mhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevatlon:
ft. Odor 000a5: none
sampling,
check
Volume of water pumped/bailed before sampling:
5.0
gallons
Appearance Semi -clear
here:❑
Samples for metals were collected unfiltered: ® YES ❑ NO and field acidified. ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:418/21
Laboratory Name: Enviro Chem
Certification No. 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0,02
mg/L Pb - Lead 01051 uglL
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 0.16
mg/L Zn - Zinc 01092 mg/L
Colftrm: MF Total 31504
11 OOmL Phosphorus:
Total as P 00665 2.17
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved Solids:Total 7030o 250
mg1L
Al - Aluminum oft o5
mg/L
pH (Lab) oo4oa 6.57
units
Ba - Barium 01007
ug1L
TOC ooBBo 8.1
mg/L
Ca - Calcium oo916
mg/L
Chloride oo94o 14
mg/L
Cd - Cadmium 01027
ug1L
Arsenic 01002
ug/L
Chromium: Total 01034
ug1L
Grease and Oils oo552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug1L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate oo945
mg/L
Hg - Mercury 71900
ug1L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095
µMhos
K - Potassium 00937
mg/L VOC 7e732: method #
Total Ammonia oo610 <0.2
mg/L
Mg - Magnesium 00927
mg/L method #
(Ammonla Nitrogen; NH3 as N; Ammonla Nitrogen, Total)
Mn -Manganese 01o55
ug1L , method #
TKN as N u0625
mg/L
Ni - Nickel 01067
ug/L method #
t-or Kemedlation Systems Only (Attach Lab Reports): Influent Total VOCs:
Rod Holley Wastewater Superintendent Trainee
Perrnittee (orAuthorized Agent) Name and Title - Please print or type
mg/L Effluent Total VOCs:
mg/L VOC Removal%
GW-59 Rev.212010

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
DEPARTMENT:OF.ENVIRONMENT; $ NATURAL RESOURCES '
DIV1sION OF WATERQUALITY-iNFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
.
� �
1617 MAILSERVICE CENTER, RALEIGH,I NC 27699-1617 Phone: [phone]
FACILITY INFORMATION
Please Pdrit
Clearly or Type
PERMIT Number: WQ0000185 Expiration Date: 6/30/2024
Facility Name: Ocean Sands
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
Corolla NC
27927 Cunituck
County
El Lagoon El Remediation: Infiltration Gallery
r0(o ts!A' I'Zr"
❑ Spray Field ❑ Remediation:
Contact Person: Rod Halley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Ocean Sands
No, of wells to be sampled: 5
❑ Water Source Heat Pump ® Other: Infiltration
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW6
Date sample collected: 418121
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 im
pH o0400: 6.82 units Temp. 000lo: 18.4 °C
DRY at
Depth to Water Level 82546:6.1
p ft. below measuring paint Screened Interval: 12 ft.
to 17 ft. Spec. Cond. 00fl94: µ Mhos
time of
Measuring Point is 2 it. above land surface
Relative M.P. Elevation:
ft. Odor 00085: none
sampling,check
Volume of water pumpedibailed before sampling:
5.0
gallons
Appearance clear
here:
❑
Samples for metals were collected unfiltered: ® YES
El NO and field acidified: El YES
El NO
LABORATORY INFORMATION
Date sample analyzed:4l8121
Laboratory Name: Enviro Chem
Certification No. 94
PARAMETERS NOTE: Values should reflect dissolved
and colloidal concentrations.
COD oo335
mg/L
Nitrite (NO2) as N 00615 <0.02
mg/L Pb - Lead 01o51 ug 1L
Coliform: MF Fecal 3t616 <1
/100mL
Nitrate (NO3) as N 00620 4.07
mg1L Zn - Zinc o1092 mglL
Coliform: MF Total 31504
1100mL
Phosphorus: Total as P ©0665 3.05
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
]ssolved Solids:Total 703oo 397
mg/L
AI - Aluminum oilo5
mg/L
pH (Lab) 00403 6.82
units
Ba - Barium 01007
ug1L
TOC 0068o 3.5
mg/L
Ca - Calcium 00916
mg/L
Chloride 00940 58
mg/L
Cd - Cadmium 01027
ug1L
Arsenic 01002
ug1L
Chromium: Total oio34
ug1L
Grease and Oils 00552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPLC)
Phenol 32730
ug1L
Fe - iron 01045
ug/L (Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg1L
Hg - Mercury 71900
ug1L Lab Report Attached? ❑ Yes (1) ❑ No (0)
Specific Conductance 00095
µMhos
K - Potassium o0937
mglL VOC 76732: method #
Total Ammonia 00610 <0.2
mg1L
Mg - Magnesium 00927
mglL method #
(Ammonla Nitrogen; NH�as N; Ammonia Nitrogen, Total)
Mn - Manganese moss
ug1L method #
TKN as N 00025
mg1L
NI - Nickel 01067
ug1L method #
For Remediation Systems Only (Attach Lab Reports): Influent Total VOCs:
Rod Holley Wastewater Superintendent Trainee
Permlttee (or Authorized Agent) Name and Title - Please print or type
mg1L Effluent Total VOCs:
mg/L VOC Removal%
_: #129i21
(Date)
GW-59 Rev.2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
l)E PARTMENT OF ENVIRONMENT &'NATURAi RESOURCES
l)IViSEON OF WATER QUALITY -INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM
16 i7 MAIL SERVICE CENTER; RALEIGH, NC 27699-ts17 Phona, {819} 73373221
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: WQ0000185 Expiration Date: 6/30/2024
Facility Name: Ocean Sands
Non -Discharge kIC
Permit Name Of different):
NPDES Other
Facility Address. 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
Corolla ""` " NC
27927
County Currituck
❑Lagoon ❑ Remediatian: Infiltration Gallery
(SIP
❑ Spray Field ❑ Remediation:
Contact Person: Rod Holley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Ocean Sands
No. of wells to be sampled: 5
❑ Water Source Heat Pump ® Other: Infiltration
from Permh
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW7
Date sample collected: 4/8/21
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft.
Well Diameter: 3 in.
pH omoo: 6.22 units Temp. 000lo: 17.9 °C
DRY at
Depth to Water Level 82546:4.2
p ft. below measuring point
Screened Interval: 12 ft.
to 17
ft. Spec. Cond. 0a0s4: µ Mhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation:
ft.
Odor aoo85: none
sampling,check
Volume of water pumped/bailed before sampling:
5.0
gallons
Appearance semi -clear
here:❑
Samples for metals were collected unfiltered: ® YES ❑ NO and field acidified: ❑ YES
❑ NO
LABORATORY INFORMATION
Date sample analyzed:418/21
Laboratory Name: Enviro Chem
Certification No. 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 0,02
mg/L Pb - Lead o1o51 ug1L
Coliform: MF Fecal 31616 <1
/100mL
Nitrate (NO3) as N 00620 0.95
mg/L Zn - Zinc 01092 mg/L
Coliform: MF Total 31504
N00mL Phosphorus:
Total as P 00665 0.47
mg1L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration knits):
issolved Solids:Total 703oo 252
mg/L
Al - Aluminum of io5
mg/L
pH (Lab) owo3 6.22
units
Ba - Barium 01007
ug/L
TOC oosso 6.9
mg/L
Ca - Calcium oo916
mg/L
Chloride 0094o 36
mg1L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total 01a34
ug/L
Grease and Oils oo552
mg/L
Cu - Copper 01042
mg/L ORGANICS: (by GC, GC/MS, HPL.C)
Phenol 32730
ug/L
Fe - iron 01045
ug/L
(Specify test and method #. ATTACH LAB REPORT.)
Sulfate 00945
mg1L
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 oomo <0.2
mg1L
Mg - Magnesium 00927
mg/L method #
(Amrnonla Nitrogen; NHyas N; Ammonia Nitrogen, Total)
Mn -Manganese o1055
uglL
,method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug/L
method #
t-or izemealation systems only (Attach Lab Reports): Influent Total VOCs:
Rod Holley Wastewater Superintendent Trainee
Permittee (or Authorized Agent) Name and Title - Please print or type
mglL Effluent Total VOCs:
(or
mg/L VOC Removal%
GW-59 Rev.2/2010

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING:
PARTMENT=,OF ENVIRONMENT:& NATURAL RESOURCES
171YISIDN OF WATERQUALnY-INFORMATION PRGGESStNG UNIT
COMPLIANCE REPORT FORM
e
+ o
1517 MAIL SERVICE CENTER; RALE[GH, HG 27689-1617 Phone: [phone]
FACILITY INFORMATION
Please Print Clearly or Type
PERMIT Number: WOOOOD185 Expiration Date: 6/30/2024
Facility Name: Ocean Sands
Non -Discharge UIC
Permit Name (if different):
NPDES Other
Facility Address: 741 Ocean Trail
TYPE OF PERMITTED OPERATION BEING MONITORED
Corolla "`'" NC
27927
County Currituck
El Lagoon ❑Remediation: Infiltration Gallery
❑ Spray Field ❑ Remediation:
Contact Person: Rod Holley
Telephone#: [phone]
❑ Rotary Distributor ❑ Land Application of Sludge
Well Location/Site Name: Ocean Sands
No. of wells to be sampled: 5
❑ Water Source Heat Pump ® Other: Infiltration
from Permit
SAMPLING INFORMATION
If WELL
WELL ID NUMBER (from Permit): MW9
Date sample collected: 4/8/21
FIELD ANALYSES:
WAS
Well Depth: 17.6 ft,
Well Diameter: 3 in.
pH oo400: 6.77 units Temp. 000lo: 16.6 eC
DRY at
Depth to Water Level 82546:6.2 ft. below measuring point
Screened Interval: 12 ft.
to 17
ft. Spec. Cond. 00094. µMhos
time of
Measuring Point is 2 ft. above land surface
Relative M.P. Elevation:
ft.
Odor 00085: none
sampling,check
Volume of water pumped/bailed before sampling:
5.0
gallons
Appearance semi -clear
here:
❑
Samples for metals were collected unfiltered: ® YES El NO and field acidified: El YES
El No
LABORATORY INFORMATION
Date sample analyzed:418121
Laboratory Name: Enviro Chem
Certification No. 94
PARAMETERS NOTE: Values should reflect dissolved and colloidal concentrations.
COD 00335
mg/L
Nitrite (NO2) as N 00615 <0,02
mg/L Pb - Lead o1o51 ug/L
Conform: MF Fecal 31616 <1
/100ml-
Nitrate (NO3) as N 00620 2.29
mg/L Zn - Zinc 01092 mg1L
Conform: MF Total m5o4
I100ml- Phosphorus:
Total as P oos65 2.12
mg/L
(Note: Use MPN method for highly turbid samples)
Orthophosphate 70507
mg/L Other (Specify Compounds and Concentration Units):
issolved SoliftTotal 703oo 383
mg/L
AI - Aluminum o11o5
mg1L
pH (Lab) 00403 6.77
units
Be - Barium o1007
ug1L
TOC oo660 15.5
mg/L
Ca - Calcium 00916
mg1L
Chloride oos4o 37
mg/L
Cd - Cadmium 01027
ug/L
Arsenic 01002
ug/L
Chromium: Total wom
ug1L
Grease and Oils 00552
mg/L
Cti - Capper 01042
mg/L ORGANICS- (by GC, GC/MS, HPLC)
Phenol 32730
ug/L
Fe - Iron 01045
ug1L
(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 o0os5
µMhos
K - Potassium 00937
mg1L VOC 7e732: , method #
Total Ammonia 00610 <0.2
mg/L
Mg - Magnesium 00927
mg/L , method #
(Ammon€a Nitrogen; NH3as N; Ammonia Nitrogen, Total)
Mn - Manganese o1a55
ug1L
method #
TKN as N 00625
mg/L
Ni - Nickel 01067
ug1L
method #
vor KemeptatlOn 5ystemS Only (Attach Lab Reports): Influent Total VOCs:
Rod Holley Wastewater Superintendent Trainee
Permittee (or Authorized Agent) Name and Title - Please print or type
mg/L Effluent Total VOCs:
of Permittee for
mg1L VOC Removal%
(Date)
GW-59 Rev.2/2010