WQ0034380_Report_20210831

GW-59A COMPLIANCE REPORT FORM Permit # WQoo348p
(Submit one each monitoring period with GW-59 forms.) 4tio
1
Enter date monitoring results were due. (8/31/2021 ) Will this monitoring report (GW-59 and GW-594'b,,'LS
we'. (:)/'
9'0a>s
N,
X
be submitted after the established due date? 9
2
Was any required information missing on the GW-59 report forms?
*
NO
v
IF the answer to question 1 or 2 is "YES`, fist 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 answer 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
X
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:
5
, For the constituents identified in question 4 above, have standards been exceeded previously for the
same constituents) 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 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).
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.
7
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 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.
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.
I hereby acknowledge that the above information was evaluated and the information submitted In this
report ( omphiance, Report GW-59A) is true and complete to the best of my knowledge.
/1 —7/2)/2(
ignature of Permittee (or Authorized Agent) ate
GW-59A 12/8/2003