WQ0002520_Monitoring - 03-2021_20210426

i
SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF ENVIRONMENTALAwATERRESOURCE$
INFORMATIONION PROCESSING UNIT
COMPLIANCE REPORT FORM and 1 Copy t0: 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 4/20/21
Facility Name: Town of Bath Non-Discharge WQ0002520 UIC
Permit Name(if different): NPDES Other
Facility Address: 403 Possum Hill RD.Bath,NC 27808 TYPE OF PERMITTED OPERATION BEING MONITORED
403 Possum Hill RD,Bath,NC 27808 ~ County Beaufort ® Lagoon 0 Remediation:Infiltration Gallery
(Snu<) (z,,,,
a Spray Field ❑Remediation:
Contact Person: Sonny Grant Telephone#:[phone] 0 Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name: Possum Hill RD. No.of wells to be sampled: 6 0 Water Source Heat Pump ❑Other:
(from Pernit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): #1 Date sample collected:3/25/21 FIELD ANALYSES: WAS
Well Depth: 16 ft. Well Diameter:2 in. pH 00400:5.29 units Temp. 00010: 14.4 °c DRY at
Depth to Water Level 82546:7.9 ft. below measuring point Screened Interval: ft. to ft. Spec. Cond.00094: µMhos time of
sampling,
Measuring Point is 2 ft. above land surface Relative M.P,Elevation: ft. Odor 00085: none check 1
Volume of water pumped/bailed before sampling: 1 gallons Appearance yellow/rusty here:—
Samples for metals were collected unfiltered: DYES ❑ NO and field acidified: 0 YES 0 NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Environment 1 INC. Certification No.373
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead o1051 ug/L
Coliform:MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620<0.04 mg/L Zn-Zinc 01092 mg/L
Colfform:MF Total 31504 /100mL Phosphorus:Total as P 00665 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 110 mg/L Al-Aluminum 01105 mg/L
pH (Lab)00403 5.2 units Ba-Barium 01007 ,n{ ug/L ,
TOC oos8o 5.89 mg/L Ca-Calcium oos16 Y V mg/L ��� 2 2Qc
Chloride oos4o 9 mg/L Cd-Cadmium o1027 X 7 ZO mg/L
Arsenic ot002 ug/L Chromium:Total mug/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 U.ATTACH LAB REPORT.)
Sulfate oos45 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 00095 µMhos K-Potassium oos37 mg/L VOC 7873 , method#
Total Ammonia 00610<0.04 mg/L Mg-Magnesium 00927 mg/L , method#
(Ammonia Nitrogen;NH,as 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%
I certify that.to the best of my knowledge and belief,Ins information submitted in this report is true,accurate,and complete.and that the laboratory analytical data was produced using approved methods of analysis by a
DWR-certified laboratory. I am aware that there are significant penalties for submitting false information,including the possibility of fines and imprisonment far knowing violations.
Garland Samuel Grant III �41/z7 4/20/21
Permittee(or Authorized Agent)Name and Title-Please print or type Signature of Permi ee(or Aut .rized Agent) (Date)
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF ENVIRONMENTAL
QUALITY-DIV.OF WATER RESOURCES
INFORMATION PROCESSINGUNIT
COMPLIANCE REPORT FORM and 1 copy t0: 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 4/20/21
Facility Name: Town of Bath Non-Discharge WQ0002520 UIC
Permit Name(if different): NPDES Other
Facility Address: 403 Possum Hill RD. Bath,NC 27808 TYPE OF PERMITTED OPERATION BEING MONITORED
403 Possum Hill RD.Bath,NC 27808 County Beaufort 0 Lagoon 0 Remediation: Infiltration Gallery
0 Spray Field 0 Remediation:
Contact Person: Sonny Grant Telephone#:[phone] 0 Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name: Possum Hill RD. No.of wells to be sampled: 6 0 Water Source Heat Pump 0 Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): #4 Date sample collected:3/25/21 FIELD ANALYSES: WAS
Well Depth: 16 ft. Well Diameter:2 in. pH 00400:5.20 units Temp.mote 14.4 °C DRY at
Depth to Water Level 82546:7.1 ft. below measuring point Screened Interval: ft. to ft. Spec.Cond.00094: µMhos time of
sampling,
Measuring Point is 2 ft.above land surface Relative M.P.Elevation: ft. Odor 00085: none check
Volume of water pumped/bailed before sampling: 1 gallons Appearance yellow tint hem:I I
Samples for metals were collected unfiltered: OYES ❑ NO and field acidified: ❑YES 0 NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Environment 1 INC. Certification No. 373
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:MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620<0.04 mg/L Zn-Zinc o1092 mg/L
Coliform: MF Total 31504 /100mL Phosphorus:Total as P 00665 mg/L
(Note' Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 180 mg/L Al-Aluminum o11os mg/L
pH (Lab)00403 5.2 units Ba-Barium 01007 ug/L
TOC 00680 1.75 mg/L Ca-Calcium 00916 mg/L
Chloride oosao 60 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 ug/L Chromium:Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper o1042 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) 0 No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 , method#
Total Ammonia Dodo<0.04 mg/L Mg-Magnesium 00927 mg/L , method#
(Ammonia Nitrogen;NH3 as 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%
1 certify that.to the best of my knowledge and belief,the information submitted in this report is true,acr., 1 comp'eie,and that the laboratory analytical do ;roducrol rig ar,r: „of analysis by
DM-certified laboratory. I am aware that there are significant penalties for submitting false information: ii-es and imprison t c ..-
Garland Samuel Grant Ill /� ,
l r i_f�,�,/j l
4/20/21
1 Permittee(or Authorized Agent)Name and Title-Please print or type mature of Permrttee(or Authorized Agen) (Date)
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF EN
GROUNDWATER QUALITY MONITORING: INFORMATION
FORMATIONPROCESSING UNIT WATER RESOURCES
COMPLIANCE REPORT FORM and 1 Copy t0: 817 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 4/20/21
Facility Name: Town of Bath Non-Discharge W00002520 UIC
Permit Name(if different): NPDES Other
Facility Address: 403 Possum Hill RD. Bath,NC 27808 TYPE OF PERMITTED OPERATION BEING MONITORED
403 Possum Hill RD.Bath,NC 27808 County Beaufort 0 Lagoon 0 Remediation: Infiltration Gallery
0 Spray Field 0 Remediation:
Contact Person: Sonny Grant Telephone#:[phone] El Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name: Possum Hill RD. No.of wells to be sampled: 6 0 Water Source Heat Pump 0 Other:
(horn Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): #5 Date sample collected: 3/25/21 FIELD ANALYSES: WAS
Well Depth: 16 ft. Well Diameter:2 in. pH 00400:3.60 units Temp.00010: 13.8 °C DRY at
Mhos time of
Depth to Water Level 62546:4.7 ft. below measuring point Screened Interval: ft. to_ft. Spec.Cond.00094: µ sampling,
Measuring Point is 2 ft. above land surface Relative M.P.Elevation: ft. Odor 00085: none check
Volume of water pumped/bailed before sampling: 1 gallons Appearance clear with light tint here:
Samples for metals were collected unfiltered: ❑YES 0 NO and field acidified: 0 YES 0 NO 1
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Environment 1 INC. Certification No.373
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N oos15 mg/L Pb-Lead 01051 ug/L
Coliform:MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 0.12 mg/L Zn-Zinc 01092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P o0ss5 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
dissolved Solids:Total 70300 340 mg/L Al-Aluminum o11o5 mg/L
pH(Lab)00403 3.6 units Ba-Barium 01007 ug/L
TOC 00680 1.54 mg/L Ca-Calcium 00916 mg/L
Chloride o0940 107 mg/L Cd-Cadmium o1027 uglL
Arsenic o1002 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 uglL 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 NMhos K-Potassium 00937 mg/L VOC 7873 , method#
Total Ammonia 0os10<0.04 mg/L Mg-Magnesium 00927 mg/L , method#
(Ammonia Nitrogen;NH,as 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%
I certify that,to the best of my knowledge and belief.the information submitted in this report is true,accurate,and complete,and that the labornt_ry anal _ a as v o ch r >li o snsrrcv'.c; slncds of analysis by a
DWR-certified laboratory. I am aware that there are significant penalties forsubmrtting fa•se information,inducing the possibility of fines and mph aonn., - for Kr; ..o J.-
Garland Samuel Grant III .�i/GJ'r 1' � ',fr 4/20/21
Permittee(or Authorized Agent)Name and Title-Please print or type S lure of Permittee(or Authorized Agent) (Date)
GW-59 Rev.05-02-2017

SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF ENINFORMATIONLPROCESSINGUNfT WATER RESOURCES
COMPLIANCE REPORT FORM and 1 copy to 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 4/20/21
Facility Name: Town of Bath Non-Discharge WQ0002520 UIC
Permit Name(if different): NPDES Other
Facility Address: 403 Possum Hill RD. Bath,NC 27808 TYPE OF PERMITTED OPERATION BEING MONITORED
403 Possum Hill RD.Bath,NC 27808 County Beaufort III Lagoon ❑ Remediation:Infiltration Gallery
It Spray Field Cl Remediation:
Contact Person: Sonny Grant Telephone#:[phone] ❑ Rotary Distributor 0 Land Application of Sludge
Well Location/Site Name: Possum Hill RD. No.of wells to be sampled: 6 ❑ Water Source Heat Pump ❑ Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): #10 Date sample collected:3/25/20 FIELD ANALYSES: WAS
Well Depth: 30 ft. Well Diameter:4 in. pH 00400:5.75 units Temp.00010: 13.6 °C DRY at
Depth to Water Level 82546:5.7 ft. below measuring point Screened Interval: ft. to _ft. Spec.Cond.00094: µMhos time of
sampling,
Measuring Point is 2 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: none check
Volume of water pumped/bailed before sampling: 1 gallons Appearance clear here:
Samples for metals were collected unfiltered: 0 YES ❑ NO and field acidified: 0 YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Environment 1 INC. Certification No.373
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:MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620<0.04 mg/L Zn-Zinc 01092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P o0665 mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 98 mg/L Al-Aluminum o1105 mg/L
pH(Lab)00403 5.6 units Ba-Barium 01007 ug/L
TOC 00680 1.16 mg/L Ca-Calcium 00916 mg/L
Chloride o0940 22 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 ug/L Chromium:Total 01034 ug/L
Grease and Oils oo552 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 o0945 mg/L Hg-Mercury 71900 ug/L Lab Report Attached? ❑ Yes(1) ❑ No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 , method#
Total Ammonia ooseo<0.04 mg/L Mg-Magnesium 00927 mg/L , method#
(Ammonia Nitrogen;NH,as 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%
i cp!', i u,to the best of my knowledge and hi'. i :alior ::ete,and that the laboratory analytical data was produceb using approved methods of analysis by a
D.: .lied laboratory. am aware that there are significant pang:: ;tile.possibility of fines and imprisonment for knowing viola:ioas.
C
Garland Samuel Grant Ili '"7% / 4/20/21
Permittee(or Authorized Agent)Name and Title-Please print or type S.nature of Permittee(or Authorized ,gent) (Date)
GW-59 Rev.05-02-2017

r
SUBMIT FORM ON YELLOW PAPER ONLY
Mail original DEPARTMENT OF EN
GROUNDWATER QUALITY MONITORING: INFORMATIONWATER RESOURCES
PROCESSING
COMPLIANCE REPORT FORM and 1 Copy t0: 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 4/20/21
Facility Name: Town of Bath Non-Discharge WQ0002520 UIC
Permit Name(if different): NPDES Other
Facility Address: 403 Possum Hill RD.Bath,NC 27808 P.O.Drawer 1006 NC 27808 TYPE OF PERMITTED OPERATION BEING MONITORED
403 Possum tie RD.Ban,,NC 27808 P.O.Drawer 100e' NC 27808 County Beaufort © Lagoon 0 Rernediation:Infiltration Gallery
El Spray Field ❑ Remediation:
Contact Person: Sonny Grant Telephone#: [phone] 0 Rotary Distributor El Land Application of Sludge
Well Location/Site Name: Possum Hill RD. No.of wells to be sampled: 6 0 Water Source Heat Pump ❑Other:
(from Permit)
SAMPUNG INFORMATION If WELL
WELL ID NUMBER(from Permit): #11 Date sample collected:3/25/21 FIELD ANALYSES: WAS
Well Depth: 30 ft. Well Diameter:4 in. pH 00400:5.27 units Temp.00o10: 13.9 °C DRY at
Mhos time of
Depth to Water Level 82546:6.0 ft. below measuring point Screened Interval: ft. to _ft. Spec.Cond.00094: µ sampling,
Measuring Point is 2 ft.above land surface Relative M.P. Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: 1 gallons Appearance here:
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: 0 YES El NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Environment 1 INC. Certification No.373
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:MF Fecal 31616 <1 /100mL Nitrate(NO3)as N o0620<0.04 mg/L Zn-Zinc o1os2 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P 00665 mg/L
(Note: Use MPN method for hlghty turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
Dissolved Solids:Total 70300 61 mg/L Al-Aluminum o1105 mg/L
pH(Lab)00403 5.0 units Ba-Barium 01007 ug/L
TOC oosso 1.00 mg/L Ca-Calcium oos16 mg/L
Chloride 00940 13 mg/L Cd-Cadmium 01027 ug/L
Arsenic o1002 ug/L Chromium:Total 01034 ug/L
Grease and Oils 00552 mg/L Cu-Copper o1042 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 o0095 NMhos K-Potassium 00937 mg/L VOC 7873 , method#
Total Ammonia o0610<0.04 mg/L Mg-Magnesium 00927 mg/L , method#
(Arrrnonla Nitrogen;NH,as 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%
I certify that,to'he best o ;nation submitte: renort is !abarainry an; data 2, '1 ced using approvec
DWR-certified laboratory. ,: significant penalties fors,, or kncr ; �
Garland Samuel Grant III �6�'/1 A.�,L�, (--- ��` 4/20/21
Permittee(or Authorized Agent)Name and Title-Please print or type Signature of Permittee(or A thorized A.ent) (Date)
GW-59 Rev.05-02-2017

i
SUBMIT FORM ON YELLOW PAPER ONLY
GROUNDWATER QUALITY MONITORING: Mail original DEPARTMENT OF ENVIRONMENTAL QUALITY-DIV.OF WATER RESOURCES
and 1 copy to: INFORMATION PROCESSING UNIT
COMPLIANCE REPORT FORM 1617 MAIL SERVICE CENTER,RALEIGH,NC 27699-1617 Phone:[phone]
1 FACILITY INFORMATION Please Print Clearly or Type PERMIT Number: Expiration Date: 4/20/21
Facility Name: Town of Bath
Non-Discharge WQ0002520 UIC
Permit Name(if different): NPDES Other
Facility Address: 403 Possum Hill RD.Bath,NC 27808 P.O.Drawer 6A NC 27808 TYPE OF PERMITTED OPERATION BEING MONITORED
403 Possum WI RD.Bath,NC 27808 P.O.Drawer 6A NC 27808 County Beaufort M
tY Lagoon 0 Remediation:Infiltration Gallery
iiiiiby t/-1)
E] Spray Field ❑Remediation:
Contact Person: Sonny Grant Telephone#:[phone] ❑ Rotary Distributor ❑Land Application of Sludge
Well Location/Site Name: Possum Hill RD. No.of wells to be sampled: 6 ❑ Water Source Heat Pump ❑Other:
(from Permit)
SAMPLING INFORMATION If WELL
WELL ID NUMBER(from Permit): #12 Date sample collected:3/25/21 FIELD ANALYSES: WAS
Well Depth: 30 ft. Well Diameter:4 in. pH 00400:5.27 units Temp.00010: 14.0 °C DRY at
Depth to Water Level 82546:5.7 ft. below measuring point Screened Interval: ft. to ft. Spec.Cond.00094: pMhos
time of
sampling,
Measuring Point is 2 ft, above land surface Relative M.P.Elevation: ft. Odor 00085: check
Volume of water pumped/bailed before sampling: 1 gallons Appearance here:
Samples for metals were collected unfiltered: ❑YES ❑ NO and field acidified: ❑YES ❑NO
LABORATORY INFORMATION
Date sample analyzed: Laboratory Name: Environment 1 INC. Certification No.373
PARAMETERS NOTE:Values should reflect dissolved and colloidal concentrations.
COD 00335 mg/L Nitrite(NO2)as N 00615 mg/L Pb-Lead 01051 uglL
Coliform:MF Fecal 31616 <1 /100mL Nitrate(NO3)as N 00620 0.08 mg/L Zn-Zinc 01092 mg/L
Coliform:MF Total 31504 /100mL Phosphorus:Total as P oases mg/L
(Note: Use MPN method for highly turbid samples) Orthophosphate 70507 mg/L Other(Specify Compounds and Concentration Units):
)issolved Solids:Total 70300 110 mg/L Al-Aluminum 011o5 mg/L
pH(Lab)00403 5.1 units Ba-Barium 01007 ug/L
TOC ooetio 1.01 mg/L Ca-Calcium 0o91e mg/L
Chloride o0940 30 mg/L Cd-Cadmium won ug/L
Arsenic o1002 uglL 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? 0 Yes(1) 0 No(0)
Specific Conductance 00095 µMhos K-Potassium 00937 mg/L VOC 7873 , method#
Total Ammonia oast°<0.04 mg/L Mg-Magnesium 00927 mg/L , method#
(Ammonia Nitrogen;NHI3 as N;Ammonia Nitrogen,Total) Mn Manganese 01055
9 ug/L , method#
TKN as N 00625 mg/L Ni-Nickel 01067 uglL , method#
For Remediation Systems Only(Attach Lab Reports): Influent Total VOCs: mg/L Effluent Total VOCs: mg/L VOC Removal%
' o-bmitted in tfis report is true,accurate,ono complete,and that the iaooratory analytical data was produced using approved methods of analysis by a
fed lei. am away.i .`or submitting false information,Including the possibility of fines and imprisonment for knowing violations.
Garland Samuel Grant Ill _ 4/20/21
Permlttee(or Authorized Agent)Name and Title-Please print or type Signature of Permlttee(or Authorized Agent) (Date)
GW-59 Rev.05-02-2017